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Canadian Paediatric Society

Breastfeeding promotion (As per the WHO’s Baby-friendly Initiative)

Breastfeeding is uniquely beneficial in many ways, not least as an effective preventative health measure for both mothers and babies.16 Except in very few specific circumstances, breastfeeding should be universally encouraged.

To improve worldwide breastfeeding initiation and duration rates, the World Health Organization (WHO) and UNICEF launched the Baby-Friendly Initiative (BFI) in 1991, the cornerstone of which is the Ten Steps to Successful Breastfeeding.  Since then, more than 21,000 hospitals in 156 countries have acquired “baby-friendly” status, and breastfeeding initiation and duration have both increased.17 As of March 2016, Canada reported having 114 BFI-designated facilities (hospitals and community health services) – with the majority in Ontario (23) and Quebec (86).18

Health care practitioners are ideally qualified to promote and support breastfeeding. Partnering with the BFI, a global, evidence-based, institutional framework for protecting, promoting and supporting breastfeeding, could vastly improve breastfeeding practice and outcomes for mothers and babies in Canada.19 Leadership from each province and territory is essential to ensure implementation of the BFI in all health care facilities delivering services to babies and mothers.

The Canadian Paediatric Society recommends that governments implement a BFI policy or strategy, with a designated coordinator and breastfeeding education for all health care providers, managers and volunteers working in hospitals and community services that care for mothers and babies. Provinces and territories should also: develop incentives to encourage and support BFI certification; track breastfeeding practices, especially initiation, duration and exclusivity rates; provide easily accessible supportive services, such as lactation consults in person or by phone/email, and provide pasteurized human milk banking for sick or premature infants.20

Province/Territory2012 status2016 statusRecommended actionsComments
British Columbia

Not assessed

Good

Provide incentives that encourage and support health facilities to become BFI-certified.

British Columbia has two facilities due for BFI redesignation. Facilities do not receive funding incentives from government to become BFI-certified.

Alberta

Not assessed

Good

Implement a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy. Track breastfeeding initiation, duration and exclusivity rates.

Alberta has a milk bank, though it is not government-funded. Revenue comes from hospitals and health centres that use banked milk as well as from granting agencies and corporate and private sponsorship.

Saskatchewan

Not assessed

Fair

Implement a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy. Provide incentives that encourage and support health facilities to become BFI-certified. Track breastfeeding initiation, duration and exclusivity rates. 

Saskatchewan has one community BFI-designated facility.
 

Saskatchewan sends donor milk to the NorthernStar Mothers Milk Bank in Calgary.
 

NICUs in Regina and Saskatoon offer donor milk to sick and premature infants but at a cost to the regional health authority.

Manitoba

Not assessed

Excellent

Meets all CPS recommendations.

Strategy aims to establish a milk bank and specific targets for BFI facilities by 2018.
 

Manitoba has two BFI-designated facilities.

Ontario

Not assessed

Excellent

Meets all CPS recommendations.

The province should consider developing milk depots and should continue to support the The Rogers Hixon Ontario Human Donor Milk Bank.

Quebec

Not assessed

Good

Provide incentives that encourage and support health facilities to become BFI-certified. 

Province does not offer logistical or financial incentives to institutions that become BFI-certified.
 

Due to a lack of lactation consultants, access is limited in many areas and they are often not accessible in a timely fashion.

New Brunswick

Not assessed

Fair

Provide incentives that encourage and support health facilities to become BFI-certified. Track breastfeeding initiation, duration and exclusivity rates. Provide access to banked pasteurized human milk for sick and premature infants.

Province tracks breastfeeding initiation and exclusivity at hospital discharge and is working on a process to capture duration rates.

Nova Scotia

Not assessed

Good

Provide incentives that encourage and support health facilities to become BFI-certified. Provide free province-wide access to lactation consultants in person or by phone/email. 

Breast milk donated in Halifax is shipped to the NorthernStar Mothers Milk Bank in Calgary and sent back to IWK Health Centre as needed (at the Centre’s expense).
 

A pilot project is underway to measure breastfeeding duration.

Prince Edward Island

Not assessed

Poor

Implement a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy. Provide incentives that encourage and support health facilities to become BFI-certified. Track breastfeeding initiation, duration and exclusivity rates. Provide free province-wide access to lactation consultants in person or by phone/email. Provide access to banked pasteurized human milk for sick and premature infants.

Newfoundland and Labrador

Not assessed

Good

Provide incentives that encourage and support health facilities to become BFI-certified. Provide access to banked pasteurized human milk for sick and premature infants.

Initiation and exclusivity rates are tracked by the Perinatal Program NL. The provincial government is working with public health nurses to improve access to data on duration rates from the Client Referral Management System. 

Yukon

Not assessed

Fair

Implement a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy. Provide incentives that encourage and support health facilities to become BFI-certified. Track breastfeeding initiation, duration and exclusivity rates. Provide free province-wide access to lactation consultants in person or by phone/email.

There is only one level-4 nursery in the territory. All sick or premature infants are transported out of the territory to sites that offer banked breast milk.
 

No BFI initiative has been implemented but the Whitehorse General Hospital has a breastfeeding policy.

Northwest Territories

Not assessed

Fair

Implement a BFI policy or strategy, with a designated BFI coordinator. Track breastfeeding initiation, duration and exclusivity rates. Provide access to banked pasteurized human milk for sick and premature infants.

NWT Supports Breastfeeding – a government program – provides education to mothers, families and health professionals.

Nunavut

Not assessed

Fair

Implement a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy. Provide incentives that encourage and support health facilities to become BFI-certified. Track breastfeeding initiation, duration and exclusivity rates. Provide free province-wide access to lactation consultants in person or by phone/email.

All sick or premature infants are transported out of the territory to sites that offer banked breast milk.

Excellent

Province/territory:                                                                                                                                                                                   

  • Has implemented a BFI policy or strategy, with a designated BFI coordinator and a breastfeeding education strategy for all health care providers, managers and volunteers working in hospitals and community services that care for mothers and babies.
  • Provides incentives that encourage and support health facilities to become BFI-certified.
  • Tracks breastfeeding initiation, duration and exclusivity rates.
  • Provides free access to lactation consultants in person or by phone/email.
  • Provides access to banked pasteurized human milk for sick and premature infants.

Good

Province/territory has 3 or 4 of the above components in place.

Fair

Province/territory has 1 or 2 of the above components in place.

Poor

Province has none of the criteria specified above in place.

Endnotes

  1. American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506.
  2. Pound CM, Unger SL; Canadian Paediatric Society, Nutrition and Gastroenterology Committee. The Baby-Friendly Initiative: Protecting, promoting and supporting breastfeeding. Paediatr Child Health 2012;17(6):317-21.
  3. Breastfeeding Committee for Canada. Baby-Friendly facilities in Canada: http://breastfeedingcanada.ca/documents/Designated facilities in Canada (November 2015).pdf (accessed April 20, 2016).
  4. Pound CM, Unger SL; Canadian Paediatric Society, Nutrition and Gastroenterology Committee. The Baby-Friendly Initiative: Protecting, promoting and supporting breastfeeding. Paediatr Child Health 2012;17(6):317-21.
  5. Ibid.