Breastfeeding in Toronto: Promoting Supportive Environments

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Breastfeeding in Toronto Promoting Supportive
Environments
Symposium New Directions in Breastfeeding
Research Olga Jovkovic, Healthy Families
Manager, Toronto Public Health November 24, 2010
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Todays Presentation

• Key findings of the research study
• Current and future activities

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Objectives of the Research Study

• Determine breastfeeding initiation, duration and
  exclusivity rates among first-time Toronto
  mothers
• Determine factors influencing breastfeeding
  initiation, duration, and exclusivity
• Assess breastfeeding policies and practices in
  Toronto birthing hospitals
• Assess mothers experiences with community based
  breastfeeding supports and services, including
  Toronto Public Health services

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Research Study Components

• Survey of Toronto birthing hospitals
  breastfeeding policies and practices
• Survey of first-time mothers
• Two weeks postpartum (1518 mothers)
• Six months postpartum (910 mothers)
• Self-assessment of Toronto Public Healths
  breastfeeding policies and practices

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Characteristics of Mothers Surveyed

• Place of Birth 62.3 born outside of Canada
• Length of Time in Canada 33.6 of all mothers
  lived in Canada 5 years or less
• Language of Interview 14.1 interviewed in one
  of 23 languages other than English
• Marital Status 90.6 legally married/living
  common-law
• Age 81.6 between 25 and 40 years
• Annual Family Income 37.9 family income of
  80,000 or more 13.2 family
  income of less than 20,000
• Education 69.9 had at least a post-secondary
  degree/certificate/ diploma 6.0 had less than
  high school

Source Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Prepared
by Toronto Public Health
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• Mothers Reports of Intention to Breastfeed and
• Breastfeeding Initiation, Duration, and
  Exclusivity

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Breastfeeding Intention and Initiation

• 49.3 of mothers made their infant feeding
  decision before pregnancy
• 93.4 planned to breastfeed
• 95.7 initiated breastfeeding in hospital

Source Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Prepared
by Toronto Public Health
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Any and Exclusive Breastfeeding at Hospital
Discharge, Two Weeks, and Six Months
Any Breastfeeding refers to feeding breastmilk
or breastmilk and other fluids or food.
Exclusive Breastfeeding refers to feeding
breastmilk only, including expressed breast milk
or donor human milk, and undiluted drops or
syrups consisting of vitamins, mineral
supplements or medicine.
Rates are based on mothers who initiated
breastfeeding in hospital. Error bars (I)
denote 95 confidence intervals. Sources
Toronto Public Health New Mother Breastfeeding
Survey, Time 1, 2007/08 Time 2, 2008/09 Prepared
by Toronto Public Health
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Mothers Reasons for Not Breastfeeding, Stopping
Breastfeeding and Introducing Food/Fluids in
Addition to Breastmilk

• Most frequent reasons at hospital discharge and
  two weeks were
• Perception of not having enough milk
• Problems with latching baby
• Also the most frequent reasons for stopping
  breastfeeding between two weeks and six months
• Most frequent reasons for introducing food/fluids
  in addition to breastmilk between two weeks and
  six months were
• Perception of not having enough milk
• Health care professional advice
• Perception that baby was old enough/right time

Sources Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Time 2,
2008/09 Prepared by Toronto Public Health
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Exclusive Breastfeeding at Hospital Discharge, by
Hospital of Delivery
TEGH Toronto East General Hospital SHSC Sunnybrook
Health Sciences Centre SMH St. Michaels
Hospital MSH Mount Sinai Hospital SJHC St.
Josephs Health Centre NYGH North York General
Hospital HRRH Humber River Regional
Hospital-Church/Finch Sites WOHS William Osler
Health System-Etobicoke General Hospital TSH The
Scarborough Hospital-General/Grace
Campuses RVHS Rouge Valley Health
System-Centenary Site
Rates are based on mothers who initiated
breastfeeding in hospital. Error bars (I) denote
95 confidence intervals. Wide confidence
intervals, particularly for hospitals with small
sample sizes, indicate the estimate may not be
reliable due to high variability. These estimates
should be interpreted with caution. Source
Toronto Public Health New Mother Breastfeeding
Survey, Time 1, 2007/08
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• Hospital Breastfeeding
• Policies and Practices

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WHO/UNICEF Baby-Friendly Hospital Initiative
The WHO/UNICEF Ten Steps to Successful
Breastfeeding

1. Written breastfeeding policy communicated to all
   health care staff/volunteers.
2. Train all health care providers to implement the
   policy.
3. Inform pregnant women/families about
   breastfeeding.
4. Help mothers initiate breastfeeding within a
   half-hour of birth.
5. Show mothers how to breastfeed/maintain lactation
   even if separated from baby.
6. Give newborns no food/drink other than breastmilk
   unless medically indicated.
7. Practice rooming in - mothers and infants remain
   together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers to
   breastfeeding infants.
10. Foster establishment of support groups and refer
    mothers on discharge.

The WHO International Code of Marketing of
Breastmilk Substitutes (the Code)
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Hospitals Reports of Requirements Related to the
WHO/UNICEF Ten Steps to Successful Breastfeeding,
by Hospital
TEGH Toronto East General Hospital MSH Mount
Sinai Hospital SHSC Sunnybrook Health Sciences
Centre TSH The Scarborough Hospital-General/Grace
Campuses SMH St. Michaels Hospital RVHS Rouge
Valley Health System-Centenary Site NYGH North
York General Hospital HRRH Humber River Regional
Hospital-Church/Finch Sites SJHC St. Josephs
Health Centre WOHS William Osler Health
System-Etobicoke General Hospital
Source Toronto Public Health Hospital Survey of
Breastfeeding Policies and Practices, 2007/08
Prepared by Toronto Public Health
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Hospital Breastfeeding Policies and Practices
Hospitals Reports

• Toronto birthing hospitals have room for
  improvement with respect to
• Step 1 Written breastfeeding policy communicated
  to staff/volunteers (Most hospitals met 60 of
  requirements)
• Step 6 Giving newborns no food/drink other than
  breastmilk unless medically indicated (Most
  hospitals met 40 of requirements)
• Step 9 Giving breastfeeding infants no
  artificial teats/pacifiers (Most hospitals met
  75 of requirements)

Source Toronto Public Health Hospital Survey of
Breastfeeding Policies and Practices, 2007/08
Prepared by Toronto Public Health
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Hospital Breastfeeding Policies and Practices
Mothers Reports

• Approximately 40 of mothers responded positively
  to indicators of
• Step 1 Read or saw written breastfeeding policy
• Step 3 Informed about breastfeeding during
  hospitals pre-admission visit
• The Code - 39 of mothers reported being given
  infant formula/breastmilk substitutes when
  leaving hospital

Source Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Prepared
by Toronto Public Health
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• Community Breastfeeding Supports

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Community Breastfeeding Supports
Most Frequent1 Sources of Breastfeeding Support Percent2 of Mothers Reporting Receiving Support (n910)
Professional support
Public health nurse - home visit 36.2
Public health nurse - telephone call 31.4
Hospital staff 30.8
Breastfeeding clinic 16.5
Social support
Family members, including partners 37.9
Friends/coworkers 16.3
1 10 or fewer mothers reported receiving
breastfeeding support from sources such as
doctors, lactation consultants, midwives/doulas,
the La Leche League, and community health centre
staff. 2 Percentages do not total 100 due to
multiple responses. Source Toronto Public
Health New Mother Breastfeeding Survey, Time 2,
2008/09 Prepared by Toronto Public Health
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Breastfeeding in Public Locations
Public Location1 Percent2 of Mothers (n910)
Malls 50.3
Restaurants 41.3
Recreational/cultural facilities 26.1
Places of worship 14.3
Parks 12.4
Workplaces 11.3
On public transportation 8.4
Cars/parking lots 4.4
Doctor's offices/hospitals 3.9
Streets/roads/outside 1.3
Moms groups/programs 1.0
Washrooms/family rooms 0.8
1 Mothers also reported breastfeeding in other
locations such as the laundromat and at school.
These were reported by less than five mothers and
were therefore suppressed. 2 Percentages do not
total 100 due to multiple responses. Source
Toronto Public Health New Mother Breastfeeding
Survey, Time 2, 2008/09 Prepared by Toronto
Public Health
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• Toronto Public Health Breastfeeding Policies and
  Practices

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The Breastfeeding Committee for Canada Seven
Point Plan for Community Health Services1

1. Written breastfeeding policy communicated to all
   staff/volunteers.
2. Train all health care providers to implement the
   policy.
3. Inform pregnant women/families about
   breastfeeding.
4. Support exclusive breastfeeding to six months.
5. Encourage breastfeeding with complementary foods
   beyond six months.
6. Provide a welcoming atmosphere for breastfeeding
   families.
7. Promote collaboration between health care
   providers, breastfeeding support groups, and the
   local community.

1 Based on the UNICEF UK Seven Point Plan for
Community Health Care Settings.
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Toronto Public Health Breastfeeding Policies and
Practices Areas for Improvement

• Point 1 - Written breastfeeding policy
  communicated to all staff/volunteers
• Point 3 - Inform pregnant women/families about
  breastfeeding
• Point 4 - Support exclusive breastfeeding to 6
  months
• Point 5 - Encourage breastfeeding with
  complementary foods beyond six months
• Point 7 - Promote collaboration between health
  care providers, breastfeeding support groups, and
  the local community

Source Toronto Public Health, Self-Appraisal
Questionnaire for Community Health Services
(Breastfeeding Committee for Canada), 2009
Prepared by Toronto Public Health
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• Factors Associated with
• Any and Exclusive Breastfeeding

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Factors Associated with Any Breastfeeding to Six
Months Postpartum

• Mothers were more likely to breastfeed to six
  months if they
• Were older
• Lived in Canada 5 years
• Gave birth in a hospital that reported following
  the two requirements related to breastfeeding on
  demand
• Reported that hospital staff did not give their
  baby fluids other than breastmilk
• Reported being comfortable breastfeeding in
  public locations and/or in the presence of friends

Sources Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Time 2,
2008/09 Toronto Public Health Hospital Survey of
Breastfeeding Policies and Practices, 2007/08
Prepared by Toronto Public Health
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Factors Associated with ExclusiveBreastfeeding
at Hospital Discharge

• Mothers were more likely to exclusively
  breastfeed at hospital discharge if they
• Were born in Canada or lived in Canada 6 years
• Gave birth vaginally
• Gave birth in a hospital that reported following
  a greater number of requirements related to
  having a written breastfeeding policy
• Gave birth in a hospital that reported following
  the two requirements related to breastfeeding on
  demand
• Reported that hospital staff did not give their
  baby fluids other than breastmilk
• Reported (overall) hospital breastfeeding support

Sources Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Toronto
Public Health Hospital Survey of Breastfeeding
Policies and Practices, 2007/08 Prepared by
Toronto Public Health
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Factors Associated with Exclusive Breastfeeding
to Two Weeks Postpartum

• Mothers were more likely to exclusively
  breastfeed to two weeks postpartum if they
• Were born in Canada
• Reported higher family income
• Gave birth vaginally
• Gave birth in a hospital that reported following
  the two requirements related to breastfeeding on
  demand
• Reported attempting to breastfeed within 1 hour
  of birth
• Reported that hospital staff did not give their
  baby fluids other than breastmilk
• Reported not receiving infant formula at hospital
  discharge

Sources Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Toronto
Public Health Hospital Survey of Breastfeeding
Policies and Practices, 2007/08 Prepared by
Toronto Public Health
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Factors Associated with Exclusive Breastfeeding
to Six Months Postpartum

• Mothers were more likely to exclusively
  breastfeed to six months postpartum if they
• Were older
• Reported being informed about breastfeeding
  during the hospitals pre-admission visit

Sources Toronto Public Health New Mother
Breastfeeding Survey, Time 1, 2007/08 Time 2,
2008/09 Toronto Public Health Hospital Survey of
Breastfeeding Policies and Practices, 2007/08
Prepared by Toronto Public Health
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• Current and Future Activities

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Current and Future Activities

• Toronto Public Health is pursuing the
  Baby-Friendly designation
• Working with Toronto birthing hospitals to
  support their efforts to achieve the
  Baby-Friendly designation
• Working with key stakeholders to maintain high
  rates of breastfeeding intention and initiation
• Working with key stakeholders to promote
  exclusive breastfeeding to six months
• Advocating for accurate and complete infant
  feeding data and key sociodemographic/sociocultura
  l indicators

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Current and Future Activities

• Working with key stakeholders to develop and
  implement strategies to engage public facilities
  in breastfeeding friendly initiatives
• Reporting back to the Board of Health in 2011 and
  2012 on the progress of Toronto birthing
  hospitals in moving towards Baby-Friendly
  designation

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• Questions and Discussion

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More Information
Summary and technical reports are available at
http//www.toronto.ca/health/breastfeeding/enviro
nments_report
For more information, please contact Olga
Jovkovic Healthy Families Manager Toronto
Public Health 416-338-1256 OJOVK_at_toronto.ca J
ill Mather Health Promotion Consultant Toronto
Public Health 416-338-8681 jmather_at_toronto.ca
Linda Wood Research Consultant Toronto Public
Health 416-338-1227 lwood_at_toronto.ca