The number of breastfed infants in the nation is on the rise, but local lactivists want to see more mothers choosing to breastfeed.

In 2011, the Centers for Disease Control Breastfeeding Report Card showed South Dakota was above the national average for the percentage of infants born that year who were breastfed. In 2012, South Dakota jumped above the national average in every category, even as national averages increased by about 5 percent.

"I think we are seeing the increase in part because of baby friendly facilities," said Anne Kelly, of Mitchell, a leader in the La Leche League, an organization that promotes breastfeeding. "There have been changes within hospitals to promote breastfeeding."

South Dakota is ranked fifth in the percentage of infants breastfed at six months of age. In 2011, the percentage of infants born that year that were ever breastfed was 69.9 percent. In 2012, 79.1 percent of infants were ever breastfed. In 2011, 15.2 percent of infants were exclusively breastfed at six months, with 22.1 percent in 2012.

The percentage of infants who are exclusively breastfed at three months has dropped. In 2010, 43.6 percent of infants were exclusively breastfed at three months, while in 2012 it was only 39.9 percent.

Kelly attributes the upward trends to the attention to breastfeeding at hospitals, including Avera Queen of Peace Hospital's recent hiring of a lactation consultant and the option the hospital has for mothers to rent breast pumps.

Breast milk contains antibodies that help fight and prevent bacteria and viruses. It's been associated with lower rates of childhood obesity and mortality, and has been linked to lower allergies and asthma in older children. The CDC has named breastfeeding a national priority.

World Breastfeeding Week is Aug. 1-7, and August is Breastfeeding Awareness Month. The local La Leche League does not have an event planned, but Kelly said the league wants to spread and promote breastfeeding in a community where she doesn't see many breastfeeding mothers.

Kelly said mothers, especially new moms, can find giving a baby a bottle an easier alternative to breastfeeding when it's 3 a.m., the mother is exhausted and there's a crying baby. Working moms may not have an opportunity outside of a lunch break to nurse, and some fathers want to give a baby a bottle of formula to bond with the child.

Kelly said she also hears concerns from mothers who worry if their baby is receiving enough milk because they can't see how much milk the baby is consuming while breastfeeding. She recommends looking for growth in a baby and wet diapers as confirmation the baby is being adequately fed.

While breastfeeding numbers in South Dakota are strong, a 2011 CDC study on maternity practices in infant nutrition and care in the state shows gaps in breastfeeding support in facilities.

According to the survey, only 37 percent of facilities in the state follow standard clinical practice guidelines against routine supplementation with formula, sugar water or water. Only 10 percent of facilities in the state adhere to clinical and public health regulations against distributing formula company discharge packs. The state ranks 44 out of 53 in breastfeeding support in facilities, and has a composite score of 63 out of 100.

A new survey is expected this year.

Kelly, who is a professor of psychology at Dakota Wesleyan University, breastfed her three children. Her two youngest children were born at the end of a spring semester, and nursing didn't conflict with her teaching schedule. When her oldest child was born during August, she lived next to campus and pumped.

"I credit some of that success to the support I had with DWU," Kelly said. "But, had it been a different situation, I would have hoped that my employer would have given me a place to pump. I have heard some people who have come to group meetings where they don't have support in the workplace."

With breastfeeding linked to lower sickness rates in infants, Kelly said employers can benefit from supporting breastfeeding because fewer days are taken off to deal with a sick child. "Mothers should be able to do this outside a bathroom stall, and not sitting on a toilet," Kelly said. "People are responding to that as well. We just see more conversation. That is the kind of activity that will normalize this."

Day cares, she said, also would benefit because there would be fewer sick children in a facility.

Kelly hasn't seen many mothers breastfeeding in Mitchell, whether because of the choice to breastfeed, work schedules or a stigma about public breastfeeding.

"We have no reservation about plastering [breasts] all over billboards and magazine covers," Kelly said. "We want people to accept that feeding your child is the most natural thing to do."

She hasn't heard stories about LLL members being kicked out of businesses or publicly scrutinized, mainly because breastfeeding is usually done discreetly.

"I don't think anyone notices," Kelly said. "Nobody rips off their shirt and their bra and sits there unclothed."

South Dakota law protects breastfeeding mothers from public indecency laws. Breastfeeding mothers can be exempt from jury duty, but there is no language in the state code that specifically allows breastfeeding in any public location.

The local Le Leche League will begin a series of meetings from 9 a.m. to 11 a.m. Sept. 14 at Cornerstone Coffeehouse & Deli in Mitchell. Meetings run September through April on the second Saturday of every month.