WASHINGTON — Each year more than 3.5 million women give birth in the U.S., and approximately 84% begin breastfeeding. However, many women are unable to meet their own breastfeeding goals or national recommendations, says a new report from the National Academies of Sciences, Engineering, and Medicine that analyzes breastfeeding promotion, initiation, and support across the United States and makes recommendations to encourage and support breastfeeding.

The report points to the health benefits of breastfeeding for both mothers and infants — for example, it promotes infant growth and development, strengthens the infant’s immune system, and helps with digestion. Breastfeeding can also reduce a mother’s risk of developing Type 2 diabetes, cardiovascular disease, and breast and ovarian cancer. Drawing on previously published research, the report estimates that the total cost of suboptimal breastfeeding in the United States ranges from $17.2 billion to over $100 billion annually.

“Research is clear that the majority of women and families want to breastfeed or provide human milk to their infants — however, over half of mothers ultimately stop breastfeeding or expressing milk sooner than they desired,” said Ifeyinwa Asiodu, associate professor at the University of California, San Francisco, and co-chair of the committee that wrote the report. “Given the high rates of breastfeeding intention and initiation and the noted benefits to maternal and infant health, action is needed across all levels to ensure families receive the support and resources needed to meet their breastfeeding and infant feeding goals.”

U.S. Breastfeeding Rates Fall Short

U.S. breastfeeding rates currently fall short of the Dietary Guidelines for Americans, which recommend exclusive breastfeeding up to 6 months of age and some breastfeeding until 12 months old, with introduction of complementary foods. They are also below the targets set in Healthy People 2030, a collection of national health objectives determined by the U.S. Department of Health and Human Services. Healthy People 2030 aims for 42.4% of infants to be breastfed exclusively through their first six months, and for breastfeeding to continue through 12 months for at least 54.1% of infants. In reality, 27% of U.S. babies are exclusively breastfed through their first six months, and less than 40% are still receiving breast milk by 12 months of age.

The report acknowledges that individual infant feeding goals may differ from national recommendations, and that not all mothers choose to, or are able to, breastfeed exclusively or for an extended period. National guidelines are intended to improve health outcomes over time, not to impose a singular standard of behavior.

Breastfeeding rates are notably lower among certain groups, including Black women, Native American/Alaska Native women, women with lower socioeconomic status, unmarried women, women living in rural areas, and younger mothers. Many of these communities face barriers to breastfeeding, such as the need to return to work or school early or limited access to breastfeeding education and support services during the perinatal period.

Congressional Action

Multiple government agencies have initiatives and programs to support breastfeeding, but currently no single entity coordinates the patchwork of government programs to provide a cohesive road map of supports for families to navigate easily. The report recommends Congress fund a national strategy led by HHS to ensure mothers and families have access to effective breastfeeding support and resources to meet their goals.

The report also recommends that Congress enact national paid family and medical leave for all postpartum mothers, and that in the absence of a national plan, states and employers should enact this coverage. 

Investing in Community-Led Programs

“Community-led programs and coalitions play a critical role in protecting, promoting, and supporting breastfeeding, and there is strong evidence that peer support improves breastfeeding outcomes,” said Julie A. Caswell, Distinguished University Professor Emeritus at the University of Massachusetts Amherst, and committee co-chair. “Many mothers may feel more comfortable receiving breastfeeding guidance from community members who share their background, life experiences, or language. Thus, greater investments into community-based programs and public health initiatives, such as the Special Supplemental Nutrition Program for Women, Infants, and Children, are needed.”

The report recommends Congress, insurance companies, local and state governments, and others should establish and fund a coordinated investment strategy for supporting these community-led breastfeeding programs across the U.S.

Other Recommended Actions

The report also recommends:

• Congress should ensure U.S. Department of Agriculture has adequate funding to provide breastfeeding support services administered through the WIC Program to all eligible pregnant and postpartum mothers, including peer counseling and nutrition education.

• Centers for Medicare & Medicaid Services (CMS) and others should ensure every U.S. maternity care facility implements the UNICEF/World Health Organization’s Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding as the standard of care.

• HHS, in collaboration with local and state breastfeeding support organizations, should invest in a communications strategy that considers the full range of audiences for these messages — women who breastfeed and their partners, healthcare and lactation support providers, and others. Communications should include information about what breastfeeding services and supplies are available, and how to access them.

• Food and Drug Administration and Federal Trade Commission should coordinate to rigorously regulate the marketing, including labeling and advertising, of commercial milk formula.

• CMS, the Federal Insurance Office, and public and private payers should create and ensure comprehensive coverage and payment of breastfeeding services and supplies to guarantee equal access to a standard package of services and medical equipment.

• CMS should continue to ensure that a postpartum Medicaid extension is available to all eligible pregnant and postpartum women up to 12 months after birth, at a minimum; all states should implement this option.

• Governments should strengthen and enforce existing laws and legislation that guarantee lactation accommodations and spaces are available in all workplaces, schools, colleges, universities, and childcare centers, and ensure that they comply with legal requirements.

• Accrediting boards and regulatory bodies should increase investment in the training and availability of lactation support providers.

• Federal Emergency Management Agency and others should incorporate infant and young child feeding in emergencies into their emergency preparedness and response guidance and plans.

• National Institutes of Health and other nonfederal agencies should expand funding and prioritize community, clinical, and translational breastfeeding research.

• CMS should develop and implement a Healthcare Effectiveness Data and Information Set (HEDIS) performance measure of breastfeeding.

The study — undertaken by the Committee on Understanding Breastfeeding Promotion, Initiation, and Support Across the United States: An Analysis — was sponsored by the U.S. Department of Health and Human Services. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Contact:

Megan Lowry, Media Relations Manager
Office of News and Public Information
202-334-2138; email news@nas.edu