R8: Breastfeeding

Framework Component

Population Results – Trends and Reductions in Disparities

Indicator Description

The proportion of the SNAP-Ed eligible infants that were ever breastfed, fully breastfed, or partially breastfed.

Background and Context

Breastfeeding protects infants from obesity; a meta-analysis shows the risk of childhood obesity is 22 percent lower in breastfed children than in children who were never breastfed (Yan et al., 2014). The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire.

The SNAP-Ed State Plan Guidance requires that breastfeeding activities must be planned and implemented in collaboration with the state WIC agency and state breastfeeding coordinator. The WIC Program should have the lead and primary role in all breastfeeding activities with SNAP-Ed supplementing existing WIC activities. SNAP-Ed can advance breastfeeding in its programming through such activities as working on lactation policies and promotion at low-wage worksites, child care facilities, or other community settings.

The five measures in R8 align with the breastfeeding goals outlined in Healthy People 2020, in maternal, infant, and children’s health:

  • Increase the proportion of infants who are breastfed ever to 81.9 percent
  • At 6 months to 60.6 percent
  • At 1 year to 34.1 percent
  • Exclusively through 3 months to 46.2 percent
  • Exclusively through 6 months to 25.5 percent

Outcome Measures

Five measures of breastfeeding rates among infants:

R8a. Ever breastfed
R8b. Breastfeeding at 6 months
R8c. Breastfeeding at 12 months
R8d. Exclusive breastfeeding at 3 months
R8e. Exclusive breastfeeding at 6 months

What to Measure

CDC administers the National Immunization Survey, which is a nationally representative sample of all 50 states and the District of Columbia. To maximize the sample size for state-level estimates by socio-demographic categories, 3 birth years are combined for analysis. Breastfeeding indicators are calculated by year of child’s birth rather than survey year. Because children are 19–35 months of age at the time of the parent interview, each survey year represents children born over 3 years, and each birth year can consist of respondent data from up to 3 survey years. SNAP-Ed agencies can use CDC state-by-state breastfeeding data listed in the Breastfeeding Report Card: https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf.

Breastfed at 6 months is defined as breastfeeding to any extent with or without the addition of complementary liquids or solids. Exclusive breastfeeding is defined as ONLY breast milk—no solids, no water, and no other liquids.

FNS also collects state and local WIC agency breastfeeding performance measurements based on program participant data of the number of partially and fully breastfed infants for each WIC state and local agency. Local agencies reporting 30 or fewer total infant participants are excluded.



Surveys and Data Collection Tools


  1. Was [child] ever breastfed or fed breast milk?
  2. How old was [child’s name] when [child’s name] completely stopped breastfeeding or being fed breast milk?
  3. How old was [child’s name] when (he/she) was first fed formula?
  4. This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow’s milk, sugar water, baby food, or anything else that [child] may have been given, even water. How old was [child’s name] when (he/she) was first fed anything other than breast milk or formula?

Additional evaluation tools to measure R8 can be found in the SNAP-Ed Library.

Key Glossary Terms


Additional Resources or Supporting Citations

Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health 2014;14:1267. Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1267.

The CDC Division of Nutrition, Physical Activity and Obesity’s Data, Trends and Maps online tool – Breastfeeding indicators: https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByTopic&islClass=BF&islTopic=&go=GO