Most Hospitals Do Not Sufficiently Support Breastfeeding

Hospital support for breastfeeding has improved since 2007, according to the latest CDC Vital Signs report released October 6, 2015. The percentage of U.S. hospitals using a majority of the Ten Steps to Successful Breastfeeding, the global standard for hospital care to support breastfeeding, increased from approximately 29 percent in 2007 to 54 percent in 2013, a nearly two-fold increase over six years. Improved hospital care could increase rates of breastfeeding nationwide and contribute to healthier children.


“Breastfeeding has immense health benefits for babies and their mothers,” said CDC Director Tom Frieden, M.D., M.P.H. “More hospitals are better supporting new moms to breastfeed -- every newborn should have the best possible start in life.” The American Academy of Pediatrics recommends babies be fed nothing but breast milk for about the first 6 months and continue breastfeeding for at least 1 year. However, most hospitals have not fully supported breastfeeding.


Of the nearly four million babies born each year in the U.S., 14 percent are born in Baby-Friendly hospitals, a number that has nearly tripled in recent years, but remains low. The Baby-Friendly Hospital Initiative (BFHI) was established by the World Health Organization and UNICEF and endorsed by the American Academy of Pediatrics. The core of the BFHI is the Ten Steps to Successful Breastfeeding.


“What happens in the hospital can determine whether a mom starts and continues to breastfeed, and we know that many moms – 60 percent – stop breastfeeding earlier than they’d like,” said Cria Perrine, PhD, epidemiologist in the CDC’s Division of Nutrition, Physical Activity and Obesity. “These improvements in hospital support for breastfeeding are promising, but we also want to see more hospitals fully supporting mothers who want to breastfeed. The Ten Steps help ensure that mothers get the best start with breastfeeding.”


This Vital Signs report examined data from the CDC’s national survey, Maternity Practices in Infant Nutrition and Care (mPINC), which measures the percentage of U.S. hospitals with practices that are consistent with the Ten Steps to Successful Breastfeeding. The Ten Steps are measures of a hospital’s breastfeeding support before, during, and after a mother’s hospital stay.


 The Ten Steps to Successful Breastfeeding were developed by a team of global experts and consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration. Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive, and retain, a Baby-Friendly designation.


The Ten Steps to Successful Breastfeeding are:


  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in - allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.


The report included other encouraging findings. Across all survey years, hospital staff provided high levels of prenatal breastfeeding education (91 percent in 2007 and 93 percent in 2013) and teaching mothers breastfeeding techniques (88 percent in 2007 and 92 percent in 2013). Early initiation of breastfeeding increased from approximately 44 percent in 2007 to nearly 65 percent in 2013.


Other mPINC data show why continued improvement is needed. In 2013, just 26 percent of hospitals ensured that only breast milk was given to healthy, breastfeeding infants who did not need infant formula for a medical reason. In 2013, only 45 percent of hospitals kept mothers and babies together throughout the entire hospital stay, which provides opportunities to breastfeed and helps mothers learn feeding cues. In 2013, only 32 percent of hospitals provided enough support for breastfeeding mothers when they left the hospital, including a follow-up visit and phone call, and referrals for additional support.


There are specific actions hospitals can take to better support mothers to breastfeed. These actions include: (1) implement the Ten Steps to Successful Breastfeeding and work towards achieving Baby-Friendly status; (2) use the CDC’s Maternity Practices in Infant Nutrition and Care survey customized reports to improve maternity care practices that support breastfeeding; and (3) work with doctors, nurses, lactation care providers, and organizations to create networks that provide clinic-based, at-home, or community breastfeeding support for mothers.


There are many health benefits to breastfeeding. Babies that are breastfed have reduced risks for ear, respiratory, stomach, and intestinal infections. They also are at lower risk of asthma, obesity, and sudden infant death syndrome (SIDS). Pre-term infants are at a particularly high risk of necrotizing enterocolitis, a disease that affects the stomach and intestinal tract; breastfeeding can protect infants from this disease.


Childhood obesity is an epidemic. In the U.S., one preschooler in five is at least overweight, and half of these are obese. Breastfeeding helps protect against childhood obesity. A baby's risk of becoming an overweight child goes down with each month of breastfeeding. In the U.S., most babies start breastfeeding, but within the first week, half have already been given formula, and by nine months, only 31% of babies are breastfeeding at all. Hospitals can either help or hinder mothers and babies as they begin to breastfeed.


There are other benefits of breastfeeding. For example, mothers that breastfeed are less likely to get breast cancer, ovarian cancer, type 2 diabetes and heart disease. Breastfeeding also saves money. More than $2 billion in yearly medical costs for children could be saved if breastfeeding recommendations were met.


One of the most highly effective preventive measures a mother can take to protect the health of her infant is to breastfeed. However, in the United States, although most mothers hope to breastfeed, and 79% of babies start out being breastfed, only 19% are exclusively breastfed six months later. Additionally, rates are significantly lower for African-American infants.


The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding.


See the CDC Announcement


See the CDC Report


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