Minnesota Title V MCH Needs Assessment Fact Sheets
Pregnant Women, Mothers and Infants
Breastfeeding
Fall 2004
Size of the Problem
Over 68,000 births occur annually in Minnesota [1]. Recent data for Minnesota indicate that between 79.5% and 83% of women chose to breastfeed their infant in the hospital following birth [2,3]. Minnesota has met the Healthy People 2010 goal that 75% of new mothers initiate breastfeeding. Minnesota continues to work toward the breastfeeding continuation goal that 50% of infants will be breastfed for 6 months.
Seriousness
Research demonstrates the benefits of breastfeeding for mothers and infants as well as the risks of not breastfeeding:
- A 2002 study found that the more human milk consumed by babies through 9 months of age, the higher they scored on intelligence tests in their late teens and 20’s [4].
- Mothers who breastfeed their infants may decrease their own risk of breast cancer [5].
- One study reports that infants who are breastfed are 80% less likely to die before the age of 1, than are infants who were never breastfed [6].
- Breastfed infants, as compared to those not breastfed, have advantages on general health and growth and development, and have less risk of a growing list of acute and chronic diseases [7].
Minnesota’s Women, Infants and Children Nutrition Program (WIC) strongly encourages participating women to breastfeed their infants and provides opportunities to address barriers to breastfeeding. WIC serves women representing demographic groups that often have lower rates of breastfeeding. Minnesota WIC participants have a higher rate of breastfeeding with a newborn in-hospital rate of 69.3% as compared to 58.8% of infants on WIC nationally.
All infants born in Minnesota are affected by their mother’s decision to breastfeed and their knowledge of proper infant feeding. A recent study indicated that only 8% to 24% of women report receiving guidance about infant feeding from their physician [8]. This indicates that between 51,680 and 62,560 Minnesota pregnant women would benefit each year from prenatal education and assistance on infant feeding and breastfeeding.
| 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | |
|---|---|---|---|---|---|---|
| All Infants | 72% |
72.5% |
75.2% |
76.2% |
79.1% |
79.5% |
| WIC Infants | 60.5% |
59.9% |
64.5% |
64.6% |
68.7% |
69.3% |
| U.S. Goal | 75% |
75% |
75% |
75% |
75% |
75% |
| Source: Mothers Survey, Ross Products. November 2003 | ||||||
The Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a statewide sample of mothers with babies aged 2 to 6 months. According to PRAMS data, the main reasons cited by new mothers who stop breastfeeding include:
- Believed not producing enough milk (13%)
- Breastfeeding alone did not satisfy baby (12%)
- Nipples were sore, cracked, bleeding (9%)
- Went back to work or school (9%) [9]
Minnesota breastfeeding rates decrease an estimated 30% between birth and 6 months of age for all Minnesota infants. The discontinuation rates were even higher, about 38% to 47%, among WIC participants.
| 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | |
|---|---|---|---|---|---|---|
| All Infants - 6 mo | 29.9% |
37.4% |
30.9% |
37.8% |
40.9% |
45.1% |
| WIC Infants - 6 mo | 19.9% |
21.9% |
13.6% |
17.9% |
21.1% |
26.6% |
| U.S. Goal - 6 mo | 50% |
50% |
50% |
50% |
50% |
50% |
| Source: Mothers Survey, Ross Products. November 2003 | ||||||
Disparities
National survey data indicate that women who are African American, <20
years of age, primiparous, employed, participating in the WIC program,
and have high school or less education, were less likely to breastfeed
[2,10].
The survey also found that the greatest increases in breastfeeding occurred among African American mothers between 1996 and 2001. In-hospital breastfeeding increased 42.6% in 2001 over 1996 levels. African American infants breastfed at 6 months of age increased 93.8% [2]. The primary reason given by African American women for not breast-feeding was a “preference for bottle feeding.” It is important to understand this reason for not breast-feeding so that more effective education interventions may be developed. Recent research on the racial difference in infant mortality indicates that lack of breastfeeding is as good a predictor of infant death among African American infants as is low birth weight [6].
Hispanic mothers demonstrated the next highest increase in breastfeeding with an increase of 20.7% in-hospital and 68.2% at 6 months. This compares to white mothers’ increase of 13.2% in-hospital and 40.7% at 6 months [2].
Of great concern are the low breastfeeding rates of Asian WIC participants. Only 40.6% of Asian pregnant women in 2002 breastfed their baby compared to 56.9% of American Indian women, 85% of Hispanic women, 66.8% of African Americans and 66.5% of white mothers [10].
Economic
A minimum of $3.6 billion would be saved nationally if breastfeeding rates
were increased from current levels to the target rate of 75% in- hospital
and 50% at 6 months of age. These savings would result from reducing direct
costs (formula costs, physician, hospital, laboratory and procedural fees)
and indirect costs (time and wages lost by parents attending to an ill
child) [6].
Interventions
Two recommendations for cost-effective interventions have been identified by the U.S. Preventive Services Task Force including:
- That clinicians routinely provide behavioral interventions to promote breastfeeding.
- That lactation consultants or other experts provide on-going support for mothers through in-person visits or telephone contacts to increase the proportion of women continuing to breastfeed for up to six months.
The American Academy of Pediatrics (AAP) recommends breastfeeding babies
until they are 12 months of age. The AAP has also published recommendations
for collaboration with local WIC programs to support breastfeeding exclusively
for the first six months of life [7,12].
Few contraindications exist to prevent women from breastfeeding. Guidelines
to help clinicians assess for the few true contraindications have been
developed [13].
Effectiveness of Interventions
The effectiveness of breastfeeding and impact on the health of mother
and infant has been well documented [5,7].
Status
Minnesota Resources
Public health programs and strategies that promote breastfeeding and appropriate
infant feeding include:
- Women, Infants, Children Nutrition Program
- Public health nurse home visiting programs
- Twin Cities Healthy Start
- La Leche League
- Lactation consultants
- Doula programs
- The Childbirth Collective
- MDH’s Breastfeeding Coordinator groups
- Local breastfeeding coalitions
St. Paul-Ramsey County’s WIC Program has a project to increase culturally competent breast feeding education in the prenatal period among Hmong women by including the extended family and addressing cultural barriers to breastfeeding. Prior to immigration to the US, almost all Hmong babies were breastfed.
The Minnesota WIC Program has a breastfeeding initiative that has successfully brought the breast-feeding rates of Minnesota WIC participants up to the national, non-WIC breastfeeding rates.
Minnesota legislation was passed in 1998 that obliged employers to support breastfeeding mothers with workplace accommodations to pump breast milk in conditions that are private and sanitary. Following this legislation, the Lactation Friendly Workplace program sought to increase access to worksite support for breastfeeding throughout the state.
Minnesota also has a statute that excludes public exposure of the breast for the purpose of breastfeeding from the indecent exposure penalty.
Several Minnesota hospitals are working to implement the evidence-based breastfeeding support strategies as outlined in the The Baby Friendly Hospital Initiative (BFHI) developed by the World Health Organization.
Community Awareness
In spite of these laws and initiatives, societal and employer barriers
to breastfeeding still exist in Minnesota. It is hoped that the new national
campaign of the Ad Council launched in June, 2004, will increase awareness
among the public of the importance of breastfeeding and encourage women
to ask for their legally required supports for breastfeeding [14].
References
1. MDH. Minnesota Center for Health Statistics. 2003
2. Mothers Survey, Ross Products Division, Abbott Laboratories.
November 2003.
3. MDH. Initial Findings from the Minnesota Pregnancy
Risk Assessment Monitoring System (PRAMS)-2002. 2004.
4. Mortenson, E. L., Michaelsen, K.F., Sanders, S.A.,
Reinisch, J.M. The Association Between Duration of Breastfeeding and Adult
Intelligence. JAMA. 2002. 287:2365-2371.
5. Furberg et al. 1999. Lactation and breast cancer risk.
Int. J Epidemiology 28 (3): 396-402.
Coll. group on hormonal factors in breast cancer: Breast cancer and breastfeeding.
2002. Lancet 360 (9328):187-195.
6. Forste, R., Weiss, J., Lippincott,E. “The Decision
to Breastfeed in the United States: Does Race Matter.” Pediatrics.
2001. 108(1):291-296.
7. American Academy of Pediatrics. Breastfeeding and the
use of human milk. Pediatrics. 1997.100: 1035-1039
8. Weimer J. The Economic benefits of breastfeeding: A
review and analysis. US Dept. of Agriculture. Food Assistance and Nutrition
Research Report No. 13. March 2001.
9. MDH.2004. Minnesota Center for Health Statistics. PRAMS
2002.
10. Meek, J.Y. “Breastfeeding in the Workplace.”
Pediatric Clinics of North America. 2001. 48:465.
11. CDC. 2002 Pregnancy Nutrition Surveillance- Minnesota.
2003.
12. Provisional Section on Breastfeeding. WIC Program.
Pediatrics. 2001. 108(5):1216-1217.
13. Behavioral Interventions to promote Breastfeeding:
Recommendations and Rationale. Annals of Family Medicine. 2003.1(2):79.
14. Breastfeeding- Best for Baby. Best for mom. Accessed
7-12-04 www.4women.gov/breastfeeding [Attn: Non-MDH Link]
