Kidsdata.org provides indicators of in-hospital breastfeeding initiation by mother's county of residence and newborn's race/ethnicity. Data are based on feedings from birth to the time of specimen collection by the California Department of Public Health's Newborn Screening Program (usually 24 to 48 hours after birth). Two types of breastfeeding are reported: (i) exclusive breastfeeding, which measures the number and percentage of newborns who receive breast milk only, and (ii) any breastfeeding, which measures the number and percentage of newborns who receive at least some breast milk (i.e., those who receive breast milk only and those who receive both breast milk and formula).

Breast milk is widely acknowledged as the most complete form of nutrition for infants, with a range of benefits for health, growth, and development (1). Infants who are breastfed receive protection from serious health conditions, including respiratory, ear, and gastrointestinal infections, allergies, diabetes, and obesity (1). Studies indicate that breastfeeding can reduce the incidence of Sudden Infant Death Syndrome (SIDS) when compared with formula feeding (1). Breastfeeding also offers health advantages to mothers, such as reducing the risk of breast and ovarian cancer, cardiovascular disease, and diabetes (1). Increasing the proportion of children who are breastfed for at least the first year of life—as well as the percentage who are breastfed exclusively for the first six months—are important public health goals (1, 2). In fact, California has a statewide goal to make breastfeeding the normal method of infant feeding for at least the first year of life (3).

Not all women should breastfeed, however. For example, breastfeeding is not recommended for women who test positive for HIV, use certain drugs, or have active, untreated tuberculosis (1, 4). And not all women can breastfeed consistently due to occupational or other challenges (1, 5).

Among California newborns delivered in a hospital in 2018, 70% were breastfed exclusively during their hospitalization, up from 57% in 2010. At the county level, percentages ranged from 37% (Shasta County) to 91% (Nevada County) in 2018, among regions with data. Since 2010, rates of exclusive breastfeeding have been consistently higher for white newborns (81% in 2018) than for newborns in other racial/ethnic groups statewide.

Recognizing that breastfeeding has significant health benefits for children and mothers, all major health organizations recommend that infants be breastfed exclusively for the first six months, followed by continued breastfeeding with complementary foods until at least 12 months (1). While breastfeeding rates generally have been on the rise, and 87% of California infants start out breastfeeding, only 26% are breastfed exclusively at the end of six months (1).

To increase breastfeeding rates, mothers need information about its benefits and support from the start to maintain breastfeeding through infancy (2). New mothers are more likely to breastfeed exclusively when hospitals develop breastfeeding policies and practices that keep mothers and infants together, facilitate breastfeeding within one hour after birth, and limit items that discourage breastfeeding (e.g., formula and pacifiers) (2). After leaving the hospital, mothers sometimes discontinue breastfeeding due to lack of insurance coverage for lactation consultants or breast pumps, or due to other barriers such as unsupportive workplaces (2). Continued breastfeeding is more likely when employers, health care systems, child care providers, families, and communities support that effort (2).

Policy options that could increase breastfeeding include:

• Continuing efforts to ensure that all California hospitals adopt and effectively implement infant-feeding policies aligned with the Baby-Friendly Hospital Initiative, as required by law; hospitals also need sufficient qualified professionals to support all new mothers with breastfeeding (2)
• Promoting collaboration among hospitals, health care providers, public health agencies, insurers, and other community partners to guarantee that new mothers continue to receive culturally competent, skilled support for lactation after they leave the hospital (2)
• Requiring health insurers to cover best practices for breastfeeding support, including in-person access to International Board Certified Lactation Consultants and quality breast pumps (2)
• Supporting and expanding paid family leave policies, as longer maternity leaves may increase breastfeeding duration (3)
• Educating employers and improving enforcement of existing laws which require employers (with some exceptions) to provide breastfeeding employees with a private space and time to pump breast milk (2, 4, 5)
• Promoting breastfeeding education for child care providers, so they can help support exclusive breastfeeding for children in their care, when needed (2)
• Enforcing state law permitting breastfeeding in public places (6)