The Current Landscape of Breastfeeding in the US: A Tapestry of Progress and Promise

What an exciting time to be a part of breastfeeding education! The marked shift back toward the breast - after a generation of mothers turned to bottles and formula - is nothing short of amazing. From wide-scale national public health efforts to the tireless determination of grassroots community educators, there is plenty of credit to spread around for the wins that we are seeing. And everyone who has had a hand in this work should be proud of the clear success of the movement. That is not to say, of course, that our work is done. Hardly so. For every hospital that has become Baby Friendly and placed breastfeeding education and support at the forefront of their pre and post-natal offerings, there are several more who still have yet to prioritize increasing their breastfeeding rates. For every pediatrician and obstetrician who advises an expecting parent to consider breastfeeding, there are several more who never mention it or maintain outdated perspectives. And the truth is, for every state that is meeting and surpassing the Healthy People 2020 goals for breastfeeding initiation and duration, there are states that are not even close. While there is cause for celebration, it’s too soon to rest on our laurels.  This post is the first in a series that will dig into the current state of breastfeeding in the US, examine the outliers on both ends of the data, and consider how we can continue the work to increase equity in lactation across the country.

According to the CDC’s latest Breastfeeding Report Card, the number of babies who were put to the breast at least once in 2013 is 81.1%. That number is an average across 50 states, plus Washington DC and Puerto Rico. This means there are states faring way better (I’m looking at you, Utah, with 94.4%), and there are those who fared far less (O-Mississippi-G with 52%) being factored in. Once you start to explore the data at a state level, glaring differences like this emerge again and again. How could Utah’s breastfeeding initiation rates be 20-40 percentage points higher than every state in the deep south? Why does every state west of Texas tout initiation rates above the Healthy People 2020 goal of 81.9%, but so few on the east coast have even come close to that benchmark? What is happening differently across the country? How can we help to close to gaps?

The good news is that in most states, there are innovative programs aimed at addressing local challenges to breastfeeding. The services range from grassroots community organizations to statewide coalitions, and everything in between. They provide catered solutions to the specific challenges of the families in those areas. And they are making steady progress. However, huge extenuating factors like economics and race play a particularly significant role in breastfeeding in many of the states that are the most challenged. That means the incredibly important and delicate work of dismantling barriers and mindsets is needed to reverse some of the trends that are being seen. So there is no easy or quick fix. But there are strategies and solutions and communities who are committed to progress.

Helping to remove barriers to breastfeeding in the states where the least number of mothers are putting babies to the breast (and subsequently keeping them at the breast) is a worthy focus because it has the potential to save lives in areas where infant mortality rates are frighteningly high. And it’s where we will pay particular attention as this series progresses. We hope you’ll tune in as we start to look a bit closer at the data and also at the national, state and local efforts that are working to turn some of the statistics around. We’ll also discuss how you can become involved in fostering change to bring about lactation equity in those areas where it’s most needed, and help to push more states across the line from promise to progress.

Next up: North, South, East, West: A Breastfeeding Tale of Four cities

Nikki Killings MPH, IBCLC, CLC, LLLL lives and works in California with her husband and children. She spends her time writing, reading and supporting families in underserved communities.