Breastfeeding

Breast milk is considered the ideal source of nutrition for most infants.5 Infants who are fed breast milk have a reduced risk of infections, asthma, obesity, type 1 diabetes, and sudden infant death syndrome.6, 7 Breastfeeding initiation is also associated with reduced odds of infant death.8 Mothers providing breast milk have a reduced risk of high blood pressure, type 2 diabetes, ovarian cancer, and breast cancer.9 10 Breastfeeding is considered a national public health priority;11 exclusive breastfeeding through 6 months of age with continued breastfeeding for at least 2 years is recommended.5 Breastfeeding rates have improved across the past decade, but disparities exist. Breastfeeding trends are presented as four side-by-side figures depicting rates of exclusive breastfeeding through 6 months of age and rates of any breastfeeding at 12 months of age for children born from 2010 to 2020, stratified by race and Hispanic origin, maternal age, poverty status, and maternal education.

Figure 5: Breastfeeding rates among U.S. children by child race and Hispanic origin, birth years 2010–2020
Breastfeeding rates among U.S. children by child race and Hispanic origin, birth years 2010–2020

Breastfeeding is defined as feeding at the breast or feeding expressed human milk; exclusive breastfeeding is defined as receiving only breast milk (no solids, water, or other liquids). Race and Hispanic origin are based on parent/guardian reported race and Hispanic origin of the child and categories reflecting the Office of Management and Budget (OMB) statistical standards for collecting and reporting race and Hispanic origin across federal agencies. Breastfeeding rates for children identified as Hawaiian or Pacific Islander, non-Hispanic or American Indian or Alaska Native, non-Hispanic are not presented because of the uncertainty of the estimates as a result of small sample sizes. Chi-square tests were used to compare the differences between each subgroup and the reference that has the highest rate under the same stratum among 2020 births; weighted least-squares regressions were used to test the significance of breastfeeding trends within each subgroup for children born from 2010 to 2020. A p-value of <0.05 was considered significant.

SOURCE: Centers for Disease Control and Prevention, National Immunization Survey—Child.

Overall, rates of exclusive breastfeeding through 6 months of age improved from 17.2% for children born in 2010 to 25.4% for children born in 2020, but disparities by race and Hispanic origin existed. For 2020 births, the highest rate was among Asian, non-Hispanic children (29.1%) and the lowest rate was among Black, non-Hispanic children (20.4%). Rates of exclusive breastfeeding through 6 months significantly increased within each race and Hispanic origin subgroup for children born from 2010 to 2020. Specifically,

  • among Hispanic children, the rate increased from 17.5% for 2010 births to 24.3% for 2020 births;
  • among Asian, non-Hispanic children, the rate increased from 18.1% for 2010 births to 29.1% for 2020 births;
  • among Black, non-Hispanic children, the rate increased from 13.2% for 2010 births to 20.4% for 2020 births; and
  • among White, non-Hispanic children, the rate increased from 18.4% for 2010 births to 27.6% for 2020 births.

Overall, rates of any breastfeeding at 12 months of age improved from 25.3% for children born in 2010 to 37.6% for children born in 2020, but disparities by race and Hispanic origin existed. For 2020 births, the highest rate was among Asian, non-Hispanic children (48.5%) and the lowest rate was among Black, non-Hispanic children (26.8%). Except for Asian, non-Hispanic children, the rates of any breastfeeding at 12 months significantly increased within each race and Hispanic origin subgroup for children born from 2010 to 2020. Specifically,

  • among Hispanic children, the rate increased from 26.9% for 2010 births to 35.7% for 2020 births;
  • among Black, non-Hispanic children, the rate increased from 14.6% for 2010 births to 26.8% for 2020 births; and
  • among White, non-Hispanic children, the rate increased from 27.1% for 2010 births to 40.7% for 2020 births.

Figure 6: Breastfeeding rates among U.S. children by maternal age, birth years 2010–2020
Breastfeeding rates among U.S. children by maternal age, birth years 2010–2020

NOTE: Breastfeeding is defined as feeding at the breast or feeding expressed human milk; exclusive breastfeeding is defined as receiving only breast milk (no solids, water, or other liquids). Maternal age is based on parent/guardian self-reported age. Breastfeeding rates for children with mothers aged <20 years are not presented due to the uncertainty of the estimates as a result of small sample sizes. Chi-square tests were used to compare the differences between each subgroup and the reference that has the highest rate under the same stratum among 2020 births;weighted least-squares regressions were used to test the significance of breastfeeding trends within each subgroup for children born from 2010 to 2020. A p-value of <0.05 was considered significant.

SOURCE: Centers for Disease Control and Prevention, National Immunization Survey—Child.

Disparities in rates of any breastfeeding at 12 months also existed by maternal age. For 2020 births, the rate was higher among children born to mothers age 30 and over (41.8%) than among children born to mothers ages 20–29 (29.6%). The rates of exclusive breastfeeding through 6 months significantly increased within both maternal age subgroups for children born from 2010 to 2020. Specifically,

  • among children born to mothers ages 20–29, the rate increased from 15.0% for 2010 births to 22.2% for 2020 births; and
  • among children born to mothers age 30 and over, the rate increased from 19.4% for 2010 births to 27.1% for 2020 births.

Disparities in rates of any breastfeeding at 12 months also existed by maternal age. For 2020 births, the rate was higher among children born to mothers age 30 year and over (41.8%) than among children born to mothers ages 20–29 (29.6%). The rates of any breastfeeding at 12 months significantly increased within both maternal age subgroups for children born from 2010 to 2020. Specifically,

  • among children born to mothers ages 20–29, the rate increased from 18.1% for 2010 births to 29.6% for 2020 births; and
  • among children born to mothers age 30 and over, the rate increased from 31.8% for 2010 births to 41.8% for 2020 births.

Figure 7: Breastfeeding rates among U.S. children by household poverty status, birth years 2010–2020
Breastfeeding rates among U.S. children by household poverty status, birth years 2010–2020

NOTE: Breastfeeding is defined as feeding at the breast or feeding expressed human milk; exclusive breastfeeding is defined as receiving only breast milk (no solids, water, or other liquids). Household income is based on parent/guardian self-report and is defined as a percentage of the federal poverty level (% FPL). Chi-square tests were used to compare the differences between each subgroup and the reference that has the highest rate under the same stratum among 2020 births; weighted least-squares regressions were used to test the significance of breastfeeding trends within each subgroup for children born from 2010 to 2020. A p-value of <0.05 was considered significant.

SOURCE: Centers for Disease Control and Prevention, National Immunization Survey—Child.

Disparities in rates of exclusive breastfeeding through 6 months also existed by household poverty status.. Household poverty status is based on parent/guardian self-reporting and is defined as a percentage of the federal poverty level (% FPL). For 2020 births, the highest rate was among children born to households with 400–599% FPL (30.3%) and the lowest rate was among those with less than 100% FPL (19.7%). Except for households with income ≥600% FPL, the rates of exclusive breastfeeding through 6 months significantly increased within each household income subgroup for children born from 2010 to 2020. Specifically,

  • among households with income levels less than 100% FPL, the rate increased from 13.2% for 2010 births to 19.7% for 2020 births;
  • among households with income levels at 100–199% FPL, the rate increased from 17.1% for 2010 births to 23.4% for 2020 births;
  • among households with income levels at 200–399% FPL, the rate increased from 19.2% for 2010 births to 27.8% for 2020 births; and
  • among households with income levels at 400–599% FPL, the rate increased from 20.5% for 2010 births to 30.3% for 2020 births.

Disparities in rates of any breastfeeding at 12 months also existed by household poverty status. Household poverty status is based on parent/guardian self-reporting and is defined as a percentage of the federal poverty level (% FPL). Among 2020 births, the highest rate was among children born to households with 400–599% FPL (48.2%) and the lowest rate was among those with less than 100% FPL (25.5%). Rates of any breastfeeding at 12 months significantly increased within each household income subgroup for children born from 2010 to 2020. Specifically,

  • among households with income levels less than 100% FPL, the rate increased from 20.6% for 2010 births to 25.5% for 2020 births;
  • among households with income levels at 100–199% FPL, the rate increased from 22.5% for 2010 births to 32.9% for 2020 births;
  • among households with income levels at 200–399% FPL, the rate increased from 28.9% for 2010 births to 40.7% for 2020 births;
  • among households with income levels at 400–599% FPL, the rate increased from 30.9% for 2010 births to 48.2% for 2020 births; and
  • among households with income levels ≥600% FPL, the rate increased from 35.1% for 2010 births to 47.4% for 2020 births.

Figure 8: Breastfeeding rates among U.S. children by maternal education, birth years 2010–2020
Breastfeeding rates among U.S. children by maternal education, birth years 2010–2020

NOTE: Breastfeeding is defined as feeding at the breast or feeding expressed human milk; exclusive breastfeeding is defined as receiving only breast milk (no solids, water, or other liquids). Maternal education is based on parent/guardian self-report. Chi-square tests were used to compare the differences between each subgroup and the reference that has the highest rate under the same stratum among 2020 births; weighted least-squares regressions were used to test the significance of breastfeeding trends within each subgroup for children born from 2010 to 2020. A p-value of <0.05 was considered significant.

SOURCE: Centers for Disease Control and Prevention, National Immunization Survey—Child.

Disparities in rates of exclusive breastfeeding through 6 months also existed by maternal education. For 2020 births, the highest rate was among children born to mothers who were college graduates (30.4%) and the lowest rate was among children born to mothers with less than a high school degree (19.0%). The rates of exclusive breastfeeding through 6 months significantly increased within each maternal education subgroup for children born from 2010 to 2020. Specifically,

  • among children born to mothers with less than a high school degree, the rate increased from 12.4% for 2010 births to 19.0% for 2020 births;
  • among children born to mothers who were high school graduates, the rate increased from 15.7% for 2010 births to 21.9% for 2020 births;
  • among children born to mothers with some college or technical school, the rate increased from 14.4% for 2010 births to 23.9% for 2020 births; and
  • among children born to mothers who were college graduates, the rate increased from 23.1% for 2010 births to 30.4% for 2020 births.

Disparities in rates of any breastfeeding at 12 months also existed by maternal education. For 2020 births, the highest rates were among children born to mothers who were college graduates (49.3%) and the lowest rates were among children born to mothers who were high school graduates (27.7%). The rates of any breastfeeding at 12 months significantly increased within each maternal education subgroup for children born from 2010 to 2020. Specifically,

  • among children born to mothers with less than a high school degree, the rate increased from 21.7% for 2010 births to 28.7% for 2020 births;
  • among children born to mothers who were high school graduates, the rate increased from 20.9% for 2010 births to 27.7% for 2020 births;
  • among children born to mothers with some college or technical school, the rate increased from 17.6% for 2010 births to 32.8% for 2020 births; and
  • among children born to mothers who were college graduates, the rate increased from 36.1% for 2010 births to 49.3% for 2020 births.

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5 Meek JY, Noble L, and the Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics. 2022; 150 (1): e2022057988.

6 Branger B, Bainier A, Martin L, et al. Breastfeeding and respiratory, ear and gastro-intestinal infections, in children, under the age of one year, admitted through the paediatric emergency departments of five hospitals. Front Pediatr. 2023 Feb 15;10:1053473.

7 Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007 Apr;(153):1–186.

8 Li R, Ware J, Chen A, Nelson JM, Kmet JM, Parks SE, Morrow AL, Chen J, Perrine CG. Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis. Lancet Reg Health Am. 2022 Jan;5:100094.

9 Feltner C, Weber RP, Stuebe A, et al. Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jul.

10 Victora CG, Bahl R, Barros AJ, et al. Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475–90.

11 US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Infants. Available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants. Accessed November 29, 2023

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