title: Breastfeeding status on US birth certificates: where do we go from here?
abstract: OBJECTIVE
  The objectives of this study were to assess the extent to which states collected breastfeeding data on the birth certificate, to verify the wording of the breastfeeding questions used, and to develop recommendations for future revisions of the breastfeeding question asked on the US Standard Certificate of Live Birth.
  
  
  METHODS
  Registrars of vital statistics in US states and territories were contacted via telephone with e-mail follow-up between April 2006 and May 2008 to determine whether their state/territory collected breastfeeding data on its birth certificate. Responses were categorized as follows: (1) breastfeeding data currently collected; (2) breastfeeding data not currently collected but implementation date set; or (3) breastfeeding data not currently collected and no implementation plans.
  
  
  RESULTS
  In May 2008, 56.6% (30 of 53) of US states and territories were collecting data on breastfeeding status at hospital discharge on their birth certificate. The questions used to collect breastfeeding data, however, had not been standardized. Approximately one quarter (12 of 53) reported that they were not yet collecting breastfeeding data on their birth certificate but that an implementation date had been set. Approximately one fifth (11 of 53) indicated that their state birth certificate did not plan to collect breastfeeding data by January 2010.
  
  
  CONCLUSIONS
  A total of 79% of the registrars reported that breastfeeding data were collected on the birth certificate or that the process would begin within the next 2 years. Future revisions to the Standard Certificate of Live Birth breastfeeding question should assess breastfeeding exclusivity. The revision process should include feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and extensive training before data collection.
authors.affiliation: University of Connecticut, Department of Nutritional Sciences, 3624 Horsebarn Rd Extension, Storrs, CT 06269-4017, USA. donna.chapman@uconn.edu
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Chapman
authors.forename: Anne
authors.initials: A
authors.lastname: Merewood
authors.forename: Robert Ackatia
authors.initials: RA
authors.lastname: Armah
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001719:Birth Certificates; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior; D009751:Nutritional Requirements; D012042:Registries; D012680:Sensitivity and Specificity; D014481:United States; D055815:Young Adult