Breastfed in North Carolina

North Carolina

Breastfeeding has many benefits for mothers and infants. Both the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months of a baby’s life. Breastfeeding provides infants with vital nutrients and supports healthy brain and immune system development. Additional benefits to infants include:

• Reduced risk of infant mortality.
• Reduced risk of chronic disease, including childhood asthma, gastroenteritis, diabetes, childhood leukemia and obesity.
• Reduced risk of sudden infant death syndrome (SIDS).

Breastfeeding benefits for mothers include decreased risk of breast and ovarian cancers, Type 2 diabetes and high blood pressure. Breastfeeding also facilitates bonding between mother and infant.

In 2019, approximately 83% of new mothers in the United States initiated breastfeeding, and 25% continued to exclusively breastfeed for six months following birth. 

Several social and cultural factors may lead women to never start breastfeeding or to stop breastfeeding early. Factors associated with lower breastfeeding rates include: 

• Not offering paid maternity leave to women with low income.
• Not giving sufficient breaks at work to pump breast milk or breastfeed. 
• Shaming women for breastfeeding in public.
• Past difficulties with breastfeeding other children.
• Struggling with poor positioning and latching.
• Inadequate social support, such as having a family that does not approve of breastfeeding.

According to the Centers for Disease Control and Prevention, rates of breastfeeding are higher among: 

• Infants born to Asian, non-Hispanic white and Hispanic women compared with those born to non-Hispanic Black women.
• Infants born to women age 30 or older compared with those born to younger women ages 20-29. 
• Infants living in urban areas.
• Infants living in the Northeast, Southwest, West and Midwest regions compared with those living in the Southeast region.

Additionally, low-income women are more likely to return to work earlier and to have jobs that make it more difficult to continue breastfeeding, compared with women with higher incomes.

Interventions that support breastfeeding have been shown to increase rates of breastfeeding initiation and duration, according to the U.S. Preventive Services Task Force. In 2012, the Affordable Care Act began requiring health insurers to cover breastfeeding equipment and support services, which led to a 10% increase in the duration of breastfeeding and a 21% increase in the duration of exclusive breastfeeding. 

Social and emotional support programs play an important role for breastfeeding women as well by creating environments for encouragement and advice to be exchanged. 

Hospitals participating in the Baby-Friendly Hospital Initiative, which involves implementing the Ten Steps to Successful Breastfeeding, help encourage new mothers to start and continue breastfeeding. Higher proportions of Baby-Friendly Hospitals at the state level are associated with increased breastfeeding rates. Moreover, increased use of the Ten Steps is associated with a decrease in racial disparities in breastfeeding initiation. Improving the delivery of culturally relevant breastfeeding services tailored to meet the needs of communities most at risk of not breastfeeding can further narrow disparities.

Policies like paid maternity leave and workplace support can also increase the proportion of women who start and continue breastfeeding. Effective workplace breastfeeding interventions include worksite lactation spaces and breast milk extraction breaks.

Healthy People 2030 has an objective to increase the percentage of infants breastfed exclusively for their first six months.

Centers for Disease Control and Prevention. “Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies.” Atlanta, GA: U.S. Department of Health and Human Services, 2013. https://www.cdc.gov/breastfeeding/pdf/bf-guide-508.pdf.

Dewey, Kathryn G, Darcy Güngör, Sharon M Donovan, Emily M Madan, Sudha Venkatramanan, Teresa A Davis, Ronald E Kleinman, et al. “Breastfeeding and Risk of Overweight in Childhood and beyond: A Systematic Review with Emphasis on Sibling-Pair and Intervention Studies.” The American Journal of Clinical Nutrition 114, no. 5 (November 8, 2021): 1774–90. https://doi.org/10.1093/ajcn/nqab206.

Dietrich Leurer, Marie, and Eunice Misskey. “The Psychosocial and Emotional Experience of Breastfeeding: Reflections of Mothers.” Global Qualitative Nursing Research 2 (November 5, 2015). https://doi.org/10.1177/2333393615611654.

Eidelman, Arthur I., Richard J. Schanler, Margreete Johnston, Susan Landers, Larry Noble, Kinga Szucs, and Laura Viehmann. “Breastfeeding and the Use of Human Milk.” Pediatrics 129, no. 3 (March 1, 2012): e827–41. https://doi.org/10.1542/peds.2011-3552.

Gurley-Calvez, Tami, Lindsey Bullinger, and Kandice A. Kapinos. “Effect of the Affordable Care Act on Breastfeeding Outcomes.” American Journal of Public Health 108, no. 2 (February 2018): 277–83. https://doi.org/10.2105/AJPH.2017.304108.

Jolles, Diana R., and Lauren Hoehn-Velasco. “Breastfeeding as a Quality Measure: Demonstrating Levers of the National Quality Strategy.” The Journal of Perinatal & Neonatal Nursing 35, no. 3 (September 2021): 221–27. https://doi.org/10.1097/JPN.0000000000000577.

Kim, Tae Hyeon, Hyeri Lee, Selin Woo, Hayeon Lee, Jaeyu Park, Guillaume Fond, Laurent Boyer, Jong Woo Hahn, Jiseung Kang, and Dong Keon Yon. “Prenatal and Postnatal Factors Associated with Sudden Infant Death Syndrome: An Umbrella Review of Meta-Analyses.” World Journal of Pediatrics 20, no. 5 (May 2024): 451–60. https://doi.org/10.1007/s12519-024-00806-1.

Li, Ruowei, Julie Ware, Aimin Chen, Jennifer M. Nelson, Jennifer M. Kmet, Sharyn E. Parks, Ardythe L. Morrow, Jian Chen, and Cria G. Perrine. “Breastfeeding and Post-Perinatal Infant Deaths in the United States, A National Prospective Cohort Analysis.” The Lancet Regional Health - Americas 5 (January 2022). https://doi.org/10.1016/j.lana.2021.100094.

Marks, Kristin J., Jasmine Y. Nakayama, Katelyn V. Chiang, Mary Ellen Grap, Erica H. Anstey, Ellen O. Boundy, Heather C. Hamner, and Ruowei Li. “Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity — United States, 2020–2021.” Preventing Chronic Disease 20 (December 14, 2023): 230199. https://doi.org/10.5888/pcd20.230199.

Rollins, Nigel C., Nita Bhandari, Nemat Hajeebhoy, Susan Horton, Chessa K. Lutter, Jose C. Martines, Ellen G. Piwoz, Linda M. Richter, and Cesar G. Victora. “Why Invest, and What It Will Take to Improve Breastfeeding Practices?” The Lancet, Breastfeeding 2, 387, no. 10017 (January 30, 2016): 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.

Victora, Cesar G., Rajiv Bahl, Aluísio J. D. Barros, Giovanny V. A. França, Susan Horton, Julia Krasevec, Simon Murch, Mari Jeeva Sankar, Neff Walker, and Nigel C. Rollins. “Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Effect.” The Lancet, Breastfeeding 1, 387, no. 10017 (January 2016): 475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.

Vilar-Compte, Mireya, Rafael Pérez-Escamilla, and Ana L. Ruano. “Interventions and Policy Approaches to Promote Equity in Breastfeeding.” International Journal for Equity in Health 21, no. 1 (December 2022): 63, s12939-022-01670-z. https://doi.org/10.1186/s12939-022-01670-z.