Definition

Percentage of infants who were fed breast milk for at least 6 months; exclusively breastfed for at least 3 months; exclusively breastfed for at least 6 months.

Numerator

Number of infants whose mother reported feeding breast milk for at least 6 months; exclusively for at least 3 months; exclusively for at least 6 months.

Denominator

Number of infants who turned 3 months and 6 months during the calendar year; number of mothers responding to survey.

Why Is This Important?

Research indicates that women who do not exclusively breastfeed (provide only breast milk) their infants during the first six months of life have infants who are more likely to have infections and allergies, poorer health outcomes for gastrointestinal disease, otitis media, respiratory illnesses, and atopic disease.

Other Objectives

{{style color:#003366 Healthy People 2020 Objective MICH-21.2:}} Increase the proportion of infants who are breastfed at 6 months[[br]] '''U.S. Target:''' 60.6 percent[[br]] [[br]] {{style color:#003366 Healthy People 2020 Objective MICH-21.4:}} Increase the proportion of infants who are breastfed exclusively through 3 months[[br]] '''U.S. Target:''' 46.2 percent[[br]] [[br]] {{style color:#003366 Healthy People 2020 Objective MICH-21.5:}} Increase the proportion of infants who are breastfed exclusively through 6 months[[br]] '''U.S. Target:''' 25.5 percent[[br]] [[br]] For additional information, see the Other Objectives sections of the [[a href="indicator/view/BrstFeed.html" Breastfeeding (Ever)]] and [[a href="indicator/view/BrstFeed1Yr.html" Breastfeeding at 1 Year]] Indicator Reports.

How Are We Doing?

The Utah rate for breastfeeding at 6 months in 2021 was 67.3% The Utah rate for 3-month exclusive breastfeeding in 2021 was 51.1%. The Utah rate for 6-month exclusive breastfeeding in 2021 was 26.8%.

How Do We Compare With the U.S.?

From 2002-2021 the Utah rate exceeded the U.S. rate of breastfeeding at 6 months. From 2004-2021 the Utah rate exceeded the U.S. 3-month exclusive breastfeeding rates, except for 2012. The 6-month exclusive breastfeeding rates for Utah were higher than the U.S. rates from 2005-2011, 2013-2015, and 2017-2020. In 2021 the Utah 6-month exclusive breastfeeding rate was lower than the U.S. rate.

What Is Being Done?

According to evidence-based research, the Utah WIC Program promotes exclusive breastfeeding (provide only breast milk), for the first six months of life. Incentives such as enhanced food benefits are provided to exclusively breastfeeding women up to one year postpartum. All counties across the state have an extensive Breastfeeding Peer Counselor Program (BFPCP) that provides mother-to-mother support and outreach to hospitals and the community. Single user breast pumps are provided free of charge to support exclusively breastfeeding working/returning to school mothers. A variety of breast pumps are offered free of charge as a loan from the program for mothers going to work or school or who are separated from their infants due to hospital interventions. Breastfeeding is supported by ongoing classes, support groups, and Breastfeeding Peer Counselors. Individualized counseling is provided by International Board Certified Lactation Consultants (IBCLCs), Registered Dietitians (RDs), and Breastfeeding Peer Counselors. The Utah WIC Program works with the Utah Breastfeeding Coalition to establish corporate or workplace programs in local area businesses to help support breastfeeding families. Women need sensitive and skilled assistance in learning to breastfeed, and follow-up care should continue until their infants are breastfeeding effectively. Research indicates that optimal positioning is essential to the comfortable establishment of lactation. It is the professional responsibility of staff entrusted with the care of any mother and baby to be skilled in the basics of positioning and knowledgeable about the early signs of breastfeeding problems. It is the responsibility of institutions to validate these competencies among their staff and to routinely maintain data on breastfeeding success rates. Utah is working on these efforts and promoting the use of such publications as the AAP Breastfeeding Handbook for Physicians, AAP Sample Hospital Breastfeeding Policy for Newborns, AAP Breastfeeding Residency Curriculum, and the AAP Safe and Healthy Beginnings Toolkit.

Evidence-based Practices

Core competencies in breastfeeding care and services were developed to provide health professionals with a guideline and framework to integrate evidence-based breastfeeding knowledge, skills, and attitudes into their standard health care delivery practices. The United States Breastfeeding Committee recommends that all health professionals possess the core competencies in order to integrate breastfeeding care effectively and responsibly into current practice and thus provide effective and comprehensive services to mothers, children, and families. Evidence suggests that breastfeeding during pregnancy, tandem breastfeeding, lactation, and induced lactation do occur and, indeed, are usual and beneficial in many cultural contexts. In addition, research indicates that many women and families lack knowledge of the basic skills of breastfeeding, and breastfeeding is an art lost in some cultures (including the U.S.) due to recent decades of the introduction of artificial infant formula, infant bottle-feeding, and the cultural misrepresentation that this is the norm. Studies show that many infant foods and equipment companies market their products in ways that affect women's choices about infant feeding. The International Lactation Consultants Association (ILCA) proposes that the International Code of Marketing of Breast-milk Substitutes be considered a minimum standard for assessing industry marketing practice. Evidence indicates that, in general, disease rates are higher in child care institutions than in family homes. The ILCA believes that the provision of maternal breast milk for infants in child care is to be encouraged, and that child care workers should be educated in its value, its care, and its use. Other research findings and informed evidence reveal the following: *breastfeeding prevents more births worldwide than all other means of contraception. *the woman who is exclusively breastfeeding and amenorrheic are at very small risk of conception in the first six months after birth. *women should be informed about the fertility-reducing effects of breastfeeding. *contraceptive methods offered to the lactating mother should be compatible with continued lactation. *women who do not breastfeed may be in an abnormal postpartum hormonal state. *education for health professionals has not dealt adequately with either normal lactation or its problems. *women needing special assistance with breastfeeding should be referred to an appropriate individual, institution, or agency. *lactation should be included in the basic curricula of all maternal and child health education programs and should be taught by knowledgeable persons familiar with current research and management practices.

Available Services

The Utah WIC Program, through local health department WIC Clinics, provides breastfeeding education and support, community resources, breastfeeding classes, individualized consultation with an International Board Certified Lactation Consultant or Breastfeeding Peer Counselor, nutritious food for breastfeeding mothers (up to 1 year postpartum), and manual as well as electric breast pumps and supplies. Lactation professionals are available in every local health district in Utah. (1-877-WIC-KIDS) [http://wic.utah.gov] Baby Your Baby Hotline: lactation professionals are available to answer questions by phone, during regular working hours. (1-800-826-9662) MotherToBaby: answers to questions about medications and herbs during lactation. (1-800-822-2229) La Leche League of Utah: provides mother-to-mother support (801-264-5683) Utah Breastfeeding Coalition (UBC): [http://www.utahbreastfeeding.org] Intermountain Pediatric Society: 801-963-3411 Utah Academy of Nutrition and Dietetics: 801-363-1359 [http://www.eatrightutah.org/]

Health Program Information

Utah is working to help promote, protect, and support breastfeeding by following evidence-based practices and the recommendations of the American Academy of Pediatrics (AAP), the World Health Organization (WHO), the U.S. Surgeon General's Call to Action, and the Centers for Disease Control and Prevention (CDC). The American Academy of Pediatrics Policy Statement, Breastfeeding and the Use of Human Milk (March 2012) states: Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. Hospital routines to encourage and support initiating and sustaining exclusive breastfeeding should be based on the AAP-endorsed WHO/UNICEF Ten Steps to Successful Breastfeeding. National strategies supported by the U.S. Surgeon General's Call to Action, CDC, and The Joint Commission are involved to facilitate breastfeeding practices in U.S. hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. Growth patterns for monitoring in the first two years of life should use the WHO's standard growth charts that represent standards of growth patterns of healthy term breastfed infants. Growth charts that reflect infants fed on artificial infant formula are not accurate in measuring growth. The American Academy of Pediatrics role of the pediatrician includes: # Promote breastfeeding as the norm for infant feeding # Become knowledgeable in the principles and management of lactation and breastfeeding # Develop skills necessary for assessing the adequacy of breastfeeding # Support training and education for medical students, residents, and postgraduate physicians in breastfeeding and lactation # Promote hospital policies that are compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and the WHO/UNICEF Ten Steps to Successful Breastfeeding # Collaborate with the obstetric community to develop optimal breastfeeding support programs # Coordinate with community-based health care professionals and certified breastfeeding counselors to ensure uniform and comprehensive breastfeeding support[[br]] [[br]] The American Academy of Pediatrics' Recommendations on Breastfeeding Management for Healthy Term Infants include exclusive breastfeeding for about 6 months, followed by continued breastfeeding as foods are introduced, with the continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Peripartum policies and practices that optimize breastfeeding initiation and maintenance should be compatible with the AAP and Academy of Breastfeeding Medicine Model Hospital Policy and include direct skin-to-skin contact with mothers immediately after delivery until the first feeding is accomplished; delay in routine procedures (weighing, measuring, bathing, blood tests, vaccines, and eye prophylaxis) until after the first feeding is completed; ensure 8 to 12 feedings at the breast every 24 hours; ensure formal evaluation and documentation of breastfeeding by trained caregivers; give no supplements (water, glucose water, commercial infant formula, or other fluids) unless medically indicated using standard evidence-based guidelines for the management; avoid routine pacifier use in the postpartum period and until breastfeeding has been established; all breastfeeding newborn infants should be seen by a pediatrician at 3 to 5 days of age; evaluate hydration (elimination patterns) and body weight gain; assess feeding and observe feedings; and mother and infant should sleep in proximity to each other to facilitate breastfeeding.

Relevant Population Characteristics

Breastfeeding for at least 6 months is more common among women who are White or non-Hispanic Asian, college-educated, and not enrolled in WIC. Mothers are more likely to continue to breastfeed beyond the newborn period if they are not employed outside the home, or if they work part-time. Employers are encouraged to implement workplace policies to protect and support breastfeeding mothers. Mothers are encouraged to discuss this with their employers.

Health Care System Factors

Health care providers must receive training to support breastfeeding mothers and infants to continue breastfeeding. Discharge formula packs given by hospitals encourage complementary feeding and reduce exclusive breastfeeding.

Risk Factors

Infants not breastfed for at least six months are at increased risk for gastrointestinal illness, ear infections, diabetes, childhood and adult obesity, and other acute and chronic diseases.

Health Status Outcomes

Breastfeeding promotes optimal health status for infants and mothers, and may provide long-term health benefits as well (for the infant, breastfeeding, protects against obesity, diabetes, Crohn's disease, promotes positive oral health; for the mother, breastfeeding, protects against anemia, overweight, breast cancer, and osteoporosis).

Utah exceeded the 6-month breastfeeding rates of the U.S. from 2002-2021. Utah exceeded the Healthy People 2010 Objective of breastfeeding at 6 months (50%) from 2000-2010. Utah exceeded the Healthy People 2020 Objective of breastfeeding at 6 months (60.6%) from 2011-2021.

Data Source

National Immunization Survey, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

From 2004-2021 Utah exceeded the U.S. 3-month exclusive breastfeeding rates, except for 2012. From 2005-2009 Utah exceeded the 2010 Healthy People Objective of breastfeeding exclusively through 3 months (40%). Utah exceeded the 2020 Healthy People Objective of breastfeeding exclusively through 3 months (46.2%) for 2011 and 2013-2021.

Data Source

National Immunization Survey, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

The 6-month exclusive breastfeeding rates for Utah were higher than the U.S. rates from 2005-2011, 2013-2015, and 2017-2020 except for the year 2008 where they were equal. Utah exceeded the 6-month exclusive breastfeeding Healthy People 2010 Objective (17%) in 2005, 2006, 2009, and 2010. Utah exceeded the 6-month exclusive breastfeeding Healthy People 2020 Objective (25.5%) in 2013-2015 and 2017-2021.

Data Source

National Immunization Survey, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

References and Community Resources

'''Breastfeeding Information Websites:'''[[br]] *U.S. Department of Health and Human Services. HHS Blueprint for Action on Breastfeeding, Washington, D.C. U.S. Department of Health and Human Services, Office on Women's Health, 2000. [http://www.womenshealth.gov] *Academy of Breastfeeding Medicine (ABM) Statements and Clinical Protocols [http://www.bfmed.org/protocols] *American Academy of Family Physicians (AAFP) Policies [http://www.aafp.org] *American Academy of Pediatrics (AAP) [http://www.aap.org] *American College of Nurse-Midwives (ACNM) [http://www.midwife.org/] *American College of Obstetricians and Gynecologists (ACOG) [http://www.acog.org] *American Academy of Nutrition and Dietetics Position Statement [http://www.jandonline.org/article/S2212-2672(14)01876-0/fulltext] *Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Position Statements [http://www.awhonn.org] *Baby Friendly Hospital Initiative [http://www.babyfriendlyusa.org/] *Centers for Disease Control and Prevention [http://www.cdc.gov/breastfeeding] *International Lactation Consultant Association [http://www.ilca.org] *United States Lactation Consultant Association [http://www.uslca.org] *La Leche League International [http://llli.org/] *World Alliance for Breastfeeding Action [http://waba.org.my/] *United States Breastfeeding Committee [http://www.usbreastfeeding.org/] *World Health Organization [http://www.who.int/topics/breastfeeding/en/][[br]] [[br]] '''Resources for Health Care Professionals:'''[[br]] The Surgeon Generals Call to Action to Support Breastfeeding[[br]] [http://www.surgeongeneral.gov/topics/breastfeeding/index.html][[br]] [[br]] '''Position Papers/Policy Statements:'''[[br]] Breastfeeding and the Use of Human Milk[[br]] American Academy of Pediatrics, 2012[[br]] [http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552][[br]] [[br]] Family-Centered Care and the Pediatrician's Role[[br]] American Academy of Pediatrics, 2012[[br]] [http://pediatrics.aappublications.org/content/129/2/394][[br]] [[br]] The Lifelong Effects of Early Childhood Adversity and Toxic Stress[[br]] Pediatrics 2012;129;e232; originally published online December 26, 2011;[[br]] [http://pediatrics.aappublications.org/content/early/2011/12/21/peds.2011-2663][[br]] [[br]] Human Milk, Breastfeeding, and Transmission of HIV Type 1 in the United States [[br]] American Academy of Pediatrics Pediatrics. 2003; 112: 1196-1205.[[br]] [http://pediatrics.aappublications.org/content/112/5/1196][[br]] [[br]] Evidence for the Ten Steps to Successful Breastfeeding[[br]] World Health Organization[[br]] [http://www.who.int/teams/nutrition-and-food-safety/food-and-nutrition-actions-in-health-systems/ten-steps-to-successful-breastfeeding][[br]] [[br]] Evidence on the Long-Term Effects of Breastfeeding[[br]] World Health Organization[[br]] [http://www.who.int/publications/i/item/9789241505307][[br]] [[br]] Protecting, Promoting and Supporting Breastfeeding.[[br]] World Health Organization[[br]] [http://www.who.int/westernpacific/activities/protecting-supporting-and-promoting-breastfeeding]