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That Ottawa is a city where the value of breastfeeding for health and food security is recognized and appropriate breastfeeding supports are available.
Policy Recommendations and Details
Recognizing that parents and babies have different needs and life circumstances, this proposal makes the following recommendations to support, encourage, and increase breastfeeding in Ottawa.
1) That all City of Ottawa facilities are designated as breastfeeding friendly. It is recommended that the City will support women to breastfeed their children in any city facility by:
- Providing a dedicated space for breastfeeding;
- Posting signage that says why breastfeeding is important and welcomed;
- Making women feel welcome to breastfeed anytime, anywhere;
- Training staff on breastfeeding-friendly practices, and
- Providing resources and opportunities to help support breastfeeding in the workplace and for breastfeeding education and skill-building.
2) That the Champlain Local Health Integrated Network (LHIN) considers
breastfeeding as a complementary component of the current priorities of (childhood) pre-diabetes and diabetes.
3) That Ottawa Public Health (OPH) achieves a Baby Friendly™ designation (through the WHO/UNICEF Baby Friendly Initiative in Canada – BFI™).
Precedent: Other Ontario public health units are designated Baby Friendly (Appendix A2).
4) That Ottawa hospitals and Community Health Centres work towards Baby-Friendly™ designation.
Precedent: Centretown and Somerset West Community Health Centres have had experience of the process achieving Baby-Friendly designation.
5) That the City of Ottawa encourages the province to act on the recommendations in the December 2009 proposal, “Recommendations for a provincial breastfeeding strategy for Ontario”(Appendix A4), which was developed by a collaboration of stakeholders in Ontario including the Montfort Hospital, Ontario Public Health Association Breastfeeding Promotion Workgroup, the Ontario Lactation Consultant Association, the Breastfeeding Committee of Canada, INFACT Canada, La Leche League and others.
Precedent: In Quebec, breastfeeding rates increased dramatically when a provincial breastfeeding strategy was implemented by that province in 2001.
Recognizing that there can be significant barriers to breastfeeding for some parents and babies, this policy proposal promotes any breastfeeding that is possible, for the following reasons. For more details and further background, please refer to Appendix A1: Background.
- If a food security policy is to be comprehensive, it must include people throughout all life stages.
- Research has shown that exclusive breastfeeding for the first six months of life has health benefits for both the baby and mother and that not breastfeeding can have health consequences:
- Breastfeeding promotes optimal growth and development, including cognitive development, reduces infant mortality, protects against childhood obesity and infections in young children, and may protect against allergies.
- Not breastfeeding increases the risk of childhood illness and of hospitalization related to a wide range of acute and chronic diseases such as respiratory and middle ear infection, diabetes, and sudden infant death syndrome.
- There is a correlation between length of breastfeeding and health of both child and mother. That is, the longer breastfeeding is practiced, the more health benefits for mother and child later in life with regard to health conditions like diabetes and heart disease.
- From an economic perspective, breastfeeding provides families with immediate, intermediate and long-term cost savings.
- Breastfeeding is environmentally-friendly as it does not involve any manufacturing or packaging.
- Therefore having all health care institutions achieve Baby-Friendly™ status in Ottawa is a critical component of a healthier food system and society. Ottawa Public Health is in a position to lead area health care institutions to become Baby FriendlyÔ.
Appendix A1: Background
- The WHO defines “optimal breastfeeding” as exclusively breastfeeding for the first 6 months of life with continued breastfeeding, augmented by appropriate foods, up until two years of age and beyond.
- There are more than 20 000 Baby Friendly™ designated facilities in 152 countries thanks to a WHO-UNICEF initiative.
Breastfeeding in CANADA/ONTARIO
- In Canada, attaining a Baby-Friendly Initiative™ (BFI) designation requires hospitals and community health facilities to adhere to the Integrated Ten Steps and WHO Code Practice Outcome Indicators for Hospitals and Community Health Services (Appendix A3).
- Ontario Public Health Standards call for “an increased rate of exclusive and sustained breastfeeding for all children to attain and sustain optimal health and developmental potential.
- Ontario breastfeeding rates fall short of the objectives. In 2005, 88% of mothers initiated breastfeeding but only 15.8% were breastfeeding exclusively at 6 months.
- The sharp drop in breastfeeding within a few weeks of leaving hospital suggests a number of factors that contribute to the decision to discontinue breastfeeding including lack of knowledge, support and encouragement or reinforcement within the family or community. A number of studies have called on health care professionals to provide consistent, clear information about breastfeeding and support throughout pregnancy, childbirth and the postpartum period.
Breastfeeding in the City of Ottawa
A 2005 City of Ottawa Infant Care Survey found that:
- Between 42% and 46% of women planned to breastfeed their babies for 6 – 12 months.
- Approximately 45% of women reported that formula feeding was provided to their baby during their hospital stay.
- Of the women who chose to breastfeed their babies, 93% cited reasons of improved infant health while only 11% were aware of any potential health benefits for themselves as a result of breastfeeding.
- The majority of Ottawa women (91%) initiated breastfeeding in the first few days after birth (56% were exclusively breastfeeding and 35% were breastfeeding with a supplement).
- 60% of women who had completed a university or postgraduate degree fed their baby breast milk at all feedings during first few days after birth. Half the women who had a college or high-school degree or less breastfed exclusively, during the first few days after birth.
- The proportion of women who breastfed exclusively during the first few days after birth increased slightly, (though not significantly), as household income increased. Fifty percent of women in the lowest income bracket (<$30,000) and 59% of women in the highest income bracket (>$100,000) exclusively fed breast milk during the first few days after birth.
- There was no difference in the proportion of women exclusively breastfeeding during the first few days after birth between English (59%) and French first language (58%), however, women with a first language other than English or French were least likely to breastfeed exclusively during the first few days after birth (46%).
- The most common sources of information/help about breastfeeding to mothers were nurses (36%), family or friends (32%), written information or the Internet (31%), and lactation consultants (24%). Nearly one quarter of women reported that they had not required help with breastfeeding.
- 56% of women (in both a 3-month sample and 6-month sample) reported receiving free formula samples. Most of the women received free formula through the mail (75%). Twenty-seven percent of women received formula from hospitals and 13% received free formula from physicians. Forty six percent of the mothers (in the 3 month group) and 63% of the mothers (in the 6 month group) used the free formula sample they received. Approximately 40% of these women used the free formula within the first 2 weeks after birth.
- 43% of women reported that they had felt uncomfortable breastfeeding in public places. Shopping malls (69.7%) and restaurants (55.3%) were the public places where women felt most uncomfortable to breastfeed. 20% indicated that they felt uncomfortable breastfeeding anywhere in public.
BFI™ in Canadian Jurisdictions
- In 2006, the Thunder Bay District Health Unit became the first community health service in Ontario to receive the designation of Baby-Friendly™ as outlined by the BCC, based on the WHO/UNICEF initiative.
- There are the other jurisdictions in Ontario with Baby-Friendly™ designated facilities including Toronto, Brampton, Kitchener, Sault Ste. Marie, Peterborough, Chatham, and Oakville.
BFIs in Ottawa
- Somerset West Community Health Centre achieved a Baby-Friendly™ designation in 2006 and is therefore up for reassessment in 2011.
- Centretown Community Health Centre is in the process of becoming BF designated, and expects to have completed the process by the end of 2011.
Appendix A2: Baby-Friendly™ designated facilities in Canada
Appendix A3: Breastfeeding Committee for Canada (BCC) Integrated 10 Steps & WHO Code Practice Outcome Indicators for Hospitals and Community Health Services (Summary)
Appendix A4: The December 2009 Ontario Provincial Breastfeeding Strategy proposal
 An example of an appropriate training course is the 1 hour web-based course called Healthy Mothers, Healthy Babies from the Best Start Resource Centre ((http://www.beststart.org/courses/login/index.php). All employees of Centretown Community Health Centre have completed training as part of their Baby-Friendly designation process.
 “Baby Friendly™” is a designation that requires hospitals and community health facilities to adhere to the Integrated Ten Steps and WHO Code Practice Outcome Indicators for Hospitals and Community Health Services as outlined by the World Health Organization (WHO)/ UNICEF and World Health Organization (WHO)/UNICEF Baby Friendly™ Hospital Initiative (BFHI)and interpreted by the Breastfeeding Committee for Canada (BCC). This document can be accessed online at: http://breastfeedingcanada.ca/documents/2011-03-30_BCC_BFI_Integrated_10_Steps_summary.pdf
 A timeline needs to be developed with and by Ottawa Public Health. Learning from the Centretown Community Health Centre’s experience, the timeline suggests that completion of the full designation process may take 2-4 years; plan to allocate $4000 for accreditors’ honoraria and expenses, about $2000 for staff training, and allocate staff time for coordinating and planning the effort from within.
 See the December 2009 Ontario Provincial Breastfeeding Strategy Position Paper which includes details regarding the Quebec provincial breastfeeding strategy and rates of breastfeeding after its implementation, http://www.aom.on.ca/files/Communications/Position_Statements/2009_ON_Provincial_BF_Strategy_Dec_21.pdf
Ontario Provincial Breastfeeding Strategy (2009). “Recommendations for a provincial breastfeeding strategy for Ontario,” accessed online December 2011 at http://www.breastfeedingontario.org/pdf/2009%20ON%20Provincial%20BF%20Strategy%20Dec%2021.pdf
Ontario Public Health Association (2007). “Breastfeeding Position Paper”. Accessed online December 2011 at http://www.opha.on.ca/our_voice/ppres/papers/2007-03_pp.pdf.
Ip, S., et al. (2007). “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries”. AAP Grand Rounds 18:15-16. This study shows that exclusive breastfeeding reduces the risk of ear infection by 50%.
 A 2004 cost comparison of social assistance rates in Canada and the cost of formula feeding shows that, in Ontario, formula may cost as much as 11% to 54% of household income (depending on the type of formula purchased). Infact Canada (2004). “Breastfeeding and Food Security: The High Cost of Formula Feeding”. Infact Canada Fact Sheet.
 World Health Organization (WHO), (2010). “Infant and Young Child Feeding,” Media Centre Fact Sheet No. 342, accessed online April 2011 at http://www.who.int/mediacentre/factsheets/fs342/en/
 Ministry of Health and Long -Term Care (2008). “Implementation Guidelines for the Healthy Babies, Healthy Children Program – Phase II,” Government of Ontario Public Health Standards 2008, accessed online September 2011 http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_2008.pdf
 Public Health Agency of Canada (PHAC). (2009). “Recommendations for a provincial breastfeeding strategy for Ontario,” Ontario Provincial Breastfeeding Strategy, accessed online November 2010 at http://www.breastfeedingontario.org/pdf/2009%20ON%20Provincial%20BF%20Strategy%20Dec%2021.pdf
 City of Ottawa & Ottawa Public Health (2006). “Infant Care Survey 2005,” Ottawa Public Health and City of Ottawa, accessed online at http://www.ottawa.ca/residents/health/publications/ics_2005/ics_2005_en.pdf
 The goal for the Breastfeeding Committee for Canada (BCC ) is for each Canadian Province or Territory to establish a Provincial/ Territorial Baby-Friendly Initiative™ Committee (P/T BFI Committee) approved by the BCC and recognized by the P/T government as the P/T BFI Authority. Where such a committee does not yet exist or does not have sufficient capacity, the Breastfeeding Committee for Canada (BCC) BFI Assessment Committee will serve in the place of the P/T BFI Committee.
 Thunder Bay District Health Unit, (2011). “The Baby Friendly Initiative,” Healthy Babies & Families, accessed November 2010 at http://www.tbdhu.com/HBHF/Breastfeeding/Initiative.htm.
 See Appendix A2 for more details
 Centretown Community Health Centre, Personal communication, April 2011.