A Closer Look at the 2022 CDC Breastfeeding Report Card

Suzan Ajlouni, Public Health Writing Specialist

Every two years, the Centers for Disease Control and Prevention (CDC) releases the Breastfeeding Report Card which brings together key data on national, state, and territorial breastfeeding practices, as well as the environmental factors that are proven to impact breastfeeding outcomes. This report allows us to track U.S. infant feeding practices across time and helps us understand the gaps and barriers that influence human milk feeding.

The ​critical insights from the Breastfeeding Report Card help guide efforts from government agencies, non-profit organizations, coalitions, educational institutions, and stakeholders from across the field of public health to design interventions and strengthen systems of support. Given the long-lasting positive health outcomes for children and those who lactate, the far-reaching impact on public health, and the widespread consensus from leading pediatric and medical associations, there is no doubt that our work together to build a landscape of support for breastfeeding families is essential.
 
The 2022 Breastfeeding Report Card showed a persistence of racial and ethnic disparities, a need for strengthened systems of support for families, and while not statistically significant, a slight decline in any and exclusive breastfeeding rates. We will take a closer look at key findings from this year’s report to help inform our work to improve breastfeeding practices and supports.

Breastfeeding Report Card, 2022

The most recent report card looks at breastfeeding rates among children born in 2019. This data was collected across 2020–2021, and the CDC notes that it may partially reflect breastfeeding duration and exclusivity during the COVID-19 pandemic. In addition to statistics on breastfeeding initiation and duration, this year’s report included data on maternity care practices, workplace policies, and childcare practices.

To assess how maternity care practices are impacting lactation outcomes, the report card includes state scores from the Maternity Practices in Infant Nutrition and Care (mPINC) survey and the portion of births that occurred at Baby-Friendly designated facilities. The 2022 Breastfeeding Report Card also features two new support indicators:

• Paid family and medical leave (PFML): This indicator identifies whether a state has enacted a paid family and medical leave program.
• State Early Care and Education (ECE) Licensing Breastfeeding Support Score: This indicator measures how state licensing regulations support and encourage breastfeeding among families served by the center.

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Key Findings

Most Infants Initiate Breastfeeding
The latest data shows that 83.2% of infants initiate breastfeeding with 24.9% of babies exclusively breastfeeding at 6 months of age. When we look at these rates from 2007 to 2022, we see that there is a relatively steady increase in breastfeeding rates across time. However, as depicted in Figure 1, we see a slight decrease in the most recently published report in 2022. This shift is not statistically significant, however the U.S. Breastfeeding Committee and our partners are closely following how this data changes over time.

Figure 1. Percentage of Babies in the U.S. That Were Ever Breastfed & Exclusively Breastfed Through 6 Months, As Reported in CDC Breastfeeding Report Cards Across Time

​Racial & Ethnic Disparities Persist
CDC data shows that breastfeeding rates still vary significantly by race and ethnicity. Among children born in 2019, Non-Hispanic White infants were breastfed at higher rates than Non-Hispanic Black infants and Hispanic infants. At six months, more white infants (26.9%) were exclusively breastfed, in comparison to their Black (19.1%) and Hispanic (23.5%) counterparts. Disparities in access to lactation-supportive environments are creating and perpetuating disparities in breastfeeding rates and associated health inequities. The lactation field must prioritize closing these gaps.
 
Rates Plummet as Babies Grow
This year's report continues to show a significant drop in breastfeeding rates as the child ages. While the majority of infants initiated breastfeeding, by six months of age this number dropped drastically. This discrepancy demonstrates why the strength and accessibility of systems of support at the policy, organizational, and community levels are so critical for improving breastfeeding duration and exclusivity.
 
Systems of Care for Families Need to be Strengthened
These outcomes highlight the need to continue to strengthen the support landscape so that families can make informed decisions and are set up for success. No baby should ever go hungry, and the policies that shape and influence a family's experience can make a difference in protecting the nutrition security of infants.

"Policy, systems, and environmental changes that address breastfeeding barriers, such as better maternity care practices, paid leave policies, and supportive ECE centers, can help to improve breastfeeding rates and reduce disparities. When systems of care align to support breastfeeding, states and their communities are better able to address barriers so that families benefit from supportive environments and achieve their breastfeeding goals."  (Breastfeeding Report Card, 2022)

​Research clearly demonstrates that maternity care practices have a significant and lasting impact on infant feeding outcomes. The report card continues to include mPINC scores, formula supplementation rates, and the percentage of births taking place in Baby-Friendly designated hospitals.

In the absence of a national paid family and medical leave program, many mothers and parents have no choice but to return to work quickly after the birth of their child, often before they have established a strong feeding routine. This year’s report card newly identifies which states have enacted statewide paid family and medical leave (PFML) programs and how many weeks are covered for new parents. Currently, 12 states have passed legislation to create PFML programs. However, four of these were recently passed and have not yet begun paying benefits.
 
Many families rely on early childcare providers for their infants as caregivers continue to work or go to school. This year's Breastfeeding Report Card includes scores that rate how strongly state early care and education licensing requirements align with the breastfeeding support standard, with nine states receiving the top score and five states not addressing lactation in any way.
 
Together, these new indicators and the maternity care practices data help paint a clearer picture of the supportive environments that can benefit all families and allow them to provide human milk to their babies.

A Call to Action

The 2022 Breastfeeding Report Card suggests that we can and must do better for our nation's babies. The solutions are clear: we need policy, system, and environmental change to remove the barriers and ensure infants have access to human milk. Human milk feeding is a high-value, low-cost public health intervention that provides a substantial return on investment. Please take action today by urging the President and Vice President to increase funding for breastfeeding in the President's budget request!