Tennessee Opportunities for Improvement in Breastfeeding

The month of August is National Breastfeeding Month and provides an opportunity for us to reflect on breastfeeding rates and practices.  The CDC recently released the results of the revised Maternity Practices in Infant Nutrition and Care Survey (mPINC).  Forty-four of Tennessee’s birthing hospitals completed the survey and the state received a score of 72/100 or 49th place (out of 51). View the full report here.

What are the TN opportunities for improvement?

  • Provide uninterrupted skin to skin time after delivery
  • Encourage mom and baby to share a room and perform all care in that space
  • Purchase formula (like other hospital items) and stop giving free samples / industry sponsored gifts to families
  • Avoid non-medical supplementation
  • Develop a written policy that supports best breastfeeding practices

Why are these practices important?  The state of Tennessee traditionally lags behind the US average in breastfeeding initiation but over the past 5 years or so, we have made modest gains so that 80.8% of our TN infants had breastfeeding initiated.  But we must look deeper into that percentage and ask ourselves is that equitable to all infants?

Sadly, the answer is NO!  The breastfeeding initiation rate of Non-Hispanic Black Infants continues to be lower than that of Non-Hispanic White Infants, although the optimist in me sees that the gap is closing a little maybe due to hard work of groups like BSTARS ( and ROSE (  We must be purposeful in addressing this disparity.  What are some concrete steps that you can take in your settings?  We would love to hear your ideas!

Anna Morad, MD, FAAP is an Associate Professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt in the Division of Academic General Pediatrics, and is the Medical Director of the Newborn Nursery. She is also the current active Infant Medical Director for the Tennessee Initiative for Perinatal Quality Care.