Why is it so hard for mothers to breastfeed in Canada?

An Icelandic MP breastfed her baby while delivering a speech in parliament recently. No one reacted to her breastfeeding, because in Iceland, breastfeeding is the cultural norm. The mother stated this was the most natural thing in the world.

If only that were the case in Canada.

According to Statistics Canada, while Canada has made significant strides toward breastfeeding as a cultural norm—89 per cent of women initiated breastfeeding in 2012, compared to 69 per cent in 1982—we still have a long way to go.

Why is breast feeding so important?

Overwhelming evidence shows breastfeeding is good for babies’ brains and for social development. Breastfed babies are thought to thrive because of the health qualities of breastmilk in combination with the healthy relationships promoted by close contact between mom and baby.

Breastfeeding is also convenient—just ask any breastfeeding mom. Breast milk is always available, the right temperature, clean and perfectly timed to an infant’s feeding needs, as the baby grows and even over the course of a single feeding. It’s also free.

What could be more natural?

There are also risks for not breastfeeding—for mothers and babies. Mothers who don’t breastfeed have an increased risk of cardiovascular disease, type 2 diabetes, breast and ovarian cancers, and delayed return to healthy weight. Infants who are not breastfed have a higher risk of sudden infant death syndrome, common childhood illnesses, childhood obesity, cancer and diabetes.

So what’s the barrier?

Iceland, people grow up seeing breastfeeding in public. By contrast, in Canada baby formula as an alternative to breast milk is promoted widely to parents in many ways: through free samples and coupons, through disguised “educational” materials on baby feeding with an emphasis on formula, and showcased in parenting books and magazines.

The Canadian health-care system contributes to a formula feeding culture when some hospitals and other health facilities contract with formula companies, whose product is then promoted in the institution, thus providing credibility. Evidence shows that mothers are more likely to initiate breastfeeding and breastfeed longer when their baby is not offered or supplemented with formula in the hospital unless medically indicated.

With such an emphasis on formula, it’s difficult for breastfeeding to become the cultural norm in Canada—or for families to make an informed decision about feeding babies, free from commercial influence.

Not surprisingly, even amongst those who decide to breastfeed, data from the Alberta Pregnancy Outcomes and Nutrition study showed that only 54 per cent of mothers are exclusively breastfeeding by the time their babies are three months of age and only 15 per cent by six months of age.

There is a way that our situation can be turned around. Canadian hospitals should adopt the World Health’s Organization’s Baby-Friendly Initiative (BFI). Hospitals must take 10 steps to achieve BFI standing.

One of the steps requires hospitals to reject contracts for free or reduced cost formula, and they are not permitted to market formula to their patients. In BFI hospitals, formula is only used if medically indicated and, when given, the formula label is removed. A few Canadian hospitals (about five per cent) have achieved BFI designation.

Of course, not all moms are able to breastfeed, or choose not to. All the more reason to support all mothers in finding the best way to nourish their baby. We can do this by providing support for women who want to breastfeed and are struggling, as well as promoting healthy alternatives.

Prenatal education should include information on how to access lactation consultants—experts trained in the art of breastfeeding—as well as breastfeeding support call centres and healthy alternatives to breast milk. In several locations across Canada, La Leche League provides a free mother-to-mother support call line.

Promoting a breastfeeding culture should not be seen as an affront to women who, for whatever reason, choose to formula feed their babies. We live in a society where multiple approaches are respected. BFI doesn’t advocate one size fits all. Rather, it advocates promoting the best evidence so everyone can make the most informed decisions about baby feeding.

As funders, provincial governments should direct hospitals and other health facilities to take concrete steps to create a baby-friendly environment, which includes promoting breastfeeding and ceasing contractual arrangements that may provide a modest advantage to the hospital budget but disadvantage babies.

Members of the public can help by supporting women’s right to breastfeed in public and lead the way towards demanding baby-friendly standards in health-care settings.

— Nicole Letourneau is an expert adviser with EvidenceNetwork.ca and the author of Scientific Parenting: What Science Reveals about Parental Influence. She is a professor in the Faculties of Nursing and Medicine. She also holds the Norlien/Alberta Children’s Hospital Foundation Chair in Parent-Infant Mental Health at the University of Calgary.

— Mary Lougheed is a certified Lactation Consultant (IBCLC) with the BFI Research Group of the Calgary Breastfeeding Matters Group Foundation, and has worked as an IBCLC for over 20 years. She is a board member of the Calgary Counselling Centre, and a past board member of the Calgary United Way, the Calgary Women’s Emergency Centre, and past member of the Calgary Poverty Reduction Coalition.



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