How can breastfeeding be promoted in the community?

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Evidence Rating  

Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Evidence Ratings

• Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

• Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

• Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

• Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.

• Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.

• Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.   Learn more about our methods

Evidence Rating  

Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Evidence Ratings

• Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

• Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

• Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

• Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.

• Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.

• Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.   Learn more about our methods

Health Factors  

Health factors shape the health of individuals and communities. Everything from our education to our environments impacts our health. Modifying these clinical, behavioral, social, economic, and environmental factors can influence how long and how well people live, now and in the future.

Learn how health factors work together by viewing our model

Diet and Exercise

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Health Care

Government

Public Health

Nonprofits

Breastfeeding promotion programs provide education and information about breastfeeding to women throughout pre- and post-natal care, and offer counseling from health care providers or trained volunteers, and support groups for nursing mothers. Programs often establish breastfeeding policies and supports in clinical settings such as hospitals and birth centers, as well as community settings such as workplaces and child care centers. Breastfeeding promotion programs can also provide information and education to doctors, nurses, midwives, nurse practitioners, nutritionists, lactation consultants, and other health care professionals.

Expected Beneficial Outcomes (Rated)

• Increased breastfeeding rates

Other Potential Beneficial Outcomes

• Improved health outcomes

Evidence of Effectiveness

There is strong evidence that breastfeeding promotion programs increase initiation, duration, and exclusivity of breastfeeding, , , , , , . Breastfeeding provides many health benefits to children, including fewer ear infections, lower respiratory tract infections, and gastrointestinal infections for infants, , and lower likelihood of childhood obesity, type 2 diabetes, and asthma, , . Breastfeeding has also been shown to reduce rates of breast and ovarian cancer for mothers, , and has been associated with lower rates of maternal hypertension, diabetes, and cardiovascular disease.

Education interventions increase breastfeeding initiation rates, particularly among women with low incomes, and increase exclusive breastfeeding until babies are 6 months old. Face-to-face support and tailored education, increase the effectiveness of breastfeeding promotion programs. Combining pre- and post-natal interventions increases initiation and duration more than pre- or post-natal efforts alone, .

Support from health professionals, , , lay health workers, , , , and peers, , , have demonstrated positive effects, including increases in initiation, duration, and exclusivity of breastfeeding. For employed mothers, supportive work environments also increase the duration of breastfeeding, .

Components of the Baby Friendly Hospitals Initiative (BFHI), which includes 10 steps to support breastfeeding, have been shown to increase breastfeeding rates when implemented as a whole or individually, , , . Step 3 of BFHI, which combines breastfeeding education and interpersonal support, increases breastfeeding rates, especially when women’s partners or family are involved. BFHI increases breastfeeding rates among mothers with lower education levels, which may reduce socio-economic disparities in breastfeeding rates.

Breastfeeding promotion programs can help reduce obstacles that make breastfeeding particularly challenging for women of color who earn low incomes and may reduce disparities in breastfeeding rates and breast cancer risk between black and white women. Breastfeeding rates are also disproportionately low among adolescent mothers; interventions that focus on adolescent mothers, as well as their mothers and partners, may help promote breastfeeding initiation, duration, and exclusivity among adolescent mothers. Experts suggest breastfeeding promotion programs incorporate multicultural awareness and cultural sensitivity training to best support the needs of mothers from different backgrounds and increase breastfeeding.

Cost benefit analysis suggests that breastfeeding promotion programs are cost effective.

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The Affordable Care Act (ACA) includes provisions to encourage breastfeeding such as requiring insurance coverage of supplies and support, and requiring employers to provide unpaid time and private space for nursing mothers to pump breast milk at work.

As of 2017, 49 states and Washington DC have laws that allow women to breastfeed in any public or private location, 28 states and Washington DC have workplace breastfeeding legislation, and 6 states and Puerto Rico have implemented or encouraged development of a breastfeeding awareness education campaign, . 

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides breastfeeding promotion and support programs, including breastfeeding education and peer counseling. A survey of almost 1,800 local WIC agencies found that nearly all provided ongoing training in breastfeeding promotion.

As of 2016, approximately 18% of live births occur at Baby Friendly facilities. CDC’s 2013 Prevention Status Reports assess breastfeeding support at birth facilities; 5 states score over 80% on this measure, 19 score between 70-79.9%, and 27 score under 70%. 

Implementation Resources

CDC-Breastfeeding - Centers for Disease Control and Prevention (CDC). Breastfeeding.

CDC-Breastfeeding 2013 - Centers for Disease Control and Prevention (CDC). The CDC guide to strategies to support breastfeeding mothers and babies. Atlanta: US Department of Health and Human Services (US DHHS); 2013.

US DHHS OWH-Breastfeeding - US Department of Health and Human Services (US DHHS), Office on Women’s Health (OWH). Breastfeeding.

CDC DNPAO-Breastfeeding resources - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Breastfeeding: Strategies and resources.

CDC DNPAO-Data - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition, physical activity and obesity: Data, trends and maps online tool.

Medline-Breastfeeding - US National Library of Medicine, Medline Plus. Breastfeeding.

Footnotes

* Journal subscription may be required for access.

1 CDC-Breastfeeding 2013 - Centers for Disease Control and Prevention (CDC). The CDC guide to strategies to support breastfeeding mothers and babies. Atlanta: US Department of Health and Human Services (US DHHS); 2013.

2 Oliveira 2017* - Oliveira IBB, Leal LP, Coriolano-Marinus MW de L, et al. Meta-analysis of the effectiveness of educational interventions for breastfeeding promotion directed to the woman and her social network. Journal of Advanced Nursing. 2017;73(2):323-335.

3 Cochrane-Balogun 2016 - Balogun OO, O’Sullivan EJ, McFadden A, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews. 2016;(11):CD001688.

4 Patnode 2016* - Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. Primary care interventions to support breastfeeding: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316(16):1694-1705.

5 Haroon 2013 - Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. Breastfeeding promotion interventions and breastfeeding practices: A systematic review. BMC Public Health. 2013;13(Suppl 3):S20.

6 Cochrane-Renfrew 2012 - Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews. 2012;(5):CD001141.

7 Cochrane-Lewin 2010* - Lewin S, Munabi-Babigumira S, Glenton C, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews. 2010;(3):CD004015.

8 Dyson 2010 - Dyson L, Renfrew MJ, McFadden A, et al. Policy and public health recommendations to promote the initiation and duration of breast-feeding in developed country settings. Public Health Nutrition. 2010;13(1):137-44.

9 Stuebe 2009 - Stuebe A. The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology. 2009;2(4):222-231.

10 Fisk 2011 - Fisk CM, Crozier SR, Inskip HM, et al. Breastfeeding and reported morbidity during infancy: Findings from the Southampton Women’s Survey. Maternal & Child Nutrition. 2011;7(1):61-70.

11 Giugliani 2015 - Giugliani ERJ, Horta BL, Loret de Mola C, Lisboa BO, Victora CG. Effect of breastfeeding promotion interventions on child growth: A systematic review and meta-analysis. Acta Paediatrica. 2015;104(467):20-29.

12 Harder 2005 - Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: A meta-analysis. American Journal of Epidemiology. 2005;162(5):397-403.

13 AICR-CUP report 2017 - World Cancer Research Fund/American Institute for Cancer Research (AICR). Diet, nutrition, physical activity and breast cancer. Continuous Update Project (CUP). 2017.

14 Li 2014a - Li DP, Du C, Zhang ZM, et al. Breastfeeding and ovarian cancer risk: A systematic review and meta-analysis of 40 epidemiological studies. Asian Pacific Journal of Cancer Prevention. 2014;15(12):4829-4837.

15 Schwarz 2009 - Schwarz EB, Ray RM, Stuebe AM, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics & Gynecology. 2009;113(5):974-982.

16 USPSTF-Chung 2008* - Chung M, Raman G, Trikalinos T, Lau J, Ip S. Interventions in primary care to promote breastfeeding: An evidence review for the US Preventive Services Task Force. Annals of Internal Medicine. 2008;149(8):565-82.

17 USPSTF-Breastfeeding 2008 - US Preventive Services Task Force (USPSTF). Primary care interventions to promote breastfeeding: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2008;149(8):560-4.

18 Chapman 2010 - Chapman DJ, Morel K, Anderson AK, Damio G, Perez-Escamilla R. Breastfeeding peer counseling: From efficacy through scale-up. Journal of Human Lactation. 2010;26(3):314-26.

19 Dinour 2017* - Dinour LM, Szaro JM. Employer-based programs to support breastfeeding among working mothers: A systematic review. Breastfeeding Medicine. 2017;12(3):131-141.

20 Wouk 2017* - Wouk K, Tully KP, Labbok MH. Systematic review of evidence for Baby-Friendly Hospital Initiative Step 3: Prenatal breastfeeding education. Journal of Human Lactation. 2017;33(1):50-82.

21 Perez-Escamilla 2016 - Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: A systematic review. Maternal & Child Nutrition. 2016;12(3):402-417.

22 Hawkins 2015 - Hawkins SS, Stern AD, Baum CF, Gillman MW. Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: A multi-state analysis. Public Health Nutrition. 2015;18(2):189-197.

23 Louis-Jacques 2017* - Louis-Jacques A, Deubel TF, Taylor M, Stuebe AM. Racial and ethnic disparities in U.S. breastfeeding and implications for maternal and child health outcomes. Seminars in Perinatology. 2017;41(5):299-307.

24 Anstey 2017 - Anstey EH, Shoemaker ML, Barrera CM, et al. Breastfeeding and breast cancer risk reduction: Implications for black mothers. American Journal of Preventive Medicine. 2017;53(3 Suppl 1):S40-S46.

25 Sipsma 2015* - Sipsma HL, Jones KL, Cole-Lewis H. Breastfeeding among adolescent mothers: A systematic review of interventions from high-income countries. Journal of Human Lactation. 2015;31(2):221-229.

26 Bartick 2010* - Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics. 2010;125(5):e1048-e1056.

27 AMCHP-Breastfeeding 2012 - Association of Maternal & Child Health Programs (AMCHP). Health reform: What is in it to promote breastfeeding? Washington, DC: Association of Maternal & Child Health Programs (AMCHP); 2012.

28 NCSL-Breastfeeding - National Conference of State Legislatures (NCSL). Breastfeeding laws.

29 NPHL-Breastfeeding - The Network for Public Health Law (NPHL). Maternal and child health issue brief: Breastfeeding in the workplace.

30 Mathematica-Forrestal 2015 - Forrestal S, Briefel R, Mabli J. The WIC breastfeeding policy inventory study (In focus brief). Princeton: Mathematica Policy Research (MPR); 2015.

31 CDC-Breastfeeding RC 2016 - Centers for Disease Control and Prevention (CDC). Breastfeeding Report Card: Progressing toward national breastfeeding goals. Atlanta: US Department of Health and Human Services (US DHHS); 2016.

32 CDC-NPAO PSR 2013 - Centers for Disease Control and Prevention (CDC). Nutrition, physical activity, and obesity: Prevention status reports (PSR). 2013.