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Achieving Exclusive Breastfeeding in the United States: Findings and Recommendations


Exclusive breastfeeding for the first six months of life is strongly associated with optimal health outcomes for mother and child, in the short and long term. Yet exclusive breastfeeding is practiced by a minority of families, and the duration rates of both any and exclusive breastfeeding at six months are well below the United States Department of Health and Human Services Healthy People 2010 objectives.

Conceptual Framework and Methods

The literature on factors shown to influence rates of exclusive breastfeeding is explored using a conceptual framework that includes the impact of 1) health care system and providers; 2) social, economic, and political factors; and 3) media and marketing practices. Each of these was examined to assess the varying obstacles and constraints that arise at different points in time during the decision-making and behavior continuum associated with exclusive breastfeeding. The literature review, for the most part, is limited to those articles that specifically address exclusive breastfeeding. While every effort was made to include only those studies carried out in developed settings, a few exceptions were made where findings were complementary. Findings are summarized as matrices and explored for obstacles and constraints unique to support for exclusive breastfeeding.


Many of the interventions supported in the literature as having impact on initiation and duration of breastfeeding also affect initiation and duration of exclusive breastfeeding, including hospital practices, provider skills, social and workplace support, and media and marketing. Increased awareness and attention to the importance of exclusive breastfeeding by health care, socioeconomic, political, and media sectors will help achieve exclusive breastfeeding. Obstacles and constraints specific to exclusive breastfeeding included:

Health care system and providers

  • Limited provider awareness, knowledge, skills, and practices and limited self-awareness;
  • Unnecessary use of medical interventions during labor and delivery;
  • Insufficient attention to immediate skin-to-skin contact at birth and evidence-based breastfeeding support practices, such as safe co-sleeping; and
  • Insufficient numbers of providers skilled in both clinical and social support.

Social, economic, and political factors

  • Limited community, political, legislative, and regulatory awareness of the public health impact and concomitant limited attention to action;
  • Misperceptions and fears due to lack of societal awareness and support;
  • Limited third party payment for sufficient support;
  • Rarity of public health programming in support of exclusive breastfeeding outside of WIC, and limitations within WIC;
  • Lack of paid maternity leave/brevity of any leave; and
  • Lack of workplace support.

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