More than three out of four new Arizona moms start breastfeeding after they give birth.
About three months later, 20 percent are still nursing. But by the time infants reach 12 months of age, just 15 percent continue to breastfeed.
Arizona health officials hope to change that.
The state launched the "AZ Baby Steps to Breastfeeding Success" effort last year, but the first training of hospitals begins this month.
Adrienne Udarbe, community program manager in the health department's Bureau of Nutrition and Physical Activity, said there are a number of reasons moms stop nursing or expressing milk three months after birth.
"That's the time a lot of women go back to work or school. They don't have the resources they need to realize they can continue," she said.
Hospitals are being asked to adopt five steps while a woman is still in the hospital after birth to improve the odds that moms will commit to nursing longer.
The steps include: initiate breastfeeding within the first hour after birth; avoid giving the baby fluids other than breast milk while in the hospital; keep mom and baby together during their entire hospital stay (also known as "rooming in"); avoid pacifier use during hospital stay; and provide access to the state's 24-hour help hotline, (800) 833-4642.
"The goal is not to just increase initiation, but duration as well," Udarbe said. "We know when they get off to a good start they're more likely to continue to breastfeeding."
Banner Gateway Hospital's Julia Kalehuawehe, a registered nurse and 19-year international board certified lactation consultant, said her staff will participate in training later this month.
About 92 percent of moms at the hospital initiate nursing, she said.
"The first hour is so important. The babies are really in tune, awake and alert. They do really go at it that first feeding. We know the chances of success go up just from that first feeding," she said.
The hospital also provides a bi-monthly support group for nursing, as well as training during a mom and baby's stay.
The toughest steps for hospitals will be educating moms that babies don't automatically need a pacifier while they're in a hospital.
"If they watch the baby's cues, they don't have to give a pacifier," those first few days, she said. Once good nursing habits are created, pacifier use can be initiated.
Chandler mom Susie Leo got a step up to nursing when her son was born a year and a half ago: Her employer, the state Department of Health Services, allows parents to bring their infants to work until they are 6 months old.
Now, Leo works with other department moms and dads who want to bring in their babies. The program was set up several years ago for nursing moms, but now has expanded to all parents.
But the benefit is that moms like Leo can have their baby right at their sides during the crucial nursing months.
"Really it was the health benefit to breastfeeding" that the state encourages," Leo said. "So why not encourage our employees to do it?"
Leo went on to nurse her son until he was 14 months old. The state recommends babies receive breast milk exclusively for six months, and then continue until at least 12 months, she said.
The state provides lactation rooms in offices for moms as well.
The new health care bill signed by President Obama requires employers with at least 50 employees to provide a time and place for new moms to pump, which could also increase breastfeeding in the state, officials say.