August 2011 - In Addition…

From Promotion to Action: The Baby Friendly Initiative

Breastfeeding is widely accepted as optimal nutrition for infants and young children by healthcare providers as well as the general public. The combination of health promotion and education by health care providers has resulted in increased social awareness and acceptance of breastfeeding. This has led to an increase in breastfeeding initiation rates to the point where most Canadian mothers begin breastfeeding. However, while more mothers are continuing to breastfeed to 6 months, very few babies are exclusively breastfed during this time and only the rare child is receiving breastmilk on his or her second birthday, as recommended by Health Canada (2004). The Baby Friendly Initiative (BFI) is an evidence-based strategy, proven to increase breastfeeding initiation, exclusivity, and duration.

Promotion of Breastfeeding is Not Enough

Breastfeeding promotion campaigns with themes such as “breast is best’ and “the risks of not breastfeeding” have been effective in educating healthcare professionals and the general public that breastfeeding is the ideal way to feed a baby. The majority of pregnant women intend to breastfeed. However, there has been backlash in response to breastfeeding promotion campaigns. For instance, articles in the media have described mothers as upset with the “intense pressure to breastfeed” and claim that some mothers who were unsuccessful with breastfeeding are now “made to feel guilty” by the public and health professionals. Mothers may feel regret that they were unable to meet their own goals. For instance, one Ontario mother said of her feeding choices: “I chose to breastfeed, but I ended up formula feeding”.

The knowledge that breastfeeding is the optimal way to nourish a baby is not sufficient to ensure that babies are breastfed exclusively for 6 months and to keep mothers breastfeeding throughout the first few years of their child’s life. According to the Canadian Community Health Survey, in 2009, 87.5% of Canadian babies received some breastmilk compared to only 76.7% in 1997 but only 24.4% of all babies in 2009 were receiving breastmilk by 6 months. So while mothers know breastfeeding is best, rates drop quickly after birth and many babies also receive infant formula. Mothers also need individualized support to help them navigate through their own challenges. Without a supportive environment mothers struggle to follow through on the recommendation to breastfeed. 
 
Why do breastfeeding rates drop in the first few weeks, and what can those who work in public health do to increase breastfeeding exclusivity and duration? How can we ensure that mothers receive the support they need to keep breastfeeding? How can we reduce the incidence of unnecessary supplementation with infant formula?

Some women may introduce formula, not because they intended to, but because health professionals, employers, family members and the media are not always supportive in helping them to meet their breastfeeding goals. These mothers who intended on breastfeeding may now feel sad and regretful that they were unable to do “the best” for their babies.

The Baby Friendly Initiative

The Baby Friendly Initiative (BFI) provides an opportunity for health units to create supportive environments for breastfeeding with links to peer support and access to health professionals who are knowledgeable in breastfeeding. BFI is an international accreditation awarded to facilities (hospitals and public health units) that provide the gold standard in health teaching regarding infant nutrition. BFI designation takes several years, a journey that requires the facility to meet 10 steps. Six health units in Ontario have achieved BFI designation (Thunder Bay, Algoma, Chatham-Kent, Peel, Halton, and Peterborough County-City). BFI status is the Child and Reproductive Health Indicator in the Accountability Agreements and Performance Indicators for the Performance Management Framework for Public Health. BFI also compliments the requirements of the 2008 Ontario Public Health Standards.

A BFI accredited health unit addresses barriers to breastfeeding by:

  • ensuring all staff who provide health teaching have the appropriate and highest level of education
  • creating a breastfeeding-friendly environment
  • having a written breastfeeding policy that is communicated to all staff
  • fostering a seamless transition of breastfeeding support from prenatal classes to hospital to community, with consistent, evidence-informed messaging
  • promoting collaboration between the health unit, hospital(s), doctors, midwives and community-based breastfeeding support groups
  • not allowing or endorsing images or messaging that may promote artificial feeding or feeding devices, including sponsorship from companies in violation of the International Code of the Marketing of Breastmilk Substitutes (the Code)

BFI promotes breastfeeding as the norm for infant feeding, and ensures that systems are in place to provide assistance and support for families in any stage of their breastfeeding journey. BFI creates an environment that normalizes breastfeeding in public and in the workplace and enhances community support. BFI is a powerful example of effective public health promotion.

For more information:

Breastfeeding Committee for Canada (2011). Retrieved 23 July 2011 from http://breastfeedingcanada.ca/BFI.aspx
UNICEF. (2011). Infant and Young Child Feeding. Retrieved 23 July 2011 from http://www.unicef.org/index.php

World Health Organization (2011). Breastfeeding. Retrieved 23 July 2011 from: http://www.who.int/en/.

References:

Health Canada. (2004). Exclusive Breastfeeding Duration – 2004 Exclusive Breastfeeding Recommendation. Retrieved 23 July 2011 from http://www.hc-sc.gc.ca/index-eng.php

Ministry of Health and Long Term Care & Ministry of Health Promotion and Sport. (2011). Performance Management Framework for Public Health: Accountability Agreements and Performance Indicators. Retrieved 23 July 2011 from http://www.healthunit.com/(F(Lt05gK8SLOlxNYXIH1LUFkUrd3gxjXIapvK6J2cuMoK6L1A5GR0cae_pv26LgolSqTZEg3dPwyjXYoUzTezzABHAYoPEMEX9RS4jQgEpJZtGCTyYBH4VsiPyyt6J6PgmxEmrb_zC2oyG5vBAWdbHOy_aOIxmF-vhNRsVPr5H7TP7wvjN0))/articlesPDF/16794.pdf

Statistics Canada. (2011). Breastfeeding, 2009. Retrieved 23 July 2011 from http://www.statcan.gc.ca