Supplemental Information to 2020 In-Hospital Breastfeeding Data

• Data to Monitor Progress in Hospital Policies and Practices that Support Breastfeeding in California
  
• Hospital Infant Feeding and Care Requirements
  

• Resources and Technical Assistance for Developing Hospital Policies that Support Breastfeeding
  

Data to Monitor Progress in Hospital Policies and Practices that Support Breastfeeding in California

Hospital Breastfeeding Data

The California Department of Public Health (CDPH) has released 2020 in-hospital breastfeeding initiation rates. Hospital staff and administrators can use this information to examine the percentage of women who initiate "exclusive" or "any" breastfeeding at their hospital. For these data, exclusive breastfeeding is defined as infants receiving only breast milk up to the time of specimen collection for newborn genetic screening tests prior to hospital discharge. Reference to any breastfeeding includes infants who were exclusively breastfed, as well as infants receiving both breast milk and formula.

California in-hospital breastfeeding initiation rates remained relatively stable in 2020. From 2010 to 2020, the rate of any breastfeeding increased from 90.8% to 93.6%, while exclusive breastfeeding rates increased from 56.6% to 69.7%. This translates to an overall decrease in formula supplementation from 34.2% to 30.3% during this time period. There was a slight decrease in exclusive in-hospital breastfeeding initiation from 2019 (70.2%) to 2020 (69.7%).

Although improvements were seen, racial/ethnic disparities in in-hospital breastfeeding initiation persist. In 2020, Hispanic (64.6%), Pacific Islander (64.4%), Asian (67.2%), and Black (60.7%) Californians had lower exclusive breastfeeding rates than that of the state overall (69.7%). (Data source: Genetic Disease Screening Program, Newborn Screening Data, 2010-2020).

Future of In-Hospital Breastfeeding Initiation Data Releases

The Maternal, Child, and Adolescent Health (MCAH) Division now has indicator-specific dashboards for California, all designed to serve the data needs of our partners and stakeholders. State-, county- and/or regional-level indicator data are shown by various stratifications or subgroups and by year. Each dashboard also includes a link to download the data. The dashboards are organized by the five Title V Block Grant health domains: Women/Maternal, Perinatal/Infant, Child, Children and Youth with Special Health Care Needs (CYSHCN), and Adolescent. The In-hospital Breastfeeding Initiation data dashboard is available on the MCAH data dashboard webpage.  Future data releases will be available through the Breastfeeding Initiation dashboard. 

Maternity Practices in Infant Nutrition and Care Survey

The Centers for Disease Control and Prevention (CDC) recently completed data collection for the 2022 Maternity Practices in Infant Nutrition and Care (mPINC) Survey among hospitals and birthing centers throughout the United States. As in past years, each participating facility will receive its survey results in the form of a customized mPINC Benchmark Report that addresses barriers to evidence-based maternity care related to breastfeeding. Hospitals are encouraged to utilize their mPINC reports to support quality improvement efforts within the maternity care setting. For more information, visit the CDC's mPINC Survey website . 

Baby Friendly Hospital Initiative

California leads the nation with 91 designated Baby-Friendly hospitals and birth centers , representing slightly over 40% of California's birthing hospitals. Information and the names of the California facilities with this designation can be found on the Baby-Friendly USA website . 

Hospital Infant Feeding and Care Requirements

The Joint Commission's Perinatal Care Core Measure Set

The Joint Commission requires accredited hospitals with 300 or more births per year to use Perinatal Care Core Measures, a set which includes exclusive breast milk feeding. The Perinatal Care Core Measures focus on achieving integrated, coordinated, patient-centered care for clinically uncomplicated pregnancies and births. As a resource, the United States Breastfeeding Committee  (USBC) produced a document entitled "Implementing the Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding ;" hospitals are encouraged to utilize this resource.

Hospital Infant Feeding Act

The Hospital Infant Feeding Act  (California Health & Safety Code §123366) requires every California hospital with a perinatal unit to have an infant feeding policy. Each policy needs to promote breastfeeding and utilize guidance from the Baby-Friendly Hospital Initiative  or the most recent California Breastfeeding Model Hospital Policy Recommendations (approved and published in 2022 by CDPH). Each policy must be clearly posted and routinely communicated to staff.

California Health & Safety Code § 123367

California Health & Safety Code §123367  requires that, by 2025, every hospital with a perinatal unit adopts the "Ten Steps to Successful Breastfeeding" per Baby Friendly USA's Baby-Friendly Hospital Initiative , the California Breastfeeding Model Hospital Policy Recommendations, or an alternate process adopted by a health care service plan that includes evidenced-based policies and practices with targeted outcomes.

Resources and Technical Assistance for Developing Hospital Policies that Support Breastfeeding

CDPH Breastfeeding website

The CDPH Breastfeeding website includes a variety of resources:

• The California Infant Feeding Guide

• Breastfeeding Model Hospital Policy Recommendations, 2022

• 9 Steps To Breastfeeding Friendly: Guidelines for Community Health Centers and Outpatient Care Settings

Local Breastfeeding Coalitions and Coordinators

CDPH urges all labor and delivery facilities to work with local breastfeeding coalitions and/or local health jurisdiction breastfeeding coordinators to address barriers to exclusive breastfeeding.

The Regional Perinatal Programs of California

The Regional Perinatal Programs of California (RPPC) is a network of regional public health consultants who promote access to risk-appropriate perinatal care for pregnant women and their infants and can assist hospitals in implementing breastfeeding quality improvement initiatives. The contact information for each Region's RPPC Coordinator can be found on the RPPC website.

Women, Infants and Children

Women, Infants and Children (WIC) provides prenatal breastfeeding education; breast pumps, when needed; and peer counselors to support breastfeeding mothers. Regional breastfeeding liaisons (RBLs) facilitate seamless breastfeeding support by collaborating with health care providers, hospitals, employers, and the community. To see if there is a WIC RBL in a specific region, contact the WIC Local Agency. To locate WIC sites near a specific hospital, use the "WIC Office" search function on the MyFamily.WIC.ca.gov  website.