The Majority of U.S.

hospitals do not fully support breastfeeding 
 New CDC

report shows missed opportunities for preventing childhood obesity beginning at
birth

Breastfeeding protects against childhood obesity, yet less than 4 percent of U.S. hospitals provide
the full range of support mothers need to be able to breastfeed, according to the most recent Vital
Signs report released today by the Centers for Disease Control and Prevention. Improving rates of
breastfeeding by providing better hospital support to mothers and babies is an important strategy
to improve children′s health, including a reduced risk of childhood obesity.

Childhood obesity is a national epidemic in the United States. Increasing the proportion of mothers who
breastfeed is one important public health strategy for preventing childhood obesity. The World Health
Organization and United Nations Children’s Fund (UNICEF) Baby-Friendly Hospital Initiative specifies
Ten Steps to Successful Breastfeeding that delineate evidence-based hospital practices to improve
breastfeeding initiation, duration, and exclusivity.

Methods: In 2007 and 2009, CDC conducted a national survey of U.S. obstetric hospitals and birth
centers. CDC analyzed these data to describe the prevalence of facilities using maternity care practices
consistent with the Ten Steps to Successful Breastfeeding.
Results: In 2009, staff members at most hospitals provide prenatal breastfeeding education (93%) and
teach mothers breastfeeding techniques (89%) and feeding cues (82%). However, few hospitals have
model breastfeeding policies (14%), limit breastfeeding supplement use (22%), or support mothers
postdischarge (27%). From 2007 to 2009, the percentage of hospitals with recommended practices
covering at least nine of 10 indicators increased only slightly, from 2.4% to 3.5%. Recommended
maternity care practices vary by region and facility size.

Conclusion: Most U.S. hospitals have policies and practices that do not conform to international
recommendations for best practices in maternity care and interfere with mothers’ abilities to breastfeed.
Implications for Public Health Practice: Hospitals providing maternity care should adopt evidence-based
practices to support breastfeeding. Public health agencies can set quality standards for maternity care and
help hospitals achieve Baby-Friendly designation. Because nearly all births in the United States occur in
hospitals, improvements in hospital policies and practices could increase rates of exclusive and continued
breastfeeding nationwide, contributing to improved child health, including lower rates of obesity.

Latest Findings
Most hospitals do not fully support breastfeeding

Breastfeeding helps protect against childhood obesity and other illnesses, and lowers medical costs.

• 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.

• Babies who are fed formula and stop breastfeeding early have higher risks of obesity, diabetes, respiratory and
ear infections, and sudden infant death syndrome (SIDS), and tend to require more doctor visits,
hospitalizations, and prescriptions.

• Low rates of breastfeeding add $2.2 billion a year to medical costs.

• Mothers who breastfeed have lower risks of breast and ovarian cancers.

Hospitals should do more to help mothers start and continue breastfeeding.

• Hospitals that wait to start the first breastfeed, or separate babies from mothers, or routinely give formula to
breastfeeding babies make it harder for mothers and babies to be able to breastfeed.

• When hospitals support mothers to feed their babies only breast milk, it helps mothers to continue feeding only
breast milk at home.

Baby-Friendly hospitals make special efforts to support mothers to breastfeed.

• The World Health Organization/UNICEF Baby-Friendly Hospital Initiative, endorsed by the American Academy of
 Pediatrics, recognizes hospitals that follow the Ten Steps to Successful Breastfeeding.

• When hospitals have more of the Ten Steps to Successful Breastfeeding in place, mothers breastfeed longer.

The Baby-Friendly Ten Steps to Successful Breastfeeding

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

Who's At Risk?
Percentage of any and exclusive breastfeeding by month since birth among US infants born in
2008

*Exclusive breastfeeding = infant receives only breast milk and vitamins or medications, but no other
solids or liquids.

SOURCE: CDC National Immunization Survey

Percentage of US hospitals with recommended policies and practices to support

breastfeeding, 2007 and 2009
SOURCE: CDC National Survey of Maternity Practices in Infant Nutrition and
Care (mPINC)

Percentage of hospitals by number of recommended policies

and practices to support breastfeeding in 2009

U.S. State Info

Percentage of births at Baby-Friendly facilities in 2011, by state
SOURCE: Baby-Friendly Facililties in 2011 & CDC/National Center for Health Statistics 2009 Live Births

What Can Be Done?

We must help hospitals support mothers to breastfeed.

Encourage Hospitals to:

• Become more baby-friendly

• Use CDC's Maternity Practices in Infant Nutrition and Care (mPINC) survey data to prioritize
changes to improve maternity care practices.

• Stop distributing formula samples and give-aways to breastfeeding mothers.

• Work with community organizations, and fellow allied health professionals to create networks
that provide at-home or clinic-based breastfeeding support for every newborn.

Doctors and nurses can:

• Help write hospital policies that encourage every mother to initiate breastfeeding.

• Learn how to counsel mothers on breastfeeding during prenatal visits and support breastfeeding
in the hospital and at each pediatric visit until breastfeeding stops.

• Include lactation consultants and other breastfeeding experts on patient care teams.

• Coordinate lactation care between the hospital, outpatient clinic and home.

Full Report Accessible at: http://www.babyfriendlyusa.org/eng/index.html