The U.S. Breastfeeding Committee has compiled a collection of resources and reference materials on a variety of important topics of relevance to the First Food field. Each category listed below contains policy statements, relevant articles, letters, and reference materials for each topic.

We aim to continually update this webpage as new information emerges and new resources become available, and you can help enhance this project by letting us know if we are missing anything via our Communication Channel Submission Form. Please email [email protected] with any questions or comments.

Reference Materials for Policy, Systems, and Environmental Change (PSE)

Use the Table of Contents links to navigate between sections of this resource page and click the button below to download a PDF of the resources contained within. 

Table of Contents

Public Health Case for Breastfeeding

All major medical authorities recommend exclusive breastfeeding for the first 6 months of life, with continued breastfeeding following the introduction of complementary foods. ​
National & International Policy Statements Recommending Breastfeeding

Impact of Breastfeeding and Human Lactation on Health Outcomes

​Breastfeeding has a profound impact on population health outcomes. The evidence for the value of human milk on overall health for infants, children, and mothers is scientific, robust, and continually reaffirmed by new research.

Maternal Health

Breastfeeding reduces the risk of a range of chronic diseases, including type 2 diabetes, cardiovascular disease, and breast and ovarian cancers.

Infant Health​
Breastfed infants are at lower risk of certain infections, sudden unexplained infant death, and a range of chronic diseases, including obesity, type 1 and 2 diabetes, asthma, and childhood leukemia. Ever breastfeeding is associated with a significant reduction in the odds of post-perinatal (between 7-364 days) infant death.

Donor Human Milk​
​Pasteurized donor human milk feeding has been shown to reduce infant mortality rates, lower healthcare costs, and shorten hospital stays. Specifically, the use of donor milk is associated with increased survival rates and lowered rates of infections, sepsis, serious lung disease, and gastrointestinal complications. The World Health Organization and the American Academy of Pediatrics recommend the use of donor milk for low-birthweight infants, as well as for sick infants who cannot be fed their mother’s own milk.

Economic Case for Breastfeeding

​Low breastfeeding rates in the United States cost our nation millions of dollars through higher health systems costs, lost productivity, and higher household expenditures. At the national level, improving breastfeeding practices through programs and policies has been shown to be one of the best investments a country can make, as every dollar invested is estimated to result in a U.S. $35 economic return. Increased breastfeeding rates are also associated with reduced environmental impact and associated expenses.

National Cost of Not Breastfeeding

Policy, System, and Environmental Factors Impacting Human Milk Feeding: Barriers, Facilitators, and Disparities

​Increasing breastfeeding rates and creating lactation-friendly environments have been identified as critical public health priorities both nationally and globally. Yet policy, system, and environmental barriers to establishing and maintaining the human milk feeding relationship are persistent and pervasive in the United States. 

Access to Lactation Support and Supplies​
​Every infant feeding journey is different. For some, breast pumps, lactation supplies, and/or knowledgeable support from lactation support providers are helpful or necessary. Most health plans are required under the Patient Protection and Affordable Care Act to cover the costs of lactation support services and breastfeeding equipment and supplies.
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Maternity Care Practices​
Supportive, culturally aligned maternity care practices play an essential role in setting families up for breastfeeding success. Research clearly demonstrates that maternity care practices have a significant and lasting impact on infant feeding outcomes. Birth facility policies and practices that create a supportive environment for breastfeeding begin prenatally and continue through discharge. In the United States, Baby-Friendly USA accredits hospitals and birth centers that follow the standards set forth through the international Baby-Friendly Hospital Initiative to protect, promote, and support breastfeeding. 

Employment​
​Access to paid family leave programs can lay the groundwork for breastfeeding success. Paid family leave programs make it possible for employees to take time for childbirth recovery, bonding with their baby, establishing feeding routines, and adjusting to life with a new child without threatening their family's economic well-being. This precious time provides the foundation for success, contributing to improved breastfeeding initiation and duration rates. When returning to work, lactation accommodations in both the workplace and in childcare settings are critical to maintaining breastfeeding. Under federal law, employers are required to provide their employees with the time and space to pump breast milk.

Students

​Lactating students share many of the same needs as lactating employees, including time away from their studies without penalty, access to time and space to pump during the school day, and safe storage of expressed breast milk. Under federal law, academic institutions are required to provide pregnant and postpartum students with medically-necessary leave, lactation space, and reasonable breaks to pump or breastfeed. 
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Formula Marketing​
To protect, promote, and support breastfeeding, the World Health Assembly adopted The International Code of Marketing of Breast-Milk Substitutes in 1981 and has since passed many associated resolutions (known as "the Code"). Infant formula manufacturers utilize marketing strategies for families, healthcare providers, and policymakers to portray their products as solutions to common infant health issues in ways that systematically undermine breastfeeding and that are not in accordance with the Code. The United States has not adopted the Code or placed marketing restrictions on baby food manufacturers.
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Infant & Young Child Feeding in Emergencies​
Infants and children are among the most vulnerable in an emergency. It is critical to ensure that infants are safely fed and supported in times of crisis. Breastfeeding saves lives! Human milk is always clean, requires no fuel, water, or electricity, and is available, even in the most dire circumstances.

Racial and Ethnic Disparities

​Policy, system, and environmental barriers to breastfeeding impact all families but have a disproportionate impact on historically underserved and historically marginalized populations. There are significant and persistent disparities in access to lactation support and in lactation outcomes based on race, geography, and socio-economic status. These disparities contribute to health inequities across the lifespan.
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Breastfeeding Data & Public Health Surveillance Sources

​Surveillance of breastfeeding and lactation-supportive practices is crucial for monitoring progress over time and identifying priority areas that need attention.
  • National Immunization Survey - Child (NIS-Child) 
    • Implemented by the CDC, the NIS-Child uses random-digit dialing to survey U.S. households with children aged 19-35 months and includes survey questions on breastfeeding initiation, duration, and exclusivity as well as infant formula supplementation of breastfed infants.
  • National Vital Statistics System (NVSS)
  • Pregnancy Risk Assessment Monitoring System (PRAMS)
    • Implemented by the CDC, PRAMS collects jurisdiction-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. PRAMS data reports on breastfeeding intention and duration and breastfeeding as a birth control method (Lactational Amenorrhea Method).
  • Data, Trends, and Maps (Search by Category: Breastfeeding)
    • The CDC Division of Nutrition, Physical Activity, and Obesity hosts this interactive database which provides national and state-level data about the health status and behaviors of Americans as well as environmental or policy supports, including related to breastfeeding.
  • Breastfeeding Report Card
    • The CDC Breastfeeding Report Card is published biannually to bring together key data points on national, state, and territorial breastfeeding practices, as well as the environmental factors that are proven to impact breastfeeding outcomes.
  • Infant Feeding Practices Study
    • This periodic, longitudinal study looks at feeding intention, frequency, and duration, as well as comfort nursing in public, confidence level, pumping practices, milk storage, and access to lactation support and supplies. 

Existing Federal & State Legislation

​A range of federal and state laws that have implications for breastfeeding dyads and families.
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