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Why This Topic Is Important
Growing evidence indicates that nutrition in the first two years of life provides a foundation for long-term health (1). Breast milk is widely acknowledged as the most complete form of nutrition for infants, with a range of benefits for health, growth, and development (1, 2). Breastfeeding is safe and recommended for nearly all families, with very few exceptions (3). Infants who are breastfed are at reduced risk for serious and chronic health conditions, such as diabetes, obesity, infectious disease, and sudden infant death syndrome (1, 2). Breastfeeding also offers health advantages to mothers, such as reducing the risk of breast and ovarian cancer, cardiovascular disease, and diabetes (1, 3). Increasing the proportion of children who are breastfed for at least the first year of life—as well as the percentage who are breastfed exclusively for the first six months—are important public health goals (4). In fact, California has a statewide goal to make breastfeeding the normal method of infant feeding for at least the first year of life (5).

By reducing long-term health care costs for children and mothers, breastfeeding offers broad economic benefits (2, 3). Experts also point to the environmental benefits of breastfeeding, which does not require product packaging, transportation, or use of cows (2, 3).

Access to high-quality support to help initiate and sustain breastfeeding is uneven, with lower rates of evidence-based maternity care in underserved communities, as well as consistently lower breastfeeding rates among African American mothers, in particular (2). Many mothers also face occupational or insurance barriers, such as a lack of paid family leave, limited workplace flexibility, and inadequate coverage for breastfeeding supplies and support (2, 3).
For more information, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  National Academies of Sciences, Engineering, and Medicine. (2020). Feeding infants and children from birth to 24 months: Summarizing existing guidance. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/25747/feeding-infants-and-children-from-birth-to-24-months-summarizing

2.  American Academy of Family Physicians. (2021). Breastfeeding, family physicians supporting. Retrieved from: https://www.aafp.org/about/policies/all/breastfeeding-position-paper.html

3.  American College of Obstetricians and Gynecologists. (2018). Optimizing support for breastfeeding as part of obstetric practice. Retrieved from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice

4.  Healthy People 2030. (n.d.). Increase the proportion of infants who are breastfed exclusively through age 6 months—MICH-15; Increase the proportion of infants who are breastfed at 1 year—MICH-16. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants

5.  California Department of Public Health, Maternal, Child and Adolescent Health Division. (n.d.). Profile: Breastfeeding Initiative. Retrieved from: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Communications/Profile-Breastfeeding.pdf
Policy Implications
Recognizing that breastfeeding has significant long-term health benefits for children and mothers, leading health organizations recommend that infants be breastfed exclusively for the first six months, followed by continued breastfeeding with complementary foods until at least 12 months (1). While breastfeeding rates generally have been on the rise, and 90% of California infants born in 2019 started out breastfeeding, only 27% were breastfed exclusively through six months (1).

To increase breastfeeding rates, mothers need information about its benefits and support from the start to maintain breastfeeding through infancy (2). New mothers are more likely to breastfeed exclusively when hospitals develop breastfeeding policies and practices that keep mothers and infants together, facilitate breastfeeding within one hour after birth, and limit items that discourage breastfeeding (e.g., formula and pacifiers) (2). While many hospitals have made progress in these areas, not all families have access to facilities with supportive, culturally appropriate breastfeeding practices, and data show ongoing inequities in breastfeeding rates by race/ethnicity and socioeconomic status (2, 3, 4). After leaving the hospital, mothers sometimes discontinue breastfeeding due to lack of paid maternity leave, unsupportive workplaces, or inadequate insurance coverage for lactation consultants or breast pumps (2, 5). Continued breastfeeding is more likely when employers, health care systems, child care providers, families, and communities support that effort (2, 4, 5).

Policy and practice options that could increase breastfeeding include:
  • Continuing efforts to ensure that all California hospitals adopt and implement infant-feeding policies aligned with the Baby-Friendly Hospital Initiative, as required by law; as part of this, working to eliminate inequities by improving workforce diversity, integrating family support workers into care settings, and increasing partnerships with communities (4)
  • Ensuring that family physicians are trained adequately on lactation and breastfeeding management (2)
  • Promoting collaboration among hospitals, health care providers, public health agencies, insurers, and other community partners to guarantee that new mothers continue to receive culturally responsive, skilled support for lactation after they leave the hospital (2, 4, 5, 6)
  • Requiring health insurers to cover best practices for breastfeeding support, including in-person access to International Board Certified Lactation Consultants and quality breast pumps (6)
  • Supporting adequate paid family leave policies, as longer maternity leaves may increase breastfeeding duration (2)
  • Educating employers about the benefits of breastfeeding-friendly workplaces, and improving enforcement of existing laws which require employers to provide breastfeeding employees with a private space and time to pump breast milk (2, 5, 7, 8)
  • Promoting breastfeeding education for child care providers, so they can help support exclusive breastfeeding for children in their care, when needed (9)
  • Enforcing state law permitting breastfeeding in public places (10)
For more information, see kidsdata.org’s Research & Links section or visit the U.S. Breastfeeding Committee and the Centers for Disease Control and Prevention.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (2022). Breastfeeding report card – United States, 2022. Retrieved from: https://www.cdc.gov/breastfeeding/data/reportcard.htm

2.  American Academy of Family Physicians. (2021). Breastfeeding, family physicians supporting. Retrieved from: https://www.aafp.org/about/policies/all/breastfeeding-position-paper.html

3.  Li, R., et al. (2019). Breastfeeding trends by race/ethnicity among U.S. children born from 2009 to 2015. JAMA Pediatrics, 173(12), e193319. Retrieved from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2753035

4.  California WIC Association, & UC Davis Human Lactation Center. (2020). Achieving Breastfeeding Equity in California: Are hospitals doing enough to support at-risk families? Retrieved from: https://www.calwic.org/what-we-do/breastfeeding-advocacy/breastfeeding-reports

5.  California WIC Association, et al. (2020). Lactation support for low-wage workers. Retrieved from: https://www.calwic.org/what-we-do/breastfeeding-advocacy/lactation-accommodation-resources

6.  California WIC Association, & California Breastfeeding Coalition. (2017). Breastfeeding support in the Medi-Cal program: A large return on a small investment. Retrieved from: https://calwic.org/wp-content/uploads/2018/11/WIC_BFF_AA_Analysis_R8.pdf

7.  Fair Labor Standards Act of 1938, 29 U.S.C. § 207(r) (1938 & 2010). Retrieved from: https://www.gpo.gov/fdsys/pkg/USCODE-2013-title29/html/USCODE-2013-title29-chap8-sec207.htm

8.  Cal. Lab. Code §§ 1030-1033 (2001). Retrieved from: https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=LAB&division=2.&title=&part=3.&chapter=3.8.

9.  Centers for Disease Control and Prevention. (2019). Breastfeeding and early care and education (ECE). Retrieved from: https://www.cdc.gov/breastfeeding/pdf/ece-breastfeeding-factsheet-508.pdf

10.  Cal. Civ. Code § 43.3 (1997). Retrieved from: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=CIV&sectionNum=43.3.
How Children Are Faring
Since 2010—the first year for which data are available—more than 9 in 10 California newborns delivered in a hospital have received at least some breast milk during their hospitalization (94% in 2019). The share of newborns fed only breast milk in 2019 was 70%, up from 57% in 2010. Across counties with data for 2019, the percentage of newborns breastfed exclusively ranged from 55% (Imperial) to 92% (Nevada).

Statewide, rates of exclusive breastfeeding have risen overall for all racial/ethnic groups with data, with African American/black, Hispanic/Latino, and Native Hawaiian/Pacific Islander newborns experiencing improvements of more than 30% in the decade between 2010 and 2019. Over this period, rates of exclusive breastfeeding consistently were higher for white, American Indian/Alaska Native, and multiracial newborns (more than 3 in 4 in 2019) than for newborns in other groups (fewer than 2 in 3 in 2019).