At a glance
CDC's 2022 Breastfeeding Report Card provides data on breastfeeding practices and supports in the United States, the District of Columbia, and Puerto Rico.
Overview
CDC's 2022 Breastfeeding Report Card provides compiled data on breastfeeding practices and supports in all states, the District of Columbia, and Puerto Rico. The Breastfeeding Report Card has historically been released every 2 years. CDC will not publish a Breastfeeding Report Card in 2024. The next update will be in 2025.
Breastfeeding data are also released annually on the following websites:
Breastfeeding has many health benefits for infants, children, and mothers. It is a key strategy to improve public health. The 2020–2025 Dietary Guidelines for Americans (Dietary Guidelines)1 and the American Academy of Pediatrics (AAP)2 recommend that infants be exclusively breastfed for about the first 6 months. Infants should continue breastfeeding alongside the introduction of complementary foods for:
- At least 1 year (Dietary Guidelines).
- 2 years (AAP).
- Longer if desired.
What the numbers tell us
Among infants born in 2019, most (83.2%) started out receiving some breast milk. At 1 month, 78.6% were receiving any breast milk. At 6 months, 55.8% of infants received any breast milk, and 24.9% received breast milk exclusively (Figure 1).
Families can face many challenges when breastfeeding. Yet data show that most infants start out breastfeeding, and many are still receiving some breast milk at 6 months. Even some breast milk is beneficial to infants. However, many families do not breastfeed for as long as they intend,3 and breastfeeding disparities by race and ethnicity persist.4 The rates of any breastfeeding and exclusive breastfeeding steadily decline from month to month. This finding indicates that breastfeeding families may need stronger support systems to reach their breastfeeding goals.
In each state, public health professionals and others can use the data to:
• Celebrate families who breastfeed and provide breast milk to their babies. Many infants are still receiving some breast milk at 6 months.
• Review state early care and education (ECE) licensing regulations. Assess if they fully support breastfeeding with policies that (1) support breastfeeding by parent during child care hours, (2) recommend feeding of breast milk by staff or parent, and (3) require comfortable arrangements for mothers to breastfeed or express milk on-site.
• Collaborate with hospitals to identify opportunities to improve maternity care practices.
• Help communities develop and implement breastfeeding programs to meet the needs of populations disproportionally affected by structural barriers that can lead to lower breastfeeding rates.
The 2022 report highlights selected breastfeeding support indicators that can help families reach their breastfeeding goals. These indicators include:
- Supportive maternity care practices.
- State laws requiring paid family and medical leave.
- Early care and education (ECE) policies.
Evidence-based maternity care practices that support breastfeeding are critical in the first few hours and days of an infant's life. These practices help mothers start breastfeeding and reach their breastfeeding goals.5
Maternity care practices in the United States have improved slightly in recent years. National scores on CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey increased from 79 in 2018 to 81 in 2020.
Hospitals that implement the Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding help ensure that mothers have what they need. The Ten Steps are intended to give mothers the information, confidence, and skills to successfully start and continue breastfeeding their babies and to reduce the use of formula except when medically necessary. In 2021, more than 1 in 4 babies were born in Baby-Friendly designated hospitals.
Breastfeeding support in the maternity care setting continues to improve. However, variations in care from state to state indicate more work is needed.
A family’s breastfeeding journey usually begins in the hospital. However, supportive policies and access to continued, coordinated support in the community can help families continue breastfeeding. Once families leave their birthing setting, breastfeeding rates drop slowly but consistently. This finding suggests that families may need additional support to achieve exclusive breastfeeding and longer breastfeeding.
Breastfeeding support is especially important for mothers taking leave from, and returning to, the workforce. The Surgeon General’s Call to Action to Support Breastfeeding identified a lack of paid maternity leave as a significant barrier to breastfeeding. This is especially true for employed mothers with lower incomes, who are also more likely to experience racial and ethnic disparities.6
To reduce the impact of employment on breastfeeding disparities, the Call to Action calls for efforts to establish paid maternity leave for all employed mothers. Child care centers can also support breastfeeding for employed mothers. The CTA encourages states to adopt and enforce national standards that support breastfeeding mothers and caring for breastfed infants.
CDC’s 2022 Breastfeeding Report Card provides data on support indicators related to employment, including paid family and medical leave (PFML).
PFML refers to partially or fully compensated time away from work for specific, generally significant family caregiving needs. These needs include a new child's arrival, a close family member's serious illness, or an employee’s own serious medical needs. The PFML indicator identifies:
- Whether a state has enacted legislation to create a PFML insurance program.
- Whether the program is currently paying benefits.
- The number of weeks of paid parental leave benefits that can be claimed by eligible employees. This time can be for the care of a new child by birth, adoption, or foster care.
As of May 2022, a total of 12 states had enacted PFML insurance legislation. Eight state programs are currently paying benefits. Four have not yet begun paying benefits. Among states with PFML insurance legislation, paid parental leave benefits range from 5 to 12 weeks per benefit year (Table 2). Eligible employees can claim the benefit for the arrival of a new child.
The Breastfeeding Report Card includes a State ECE Licensing Breastfeeding Support Score. This score indicates how much a state’s child care center licensing regulations meet the Caring for Our Children’s breastfeeding standard.7 This standard includes supporting and encouraging breastfeeding best practices.
To fully meet the standard, a state’s ECE licensing regulations must include two best practices. First, they should recommend that child care centers provide comfortable accommodations for mothers to express milk or breastfeed their children on-site. These accommodations might include:
- Dedicated, private space.
- A comfortable chair.
- An electrical outlet.
Two, the regulations should recommend parents or caregivers feed breast milk to infants when the child care centers are open.
State breastfeeding support scores range from 30 to 100. In 2021 (Figure 2):
- 9 states' licensing regulations fully aligned (score = 100) with the breastfeeding support standard.
- 37 states' regulations partially aligned (score = 70).
- 5 states' regulations did not address the standard (score = 30).
*Score indicates the extent to which a state’s licensing regulation for ECE centers meet the Caring for our Children’s standard to encourage and fully support breastfeeding/feeding of breast milk and by making accommodations for mothers to feed their children comfortably on-site.
Numerous barriers to breastfeeding remain, and disparities persist in breastfeeding duration and exclusivity rates by race, ethnicity, and socioeconomic status.
Policy, systems, and environmental changes that address breastfeeding barriers can help to improve breastfeeding rates and reduce disparities. For example, these changes could include:
- Better maternity care practices.
- Paid leave policies.
- Supportive ECE centers.
When systems of care align to support breastfeeding, states and their communities can better address barriers. Addressing barriers allows families to benefit from supportive environments and achieve their breastfeeding goals.
Note: The 2022 Breastfeeding Report Card reflects breastfeeding and supplementation rates among babies born in 2019. These data were collected across 2020–2021 when babies were aged 19 to 35 months. The data might partially reflect breastfeeding duration and exclusivity during the COVID-19 pandemic.
| State/Territory | Ever breastfed | Breastfeeding at 6 months | Breastfeeding at 12 months | Exclusive breastfeeding through 3 months | Exclusive breastfeeding through 6 months | Breastfed infants receiving formula before 2 days of age |
|---|---|---|---|---|---|---|
| US Nationalb | 83.2 | 55.8 | 35.9 | 45.3 | 24.9 | 19.2 |
| Alabama | 71.1 | 37.7 | 23.7 | 38.0 | 21.0 | 15.3 |
| Alaska | 92.9 | 67.6 | 50.9 | 57.6 | 30.9 | 15.5 |
| Arizona | 85.4 | 58.3 | 40.4 | 43.2 | 24.0 | 20.2 |
| Arkansas | 74.9 | 46.5 | 29.2 | 42.0 | 24.4 | 11.1 |
| California | 89.9 | 62.3 | 43.6 | 51.6 | 27.3 | 19.0 |
| Colorado | 94.0 | 66.1 | 39.6 | 62.8 | 32.1 | 9.6 |
| Connecticut | 84.2 | 58.7 | 34.1 | 44.7 | 26.3 | 23.5 |
| Delaware | 83.6 | 54.8 | 34.9 | 48.3 | 25.0 | 22.7 |
| District of Columbia | 87.7 | 66.8 | 36.8 | 49.6 | 29.2 | 20.5 |
| Florida | 71.0 | 40.3 | 23.0 | 32.4 | 18.2 | 21.4 |
| Georgia | 82.6 | 53.1 | 33.7 | 39.9 | 18.7 | 24.2 |
| Hawaii | 90.1 | 70.9 | 54.1 | 50.6 | 27.7 | 16.2 |
| Idaho | 93.5 | 65.1 | 40.7 | 57.6 | 30.4 | 15.9 |
| Illinois | 84.9 | 58.7 | 35.4 | 47.8 | 28.3 | 18.4 |
| Indiana | 85.9 | 52.9 | 30.3 | 46.2 | 21.5 | 14.3 |
| Iowa | 82.4 | 58.3 | 38.2 | 52.8 | 27.0 | 15.9 |
| Kansas | 87.1 | 59.9 | 39.5 | 47.0 | 29.2 | 16.9 |
| Kentucky | 74.7 | 49.3 | 34.5 | 35.4 | 21.2 | 20.7 |
| Louisiana | 71.1 | 45.0 | 24.2 | 38.0 | 22.2 | 15.7 |
| Maine | 86.6 | 64.2 | 41.0 | 50.5 | 28.7 | 16.9 |
| Maryland | 88.5 | 66.8 | 43.0 | 50.2 | 28.9 | 21.3 |
| Massachusetts | 80.0 | 62.9 | 44.2 | 52.8 | 29.2 | 15.2 |
| Michigan | 83.1 | 53.7 | 32.2 | 42.6 | 25.1 | 18.7 |
| Minnesota | 91.9 | 69.9 | 46.3 | 57.5 | 36.5 | 18.1 |
| Mississippi | 69.4 | 35.7 | 22.2 | 31.1 | 15.6 | 21.2 |
| Missouri | 78.3 | 54.7 | 34.0 | 42.5 | 24.6 | 19.2 |
| Montana | 83.5 | 63.9 | 42.9 | 50.4 | 34.3 | 15.9 |
| Nebraska | 86.1 | 57.5 | 37.7 | 49.3 | 26.0 | 17.6 |
| Nevada | 83.8 | 52.5 | 27.6 | 42.4 | 22.3 | 23.2 |
| New Hampshire | 82.2 | 61.3 | 42.5 | 55.0 | 31.8 | 11.8 |
| New Jersey | 82.5 | 55.4 | 33.8 | 41.2 | 23.5 | 25.2 |
| New Mexico | 83.4 | 62.3 | 42.8 | 52.3 | 29.0 | 13.0 |
| New York | 86.7 | 58.8 | 36.3 | 42.4 | 23.4 | 24.4 |
| North Carolina | 83.4 | 53.0 | 34.2 | 47.2 | 22.1 | 15.6 |
| North Dakota | 85.7 | 57.2 | 34.4 | 48.8 | 27.4 | 11.5 |
| Ohio | 79.5 | 50.4 | 32.2 | 42.7 | 23.7 | 23.9 |
| Oklahoma | 77.3 | 47.9 | 27.9 | 43.1 | 23.2 | 12.6 |
| Oregon | 87.2 | 65.2 | 44.0 | 59.2 | 34.2 | 11.4 |
| Pennsylvania | 74.8 | 53.3 | 35.2 | 42.4 | 24.6 | 22.0 |
| Puerto Rico | 86.2 | 51.8 | 35.3 | 51.6 | 35.2 | 20.3 |
| Rhode Island | 82.4 | 54.6 | 33.3 | 42.3 | 22.9 | 23.2 |
| South Carolina | 80.6 | 46.6 | 26.0 | 43.3 | 19.3 | 22.1 |
| South Dakota | 88.9 | 61.4 | 37.8 | 52.1 | 29.1 | 13.2 |
| Tennessee | 78.8 | 53.2 | 31.5 | 41.9 | 24.9 | 22.3 |
| Texas | 84.1 | 54.1 | 34.8 | 42.4 | 24.0 | 19.8 |
| Utah | 91.4 | 63.8 | 44.1 | 49.5 | 27.3 | 20.9 |
| Vermont | 91.8 | 73.2 | 54.0 | 61.0 | 36.2 | 9.5 |
| Virginia | 83.3 | 63.0 | 40.1 | 39.6 | 25.8 | 18.6 |
| Washington | 93.7 | 68.0 | 47.4 | 57.0 | 29.5 | 14.0 |
| West Virginia | 59.8 | 31.7 | 19.2 | 28.0 | 13.8 | 21.4 |
| Wisconsin | 87.5 | 61.7 | 45.1 | 59.3 | 31.3 | 12.0 |
| Wyoming | 92.4 | 62.7 | 41.3 | 55.3 | 27.2 | 11.9 |
aBreastfeeding rate indicators are the percentage of infants breastfeeding at the specified time points, calculated among all infants. The rate for infants receiving formula before 2 days of age is calculated among breastfed infants.
bData from U.S. territories are excluded from national breastfeeding estimates. This allows the data to be consistent with the analytical methods used to establish Healthy People 2030 targets on breastfeeding.
| State/Territory | mPINC total score, 2020a | Percentage of live births occurring at Baby-Friendly facilities, 2021 | Paid family and medical leave, 2022 | ECE licensing breastfeeding support score, 2021d | |
|---|---|---|---|---|---|
| Has enacted legislation | # of weeks available for the care of a new childb | ||||
| US National | 81 | 28.9 | No | — | — |
| Alabama | 76 | 18.2 | No | — | 70 |
| Alaska | 82 | 20.8 | No | — | 70 |
| Arizona | 78 | 6.4 | No | — | 70 |
| Arkansas | 75 | 31.9 | No | — | 70 |
| California | 87 | 40.9 | Yes | 8 | 100 |
| Colorado | 85 | 35.1 | Yesc | 12c | 70 |
| Connecticut | 87 | 53.5 | Yes | 12 | 70 |
| Delaware | 84 | 83.4 | Yesc | 12c | 100 |
| District of Columbia | — | 48.2 | Yes | 8 | 100 |
| Florida | 81 | 31.5 | No | — | 70 |
| Georgia | 75 | 32.6 | No | — | 100 |
| Hawaii | 75 | 12.1 | No | — | 70 |
| Idaho | 77 | 9.8 | No | — | 30 |
| Illinois | 82 | 25.8 | No | — | 70 |
| Indiana | 83 | 32.1 | No | — | 70 |
| Iowa | 75 | 8.8 | No | — | 70 |
| Kansas | 83 | 52.9 | No | — | 70 |
| Kentucky | 73 | 15.4 | No | — | 70 |
| Louisiana | 81 | 56.8 | No | — | 70 |
| Maine | 86 | 16.9 | No | — | 70 |
| Maryland | 83 | 23.5 | Yesc | 12c | 100 |
| Massachusetts | 85 | 36.6 | Yes | 12 | 70 |
| Michigan | 78 | 32.9 | No | — | 70 |
| Minnesota | 81 | 22.0 | No | — | 70 |
| Mississippi | 83 | 65.4 | No | — | 100 |
| Missouri | 79 | 20.8 | No | — | 30 |
| Montana | 81 | 40.2 | No | — | 70 |
| Nebraska | 73 | 14.7 | No | — | 70 |
| Nevada | 72 | 13.8 | No | — | 70 |
| New Hampshire | 90 | 51.7 | No | — | 70 |
| New Jersey | 82 | 28.4 | Yes | 12 | 70 |
| New Mexico | 82 | 80.2 | No | — | 70 |
| New York | 83 | 35.1 | Yes | 12 | 70 |
| North Carolina | 84 | 35.7 | No | — | 100 |
| North Dakota | 77 | 12.0 | No | — | 70 |
| Ohio | 84 | 23.0 | No | — | 70 |
| Oklahoma | 79 | 31.3 | No | — | 70 |
| Oregon | 87 | 17.5 | Yesc | 12c | 70 |
| Pennsylvania | 80 | 29.8 | No | — | 70 |
| Puerto Rico | 73 | 0.8 | No | — | — |
| Rhode Island | — | 95.9 | Yes | 5 | 70 |
| South Carolina | 82 | 47.5 | No | — | 70 |
| South Dakota | 77 | 4.6 | No | — | 30 |
| Tennessee | 70 | 14.8 | No | — | 70 |
| Texas | 79 | 16.9 | No | 100 | |
| Utah | 77 | 10.0 | No | — | 70 |
| Vermont | 85 | 11.1 | No | — | 100 |
| Virginia | 82 | 13.8 | No | — | 70 |
| Washington | 85 | 22.6 | Yes | 12 | 70 |
| West Virginia | 80 | 20.4 | No | — | 30 |
| Wisconsin | 80 | 21.1 | No | — | 70 |
| Wyoming | 75 | 2.3 | No | — | 30 |
aPossible mPINC scores are 0 to 100, with higher scores indicating better maternity care practices and policies. Scores are not reported for Rhode Island, District of Columbia, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands because of small sample sizes. However, scores for these areas are included in the U.S. National Total mPINC Score.
bAmong states with enacted legislation, the number of weeks presented are those that eligible employees can claim for the care of a new child by birth, adoption, and foster care. Weeks may also be used for other family and medical leave events that the state specifies. This might include a serious health condition of a qualified family member. In some states, additional weeks of benefits may be available for other needs. Employees must meet eligibility requirements to claim benefits. Requirements vary across state programs.
cState has enacted legislation to create a paid family and medical leave insurance program, but the program is not currently paying benefits. Paid leave benefits for eligible employees were available in 2023 (Oregon) and 2024 (Colorado). Benefits for eligible employees will be available in 2025 (Maryland) and 2026 (Delaware).
dScores indicate how well the state’s licensing regulation for ECE centers aligns with the breastfeeding support standard. 100=regulation fully aligned; 70 = regulation partially aligned; 30 = regulation does not address; 0=regulation contradicts best practice. Data for territories are not collected. No national score is available.
| Indicators | Data Sources |
|---|---|
Breastfeeding rates
|
CDC National Immunization Surveys (NIS) 2020 and 2021, among children born in 2019. The NIS provides current national, state, and selected urban-area estimates of vaccination coverage rates for U.S. children. Because breastfeeding data are obtained by maternal recall when children are between 19 and 35 months of age, breastfeeding rates are analyzed by birth cohort rather than survey year. |
| mPINC total score | Maternity Practices in Infant Nutrition and Care (mPINC) Survey, 2020. CDC's national survey of Maternity Practices in Infant Nutrition and Care (mPINC) assesses maternity care practices and policies and provides feedback to encourage hospitals to make improvements that better support breastfeeding. mPINC national, state, and territory total scores represent the overall level of maternity care practices and policies that support optimal infant feeding based on hospital survey data. Possible scores are from 0 to 100, with higher scores indicating better maternity care practices and policies. |
| Percent of live births occurring at baby-friendly facilities | Baby-Friendly USA, Baby-Friendly facilities designated as of September 30, 2021. The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to encourage and recognize hospitals and birth centers that offer an optimal level of care for lactation based on the WHO/UNICEF Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. National Center for Health Statistics (NCHS), 2020 Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2020. Vital Statistics Rapid Release; no 12. Hyattsville, MD: National Center for Health Statistics. May 2021. |
Paid family and medical leave
|
Congressional Research Service Report: Paid Family and Medical Leave in the United States as of May 2022. Donovan, SA. Paid Family and Medical Leave in the United States (CRS Report No. R448335). June 13, 2022. Paid family and medical leave (PFML) refers to partially, or fully, compensated time away from work for specific and generally significant family caregiving needs, such as the arrival of a new child or serious illness of a close family member, or an employee's own serious medical needs. The PFML indicator identifies 1) whether a state has enacted legislation to create a paid family and medical leave insurance program and whether the program is currently paying benefits, and 2) among states with enacted PFML insurance legislation, the number of weeks of paid parental leave benefits for the care of a new child by birth, adoption, or foster care available to eligible employees within a benefit year. |
| ECE licensing breastfeeding support score | National Resource Center for Health and Safety in Child Care and Early Education (NRC), 2021. Achieving a state of healthy weight: 2021 update. Aurora, CO: University of Colorado Denver. The child care licensing regulation includes on-site breastfeeding support as one of the 47 high-impact obesity prevention standards. Standard IA17: "Encourage and support breastfeeding and feeding of breast milk by making arrangements for mothers to feed their children on-site." CDC creates state scores for child care centers from the NRC data and publishes periodic State Licensing Scorecards. Higher scores indicate that the state's licensing regulation for child care centers fully supported the standard (100), and lower scores indicate the state's licensing regulation only partially addressed (70), did not address (30), or contradicted (0) the standard. These scores do not include large family or small family child care homes. |
Data, trends, and maps
Data, Trends, and Maps is an interactive tool that provides state-specific data about obesity, nutrition, physical activity, and breastfeeding. Choose your location and then “Breastfeeding” as the category to find state-specific data. You can also view statistics in various formats, including maps, tables, and trend lines.
- US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th ed. 2020. Accessed October 9, 2024.
- Meek JY, Noble L. Policy Statement: Breastfeeding and the Use of Human Milk. AAP Section on Breastfeeding. Pediatrics. 2022;150(1):e2022057988. doi:10.1542/peds.2022-057988
- Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013;131(3):e726–732. doi:10.1542/peds.2012-1295
- Centers for Disease Control and Prevention. Rates of Any and Exclusive Breastfeeding by Sociodemographic Characteristic Among Children Born in 2019. Accessed October 9, 2024.
- Centers for Disease Control and Prevention. Supporting Evidence: Maternity Care Practices. Accessed October 9, 2024.
- Office of the Surgeon General. The Surgeon General's Call to Action to Support Breastfeeding. Accessed October 9, 2024.
- Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd ed. 2012. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Accessed October 9, 2024.