Breastmilk is the best source of nutrition for most infants and has important health benefits.1,2 The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months and continued breastfeeding until 2 years or beyond.3 Healthy People 2030 (HP2030), a US Department of Health and Human Services initiative, sets national health targets, including increasing the proportion of infants exclusively breastfeeding through 6 months of age (target: 42.4%) and receiving any breastmilk at 1 year (target: 54.1%).4 We assessed the gains needed to achieve national HP2030 targets among different sociodemographic groups.
METHODS
The National Immunization Survey—Child (NIS-Child) is an annual, nationally representative survey conducted by the Centers for Disease Control and Prevention (CDC) to monitor vaccination and breastfeeding rates among US children aged 19 to 35 months.5 Data are collected by phone from a complex, stratified, multistage probability sample of eligible households. We combined survey data from 2020 to 2022 to calculate weighted breastfeeding rates among children born in 2019 and 2020. Although some data include the coronavirus disease 2019 pandemic, breastfeeding rates were similar among children born in 2016 and 2017. (data not shown).
We examined breastfeeding rates by parent- or guardian-reported child race and ethnicity (Hispanic, non-Hispanic of American Indian or Alaska Native, Asian, Black, Hawaiian or Pacific Islander, white, or ≥2 races); participation in the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) (yes, no but eligible, ineligible); household income, defined as percentage of the federal poverty level (%FPL; <100, 100–199, 200–399, 400–599, ≥600); parent marital status (married, unmarried); maternal education (less than high school degree, high school graduate, some college or technical school, college graduate); and maternal age (<20, 20–29, ≥30 years).
To estimate gains needed to achieve HP2030 national targets, we subtracted the most current breastfeeding rates among each sociodemographic subgroup from the national target rates.
This analysis was reviewed by the CDC, deemed not human subjects research, and conducted consistent with applicable federal law and CDC policy.
RESULTS
Nationally, a gain of ~17 percentage points (%) was needed to meet each HP2030 target among children born between 2019–2020 (Table 1).
TABLE 1.
Breastfeeding Rates and Percentage Point Differences From the HP2030 Breastfeeding Targets Among Children Born in 2019 and 2020, by Sociodemographic Characteristics
| Exclusive Breastfeeding Through 6 mo* | Any Breastfeeding at 12 mo* | HP2030 Target: Exclusive Breastfeeding Through 6 mo (42.4%) | HP2030 Target: Any Breastfeeding at 12 mo (54.1%) | |||
|---|---|---|---|---|---|---|
| N | % ± 1/2 of 95% CI | N | % ± 1/2 of 95% CI | Percentage point difference between breastfeeding rate and HP2030 target (%) | ||
| Total | 53 055 | 25.5 ± 0.7 | 54 900 | 37.0 ± 0.7 | 16.9 | 17.1 |
| Child race and ethnicitya | ||||||
| Hispanic | 10 114 | 24.7 ± 1.6 | 10 354 | 35.3 ± 1.7 | 17.7 | 18.8 |
| American Indian/Alaska Native, non-Hispanic | 769 | 23.0 ± 5.0 | 787 | 35.3 ± 5.8 | 19.4 | 18.8 |
| Asian, non-Hispanic | 2832 | 29.1 ± 2.8 | 2952 | 49.3 ± 3.0 | 13.3 | 4.8 |
| Black, non-Hispanic | 5365 | 20.4 ± 1.7 | 5512 | 25.7 ± 1.8 | 22.0 | 28.4 |
| Hawaiian/Pacific Islander, non-Hispanic | 281 | 27.5 ± 9.3 | 292 | 39.4 ± 10.0 | 14.9 | 14.7 |
| White, non-Hispanic | 29 250 | 27.2 ± 0.9 | 30 382 | 39.8 ± 1.0 | 15.2 | 14.3 |
| ≥2 races, non-Hispanic | 4444 | 25.0 ± 2.3 | 4621 | 38.1 ± 2.5 | 17.4 | 15.9 |
| Child WIC participationb | ||||||
| Yes | 18 030 | 18.3 ± 1.0 | 18 431 | 24.3 ± 1.1 | 24.1 | 29.8 |
| No, but eligible | 4641 | 30.9 ± 2.4 | 4822 | 41.5 ± 2.6 | 11.5 | 12.6 |
| Ineligible | 30 067 | 31.3 ± 0.9 | 31 294 | 48.1 ± 1.0 | 11.1 | 6.0 |
| Household income (% FPL)c | ||||||
| <100 | 8870 | 19.9 ± 1.5 | 9073 | 26.1 ± 1.6 | 22.5 | 28.0 |
| 100–199 | 9958 | 23.3 ± 1.6 | 10 266 | 31.9 ± 1.7 | 19.1 | 22.2 |
| 200–399 | 14 106 | 28.3 ± 1.3 | 14 576 | 40.1 ± 1.4 | 14.1 | 14.0 |
| 400–599 | 9678 | 29.7 ± 1.6 | 10 093 | 47.2 ± 1.8 | 12.7 | 6.9 |
| ≥600 | 10 443 | 28.9 ± 1.6 | 10 892 | 46.4 ± 1.7 | 13.5 | 7.7 |
| Parent marital statusd | ||||||
| Married | 38 258 | 29.9 ± 0.9 | 39 744 | 45.5 ± 0.9 | 12.5 | 8.6 |
| Unmarried | 14 797 | 18.4 ± 1.1 | 15 156 | 23.3 ± 1.2 | 24.0 | 30.8 |
| Maternal education | ||||||
| Less than high school | 2824 | 20.2 ± 2.6 | 2910 | 29.5 ± 2.9 | 22.2 | 24.6 |
| High school graduate | 9033 | 20.4 ± 1.4 | 9265 | 25.5 ± 1.5 | 22.0 | 28.6 |
| Some college/technical school | 13 174 | 24.4 ± 1.3 | 13 572 | 33.9 ± 1.4 | 18.0 | 20.2 |
| College graduate | 28 024 | 31.0 ± 1.0 | 29 153 | 48.6 ± 0.9 | 11.4 | 5.5 |
| Maternal age (y) | ||||||
| <20 | 316 | 18.7 ± 6.6 | 319 | 24.1 ± 7.8 | 23.7 | 30.0 |
| 20–29 | 14 148 | 21.9 ± 1.2 | 14 535 | 28.9 ± 1.3 | 20.5 | 25.2 |
| ≥30 | 38 591 | 27.3 ± 0.8 | 40 046 | 41.1 ± 0.9 | 15.1 | 13.0 |
CI, confidence interval.
Exclusive breastfeeding through 6 mo: receiving only breast milk (no solids, water, or other liquids) for the first 6 mo of life; any breastfeeding at 12 mo: any feeding at the breast or feeding expressed human milk at 12 mo. National Immunization Survey—Child breastfeeding rates are weighted estimates.
Race and ethnicity data are based on parent- or guardian-reported race and ethnicity of children, and the categories reflect the Office of Management and Budget statistical standards for collecting and reporting race and ethnicity across federal agencies.
Special Supplemental Nutrition Program for Women, Infants, and Children. Individuals who did not provide information on WIC status were excluded from the analysis of this variable.
% FPL represents household income as a percentage of the federal threshold by family composition.
Unmarried includes never married, widowed, separated, divorced, and living with partners.
Gains needed to achieve the exclusive breastfeeding through 6 months target ranged considerably from 13.3% among non-Hispanic Asian to 22.0% among non-Hispanic Black children; 11.1% among WIC-ineligible children to 24.1% among WIC participants; 12.7% among children with household incomes between 400% and 599% FPL to 22.5% among those with <100% FPL; 12.5% among children with married parents to 24.0% among those with unmarried parents; 11.4% among children of mothers who were college graduates to 22.2% among those with less than a high school degree; and 15.1% among children with mothers aged ≥30% to 23.7% among those with mothers aged <20 years.
Gains needed to reach the target for any breastfeeding at 12 months also varied widely, with the largest gains needed among non-Hispanic Black children (28.4%), WIC participants (29.8%), children from households with incomes <100% FPL (28.0%), those with unmarried parents (30.8%), and those with mothers who were high school graduates (28.6%) or aged <20 years (30.0%).
Figure 1 depicts the gains needed to achieve HP2030 breastfeeding targets by race and ethnicity, serving as an illustrative example of existing sociodemographic disparities in breastfeeding outcomes.
FIGURE 1.
Percentage point increases needed to achieve the HP2030 breastfeeding targets among children born in 2019 and 2020, by race and ethnicity.
DISCUSSION
No sociodemographic subgroup attained the HP2030 breastfeeding targets; the gains needed to achieve them ranged widely. Subgroups needing gains >20% to meet targets included non-Hispanic Black children, WIC participants, and children with household incomes <100% FPL, unmarried parents, mothers without any college, or mothers aged <30 years.
One limitation is the potential recall bias of parent- or guardian-reported breastfeeding practices; however, maternal recall of breastfeeding is valid and reliable within 3 years.6
Several national breastfeeding laws, programs, and policies exist that can be applied in workplace, childcare, health care, and community settings.7 These national-level strategies may be integrated with evidence-based community-level approaches, like home-visit programs with community health workers or peer mentors, Baby-Friendly hospital practices, and group-based programs,8 to improve breastfeeding outcomes and reduce disparities.
Federal funding exists for community organizations implementing local, culturally appropriate strategies to address breastfeeding disparities through the CDC’s Racial and Ethnic Approaches to Community Health Program.9 In addition, the Continuity of Care in Breastfeeding Support Blueprint offers community-driven capacity building strategies focusing on populations disproportionately impacted by structural barriers associated with lower breastfeeding rates.10
Continued collaboration between federal and local partners is needed to reduce disparities and help achieve the HP2030 national breastfeeding targets.
ABBREVIATIONS
- CDC
Centers for Disease Control and Prevention
- FPL
federal poverty level
- HP2030
Healthy People 2030
- WIC
Supplemental Nutrition Assistance Program for Women, Infants, and Children
Footnotes
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
REFERENCES
- 1.Li R, Ware J, Chen A, et al. Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis. Lancet Reg Health Am. 2022;5:100094. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;(153):1–186 [PMC free article] [PubMed] [Google Scholar]
- 3.Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1): e2022057988 [DOI] [PubMed] [Google Scholar]
- 4.US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Infants. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants. Accessed September 5, 2023
- 5.Centers for Disease Control and Prevention. National immunization survey. Available at: https://www.cdc.gov/breastfeeding/data/nis_data/index.htm. Accessed September 8, 2023
- 6.Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005;63(4):103–110 [DOI] [PubMed] [Google Scholar]
- 7.Barraza L, Lebedevitch C, Stuebe A; Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. The role of law and policy in assisting families to reach Healthy People’s maternal, infant, and child health breastfeeding goals in the United States. Available at: https://www.healthypeople.gov/2020/law-and-health-policy/topic/maternal-infant-child-health. Accessed April 15, 2024
- 8.Callahan E, Kim JH, Bahnfleth C, Higgins M. Racial and Ethnic Disparities in Human Milk Feeding in the United States: A Rapid Review Project. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2023 [PubMed] [Google Scholar]
- 9.Centers for Disease Control and Prevention. Racial and ethnic approaches to community health (REACH), 2023–2028. Available at: https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/reach-2023-2028.html. Accessed April 15, 2024
- 10.National Association of County & City Health Officials. Continuity of care in breastfeeding support blueprint. Available at: https://virtualcommunities.naccho.org/breastfeedingcoc/home. Accessed December 4, 2023