Journal of Community Health

, Volume 43, Issue 3, pp 496–507 | Cite as

Trends and Factors Associated with Breastfeeding and Infant Sleep Practices in Georgia

  • Trina C. Salm WardEmail author
  • Florence A. Kanu
  • Alex K. Anderson
Original Paper


Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004–2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.


Breastfeeding initiation Exclusive breastfeeding Infant sleep practices PRAMS Trend analysis 



Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) data were collected and provided by the PRAMS Project in the Maternal and Child Epidemiology Section of the Georgia Department of Public Health (DPH). The Centers for Disease Control and Prevention Cooperative Agreement grant number 1U01DP006194 provided funding to DPH for data collection and some staff support. We also acknowledge The PRAMS Working Group. The authors also acknowledge the efforts of Mumbi Mwaura, MSW, MPH.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was reviewed and approved by the Georgia Department of Public Health and the University of Georgia Institutional Review Boards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Trina C. Salm Ward
    • 1
    Email author
  • Florence A. Kanu
    • 2
    • 3
  • Alex K. Anderson
    • 4
  1. 1.Helen Bader School of Social WelfareUniversity of Wisconsin-MilwaukeeMilwaukeeUSA
  2. 2.Department of Epidemiology and Biostatistics, College of Public HealthUniversity of GeorgiaAthensUSA
  3. 3.Maternal and Child Health Epidemiology Section, Division of Health ProtectionGeorgia Department of Public HealthAtlantaUSA
  4. 4.Department of Foods and Nutrition, College of Family and Consumer SciencesUniversity of GeorgiaAthensUSA

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