Tuesday, August 24, 2010

Increasing breastfeeding rates in Canada

Giselle Bündchen caught a lot of flack recently for suggesting that all new mothers should be legally obligated to breastfeed for the first six months of a baby's life. While the suggestion that breastfeeding should be legally mandated is admittedly ludicrous, I can appreciate the sentiment behind her suggestion. Breastmilk is best, breastfeeding rates are lower than they should be, what can be done to change that?

I realize that there's a perception that things are 'just fine' with respect to breastfeeding rates in Canada, however, the duration of breastfeeding rates has been declining since 1960:

Recent Canadian statistics show that while almost 75% of mothers begin breastfeeding in hospital, only 60% and 30% are still exclusively breastfeeding at 3 and 6 months, respectively (Health Canada, 1996). By 9 months, only 18% of mothers still breastfed in a Vancouver cohort (Williams et al., 1996). Breastfeeding trends vary across the provinces; rates are higher in the west and drop off from Quebec to the east (Health Canada, 1996). Breastfeeding initiation and maintenance rates increase with increasing education and income levels. This suggests that there are many social factors that influence the method of infant feeding (Health Canada, 1996).

There are a number of things parents-to-be can do to increase the likelihood of a successful breastfeeding relationship, however, it is fair to suggest that more can be done to improve breastfeeding rates. If the Canadian government is going to recommend breastfeeding children until two years of age, it's not outrageous to suggest the government can do more to increase breastfeeding rates across the country.

Introduce information about breastfeeding into the school curriculum. Children need to know what breasts are for. Not all children are exposed to breastfeeding women and babies, introducing the idea of breastfeeding at an early age will help children develop a healthy attitude towards breastfeeding.

Encourage the use of human milk banks. Historically, babies who were not breastfed by their mothers were breastfed by relatives, friends, or hired help. Donated breastmilk is the next best thing to a mother's own breastmilk. Mothers who donate to human milk banks are medically screened, and their breastmilk is pasteurized. There is only one human milk bank in Canada -- why aren't there more?

Make formula available by prescription only. Harsh? Maybe, but it would reinforce the idea that formula should be a last-case resort. Obviously, donated human milk would have to be readily available to make prescription-only formula feasible.

Make lactation consultations a government-funded health service. Lactation consultants typically charge upwards of $70.00 per hour, however, it is money well-spent when you consider the health benefits offered to a mother and her baby by a successful breastfeeding relationship. If mothers need help, financial status should not determine who gets help.

Make ongoing, formal breastfeeding education compulsory for all physicians. I am SHOCKED at the stories I hear from women about incorrect advice received from the medical establishment. Clearly, many doctors are not capable of dispensing medical advice as it relates to a breastfeeding baby, or a lactating mother. Often the first line of defense when breastfeeding problems are encountered, they should be in a position to help, not hamper, the breastfeeding relationship.

As a first-time mother, Giselle Bündchen approached the subject with a holier-than-thou self-righteousness we have all been guilty of at some time or other. However, I think her motivation behind making the suggestion was a noble one. A positive attitude towards breastfeeding should not be mistaken as judgement against those who were not able to breastfeed their babies. The next time Ms. Bundchen chooses to speak out in favor of breastfeeding, I hope she chooses her words more carefully.


  1. I agree with most of your suggestions here. I don't think we need to go as far as making formula available only by prescription, but I do think that the Government of Canada should:

    1) Ensure that the hospitals it is funding all work towards the Baby Friendly Hospital status, which would involve significantly better breastfeeding support during the early days.

    2) Follow through on their endorsement of the WHO Code of Marketing of Breastmilk Substitutes by making it illegal for companies to promote infant formula, bottles, pacifiers, complimentary foods for babies under 6 months, etc. Those products should be available, but they shouldn't be promoted (advertising, sale prices, freebies, etc.).

  2. Canada is NOT doing enough! When I had my first in the hospital I got horrible BF "support". They took my son for "monitoring" and fed him a bottle of formula against my wishes! The hospital LC had cases of RTF formula right underneath the scale in her office, and she used them liberally when she wasn't satisfied with babies weight gains while running the BF clinic, never mine though, I wouldn't allow it.

    Doctors are horribly undereducated on BF- it is shameless!!! My SIL had a baby last year, her doctor told her she was too small to BF such a large baby (10.9 lbs!) but she did, and he was 23 lbs at 6 months- EBF! Then he told her she'd have to choose between birth control and breastfeeding! This is not right that a government payed employee can pass off this crap as medical advice!! Drives me nuts...

    Oh, and I think they need to teach girls some of the wonders of breastfeeding (not only for the baby, but hello lower breast cancer rates!!) in health classes at school.

  3. Another role that government has to play is in the support they provide new moms in the first year in the form of EI maternity/parental benefits.

    I'll be interested to see what happens to breastfeeding rates now that self-employed women (finally) qualify for maternity/parental benefits under EI.

    We know that the US has lower mid-term (I'm reserving the term long-term for EBF past a year) breastfeeding rates because women have to go back to work after 12 weeks. I'm sure that for many self-employed women in Canada, that's been the case too. I'd also be interested, if it is determined that 3 and 6 month breastfeeding rates increase with self-employed women being able to take time off, to see what percentage of employee Canadian women actually take the full year (because, let's face it, 55% up to 430 a week isn't a lot) and how that impacts mid-term breastfeeding rates.

  4. If working is a factor in BFing, then maybe try a carrot approach: If women are still BFing, they can get extra time off work. That would be quite an incentive!

  5. "Make lactation consultations a government-funded health service." Yes! Please!

    Currently, hospital breastfeeding clinics are funded at the discretion of the hospital and when money gets tight services get cut (or fees are charged and/or increased).

    As a midwifery client, I had limited access to the breastfeeding clinic at the hospital in my neighbourhood (where services were recently reduced due to lack of funding). So, I travelled across the city to another hospital clinic that was more accessible (i.e. no appointment required), but eventually received the support I really needed at the Newman clinic which receives no government funding - they bill OHIP for the doctor portion of the visit, but the lactation consultants are not covered. They charge a visit fee (which keeps increasing) and rely on charitable donations to continue to operate and provide the online resources that are available to the general public.

    Solid funding for lactation support is crucial - International Board Certified Lactation Consultants should be recognized as regulated health professionals and their services covered by provincial health care or in some way be covered by government funds.

  6. Are you being facetious when you suggest making formula available by prescription only? Let me ask you another question, did you have problems with nursing? And more questions: Did you do everything within your means and more and were still not able to provide enough milk to support the growth of your child? Did you attempt to nurse for an hour at a time and your child still wanted more? Do you think that you should then have to make an appointment with your doctor (whom SHOCK you with their incorrect advice) to confess that you cannot support your child and need help. How hard to do you think it would be to do this? Do you really think that mothers, new or not, want to turn to formula as the quick fix? Sure, let's make mothers feel even worse about their hard made decision to introduce formula. Why do women do this to other women? Why do you want someone (a potential customer even) who is probably feeling insecure at being a new mom (and do you remember that feeling? the doubt, the fear of screwing up?) to feel worse about what so many women say comes naturally and doesn't to her?

    Oh, and you might want to check a few more statistics. This research (http://www.statcan.gc.ca/studies-etudes/82-003/archive/2005/7787-eng.pdf) says that: “The estimated 85% of mothers who, according to the results of the 2003 Canadian Community Health Survey, attempted to breastfeed their infant is a marked increase since the mid-1960s. In that era, only about 25% of mothers breastfed their baby during their hospital stay. By the 1980s, an estimated 62% of mothers had at least initiated breastfeeding and in the early 1990s, the figure had risen to almost 75%.” If you look at the trending statistics, this would indicate that now, in 2010, the figure should be over 90%. NINETY percent of women are at least attempting to breastfeed. Let’s also think about the rise in baby-centric thinking. Your store is a good indicator of this. How many other similar places are popping up around North America and Europe? Look at the media and how it jumped on Salma Hayek breastfeeding the baby in Africa, your own quote about Giselle Bündchen, and countless outraged women (and men) when someone is asked to cover up in a restaurant/pool/public place. It’s out there and women are becoming more educated and aware.

    So when it doesn’t come easily to a woman, how do you think she feels?

    I absolutely and wholeheartedly support having breastfeeding being the first option. And providing a woman with everything that is available, without barriers, to breastfeed first, but c'mon, don't demonize formula or the woman that gives it to her infant.

  7. McFishing, I was referencing breastfeeding duration in regard to government stats, not breastfeeding attempts (big difference!). And as I suggested above, making formula prescription-only would only be possible if donated human milk was readily available. Pro-breastfeeding does not equate with anti-formula feeding. In suggesting ways for our government to step up and help make what they recommend a reality, it's not my intent to make formula-feeding mothers feel bad, quite frankly, I find the suggestion insulting.

  8. While I was successful in breast feeding my 2 daughters I do know of several mothers that were not. I don't think it is anybody's business to mandate a woman to breastfeed. Plenty of support is available to mothers around the globe who want the help but not everyone is comfortable with sharing their breasts & should not feel shamed if they choose not to.

    Instead of being critical we should try to be supportive of a woman's personal choice.

  9. I have to wonder if making formula prescription only wouldn't actually help a lot of women who have to formula feed. At that point it would become covered under many insurance plans which would drastically reduce the cost for when formula is necessary. Obviously it wouldn't help ALL women because not everybody has extra coverage, but many do.

  10. I think changing infant formula to prescription-only would change ppl's mindset about infant formula. It should be a last-case resort, however, under current conditions (lack of milk banks, high out-of-pocket cost of lactation consults), it's a necessity.

  11. I absolutely agree that formula should be by px only. It would benefit everyone, including the moms who NEED to formula feed. Also, it would be covered by insurance, so it would help with cost issues. Plus, formula IS a pharma product manufactured by pharmaceutical companies and it should be treated as such, with regards to availability and regulation. It makes perfect sense!