US national breastfeeding surveillance: Current status and recommendations

To assess the adequacy of US national breastfeeding surveillance from a health disparities perspective, we evaluated: a) data quality from national surveys and b) utilization of the US Standard Certificate of Live Birth (SCLB), which was revised in 2003 to include breastfeeding initiation data. Questionnaires from 7 federally funded national surveys were reviewed to determine if they collected data essential for evaluating breastfeeding practices within a health disparities framework. Variables of interest included: breastfeeding initiation, duration of any and exclusive breastfeeding, race/ethnicity, acculturation, maternal birthplace, and inclusion of data from Puerto Rico. Additionally, Registrars of Vital Statistics in all 50 states and Puerto Rico were surveyed regarding their adoption of the SCLB. No single survey adequately assessed all the breastfeeding outcomes, acculturation and ethnicity in the mainland US and Puerto Rico. Among the 77% of Registrars who have responded thus far, 66.7% are currently using or planning to use the SCLB by January, 2008. Thus, SCLB has potential to become part of a national breastfeeding monitoring system in the near future. In order to improve US breastfeeding surveillance, we recommend future surveys: a) use consistent definitions for breastfeeding outcomes, b) oversample more minority groups, c) minimize the use of consumer opinion panels, d) routinely collect data in Puerto Rico, e) consistently assess acculturation and f) use more detailed ethnic descriptors. We recommend that the US government consider formally establishing a national breastfeeding monitoring system that integrates data from different national and state surveys. Funded by NIH-NCMHD EXPORT grant P20 MD001765