Taking Stock of Progress in Supporting, Protecting & Promoting Breastfeeding: The National Immunization Survey and the World Breastfeeding Trends Initiative

CindyBy Guest Blogger, Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc., Affiliated Faculty, Union Institute & University

(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project, Inc. circle are taking up the blogger role.)

National Breastfeeding Data Updated

As World Breastfeeding Week (August 1-7) draws to a close, our celebration of National Breastfeeding Month continues.

This week marked the annual meeting of the United States Breastfeeding Committee (USBC) on August 4, followed by the Sixth National Breastfeeding Coalitions Conference, August 5-7, 2016.

At the USBC Annual Meeting, Carol MacGowan of the Centers for Disease Control & Prevention (CDC) noted that the National Immunization Survey (NIS) data for babies born in 2013 has been released on the CDC website[i]. The data indicates that 81.1% of US babies born in 2013 were breastfed immediately after birth, within striking distance of the Healthy People 2020 goal of 81.9%. Yay!

There have been incremental increases in breastfeeding duration and intensity (see table below).

The hard work of so many dedicated advocates, supporters, lactation care providers, health care providers, government partners, and others is having positive impact on breastfeeding success of new families. Yet, we are aware that much work lies ahead of us. There are still significant disparities in the rates of breastfeeding from one community to another, one from state to another, from one ethnic group to another.

This calls to mind a powerful finding the Baby-Friendly team at Boston Medical Center (BMC), one of our nation’s first Baby-Friendly birth facilities, reported as they examined the breastfeeding data collected over the years they strove to implement the Ten Steps to Successful Breastfeeding. At the beginning of their journey toward Baby-Friendly status, the BMC team found that women of color who were not born in the U.S. were twice as likely to breastfeed when compared with women of color who had been born in the U.S. As they implemented the Ten Steps, breastfeeding rates rose among all women, nearly doubling (34% to 74%) among the women of color born in the U.S., while breastfeeding among those born outside the U.S. increased in initiation from 78% to 96% after Baby-Friendly designation was achieved (Philipp et al., 2001).This indicates the powerful role that system factors play in supporting or eroding personal intentions and cultural traditions around infant feeding.

Boston Medical Center’s experience is echoed in recent findings of researchers from Centers for Disease Control & Prevention (2014), who examined the implementation of Baby-Friendly practices in nationwide hospitals:

The findings suggest that the implementation of maternity care practices supportive of breastfeeding vary based on the racial composition of the area, which means women living in areas with higher percentages of blacks might have less access to these services. Although the reasons for these disparities are unclear, the results might provide some insight into why there has been a persistent gap in breastfeeding initiation and duration rates between black and white infants in the United States. All facilities, regardless of the racial/ethnic composition of the populations they serve, can support the breastfeeding decisions of their patients by implementing evidence-based policies and practices shown to be critical for establishing breastfeeding, so that more infants are able to reap the numerous health benefits of breastfeeding. (p. 728)


Objective Healthy People 2020 Goal Rate among babies born in 2013 (NIS/CDC, 2016)
Ever breastfed 81.9% 81.1%
At 6 months 60.6 51.8
At 12 months 34.1 30.7
Exclusively through 4 months 46.2 44.4
Exclusively through 6 months 25.5 22.3


World Breastfeeding Trends Initiative

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Members of the Expert Panel announcing the WBTI launch at USBC, 8/4/16

At the end of the August 4 USBC annual meeting, a full day of progress reports on the progress of many initiatives underway through the USBC and its taskforces, or constellations, all attendees were invited to a celebration of the launch of the U.S.’s draft report to the World Breastfeeding Trend Initiative (WBTi). Many attended the launch, obtained copies of the draft report, and engaged in dialogue about its findings.

The WBTi was developed by International Baby Food Action Network (IBFAN) Asia in order to provide a platform for the assessment of achievement and progress toward the goals of the WHO/UNICEF Global Strategy for Infant and Young Child Feeding (“Global Strategy”). The process of engaging in the WBTi builds on the GLOPAR (Global Participatory Action) initiative of the 90’s in that it encourages careful self-assessment of the strengths and weaknesses of policies and programs toward the goal of “strengthening and stimulating breastfeeding action worldwide.”

Attendees of the WBTi Launch at USBC explore the report

Currently 107 countries have completed their WBTi assessment. Among these are many countries from Africa, Asia, and Latin America, but only 8 from Europe. The completed WBTi country reports allow immediate visual access to the status of breastfeeding in each participating country. A simple “traffic light” coding system (red/yellow/green) indicates level of achievement of each aspect of the Global Strategy.


The WBTi process has three phases:

  1. A National Assessment of the implementation of the Global Strategy. In this phase, multiple partners analyze and document the situation in their country and identify gaps according to 15 indicators.
  2. The scoring, rating grading and ranking of each country or region according to the findings of the national assessment.
  3. The repetition of the assessment after 3-5 years to analyze trends.
WBTI Workshop
Participants of the WBTi Assessment Workshop, April 2016

The National Assessment in the United States has been conducted according to the activities set forth by the WBTi Guide Book. Lois Arnold PhD and Linda Smith MPH (from the American Breastfeeding Institute), Karin Cadwell PhD, Kajsa Brimdyr PhD, and Cindy Turner-Maffei MA (from the Healthy Children Project) served as Assessment Coordinators.

Holly Hansen is the Assessment’s Editor. With funding from the Healthy Children Project, Inc., an Expert Panel with representatives from key sectors was convened and met for 5 days to collect information and draft a preliminary report. The report went through 3 rounds of editing resulting in the current draft (August 2016), and was circulated to the entire membership of the USBC and the attendees of the Breastfeeding Coalitions Conference for comment. Participating organizations are invited to include their logo on the cover of the final submission which is expected to be sent to IBFAN Asia on September 4, 2016.

Ultimately the addition of the U.S. data to the WBTi databank will provide other ways to examine and direct our efforts. Which aspects of support for optimal infant nutrition are well in place in our country? Which need some beefing up? And which are unimplemented, or unevenly implemented? How does our status compare with that of other countries? How can we learn from their experience, and apply lessons learned to improvements here? The inclusion of the U.S. National Report in the WBTi databank will allow us to explore the answers to these and other questions.




[i] Carol MacGowan reported that CDC’s 2016 Breastfeeding Report Card will be released soon, hopefully by September. This document reports on metrics including the NIS data but also data from the Maternity Practices in Infant Nutrition & Care (mPINC) survey as well as reporting on system factors in support of achievement of all of the HP2020 goals, including decreasing supplementation of breastfed newborns, increasing births in Baby-Friendly hospitals, increasing workplace support for breastfeeding. The 2014 Report Card also reported data on factors such as the number of lactation care providers, breastfeeding support groups, child care regulations in support of breastfeeding, etc. Report Card data is reported both in the aggregate as well as state by state.


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