Gains Needed to Achieve Healthy People 2030 Breastfeeding Targets

Abstract

Breastmilk is the best source of nutrition for most infants and has important health benefits.1,2 The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months and continued breastfeeding until 2 years or beyond.3 Healthy People 2030 (HP2030), a US Department of Health and Human Services initiative, sets national health targets, including increasing the proportion of infants exclusively breastfeeding through 6 months of age (target: 42.4%) and receiving any breastmilk at 1 year (target: 54.1%).4 We assessed the gains needed to achieve national HP2030 targets among different sociodemographic groups.The National Immunization Survey—Child (NIS-Child) is an annual, nationally representative survey conducted by the Centers for Disease Control and Prevention (CDC) to monitor vaccination and breastfeeding rates among US children aged 19 to 35 months.5 Data are collected by phone from a complex, stratified, multistage probability sample of eligible households. We combined survey data from 2020 to 2022 to calculate weighted breastfeeding rates among children born in 2019 and 2020. Although some data include the coronavirus disease 2019 pandemic, breastfeeding rates were similar among children born in 2016 and 2017. (data not shown).We examined breastfeeding rates by parent- or guardian-reported child race and ethnicity (Hispanic, non-Hispanic of American Indian or Alaska Native, Asian, Black, Hawaiian or Pacific Islander, white, or ≥2 races); participation in the Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) (yes, no but eligible, ineligible); household income, defined as percentage of the federal poverty level (%FPL; <100, 100–199, 200–399, 400–599, ≥600); parent marital status (married, unmarried); maternal education (less than high school degree, high school graduate, some college or technical school, college graduate); and maternal age (<20, 20–29, ≥30 years).To estimate gains needed to achieve HP2030 national targets, we subtracted the most current breastfeeding rates among each sociodemographic subgroup from the national target rates.This analysis was reviewed by the CDC, deemed not human subjects research, and conducted consistent with applicable federal law and CDC policy.Nationally, a gain of ∼17 percentage points (%) was needed to meet each HP2030 target among children born between 2019-2020 (Table 1).Gains needed to achieve the exclusive breastfeeding through 6 months target ranged considerably from 13.3% among non-Hispanic Asian to 22.0% among non-Hispanic Black children; 11.1% among WIC-ineligible children to 24.1% among WIC participants; 12.7% among children with household incomes between 400% and 599% FPL to 22.5% among those with <100% FPL; 12.5% among children with married parents to 24.0% among those with unmarried parents; 11.4% among children of mothers who were college graduates to 22.2% among those with less than a high school degree; and 15.1% among children with mothers aged ≥30% to 23.7% among those with mothers aged <20 years.Gains needed to reach the target for any breastfeeding at 12 months also varied widely, with the largest gains needed among non-Hispanic Black children (28.4%), WIC participants (29.8%), children from households with incomes <100% FPL (28.0%), those with unmarried parents (30.8%), and those with mothers who were high school graduates (28.6%) or aged <20 years (30.0%).Figure 1 depicts the gains needed to achieve HP2030 breastfeeding targets by race and ethnicity, serving as an illustrative example of existing sociodemographic disparities in breastfeeding outcomes.No sociodemographic subgroup attained the HP2030 breastfeeding targets; the gains needed to achieve them ranged widely. Subgroups needing gains >20% to meet targets included non-Hispanic Black children, WIC participants, and children with household incomes <100% FPL, unmarried parents, mothers without any college, or mothers aged <30 years.One limitation is the potential recall bias of parent- or guardian-reported breastfeeding practices; however, maternal recall of breastfeeding is valid and reliable within 3 years.6Several national breastfeeding laws, programs, and policies exist that can be applied in workplace, childcare, health care, and community settings.7 These national-level strategies may be integrated with evidence-based community-level approaches, like home-visit programs with community health workers or peer mentors, Baby-Friendly hospital practices, and group-based programs,8 to improve breastfeeding outcomes and reduce disparities.Federal funding exists for community organizations implementing local, culturally appropriate strategies to address breastfeeding disparities through the CDC’s Racial and Ethnic Approaches to Community Health Program.9 In addition, the Continuity of Care in Breastfeeding Support Blueprint offers community-driven capacity building strategies focusing on populations disproportionately impacted by structural barriers associated with lower breastfeeding rates.10Continued collaboration between federal and local partners is needed to reduce disparities and help achieve the HP2030 national breastfeeding targets.

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