Hospitals need to stop accepting free or reduced-cost formula and adopt World Health Organization guidelines.
An Icelandic member of Parliament 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 said 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 — for example, 89 percent of women initiated breastfeeding in 2012, compared with 69 percent in 1982 — we still have a long way to go.
Why is breastfeeding 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 breast milk, 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 infants’ feeding needs, over the course of a single feeding and as the baby grows. It’s also free.
What could be more natural?
There are also risks to not breastfeeding, for both 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? In countries like 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 by being 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 makers, whose product is then promoted in the institutions, 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 formula is medically indicated. With such an emphasis on formula, it is 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 among those who decide to breastfeed, data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study show that only 54 percent of mothers are exclusively breastfeeding by the time their babies are three months of age, and only 15 percent do so by six months of age.
There is a way that our Canadian situation can be turned around. Canadian hospitals should adopt the World Health’s Organization’s Baby-Friendly Initiative (BFI). Hospitals must achieve 10 steps to obtain 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 used only if medically indicated, and when it is given, its label is removed. To their credit, a few Canadian hospitals (only about 5 percent) have achieved BFI designation.
Of course, not all moms are able to breastfeed, and some choose not to: all the more reason to support all mothers on their journey of 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 by promoting healthy alternatives.
Prenatal education should include information on how to find 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 does not advocate one-size-fits-all solutions; 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 ending 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 leading the way toward adoption of baby-friendly standards in our health care settings.
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