Health professionals in Nova Scotia are hard pressed to help mothers in the province reach World Health Organization recommendations of six months of exclusive breastfeeding – largely because of a lack of information.
Exclusive breastfeeding, also recommended by the Canadian Pediatric Society, has been linked to reduced illness in children and babies, including fewer ear infections and much lower rates of gastro-intestinal illness. There are some studies that show that improved immune system responses last well into childhood, and that breastfed children may even be smarter than those who receive formula.
Is the formula good enough?
Unlike the US’s Centers for Disease Control and Prevention, which regularly publishes annual breastfeeding report cards to show how states are doing, Public Health in Nova Scotia must count on health indicator data collected by Statistics Canada in its annual Canadian Community Health Survey, which covers a range of health indicators that range from participant’s general perception of their health, to whether they smoke, to whether they wear a bike helmet. Just two questions relating to breastfeeding are asked.
Respondents are selected to represent Canadians in general, rather than Canadian mothers in particular, and the breastfeeding questions are asked of any mother who has had a baby in the past five years.
The StatCan data shows that 80% of Nova Scotian mothers breastfeed at least once, but that only 27% continue to do so exclusively for the full six months.
Because of the breadth of the survey, the robustness of the breastfeeding data is questionable, says Holly D’Angelo Scott, Senior Epidemiologist, Public Health at Capital District Health Authority.
“As a district and a province, we should be collecting our own information on a regular basis,” she says. “If you talk to moms, five years is a long time to try to remember when you stopped breastfeeding.”
Local Efforts
Hospitals throughout the province collect data on how many mothers are breastfeeding when they leave the hospital, but very little is collected after that.
“We don’t really know when it falls off,” she says. “I want to know whether [mothers] stop breastfeeding at two weeks or two months. We also want to know why. What’s going on at this point? […] That would help us figure out what we should be doing.”
Statistics Canada collected specific breastfeeding data in the late 90s and again in 2003, but since then has rolled those questions into the Canadian Community Health Survey.
In contrast to StatCan’s general health data, the United States not only keeps excellent records on breastfeeding, but is committed to making that information publicly available in an easy-to understand way. According to the Centers for Disease Control’s Breastfeeding Report Card for 2012, the rate of mothers who breastfeed at least once is similar to Nova Scotia’s numbers in most states. The CDC not only publishes the data regularly, but gives access to the detailed data to any researcher who requests it. It also looks into factors like access to lactation consultants, La Leche League leaders, and early introduction of formula, which allows health educators to zero in on concrete things they can do to improve rates.
View the CDC’s Report Cards on Breastfeeding:
Nova Scotia has a breastfeeding program where Public Health Nurses call mothers in the first few days when they return from the hospital. The help can be invaluable to new mothers who may be uncertain about whether their newborn babies are getting enough to eat, and may be having trouble establishing a good breastfeeding relationship without the constant support of the hospital environment.
But D’Angelo-Scott wonders if it is the only time mothers need help.
To help find out, Capital Health has just launched a pilot test survey to help address the shortage of data collected by StatCan and the Department of health. The pilot will survey mothers across the district about breastfeeding when they leave the hospital, then at two weeks, six weeks, two months, and six months later. D’Angelo-Scott aims to get enough responses that she can look at data down to the community health board level, if not individual neighbourhoods.
But for now, the province is counting on the StatCan numbers and breastfeeding initiation data collected by hospitals to take steps to improve breastfeeding rates. Nova Scotia’s Breastfeeding Policy was formally signed in 2005, and the Capital Region Health District launched a campaign called “The First 6 Weeks” in 2009. The IWK Hospital, the province’s largest maternity and children’s hospital, has been working on achieving “Baby-Friendly” status, even hosting a Breastfeeding Conference later this year.
A mother’s perspective
Public Health programs, like their home visit, drop-in clinic and phone support launched as a result of the 2005 strategy seem to provide help where it’s needed, at least for those who’re willing to ask.
“I think I had what I needed, between public health, friends and family who had breastfed, supportive husband and a little girl who seemed to figure it all out pretty easily,” says Heather Ternoway, who is just beginning to wean her 11-month old daughter, Helen.
She says she knows mothers who stopped breastfeeding when their babies were still young, often “for lifestyle reasons” and others who breastfed for several years.
“I think it all depends on your personality, your baby, your support network and your lifestyle,” Ternoway says.
She notes that compared to some of her friends’ formula-fed babies, Helen seemed to get fewer colds, and to get over them faster. She also hasn’t had many digestive problems.
Ternoway was surprised to hear about the lack of concrete breastfeeding data in the province and expressed hopes that this would change soon.
Where are the numbers?
D’Angelo-Scott notes that there has been a fairly successful project in Cape Breton to collect breastfeeding information at several time periods. But she notes that she only had access to that information because she was working on her PhD at the time.
“We don’t get to see that data. This is part of the problem as well,” she says. “You really can’t compare across the province.”
StatCanada numbers for Nova Scotia’s Health Authorities don’t help. With the exception of the Capital District Health Authority and the Cape Breton District Health Authority, StatCan deems the numbers “too unreliable to publish.”
Looking at the numbers across Canada, Nova Scotia 80% breastfeeding initiation rate is at the low end of the. Only Newfoundland, New Brunswick, and Nunavut have lower numbers, with Newfoundland trailing the pack at just 54% of mothers breastfeeding at all.
Statistics Canada: Canadian Community Health Survey
While the data for many provinces is unpublished, Nova Scotian’s 27% six-month exclusive breastfeeding rate trails other provinces’, like those in British Columbia and Manitoba, where rates are 10% higher.
Statistics Canada: Canadian Community Health Survey
Canada’s not alone in sketchy figures. International breastfeeding data is also pretty sparse.
Initiation of breastfeeding figures for 2006 as reported by the World Health Organization:
What’s needed and where do we go from here?
D’Angelo-Scott is optimistic about the pilot project at Capital Health. More important than the numbers, though, is the context they hope to collect, particularly about women’s breastfeeding challenges and reasons for introducing formula.
She noted that an issue that came up in her analysis of the data in Cape Breton is that many women are unaware of how the benefits of breastfeeding might outweigh other lifestyle choices.
“Our moms don’t know things like if you smoke, you should still breastfeed. The benefits outweigh,” she says. “We strongly recommend that you don’t smoke, but it’s not a reason for you not to breastfeed.”
Better information on what keeps people from continuing to breastfeed will help D’Angelo-Scott and her colleagues develop strategies and tools to help support mother and ensure that more babies in Nova Scotia receive the benefits of extended breastfeeding.
Breastfeeding Promotion – A Timeline
| 1994 | Stats Canada Starts Collecting specific breastfeeding data | ||||||
| 1996 | Stats Canada terminates breastfeeding data collection | ||||||
| 2002 | World Health Organization launches Global Strategy on infant and young child feeding – recommends exclusive breastfeeding for six months and continued breastfeeding for two years and beyond | ||||||
| 2003 | Stats Canada collects specific breastfeeding data for one year | ||||||
| 2005 | Canadian Paediatric Society recommends exclusive breastfeeding for six months and continued breastfeeding for two years and beyond | ||||||
| 2005 | Nova Scotia formalizes Breastfeeding Policy | ||||||
| 2009 | Nova Scotia Government Initates its First Six Weeks and Learning Makes it Easy campaigns | ||||||
| 2012 | Capital Health Launches Breastfeeding Data Pilot project | ||||||