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Trevor Hancock: Few Canadian hospitals are ‘baby-friendly’

The evidence of the health benefits of breastfeeding is overwhelming. UNICEF reports that, globally, optimal breastfeeding to the age of two “has the greatest potential impact on child survival of all preventive interventions.

The evidence of the health benefits of breastfeeding is overwhelming. UNICEF reports that, globally, optimal breastfeeding to the age of two “has the greatest potential impact on child survival of all preventive interventions.”

For these reasons, the World Health Organization recommends exclusive breastfeeding to six months of age, and some breastfeeding until as old as two years.

The benefits apply to high-income countries, though not as dramatically as low-income countries. In Canada, a study reported in the Canadian Journal of Public Health this year that among non-aboriginal infants, breastfeeding could potentially prevent 3.5 per cent of middle-ear infections, almost 10 per cent of sudden infant deaths and hospitalizations from lower respiratory-tract infection, and almost one in five gastrointestinal infections. The authors also reported that among aboriginal people, where breastfeeding rates are lower, the benefits are even greater.

But in addition to saving lives and reducing illness, breastfeeding saves the health-care system a lot of money. Studies suggest lower health-care costs are associated with breastfeeding, including a U.K. one that found exclusive breastfeeding to four months could save the U.K. health system about $27 million annually.

Moreover, the benefits extend to the business sector. The Breastfeeding Committee of Canada reports that the benefits of creating a supportive workplace environment for breastfeeding include “decreased days of absenteeism as a result of decreased infant illness, decreased maternal stress, decreased employee turnover, increased job satisfaction and increased productivity of the breastfeeding employees.”

Given the health, social and economic benefits, one would think that breastfeeding initiation and support to ensure high rates of breastfeeding at six months would be a high priority for Canada’s health-care system. Yet breastfeeding rates in Canada at six months are depressingly low, despite high rates of initiation.

While 90 per cent of women start breastfeeding, according to a 2009 report from the Public Health Agency of Canada, by four months, only half of infants are being exclusively breast-fed, and that rate declines to 14 per cent at six months.

There are many reasons why breastfeeding rates decline, ranging from social and cultural to economic and employment factors, and in some cases there are medical factors. But one part of the reason has been the marketing pressure of the infant-formula companies. Taking a leaf from the tobacco industry’s marketing of cigarettes to women, these companies portrayed bottle-feeding as modern and fashionable and helped change the social norm.

In response, WHO established its Baby-Friendly Hospital Initiative in 1992. To be recognized as a baby-friendly hospital, the facility must meet a set of standards that include training of staff, education and support of mothers, encouraging early contact and feeding, and no provision of dummies, soothers or forms of food or drink other than breast milk.

One would think that every one of the roughly 350 hospitals in Canada that provide maternity services would meet these requirements, but that is not the case. According to the breastfeeding committee, which administers the program, as of last month, a mere seven eligible Canadian hospitals — two per cent — are designated as baby-friendly.

Two of these are in B.C. — the G.R. Baker Memorial Hospital in Quesnel and the B.C. Women’s Hospital and Health Centre in Vancouver.

Dr. Beverly Chalmers, who served as co-chair of the 2009 Canadian Maternity Experiences Survey, noted in the Canadian Medical Association Journal that only about a quarter to a third of women received the recommended supportive interventions during their hospital stay, while more than a third were offered or given free formula.

But while some blame for low breastfeeding rates might attach to hospitals, there is a limit to what the hospital can do, because women spend little time in hospital following a normal delivery: two days on average in 2012, compared with 3.2 days in 1993. So there also has to be a comprehensive system of breastfeeding support services in the community.

In addition to requiring that every hospital become accredited as baby-friendly, the Ministry of Health should also require each health authority to provide the necessary community support services and also become designated as baby-friendly. Not only is this good for health, it makes economic sense, too. So what is stopping them?

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.