Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications

Published:October 14, 2019DOI:


      To compare the impact of Baby-Friendly designation vs rates of in-hospital breastfeeding initiation on breastfeeding outcomes at 3, 6, and 12 months postdischarge.

      Study design

      Breastfeeding outcome data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card were used as a basis for determining outcomes from the corresponding 2015 birth cohort. Linear regression models were used to determine the strength of association of breastfeeding initiation and Baby-Friendly hospital penetrance and attainment of postdischarge breastfeeding rates. All hospital births from all 50 states, 3 territories, and the District of Columbia were included in the study.


      Statewide breastfeeding initiation rates were positively associated with targeted breastfeeding outcomes. Similar associations were not found for Baby-Friendly hospital designation penetrance.


      To attain the Healthy People 2020 breastfeeding objectives, future public policy initiatives should consider the interaction of population demographics, individual hospital programs, and public health strategies used to support breastfeeding in states reporting high breastfeeding initiation rates.



      BFHI (Baby-Friendly Hospital Initiative), CDC (Centers for Disease Control), HP2020 (Healthy People 2020), SUPC (Sudden unexpected postnatal collapse), WHO (World Health Organization)
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        • US Department of Health and Human Services
        The Surgeon General's Call to Action to Support Breastfeeding.
        US Department of Health and Human Services, Office of the Surgeon General, Washington, DC2011
        • Perrine C.G.
        • Shealy K.R.
        • Scanlon K.S.
        • Grummer-Strawn L.M.
        • et al.
        Vital signs: hospital practices to support breastfeeding–United States, 2007 and 2009.
        MMWR. 2011; 60: 1020-1025
        • Centers for Disease Control and Prevention
        National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity.
        Breastfeeding Report Card, United States2018
        • Perrine C.G.
        • Galuska D.A.
        • Dohack M.S.
        • Shealy K.R.
        • Murphy P.E.
        • Grummer-Strawn L.M.
        • et al.
        Vital signs: hospital practices to support breastfeeding–United States, 2007 and 2013.
        MMWR. 2015; 64: 1112-1117
        • Goldsmith J.P.
        Hospitals should balance skin-to-skin contact with safe sleep practices. Pediatricians and the Law.
        AAP News. 2013; 34: 22
        • Thach B.F.
        Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards.
        J Perinatol. 2013; 34: 275-279
        • Bass J.L.
        • Gartley T.
        • Kleinman R.
        Unintended consequences of current breastfeeding initiatives.
        JAMA Pediatr. 2016; 170: 723-724
        • Bass J.L.
        • Gartley T.
        • Lyczkowski D.
        • Kleinman R.
        Skin-to-skin care cannot be blamed for increase in suffocation deaths-reply.
        J Pediatr. 2018; 200: 297-298
        • Freiden T.R.
        • Ehler K.
        • Schuchat A.
        Improving the health of the United States with a “Winnable Battles” initiative.
        JAMA. 2017; 317: 903-904
        • Patnode C.D.
        • Henninger M.L.
        • Senger C.A.
        • Perdue L.A.
        • Whitlock E.P.
        Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventative Services Task Force.
        JAMA. 2016; 316: 1694-1705
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Driscoll A.K.
        • Matthews T.J.
        Births: final data for 2015.
        Natl Vital Stat Rep. 2015; 66: 40
        • Centers for Disease Control and Prevention
        National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity, Breastfeeding Report Card: Progressing Toward National Breastfeeding Goals, United States.
        • Feldman-Winter L.
        • Ustianov J.
        • Anastasio J.
        • Butts-Dion S.
        • Heinrich P.
        • et al.
        Best fed beginnings: a nationwide quality improvement initiative to increase breastfeeding.
        Pediatrics. 2017; 140: e20163121
        • EMPower Breastfeeding
        EMPower Breastfeeding: Enhancing Maternity Practices.
        • Feldman-Winter L.
        • Goldsmith J.P.
        American Academy of Pediatrics Committee on Fetus and Newborn, Task Force on Sudden Infant Death. Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns.
        Pediatrics. 2016; 138: e20161889
      1. Guideline: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. World Health Organization, Geneva2017 (License: CC BY-NC-SA 3.0 IGO: pp2,8,10,32,108,110,112)
        • Hughes Driscoll C.
        • Pereira N.
        • Lichenstein R.
        In-hospital neonatal falls: an unintended consequence of efforts to improve breastfeeding.
        Pediatrics. 2019; 143: e20182488
        • Division of Healthcare Improvement
        The Joint Commission, QuickSafety: Preventing newborn falls and drops.
        • Flaherman V.
        • Von Kohorn I.
        Interventions intended to support breastfeeding: updated assessment of benefits and harms.
        JAMA. 2016; 316: 1685-1687
      2. Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services–the revised Baby-Friendly Hospital Initiative. World Health Organization, Geneva2018 (License: CC BY-NC-SA 3.0 IGO: pp 15,24,41)
        • The Joint Commission
        Approved: new perinatal care performance measure: PC-06 unexpected complications in term newborns.
        Jt Commn Pers. 2018; 38: 1-8
        • Centers for Disease Control and Prevention
        Safety in Maternity Care: Infant Safety in Maternity Care Practices that Support Breastfeeding in US Birth Facilities.
        • Shapiro-Mendoza C.K.
        Sudden unexpected infant death rates differ by age at death.
        J Pediatr. 2018; 198: 324
        • Fallon V.M.
        • Harrold J.A.
        • Chisholm A.
        The impact of the UK Baby-Friendly Initiative on maternal and infant health outcomes: a mixed-methods systematic review.
        Matern Child Nutr. 2019; : e12778
        • McKay V.R.
        • Morshed A.B.
        • Brownson R.C.
        • Proctor E.K.
        • Prusaczyk B.
        Letting go: conceptualizing de-implementation in public health and social service settings.
        Am J Commun Psychol. 2018; 0: 1-14
        • Bass J.L.
        • Gartley T.
        • Kleinman R.
        World Health Organization Baby-Friendly hospital initiative guideline and 2018 implementation guidance (JAMA Network Clinical Guideline Synopsis).
        JAMA Pediatr. 2019; 173: 93-94
        • Blumberg S.J.
        • Luke J.V.
        Wireless substitutions: Early release of estimates from the National Health Interview Survey, July-December 2018.
        (National Center for Health Statistics)2018
        • Colaizy T.T.
        • Saftias A.F.
        • Morriss Jr., F.H.
        Maternal intention to breastfeed and breastfeeding outcomes in term and preterm infants: PRAMS 2000-2003.
        Public Health Nutr. 2012; 15: 70210
        • Anstey E.H.
        • Chen J.
        • Elam-Evans
        • Perrine C.G.
        Racial and geographic differences in breastfeeding-United States, 2011-2015.
        MMWR. 2017; 66: 723-727
        • US Census Bureau
        Quick Facts: United States.
        • Maryland Hospital Breastfeeding Policy Recommendation Committee
        Maryland hospital breastfeeding policy recommendations.
        Maryland Department of Health and Mental Hygiene, 2012
        • DiGirolamo A.M.
        • Grummer-Strawn L.M.
        • Fein S.B.
        Effect of maternity-care practices on breastfeeding.
        Pediatrics. 2008; 122: S43-S49
        • Bass J.L.
        • Gartley T.
        • Lyczkowski D.
        • Kleinman R.
        Trends in the incidence of sudden unexpected infant deaths in the newborn: 1995-2014.
        J Pediatr. 2018; 196: 104-108
        • Thompson J.M.D.
        • Tanabe K.
        • Moon R.Y.
        • Mitchell E.A.
        • McGarvey C.
        • Tappin D.
        • et al.
        Duration of breastfeeding and risk of SIDS: an individual participant data Meta-analysis.
        Pediatrics. 2017; 140: e20171324

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