NCHS Data Brief ¡ No. 5 ¡ April 2008

Breastfeeding in the United States: Findings from the 

National Health and Nutrition Examination Surveys, 1999–2006

Margaret M. McDowell, M.P.H., R.D.; Chia-Yih Wang, Ph.D.; and Jocelyn Kennedy-Stephenson, M.S.

Key findings

Data from the National 

Health and Nutrition 

Examination Surveys

• The percentage of infants 

who were ever breastfed 

increased from 60% among 

infants who were born in 

1993–1994 to 77% among 

infants who were born in 

2005 –2006. 

• Breastfeeding rates 

increased significantly among 

non-Hispanic black women 

from 36% in 1993–1994 to 

65% in 2005–2006. 

• Breastfeeding rates in 

1999–2006 were significantly 

higher among those with 

higher income (74%) 

compared with those who had 

lower income (57%).

• Breastfeeding rates among 

mothers 30 years and older 

were significantly higher than 

those of younger mothers. 

• There was no significant 

change in the rate of breastfeeding at 6 months of age for 

infants born between 1993 and 

2004.

Human milk is the ideal food for most infants. Breastfeeding benefits infants 

and their mothers (1). Breastfed infants receive antibodies from breast milk, 

which protect against infection in the early postpartum period, and breastfeeding is less expensive than formula feeding. This report summarizes information on breastfeeding rates in the United States based on data from the 

1999–2006 National Health and Nutrition Examination Surveys (NHANES). 

Results are reported for the total U.S. population and three race-ethnicity 

groups by birth year cohort.

Keywords: Breastfeeding • Prevalence • Trends • National Health and Nutrition Examination Survey

Have breastfeeding rates in the United States changed over 

time?

Breastfeeding rates have increased in the United States.

0

10

20

30

40

50

60

70

80

1993–

1994

1995–

1996

1997–

1998

1999–

2000

2001–

2002

2003–

2004

2005–

2006

Birth cohort

Percent

HP 2010

target

NOTE: The trend over time is statistically significant.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. 

Figure 1. Percentage of infants who were ever breastfed by birth cohort: 

United States, 1993–2006

60 60

64 67 67

70

77

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
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NCHS Data Brief ¡ No. 5 ¡ April 2008

Breastfeeding rates in the United States increased significantly between 1993 and 2006. The percentage of infants who were ever breastfed increased from 60% among infants born in 1993–1994 

to 77% among infants born in 2005–2006. 

For infants born in 2005–2006, the percentage who were ever breastfed exceeded the Healthy 

People 2010 target of 75% (2). 

Are children from some population subgroups more likely to be breastfed 

than others?

Mexican American and non-Hispanic white children were significantly more likely to have been 

breastfed compared with non-Hispanic black children in each birth year cohort. 

In the 2005–2006 birth cohort group, 65% of non-Hispanic black infants were breastfed 

compared with 80% of Mexican American and 79% of non-Hispanic white infants. 

Although breastfeeding rates were significantly lower among non-Hispanic black infants, significant increases in breastfeeding rates have occurred in this group. 

The percentage of non-Hispanic black infants who were ever breastfed increased from 36% for 

those born in 1993–1994 to 65% for those born in 2005–2006. 

The observed increases in breastfeeding rates for non-Hispanic white and Mexican-American 

infants were not statistically significant. 

0

10

20

30

40

50

60

70

80

90

1993–

1994

1995–

1996

1997–

1998

1999–

2000

2001–

2002

2003–

2004

2005–

2006

Non-Hispanic white

Non-Hispanic black1,2

Mexican American

Percent

Birth cohort

1

Significant increase in trends over time for non-Hispanic black infants.

2

Non-Hispanic black infants are significantly different from non-Hispanic white and Mexican-American infants in 

each birth cohort. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. 

Figure 2. Percentage of infants who were ever breastfed by birth cohort and 

race-ethnicity: United States, 1993–2006
NCHS Data Brief ¡ No. 5 ¡ April 2008

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Do breastfeeding rates differ by other sociodemographic characteristics?

Breastfeeding rates were lower for infants in low income families.

Breastfeeding rates were examined by income status group. Income status was defined using the 

poverty income ratio (PIR), an index calculated by dividing family income by a poverty threshold 

that is specific for family size (3). Low income was defined as PIR less than or equal to 1.85, and 

high income was defined as PIR greater than 1.85. For the total population, the proportion of 

infants who were ever breastfed was lower among infants whose families had lower income 

(57%) compared with infants whose families had higher income status (74%). 

The differences in breastfeeding rates by family income status were only observed among nonHispanic white and non-Hispanic black infants, but not among Mexican-American infants. 

Within each income group, the breastfeeding rates for non-Hispanic black infants were significantly lower compared with the breastfeeding rates among non-Hispanic white and MexicanAmerican infants. 

0

10

20

30

40

50

60

70

80

Total Non-Hispanic

white 

Non-Hispanic

black

Mexican

American

PIR less than or equal to 1.85 PIR greater than 1.85

Percent

1

Significant differences between the two income groups.

2

Significantly different from non-Hispanic white and Mexican-American infants within income groups.

NOTES: Income status was defined using the poverty income ratio (PIR), an index calculated by dividing family 

income by a poverty threshold specific for family size. Low income was defined as PIR less than or equal to 1.85, 

and high income was defined as PIR greater than 1.85. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. 

Figure 3. Percentage of infants who were ever breastfed by poverty income ratio 

(PIR) and race-ethnicity: United States, 1999–2006

1

57

74

1

55

76

1,237

2

58

74 74

Infants whose mothers were younger were less likely to have been breastfed.

Breastfeeding rates increased significantly with increasing maternal age overall and for all raceethnicity groups. The breastfeeding rates of mothers who were under 20 years of age (43%) were 

lower compared with mothers who were 30 years and older (75%) or 20–29 years of age (65%). 
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NCHS Data Brief ¡ No. 5 ¡ April 2008

Within maternal age groups, there were race-ethnicity differences in breastfeeding rates. Mexican-American infants who were born to mothers under 20 years of age had a significantly higher 

breastfeeding rate (66%) compared with non-Hispanic white (40%) and non-Hispanic black infants (30%). Non-Hispanic black infants whose mothers were 20–29 years or 30 years and older 

were significantly less likely to be breastfed than their non-Hispanic white and Mexican American counterparts.

0

10

20

30

40

50

60

70

80

Total Non-Hispanic

white

Non-Hispanic

black

Mexican

American

Under 20 years 20–29 years 30 years and older

Percent 1

Mexican-American infants were significantly different from non-Hispanic black infants within maternal age groups.

2

Significantly different from non-Hispanic white infants and non-Hispanic black infants.

NOTE: Trend test for breastfeeding rate by maternal age was statistically significant in the total population and 

each race-ethnicity group.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey. 

Figure 4. Percentage of infants who were ever breastfed by maternal age and 

race-ethnicity: United States, 1999–2006

43

65

75

40

65

77

30

44

56

1,266

1

75 1

76

Has there been a change in the United States in the proportion of infants 

who are still breastfed at 6 months of age?

There was no significant change in the rate of breastfeeding at 6 months of age for infants born 

between 1993 and 2004.

The rates of breastfeeding at 6 months of age were computed for each birth year cohort using 

information from NHANES 1999–2004 for infants 6 months of age and older. The NHANES 

2005–2006 data were not included in the analysis because the sample size for the birth year 

cohort was too small to produce reliable estimates. 

 Overall, the rates of breastfeeding at 6 months of age were significantly higher among MexicanAmerican (40%) and non-Hispanic white infants (35%) compared with non-Hispanic black 

infants (20%), but the rates for Mexican-American and non-Hispanic white infants were not 

significantly different.

The Healthy People 2010 target goal for breastfeeding at 6 months of age is 50% (2). None of the 

race-ethnicity groups achieved the target goal. 
NCHS Data Brief ¡ No. 5 ¡ April 2008

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0

10

20

30

40

50

1993–1994 1995–1996 1997–1998 1999–2000 2001–2002 2003–2004

Total Non-Hispanic white

Non-Hispanic black

Mexican American

NOTES: Mexican-American infants significantly higher than non-Hispanic black infants in all birth cohorts.

Non-Hispanic white infants significantly higher than non-Hispanic black infants in all birth cohorts except the 

2001–2002 cohort.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

Figure 5. Percentage of infants who were still breastfed at 6 months of age by 

birth cohort and race-ethnicity group: United States, 1993–2004 Percent

HP 2010 target goal

Summary

Breastfeeding rates in the United States have increased significantly among infants born between 

1993–1994 and 2005–2006. In 2005–2006 the rates of breastfeeding exceeded the Healthy People 

2010 goal of 75%. The rates of breastfeeding at 6 months of age did not achieve the Healthy 

People 2010 target goal of 50% (2). Breastfeeding rates were associated with race-ethnicity, 

maternal age, and family income status, thus underscoring the need to continue breastfeeding 

promotion and intervention activities that target diverse populations. 

Diet is an integral component of infant and child growth and development, and healthy feeding practices have benefits that continue into childhood and adolescence. Breastfeeding benefits 

mothers and babies. Information on breastfeeding is posted on the HHS Blueprint for Action on 

Breastfeeding website (4). 

Definitions

Breastfeeding was defined as ever having been breastfed or received breast milk. 

Ever breastfed was defined by the following question: “Was {name of the infant/child} ever 

breastfed or fed breast milk?” The question was part of the Diet Behavior and Nutrition (DBQ) 

section of the NHANES household questionnaire (5). 

Breastfed at 6 months was defined by the following question: “How old was {name of infant/

child} when {he/she} completely stopped breastfeeding or being fed breast milk?” The question 

was part of the Diet Behavior and Nutrition (DBQ) section of the NHANES household question-
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NCHS Data Brief ¡ No. 5 ¡ April 2008

naire (5). All infants and children 6 months of age and older were included in the analysis. 

Infants and children who stopped breastfeeding or being fed breast milk after 6 months of age 

were considered to be breastfed at 6 months of age.

Poverty status was defined using the poverty income ratio (PIR) criterion (3). A PIR cut-point of 

1.85 was chosen because this is the income cut-point used to determine eligibility in The Special 

Supplemental Nutrition Program for Women Infants and Children (WIC) (6).

Data source and methods

NHANES is a continuous survey of the civilian, noninstitutionalized U.S. population. The survey 

is conducted to assess the health and nutritional status of the U.S. population. Survey participants 

are asked to complete household interview and health examination components. The annual 

interviewed and examined samples include approximately 5,000 persons of all ages. In 1999–

2006, non-Hispanic black persons, Mexican-American persons, adolescents 12–19 years, adults 

60 years and older, and persons with low income were oversampled to improve the reliability of 

the statistical estimates for these groups. 

This report is based on an analysis of household interview data. English and Spanish language 

questionnaires were used. A proxy respondent, usually one of the child’s parents, answered the 

breastfeeding and infant feeding questions for infants and children from birth through 6 years of 

age. 

Birth cohort groups, which were based on date of birth were created for each 2-year survey 

period. The sample sizes for each of the birth cohorts are as follows:

Birth 

Cohort 

Group

1993–

1994

1995–

1996

1997–

1998

1999–

2000

2001–

2002

2003–

2004

2005–

2006

Sample 

size 369 793 1,409 2,040 1,641 1,182 434

The survey sample weights were used for all analyses. The sample weights account for the differential probabilities of selection, nonresponse, and noncoverage. The weights are incorporated into 

the estimation process. The standard errors of the percentages were estimated using Taylor series 

linearization, a method that incorporates the sample weights and sample design.

Differences between groups were evaluated using a univariate t-statistic. Trend tests were done to 

evaluate changes in the estimates over time. All significance tests were two-sided using p <0.05 

as the level of statistical significance. All comparison findings reported are statistically significant 

unless otherwise indicated. All data analyses were performed using the statistical packages SAS 

version 9.1 (SAS Institute, Cary, N.C.) and SUDAAN version 9.0 (RTI, Research Triangle Park, 

N.C.).
NCHS Data Brief ¡ No. 5 ¡ April 2008

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About the authors

Margaret A. McDowell and Chia-Yih Wang are with the Centers for Disease Control and 

Prevention’s National Center for Health Statistics, Division of Health and Nutrition Examination 

Surveys. Jocelyn Kennedy-Stephenson is with Northrop Grumman under contract to the Centers 

for Disease Control and Prevention’s National Center for Health Statistics.

References

1. American Academy of Pediatrics Policy. Statement on breastfeeding and the use of human 

milk. Pediatrics 2005; 115(2), 496–506. Available from: http://www.healthychildcare.org/pdf/

BFPolicy.pdf [Accessed 2/20/08].

2. U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: 

U.S. Department of Health and Human Services. 2000. Available from: http://www.healthy

people.gov/document/html/objectives/16–19.htm [Accessed 2/20/08]. 

3. U.S. Census Bureau. Poverty thresholds for 2006 by size of family and number of related 

children under 18 years. 2007. Available from: http://www.census.gov/hhes/www/poverty/

threshld/thresh06.html [Accessed 2/20/08].

4. U.S. Department of Health and Human Services. HHS blueprint for action on breastfeeding. 

Washington, DC: U.S. DHHS, Office of Women’s Health. 2000. Available from: http://www.cdc.

gov/breastfeeding/pdf/bluprntbk2.pdf [Accessed 2/20/08]. 

5. Centers for Disease Control and Prevention. National Center for Health Statistics. National 

Health and Nutrition Examination Survey Questionnaire Data. Diet behavior and nutrition 

(DBQ) section. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention, 1999–2006. Available from: http://www.cdc.gov/nchs/about/

major/nhanes/datalink.htm [Accessed 2/20/08].

6. U.S. Department of Agriculture. The Special Supplemental Nutrition Program for Women, 

Infants, and Children (WIC). Nutrition program facts. Available from: http://www.fns.usda.gov/

wic/WIC–Fact-Sheet.pdf [Accessed 2/20/08].
Suggested citation

McDowell MA, Wang C-Y, KennedyStephenson J. Breastfeeding in the United 

States: Findings from the National Health 

and Nutrition Examination Surveys 1999–

2006. NCHS data briefs, no 5. Hyattsville, 

MD: National Center for Health Statistics. 

2008.

Copyright information

All material appearing in this report is in the 

public domain and may be reproduced or 

copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Director

Edward J. Sondik, Ph.D.

Acting Co-Deputy Directors

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Michael H. Sadagursky

U.S. DEPARTMENT OF 

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention 

National Center for Health Statistics

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NCHS Data Brief ¡ No. 5 ¡ April 2008

ISSN 1941-4927 (Print ed.)

ISSN 1941-4935 (Online ed.)

CS116353

T31209 (04/08)

DHHS Publication No. (PHS) 2008–1209