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Our Voice in Action |
Informed Decision Making and Infant Feeding
by Anne Smitha, OPHA Breastfeeding Workgroup Chair
The public looks to health care providers for health information that is current, evidence-based and reflective of best practice. With regard to infant feeding, the historical practice has been to inform the public solely about the benefits of breastfeeding, and not to discuss the risks associated with choosing to use artificial baby milk, commonly referred to as infant formula. In order to make truly informed decisions, the public must have knowledge of both the benefits and risks of the options available. Enabling informed decision-making is best practice.
The giving of artificial baby milk is traditionally considered an act that has no negative consequences. However, a steadily growing body of evidence shows us that feeding infants these breast milk substitutes has health consequences for babies, mothers, and society. Some examples include:
- increased risk of allergy1, gastrointestinal illness, respiratory infections2, insulin dependent diabetes3 and necrotizing enterocolitis4 for infants and children;
- increased risk of postpartum hemorrhage5, certain types of cancer6 and osteoporosis for the mother7;
- increased risk of financial hardship for vulnerable populations; and
- increased risk of morbidity and mortality of infants due to contaminated artificial baby milk.
Health Canada recommends that all healthy term infants be exclusively breastfed for the first six months of life and then continue to be breastfed, with the addition of safe and complementary foods, up to two years of age or beyond.8
The initiation and continuation of breastfeeding is heavily impacted by the early, unnecessary supplementation with artificial baby milk.
The Baby-Friendly Initiative (BFI)9 and International Code of Marketing of Breast Milk Substitutes (The Code)10 provide guidelines which inform best practice related to infant feeding. The BFI, introduced by WHO/UNICEF in 1991, outlines the information required for parents to make an informed decision about infant feeding and provides guidelines as to what constitutes appropriate care for women and their families who have decided not to breastfeed. The BFI guidelines also address the initiation and maintenance of breastfeeding if mother and baby are separated, and medical indications for supplementation of the infant. The Code aims to contribute to the provision of safe and adequate nutrition for infants by providing guidelines for appropriate marketing, distribution and use of breast milk substitutes.
Increasing awareness and utilization of the guidelines of BFI and The Code by health care professionals would foster evidence informed best practice which is consistent with the mission, vision, and values of OPHA.
aAnne Smith is a Public Health Nurse in the North Bay Parry Sound District Health Unit.
1Host A, Husby S, Osterballe O. 1988. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand. 77: 663-670.
2Beaudry M., Dufour R., Marcoux S. 1995. Relationship between infant feeding and infections during the first six months of life. J Pediatrics. 126; 191-197.
3Kostraba J. N., Cruickshanks K. J., Lawler-Heavner J., et al. 1993. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes. 42:288-295
4Noerr B., 2003. Current Controversies in the Understanding of Necrotizing Enterocolitis, Adv Neonatal Care. 3(3):107-120.
5Chua S, Arulkumaran S, Lim I. et al. 1994. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Obstet Gynaecol; 101: 804-805.
6Becher H., Schmidt,S. Chang-Claude J. 2003. Reproductive factors and familial predisposition for breast cancer by age 50 years. A case-control-family study for assessing main effects and possible gene-environment interaction. International Journal of Epidemiology. Feb.; 32 (1); 38-48.
7Blaauw, R. et al. 1994. Risk factors for development of osteoporosis in a South African population. SAMJ 84: 328-332.
8Health Canada. 2004. Exclusive Breastfeeding Duration - 2004 Health Canada Recommendation.
9World Health Organization/UNICEF. Baby-Friendly Initiative. 2006. The Ten Steps and Practice Outcome Indicators for Baby-Friendly Hospitals.
World Health Organization/UNICEF. Baby-Friendly Initiative. 2006. The Seven Point Plan and Practice Outcome Indicators For The Protection, Promotion and Support of Breastfeeding in Community Health Services.
10World Health Organization/UNICEF. 1981. International Code of Marketing of Breastmilk Substitutes and Subsequent Resolutions. Geneva
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