NICU by the Numbers

States with Supportive Breastfeeding Policies Have Higher Rates of Discharge Home on Any Human Milk among Surviving VLBW Infants

Issue 9 – September 2019


Researchers recently categorized states based on supportive breastfeeding policies including: 1) breastfeeding in public; 2) breastfeeding in the workplace beyond what is stated in the Affordable Care Act; 3) paid or unpaid maternity leave; 4) no discrimination based on breastfeeding status; 5) breastfeeding practices in hospitals; 6) breastfeeding practices in licensed childcare facilities.1


We compared rates of any human milk at discharge in the United States among surviving very low-birth-weight infants born in 2018 between states that had breastfeeding support policies and those that did not. We calculated risk ratios with 95% compatibility intervals controlling for maternal race, a known driver of differences in rates of any human milk at discharge.

Breastfeeding Policies Chart


Margaret Parker, MD, MPH, Boston Medical Center, Boston, MA

Sixty percent of mothers are unable to achieve their breastfeeding goals, according to a large national CDC study.2 Structural barriers in the hospital, workplace, and childcare setting contribute to cessation of breastfeeding. Compared to mothers of term infants, mothers of VLBW infants have even higher rates of breastfeeding intent and initiation, yet they face considerable challenges to continued breastfeeding due to the prolonged mother-infant separation that occurs as part of the NICU hospitalization and end up less likely to breastfeed after ten weeks compared to mothers delivering at term.3 Mothers of VLBW infants have disrupted maternity leaves, and many go back to work while their infants are still admitted and have prolonged exposure to hospital breastfeeding support practices. As expected, mothers of VLBW infants appear to benefit from statewide policies that support breastfeeding.

As a neonatology community, policy efforts that support breastfeeding on a state level are important. Statewide perinatal quality collaboratives and individual hospital teams can additionally support mothers by encouraging early and frequent milk expression, use of hospital grade double electric breast pumps, skin-to-skin care, early introduction to feeding at the breast and actively planning for breastfeeding support as part of the discharge process. Hospital teams should also follow through with mothers after discharge to provide continued support.4

Improving Transitions Home to Mitigate the Impact of Systemic Barriers to Breastfeeding

Teams in VON’s critical transitions internet-based quality improvement collaborative are improving care in critical transitions, such as the transition home from the NICU, and building improvement capacity that is transferable to any improvement goal, whether a team is focused on human milk at discharge or any other challenge at their center.

Go to the critical transitions internet-based quality improvement collaborative.


  1. Gonzalez-Nahm S, Grossman ER, Benjamin-Neelon SE. The role of equity in US states’ breastfeeding policies. JAMA Pediatr. 2019.
  2. 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.
  3. Colaizy TT, Saftlas AF, Morriss FH, Jr. Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003. Public Health Nutr. 2012;15(4):702-710.
  4. Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2019. Open access.

Your Data in Action

This report is made possible by Vermont Oxford Network members who voluntarily contribute data in a global effort to improve the care of high-risk newborns. VON members can view center-specific data by logging on to Nightingale and benchmark against this NICU by the Numbers report.

Editor: Erika Edwards, PhD, MPH

Analyst: Lucy Greenberg, MS


Back to all NICU by the Numbers data briefs