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Table 1.  

Jurisdiction No. of infants (% initiating breastfeeding) Largest disparity**
Overall Hispanic White Black Asian AI/AN NH/OPI Multiracial
United States†† 3,129,646 (84.1) 665,584 (87.4) 1,686,505 (85.5) 492,852 (73.6)§§ 164,602 (90.3)¶¶ 25,807 (76.6) 7,843 (80.2) 69,626 (83.1) 16.7
Alabama 56,054 (69.6) 4,730 (64.2) 32,031 (77.2) 17,285 (56.1)§§ 863 (84.6)¶¶ 140 (73.6) —*** 971 (71.5) 28.5
Alaska 9,492 (92.9) 761 (95.9) 4,685 (96.3)¶¶ 288 (94.4) 569 (81.0) 1,812 (88.5) 293 (76.1)§§ 919 (94.7) 20.2
Arizona 78,613 (88.9) 33,426 (87.9) 31,629 (91.1) 4,489 (84.5) 2,846 (93.3)¶¶ 3,739 (84.7) 218 (80.7)§§ 1,842 (86.6) 12.6
Arkansas 34,123 (73.7) 3,769 (81.9) 21,994 (78.0) 6,052 (52.3)§§ 698 (85.0)¶¶ 218 (72.9) 506 (67.0) 654 (74.3) 32.7
Colorado 62,552 (92.8) 18,032 (90.4) 35,906 (94.6)¶¶ 3,009 (88.4) 2,552 (93.3) 375 (85.1)§§ 167 (91.0) 1,532 (92.3) 9.5
Connecticut 34,558 (87.4) 8,861 (85.5) 18,616 (88.4) 4,096 (84.0)§§ 2,253 (93.1)¶¶ 687 (84.6) 9.1
Delaware 10,717 (80.5) 1,723 (83.8) 5,332 (82.2) 2,687 (72.7) 608 (93.8)¶¶ 329 (72.6)§§ 21.2
DC 13,092 (84.2) 1,846 (82.5) 4,799 (97.1)¶¶ 5,313 (71.2)§§ 808 (95.5) 300 (88.7) 25.9
Florida 215,942 (87.2) 67,193 (91.1) 91,783 (87.7) 46,750 (79.6)§§ 6,944 (92.9)¶¶ 224 (81.7) 161 (88.8) 2,839 (86.6) 13.3
Georgia 124,711 (83.1) 18,259 (90.1) 53,889 (84.5) 43,241 (77.0)§§ 5,777 (93.9)¶¶ 93 (83.9) 99 (81.8) 2,472 (84.6) 16.9
Hawaii 16,583 (89.6) 2,567 (92.1) 3,182 (96.8)¶¶ 422 (96.2) 4,287 (86.3) 1,671 (78.2)§§ 4,387 (90.3) 18.6
Idaho 21,463 (92.2) 3,653 (90.1) 16,448 (92.8) 258 (94.6) 347 (93.7) 224 (78.6)§§ 74 (97.3)¶¶ 401 (91.8) 18.7
Illinois 134,795 (83.1) 29,555 (86.4) 70,731 (85.2) 22,406 (67.7)§§ 9,091 (93.1)¶¶ 74 (81.1) 1,904 (81.5) 25.4
Indiana 80,077 (82.9) 8,316 (85.4)¶¶ 57,777 (84.1) 10,077 (74.1)§§ 2,250 (84.0) 58 (75.9) 59 (79.7) 1,516 (81.1) 11.3
Iowa 36,876 (83.1) 3,821 (81.0) 28,030 (84.9) 2,861 (69.6)§§ 1,102 (85.5)¶¶ 259 (73.7) 156 (73.7) 645 (78.3) 15.9
Kansas 36,442 (89.6) 6,290 (87.1) 25,216 (90.9) 2,626 (84.3) 1,250 (93.4)¶¶ 131 (84.7) 66 (77.3)§§ 797 (85.3) 16.1
Kentucky 49,321 (71.7) 3,216 (82.1) 39,288 (71.1) 4,650 (67.0)§§ 1,007 (86.8)¶¶ 58 (79.3) 924 (69.9) 19.8
Louisiana 56,966 (71.0) 4,851 (82.2) 28,945 (78.9) 21,027 (56.5)§§ 1,136 (87.0)¶¶ 239 (70.7) 705 (74.3) 30.5
Maine 11,148 (89.4) 237 (85.2) 9,844 (89.4) 514 (92.0) 211 (93.4)¶¶ 87 (83.9)§§ 249 (83.9)§§ 9.5
Maryland 66,056 (87.1) 12,166 (94.1) 27,898 (86.4) 19,537 (82.0)§§ 4,547 (95.4)¶¶ 67 (83.6) 1,582 (84.5) 13.4
Massachusetts 68,897 (88.4) 14,027 (86.9) 39,346 (88.3) 6,776 (90.5) 6,197 (91.4)¶¶ 78 (84.6)§§ 1,491 (85.5) 6.8
Minnesota 62,276 (89.7) 4,867 (90.2) 42,110 (91.9)¶¶ 7,690 (87.5) 5,032 (78.9) 858 (67.5)§§ 52 (86.5) 1,545 (85.8) 24.4
Mississippi 35,022 (64.7) 1,620 (71.7) 17,195 (74.5) 15,270 (52.5) 437 (83.3)¶¶ 219 (49.3)§§ 255 (70.6) 34.0
Missouri 69,799 (79.7) 4,228 (81.0) 50,967 (82.2) 10,019 (65.5)§§ 1,731 (88.9)¶¶ 150 (72.0) 219 (74.0) 2,224 (78.6) 23.4
Montana 10,929 (90.6) 611 (90.0) 8,737 (93.1)¶¶ 61 (86.9) 116 (89.7) 1,050 (70.2)§§ 324 (88.6) 22.9
Nebraska 24,724 (88.6) 4,145 (85.5) 17,316 (90.5) 1,570 (78.6) 835 (91.1)¶¶ 218 (74.3)§§ 617 (84.1) 16.8
Nevada 33,410 (80.0) 12,610 (81.9) 11,895 (84.2)¶¶ 4,263 (64.1)§§ 2,542 (81.2) 241 (83.4) 363 (72.2) 1,386 (77.4) 20.1
New Hampshire 11,609 (90.8) 728 (90.1) 9,979 (90.6) 253 (94.9) 454 (96.5)¶¶ 129 (85.3)§§ 11.2
New Jersey 95,969 (79.7) 26,746 (80.9) 43,923 (81.0) 12,877 (70.9)§§ 10,317 (83.2)¶¶ 64 (73.4) 1,075 (78.4) 12.3
New Mexico 21,040 (86.1) 11,503 (84.8) 5,728 (88.9) 332 (81.6)§§ 374 (91.2)¶¶ 2,688 (86.1) 370 (84.9) 9.6
New York 219,529 (87.9) 49,898 (90.4)¶¶ 107,699 (87.4) 31,926 (84.4) 24,683 (89.8) 358 (82.1) 71 (81.7)§§ 3,195 (82.3) 8.7
North Carolina 119,198 (81.6) 19,084 (88.1) 62,586 (84.6) 27,785 (70.8) 4,957 (89.0)¶¶ 1,429 (52.1)§§ 127 (82.7) 3,130 (79.4) 36.9
North Dakota 11,702 (85.0) 733 (83.8) 8,499 (88.2) 756 (86.0) 251 (91.6)¶¶ 847 (54.0)§§ 358 (81.3) 37.6
Ohio 128,555 (76.0) 7,428 (77.8) 91,498 (77.2) 21,415 (68.8)§§ 4,237 (87.1)¶¶ 98 (78.6) 101 (72.3) 3,600 (70.9) 18.3
Oklahoma 46,523 (81.8) 7,284 (81.8) 25,823 (84.7) 3,961 (71.6) 1,215 (85.8)¶¶ 4,485 (74.8) 218 (62.4)§§ 3,478 (80.2) 23.4
Oregon 41,473 (94.8) 8,019 (94.7) 27,456 (94.9) 1,006 (94.9) 2,374 (97.1)¶¶ 398 (88.4)§§ 336 (91.1) 1,599 (93.7) 8.7
Pennsylvania 128,439 (82.2) 16,017 (81.8) 84,758 (83.0) 16,922 (76.9)§§ 6,002 (91.1)¶¶ 77 (79.2) 3,073 (77.7) 14.2
Rhode Island 10,592 (67.7) 2,919 (56.3) 5,959 (75.2) 828 (54.5)§§ 528 (76.1)¶¶ 272 (56.6) 21.6
South Carolina 52,493 (78.1) 5,414 (86.5) 28,919 (82.8) 15,609 (66.0)§§ 1,001 (90.6)¶¶ 100 (68.0) 53 (73.6) 1,275 (77.1) 24.6
South Dakota 11,966 (80.7) 679 (77.5) 8,758 (84.7)¶¶ 421 (79.1) 208 (72.6) 1,479 (61.2)§§ 398 (76.1) 23.5
Tennessee 84,201 (81.1) 8,596 (85.3) 55,082 (83.0) 16,540 (71.3)§§ 1,846 (92.0)¶¶ 97 (87.6) 73 (87.7) 1,588 (83.2) 20.7
Texas 376,721 (88.5) 179,268 (88.4) 124,558 (90.4) 47,113 (81.5)§§ 19,806 (95.2)¶¶ 693 (87.6) 572 (86.5) 4,349 (87.8) 13.7
Utah 47,200 (86.2) 8,194 (81.8) 33,650 (88.8)¶¶ 608 (73.4) 1,088 (85.1) 354 (75.7) 447 (69.1)§§ 1,073 (88.6) 19.7
Vermont 5,062 (91.3) 124 (93.5) 4,555 (91.0)§§ 126 (97.6)¶¶ 123 (97.6)¶¶ 82 (93.9) 6.6
Virginia 95,415 (86.2) 14,294 (92.1) 51,270 (87.3) 20,448 (76.3)§§ 7,351 (94.5)¶¶ 142 (88.0) 124 (89.5) 1,706 (87.7) 18.2
Washington 82,930 (94.6) 15,885 (92.8) 46,246 (95.3) 3,689 (94.4) 8,665 (96.7)¶¶ 996 (88.8)§§ 1,177 (91.0) 3,557 (94.7) 7.9
West Virginia 18,187 (64.8) 359 (77.4) 16,590 (64.6) 591 (59.4)§§ 170 (86.5)¶¶ 387 (64.6) 27.1
Wisconsin 60,439 (81.1) 6,270 (79.0) 42,876 (86.6)¶¶ 6,357 (53.8)§§ 2,851 (68.4) 581 (69.2) 1,329 (76.1) 32.8
Wyoming 5,765 (83.9) 762 (77.3) 4,504 (85.6) 52 (65.4)§§ 65 (87.7)¶¶ 170 (70.6) 106 (83.0) 22.3
NMI 669 (97.3) 252 (97.6)¶¶ 377 (97.3)§§ 0.3
Guam 2,661 (80.6) 175 (90.9)¶¶ 721 (78.5)§§ 1,607 (79.9) 86 (84.9) 12.4
Puerto Rico 19,910 (93.6) 19,432 (93.6)¶¶ 401 (92.3)§§ 1.3

TABLE. Percentage of live infants not transferred to another facility for whom breastfeeding was initiated,* by state/territory and maternal race/ethnicity — National Vital Statistics System, 48 states,§ District of Columbia, Guam, Northern Mariana Islands, and Puerto Rico, 2019

Abbreviations: AI/AN = American Indian/Alaska Native; DC = District of Columbia; NH/OPI = Native Hawaiian/Other Pacific Islander; NMI = Northern Mariana Islands.
* Excludes infants transferred to another facility within 24 hours of delivery and those who died before completion of the birth certificate.
All racial/ethnic groups are non-Hispanic unless otherwise noted.
§ Includes all states except California and Michigan.
Denominators might not sum to total because of missing maternal race/ethnicity data.
** Largest disparity is defined as the percentage point difference in breastfeeding initiation prevalence between the racial/ethnic groups with the highest and lowest initiation prevalence.
†† United States estimates include data from 48 states and DC but exclude data from territories.
§§ Racial/ethnic group with the lowest breastfeeding initiation prevalence.
¶¶ Racial/ethnic group with highest breastfeeding initiation prevalence.
*** Data were suppressed for all racial/ethnic groups with denominators <50.

 

CME / CE

Racial and Ethnic Disparities in Breastfeeding Initiation — United States, 2019

  • Authors: Katelyn V. Chiang, MPH; Ruowei Li, MD; Erica H. Anstey, PhD; Cria G. Perrine, PhD
  • CME / CE Released: 10/1/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/1/2022
Start Activity


Target Audience and Goal Statement

This activity is intended for public health officials, obstetricians, women’s health clinicians, pediatricians, nurses and other clinicians caring for mothers and infants for whom breastfeeding may be beneficial.

The goal of this activity is to describe breastfeeding initiation by maternal race/ethnicity across the United States, according to a Centers for Disease Control and Prevention (CDC) analysis of 2019 National Vital Statistics System (NVSS) birth certificate data for 3,129,646 births from 48 of the 50 states (all except California and Michigan), DC, and 3 US territories (Guam, Northern Mariana Islands, and Puerto Rico).

Upon completion of this activity, participants will:

  • Describe rates of breastfeeding initiation overall in the United States and by state and maternal race/ethnicity, according to a Centers for Disease Prevention and Control (CDC) analysis of 2019 National Vital Statistics System (NVSS) birth certificate data
  • Describe variation among states in racial/ethnic disparities in breastfeeding initiation, according to a CDC analysis of 2019 NVSS birth certificate data
  • Describe clinical and public health implications of disparities in breastfeeding initiation by maternal race/ethnicity at the national, state, and territorial levels, according to a CDC analysis of 2019 NVSS birth certificate data


Disclosures

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Faculty

  • Katelyn V. Chiang, MPH

    Division of Nutrition, Physical Activity, and Obesity
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention
    Atlanta, Georgia
    Oak Ridge Institute for Science and Education
    Oak Ridge, Tennessee

    Disclosures

    Disclosure: Katelyn V. Chiang, MPH, has disclosed no relevant financial relationships.

  • Ruowei Li, MD

    Division of Nutrition, Physical Activity, and Obesity
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Disclosure: Ruowei Li, MD, has disclosed no relevant financial relationships.

  • Erica H. Anstey, PhD

    Division of Nutrition, Physical Activity, and Obesity
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Disclosure: Erica H. Anstey, PhD, has disclosed no relevant financial relationships.

  • Cria G. Perrine, PhD

    Division of Nutrition, Physical Activity, and Obesity
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention
    Atlanta, Georgia

    Disclosures

    Disclosure: Cria G. Perrine, PhD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

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    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.


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CME / CE

Racial and Ethnic Disparities in Breastfeeding Initiation — United States, 2019

Authors: Katelyn V. Chiang, MPH; Ruowei Li, MD; Erica H. Anstey, PhD; Cria G. Perrine, PhDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / CE Released: 10/1/2021

Valid for credit through: 10/1/2022

processing....

Introduction

Breastfeeding is the optimal source of nutrition for most infants[1]. Although breastfeeding rates in the United States have increased during the past decade, racial/ethnic disparities persist[2]. Breastfeeding surveillance typically focuses on disparities at the national level, because small sample sizes limit examination of disparities at the state or territorial level. However, birth certificate data allow for assessment of breastfeeding initiation among nearly all newborn infants in the United States both nationally and at the state and territorial levels. To describe breastfeeding initiation by maternal race/ethnicity,* CDC analyzed 2019 National Vital Statistics System (NVSS) birth certificate data for 3,129,646 births from 48 of the 50 states (all except California and Michigan), the District of Columbia (DC), and three U.S. territories (Guam, Northern Mariana Islands, and Puerto Rico). The prevalence of breastfeeding initiation was 84.1% overall and varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers, a difference of 16.7 percentage points. Across states, the magnitude of disparity between the highest and lowest breastfeeding rates by racial/ethnic groups varied, ranging from 6.6 percentage points in Vermont to 37.6 percentage points in North Dakota, as did the specific racial/ethnic groups with the highest and lowest rates. These state/territory-specific data highlight the variation that exists in breastfeeding disparities across the United States and can help public health practitioners and health departments identify groups on which to focus efforts. Targeting breastfeeding promotion programs on populations with lower breastfeeding rates might help reduce racial/ethnic disparities in breastfeeding initiation and improve infant nutrition and health.

Birth data from NVSS are a census of all live births in the United States collected by using the U.S. Standard Certificate of Live Birth.§ Birth certificate data include an infant nutrition item, determined from medical records, that indicates whether an infant received any breast milk or colostrum during the period between delivery and hospital discharge[3]. Data also include self-reported maternal race/ethnicity.**, †† Analysis was restricted to data on infants who were alive when the birth certificate was completed and who were not transferred to another facility within 24 hours of delivery. Births during 2019 in 48 states, DC, Northern Mariana Islands, Guam, and Puerto Rico were included; breastfeeding data were not available for births in California, Michigan, American Samoa, or the U.S. Virgin Islands. Births in 48 states and DC (hereafter referred to as a state), representing 85.2% of U.S. live births, contributed to nearly national estimates (hereafter referred to as national). Infants for whom maternal race/ethnicity data were missing (n = 16,827, 0.5%) were included in national, state, and territorial estimates but excluded from estimates stratified by race/ethnicity.

The percentage of infants for whom breastfeeding was initiated was calculated overall and by maternal race/ethnicity at the national, state, and territorial levels. Assessed racial/ethnic groups included infants born to Hispanic, White, Black, Asian, American Indian or Alaska Native (AI/AN), Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial mothers. Racial/ethnic disparities were calculated in each state/territory as the percentage point difference between breastfeeding initiation among the racial/ethnic group with the highest initiation prevalence and each of the other groups. Because birth data are a census, no statistical tests were conducted. Data were suppressed for any racial/ethnic group with a denominator <50. Estimates for Guam, Northern Mariana Islands, and Puerto Rico were not considered in comparisons because each territory was excluded from national estimates and had data suppressed for three or more racial/ethnic groups. SAS (version 9.4; SAS Institute) was used for all data analyses.

The prevalence of initiation of breastfeeding for newborn infants was 84.1%, ranging from 94.8% in Oregon to 64.7% in Mississippi. Initiation rates varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers. In 26 states (including DC), the breastfeeding initiation rate was lowest among infants of Black mothers; in 13 states, the rate was lowest among infants of AI/AN mothers (including in Maine, where rates were equally low among infants of multiracial mothers). Prevalence of breastfeeding initiation was highest among infants of Asian mothers in 36 states (including Vermont, where rates were equally high among infants of Black mothers) and highest among infants of White mothers in 10 states (including DC) (Table).

Generally, racial/ethnic disparities in breastfeeding initiation were larger in states with lower overall breastfeeding initiation rates (Figure 1). Nationally, the largest racial/ethnic disparity in breastfeeding initiation was 16.7 percentage points (higher for infants of Asian mothers than for infants of Black mothers) and ranged from 6.6 percentage points in Vermont (higher for infants of Black and Asian mothers than for infants of White mothers) to 37.6 percentage points in North Dakota (higher for infants of Asian mothers than for infants of AI/AN mothers). The largest disparity exceeded 20 percentage points in 22 states (including DC) and exceeded 30 percentage points in six states (Table) (Figure 2). The racial/ethnic groups that corresponded to the largest disparity varied across states. The largest disparities were most commonly observed between infants of Asian mothers and infants of Black mothers (in 22 states) followed by infants of Asian mothers and infants of AI/AN mothers (in eight states) (Table).

Enlarge

Figure 1. Breastfeeding initiation and largest disparity in breastfeeding initiation between racial/ethnic groups,* by state — National Vital Statistics System, 48 states and the District of Columbia, 2019

Abbreviation: DC = District of Columbia.
* Breastfeeding initiation is measured as a percentage. Largest disparity in breastfeeding initiation between racial/ethnic groups is measured as a percentage difference.
† Includes all states except California and Michigan. California does not report breastfeeding initiation data to the Nationa Vital Statistics System. Michigan uses nonstandard wording for the breastfeeding initiation item on the birth certificate, which prevents comparison of data to other states.
Enlarge

Figure 2. Largest disparity in breastfeeding initiation between racial/ethnic groups, by percentage point difference ─ National Vital Statistics System, 48 states and the District of Columbia, 2019

 

_____

* All racial/ethnic groups are non-Hispanic unless otherwise noted.
† California does not report breastfeeding initiation data to NVSS. Michigan uses nonstandard wording for the breastfeeding initiation item on the birth certificate, which prevents comparison of data to other states.
§ https://www.cdc.gov/nchs/data/dvs/birth11-03final-ACC.pdf
¶ Analyses were not limited to births occurring in hospitals. NVSS provides birthcertificate completion instructions to facilities, but breastfeeding information is also collected for births occurring in other locations (e.g., freestanding birth centers, clinics, doctors’ offices, and homes) via the birth certificate.
** https://www.cdc.gov/nchs/nvss/revisions-of-the-us-standard-certificates-and-reports.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fnvss%2Fvital_certificate_revisions.htm
†† https://www.cdc.gov/nchs/data/dvs/moms-worksheet-2016-508.pdf