Overview
During 2018 through 2019, breastfeeding initiation rates by county varied widely within states and ranged from 22% to more than 90% across the nation. These tables and maps present 2018 through 2019 National Vital Statistics System data from 3,079 counties or county equivalents in 48 states, the District of Columbia, and Puerto Rico. Tables also present rates for Guam and the Commonwealth of the Northern Mariana Islands.
These rates can be used to celebrate strengths and to identify locations that might benefit from focused interventions. Community-level strategies to support breastfeeding can focus on populations facing barriers that lead to low breastfeeding rates.
View the full county level details
Information being collected
Birth certificate data from 2018 through 2019 National Vital Statistics System were used to determine the percentage of live infants who initiated breastfeeding. Breastfeeding initiation was defined as receiving any breast milk or colostrum between delivery and discharge from the birth facility or birth certificate completion for home births. These rates are available by county or county equivalent (for example, independent cities, parishes, and boroughs) of the mother’s residence.
How and when data are collected
Birth certificate data are collected from information the mother provides and medical records from delivery through discharge from the birth facility or birth certificate completion for home births.
Who is included in these data
All infants born during 2018 or 2019 are included except infants who:
- Are transferred to another facility within 24 hours of delivery.
- Are missing breastfeeding initiation data.
- Are born to foreign residents or to residents of California, Michigan, American Samoa, or the U.S. Virgin Islands.
- Die before birth certificate completion.
Why some data are not shown
Birth certificate breastfeeding initiation data were not available for California, Michigan, American Samoa, or the U.S. Virgin Islands.
In addition, to prevent identification of individuals:
- Data are not shown for counties or county equivalents if the total number of infants or the number of infants initiating breastfeeding is fewer than 10.
- The exact breastfeeding rate is not displayed if it is greater than or equal to 90.0% and the total number of infants is fewer than 50.
How counties or county equivalents are categorized on the maps
They are categorized by quintiles of breastfeeding initiation. These quintiles are calculated from county or county equivalent rates for 48 states and the District of Columbia.
How data in this report differ from breastfeeding data reported from National Immunization Survey-Child (NIS-Child)
In addition to reporting data on breastfeeding initiation from birth certificates, CDC also reports data on many breastfeeding practices in the United States using the NIS-Child. The two data sources have several differences. Birth certificate data include all infants born and only measure breastfeeding initiation. NIS-Child data measure breastfeeding initiation, duration, and exclusivity. These data are collected by cell phone among a nationally representative sample of people with children aged 19 to 35 months. Each NIS-Child survey year represents children born over 3 years. CDC reports breastfeeding based on birth year.