Definition

Percentage of infants ever breastfed (or received breast milk at birth).

Numerator

Number of infants born during calendar year ever fed breast milk; number of mothers reporting breastfeeding their infant in the hospital.

Denominator

Total number of infants born during a calendar year; number of mothers responding.

Why Is This Important?

Suboptimal breastfeeding practices are unequivocally associated with a greater risk of infant morbidity and mortality and poorer developmental outcomes, particularly in premature infants. Increasing breastfeeding rates is one of the most important behaviors that can decrease infant death and illness worldwide. When breastfeeding does not occur, the important benefits are not enjoyed by infants, mothers, families, society, and the environment. It is the normal, preferred feeding for infants, including premature and sick babies.

Other Objectives

The Academy of Breastfeeding Medicine (ABM) affirms the following tenets: * Improved breastfeeding promotion, protection, and support are needed globally and at all levels, including increased support by physicians, other health workers and healthcare systems, schools, communities, corporations, and governments. The primary goal of the ABM is to educate physicians worldwide in breastfeeding and human lactation. Physician undergraduate and postgraduate medical education must include knowledge of the current evidence, instill the necessary attitudes, and provide experience in the skills necessary to fulfill their responsibility to promote, protect, and support breastfeeding. * Breastfeeding is and should be considered, normative infant and young child feeding. Health professionals widely acknowledge that breastfeeding is biologically uniquely appropriate for the mother and infant. As the norm, breastfeeding is the standard against which all other forms of infant feeding are compared in research and in clinical support. And, it is a human rights issue for both mother and child. Children have the right to the highest attainable standard of health, which entails the right to be breastfed, and women have the right to breastfeed as related to self-determined reproductive rights. Women have the right to accurate, unbiased information needed to make an informed choice about breastfeeding via the right to specific educational information to help to ensure the health and well-being of families. As breastfeeding is both a woman's and a child's right, it is, therefore, the responsibility of the healthcare system, the media, business and marketing sectors, government, and society, in general, to support and enable each woman to fulfill her breastfeeding goals and to eliminate obstacles and constraints to initiating and sustaining optimal breastfeeding practices. * The practice of medicine, at clinical, administrative, and public health policy levels, should be guided, whenever possible, by available evidence. Evidence-based medicine, the conscientious, explicit, and judicious use of current best evidence may be applied to human lactation and breastfeeding as it is to both other human physiologic systems and other health behaviors. Some aspects of breastfeeding medicine lack high-quality evidence on which to base guidelines and decisions. Funding for research in human lactation and breastfeeding medicine is critical in order to address the gaps. Noninvasive maternity practices, immediate skin-to-skin, and early initiation of breastfeeding are essential for enabling exclusive breastfeeding. Practices such as delayed clamping of the cord, providing necessary nutrient stores for the early months of exclusive breastfeeding, should be considered and incorporated as clinically indicated into standards of practice. Health systems play a crucial role in breastfeeding promotion and support, and both inpatient and outpatient settings should implement practices conducive to breastfeeding. * Governments are responsible for protecting the rights of women and children, including the right to breastfeed in both hospital and home settings and in the community, and are therefore dually responsible for promoting breastfeeding as a right in itself and as a means to diminish infant and child mortality and combat disease and malnutrition. Alliance and collaboration with other international organizations seeking to promote, protect, and support breastfeeding may be mutually beneficial and are therefore objectives of the ABM. The majority of women in the world initiate breastfeeding but cite insufficient support and societal barriers as key impediments to achieving recommended and/or desired breastfeeding rates and patterns.

How Are We Doing?

According to the National Immunizations Survey (NIS) data the 2021 Utah rate for "ever breastfed" was 91.1% which is greater than the 2020 Healthy People Objective of 81.9%.

How Do We Compare With the U.S.?

Utah breastfeeding rates exceeded the U.S. rates for ever breastfed during 2000-2021.

What Is Being Done?

The Utah WIC Program serves approximately one-third of all mothers in Utah. It provides important education and resources to families prenatally to prepare them for the early postpartum period of breastfeeding. Registered Dietitians (RDs), International Board Certified Lactation Consultants (IBCLCs), and Breastfeeding Peer Counselors provide prenatal and early postpartum support through individual counseling and support groups to assist mothers, infants, and families to exclusively breastfeed (provide nothing other than breast milk) through the first six months of life. The Utah WIC Program works closely with local agency hospitals to support evidence-based policy and practices such as the Baby-Friendly Hospital Initiative of Ten Steps to Successful Breastfeeding and to support the transition of mom and baby from hospital to home to ensure breastfeeding success. The Utah WIC Program has an extensive Breastfeeding Peer Counseling Program that allows mother-to-mother support at the crucial early postpartum period. In addition, the Utah WIC Program has supported the establishment of the first Human Milk Bank Collection site in Utah and is facilitating the establishment of a Human Milk Donor Bank, as a member of the Human Milk Banking Association of North America.

Evidence-based Practices

Policies and procedures should be in place for maternity care in hospitals and birthing centers. The maternity care experience exerts a unique influence on both breastfeeding initiation and later infant feeding behavior. BFHI (Baby-Friendly Hospital Initiative) designation (established by the World Health Organization [WHO]/UNICEF) represents hospitals that have fully implemented Ten Steps to Successful Breastfeeding, a comprehensive ten-step program, or they can be individual interventions such as increasing the rooming-in of mothers and babies or discontinuing policies that are not evidence-based. The Ten Steps to Successful Breastfeeding are as follows: # 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 a half-hour of birth # Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants # Give newborn infant no food or drink other than breast milk, unless medically indicated # Practice room-in and allow mothers and infants to remain together 24 hours a day # Encourage breastfeeding on demand # Give no artificial teats or pacifiers to breastfeeding infants # Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic [[br]] [[br]] In order to optimize breastfeeding practices universally, physicians must learn evidence-based breastfeeding medicine, skills, and attitudes (The Academy of Breastfeeding Medicine Position on Breastfeeding). Physicians play a central role in the promotion, protection, and support of breastfeeding. Research indicates that obstetric medication and anesthesia interfere with the innate feeding behavior of the infant. Hence, the International Lactation Consultants Association (ILCA) believes that all such medication should be used as sparingly as is compatible with maternal and infant health. Research indicates that a woman's knowledge about infant feeding is significantly linked with a decision to breastfeed and breastfeeding outcomes are better when infants have unrestricted access to the breast in the postpartum period. Hence, the position of ILCA is that, in the immediate postpartum period and beyond, infants should be permitted to suckle for as long and as often as they wish, and that they should not be forced into schedules of any kind. In addition, research shows that routine supplementation of any kind represents unnecessary risks to the infant is detrimental to a woman's self-confidence and her milk supply and is wasteful and costly. ILCA believes that parents have a right to know if their infant will be supplemented and recommends that the mother's informed consent be sought prior to medically indicated supplementation. Evidence suggests the following: * elevated bilirubin in newborn infants may be beneficial since bilirubin is a powerful antioxidant. * markedly elevated bilirubin levels in the breastfed neonate are often caused by restricted feeding patterns, water supplementation, or ineffective milk transfer. * non-pathologic jaundice in the healthy term neonate is not hazardous and necessitates neither interruption of breastfeeding nor supplementation with breast-milk substitutes. * other interventions, such as interrupted breastfeeding and phototherapy, often result in lactation failure and a continued perception of the infant as vulnerable to illness or injury.

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 and 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 pregnancy and 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 these recommendations and evidence-based practices. 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 the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF Ten Steps to Successful Breastfeeding. National strategies supported by the U.S. Surgeon General's Call to Action, the Centers for Disease Control and Prevention, 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 thus 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 for the first two years of life should be accomplished by using the World Health Organization'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 (nothing other than breast milk) for about the first 6 months and to continue for at least the first year and beyond as long as mutually desired by mother and child. 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 the following: direct skin-to-skin contact with mothers immediately after delivery until the first feeding is accomplished and encouraged throughout the postpartum period; 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

Women are more likely to breastfeed their babies if they are: White, non-Hispanic Asian, college-educated, and married. In the Utah WIC Program, the highest rates are found in the Southwest Public Health District.

Health Care System Factors

Pregnant women are encouraged to discuss their feeding choices with their prenatal care provider, and to receive prenatal education. Most hospitals will honor a mother's desire to keep her baby in the room with her (essential for successful breastfeeding). Mothers should request assistance from a lactation professional in the hospital. The University of Utah is the only hospital in Utah to have achieved "Baby Friendly" status based on the Ten Steps established by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Short hospital stays may not include additional time for breastfeeding assistance and anticipatory guidance. Mothers and their babies should be seen by their health care provider within the first week to ensure normal initiation of breastfeeding.

Risk Factors

In the event that a mother is separated from her newborn (due to medical condition of mother or baby), a hospital-grade breast pump should be provided and utilized to establish successful lactation. After hospital discharge, the WIC Program will provide an electric breast pump to mothers who qualify.

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).

The Utah rates for ever breastfeeding an infant exceeded the U.S. rates from 2000-2021. From 2011-2021 Utah exceeded the 2020 Healthy People Ever Breastfed Objective.

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]