Perinatal Indicator: Breastfeeding

Definitions 

Exclusive Breastfeeding: Infants who receive only human milk, either directly from the breast, or receive their mother’s own expressed milk, or milk from a human milk bank, through a feeding tube, cup, syringe or bottle.
Any Breastfeeding:
Same as above, and also infants who receive both human milk and formula

Why Does This Matter?

Breastfeeding is a well-established, low-cost, low-tech preventive health intervention with far-reaching benefits for mothers and babies. It also offers significant cost savings to the healthcare system and to employers. In a comprehensive review of the research, the U.S. Agency for Healthcare Research and Quality found that breastfeeding significantly reduces children’s risk for acute infections, Sudden Infant Death Syndrome, obesity, and chronic diseases such as diabetes and asthma. Breastfeeding reduces the mother’s risk of postpartum depression, type 2 diabetes, and breast and ovarian cancers.

Breastfed children have fewer visits to the doctor’s office, fewer days of hospitalization, and require fewer medications than those who are formula-fed.
Increasing breastfeeding rates among low-income women is a key strategy for health improvement in general, and the prevention of pediatric obesity in particular. The American College of Obstetrics and Gynecology, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians all recommend exclusive breastfeeding for the first six months of life. Even so, professional apathy and misinformation regarding breastfeeding remain widespread. A common misperception is that while breastfeeding may be “a little bit better,” formula-feeding is perfectly adequate. Many practitioners are reluctant to strongly advise a woman to breastfeed, out of concern that it will make her feel guilty if she does not. Yet, when it comes to advising their patients on other health matters, practitioners have few such reservations.  And with limited understanding of the practical management of breastfeeding, many practitioners are ill-prepared to assist mothers.

The hospital stay and early follow-up period are crucial to successful breastfeeding. Although many hospitals do promote breastfeeding, others maintain policies that undermine breastfeeding initiation. Most new mothers return home within a day or two of giving birth, before breastfeeding is well established. The AAP recommends a follow-up visit within 48 hours, but such follow-up is rare, and many women who encounter breastfeeding difficulties upon their return home never receive the help they need.

In societies where breastfeeding is traditional, the practice is passed from mother to daughter. In the U.S., the majority of grandmothers have never breastfed. At best, they can encourage their daughters; at worst, they can sabotage breastfeeding by disparaging it and actively trying to steer the mother toward formula-feeding. The AAP encourages women to breastfeed for at least a year, but in the U.S., many women go back to work within six to eight weeks of delivery, making this impractical, if not impossible. Some insurance companies do not provide reimbursement for lactation services, neither from a lactation consultant nor a physician.

Barriers to continued nursing include:

  • Lack of support from family and friends.
  • Lack of acceptance by the community and society at large.
  • Early hospital discharge.
  • Lack of timely follow-up after returning home from the hospital.
  • Lack of support in the workplace.
  • Widespread advertising and promotion of infant formula (e.g. free formula or coupons in hospital discharge packs, coupons for free or discounted formula mailed to new parents, television and magazine advertising).
  • The widespread portrayal of bottle-feeding in the mass media.

Breastfeeding is most likely to succeed when mothers and babies stay close together, allowing infants to nurse at will. But in our fast-paced, highly mobile society, many new mothers want to fit nursing into a structured routine. They may be unprepared for the frequency and unpredictability of the baby’s need to breastfeed. In addition, our culture’s fixation on the breast as a sensual object causes many nursing mothers to feel self-conscious when breastfeeding in public.

The California Maternal and Infant Health Assessment (MIHA) is an annual, statewide, representative survey of women who have recently given birth. Data from the 2006 assessment demonstrated that women are less likely to be exclusively breastfeeding at two months if their income is less than 200% of the federal poverty level, they have no college education, they are less than 25 years old, they are not white or Asian/Pacific Islander, the language spoken at home is Spanish or an Asian language, they are not privately insured, or they do not live in Northern California.

For further information, please read the LA Best Babies Network Perinatal Scorecard

Breastfeeding Rates in LA County Hospitals by Service Planning Area (SPA) 2007

  • In 2007, on average, hospitals located in SPA 5 (West Los Angeles) reported the highest rate of any breastfeeding (90.8%) as well as the highest rate of exclusive breastfeeding (56.2%).
  • On average, SPA 1 (Antelope Valley) hospitals reported the second highest average of any breastfeeding rates (85.9%), and exclusive breastfeeding rates (49.5%).
  • On average, SPA 3 (Metro Los Angeles) hospitals reported the lowest rate of any breastfeeding (78.2%).
  • On average, SPA 6 (South Los Angeles) hospitals reported the lowest rate of exclusive breastfeeding (4.2%).
  • LA County is ranked 47th in California for exclusive breastfeeding.  Only two LA County hospitals are designated as Baby-Friendly: Glendale Memorial and Providence Holy Cross.
  • 9 LA County hospitals are among the 15 lowest-scoring in the state for breastfeeding rates: Pacific Alliance Medical Center, Pacifica Hospital of the Valley, Bellflower Medical Center, Los Angeles Metropolitan Medical Center, Valley Presbyterian Hospital, Beverly Hospital, Saint Francis Medical Center, Garfield Medical Center, California Hospital Medical Center.

 

Location
Total
Number of Hospitals Included
Any Breastfeeding Average
Exclusive Breastfeeding Average

Number

Average Percent (%)
Number
Average Percent (%)
LAC
143,553
62
118,818
82.8
217,771
24.1
SPA 1
3,122
2
2,684
85.9
1,544
49.5
SPA 2
28,757
15
24,675
85.8
8,427
29.3
SPA 3
31,015
12
24,247
78.2
5,428
17.5
SPA 4
31,118
11
26,379
84.8
6,487
20.8
SPA 5
6,384
4
5,797
90.8
3,589
56.2
SPA 6
7,802
3
6,345
81.3
382
4.9
SPA 7
13,070
6
10,766
82.4
2,555
19.5
SPA 8
22,023
9
17,685
80.3
5,921
26.9

Note: All nonmilitary hospitals providing maternity services are required to complete the Newborn Screening Test Form.  Infant feeding data presented in this report includes all feedings since birth to time of specimen collection, usually 24 to 48 hours since  birth. Upon completing the form, staff must select one of the following five categories to describe ‘all feedings since birth’ (not including water feedings):  (1) Breast only; (2) Formula only; (3) Breast and Formula; (4) TPN/Hyperal and (5) Other.

Breastfeeding Rates in LA County Baby Friendly Hospitals 2007

Hospital
Total Number of Individuals
Any Breastfeeding
Exclusive Breastfeeding
Number of
Individuals
 Average Percent of Individuals (%)
Number of
Individuals
Average Percent of Individuals (%)
Hospitals in California  (269)
509,465
441,260
86.6
217,771
42.7
Hospitals in LA County (62)
143,553
143,553
82.8
34,572
24.1

Glendale Memorial Hospital*

1,719
1,558
90.6
634
36.9
Providence Holy Cross Medical Center*
2,579
2,363
91.6
1,584
61.4

*Designated Baby-Friendly Hospital 

Note: The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization and the United Nations Children’s Fund, to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies, or feeding formula safely, and gives special recognition to hospitals that have done so. 

 

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Source: California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2007

Links:

California WIC Breastfeeding page

California WIC 2011 Hospital Breastfeeding Rate Report

Quality Care Breastfeeding Resources »