The "breast" intentions: Considering breastfeeding rates in Nova Scotia

Since the introduction of commercial infant formula to the Western market in the late 1860s, breastfeeding hasn’t been every new mother’s preferred means of providing nutrients to her baby.  

But in recent years, the popularity of breastfeeding has seen something of a resurgence. With the spread of breastfeeding support groups like La Leche League, now an international organization that started in Chicago in the mid-1950s, more and more babies are getting the benefits of breast milk. Right?

Not necessarily – at least, not in Nova Scotia. In fact, a recent study by Dalhousie researchers and funded by the Nova Scotia Health Research Foundation found the number of Nova Scotia mothers who exclusively breastfeed until their babies are six months old is lower than the national average.

Dr. Linda Dodds and her co-lead in the study, Catherine Brown, a former graduate student in the Department of Community Health and Epidemiology, pulled together data gathered between 2006 and 2009 by hospitals in two regions of the province.

Analysis of these data, derived from self-reports of N.S. mothers being released from hospital with their newborns, showed that 64.1 per cent intended to initiate breastfeeding, compared with the national average of 90.3 per cent. That’s close to one-third fewer women in the province than the rest of Canada.

Keeping with it

But more importantly, how many mothers were still breastfeeding six months after delivery? In this population-based study, hospitals and public health clinics in two NS regions, the Cape Breton District Health Authority and the Guysborough Antigonish Strait Health Authority, interviewed mothers in the six-month period following delivery, also between 2006 and 2009. (Mothers answered questions either in person or by phone.) Only 10.4 per cent reported they were still exclusively breastfeeding at six months.  

Dr. Dodds points out that there isn’t such a huge margin between this number and the national average, which is 14.4 per cent. In fact, it means that a higher proportion of NS women who begin exclusively breastfeeding their babies continue to do so till six months.

“So perhaps there should be a focus on improving the initiation rates,” Dr. Dodds says, “since once Nova Scotia women start, they seem to have a greater rate of sticking with it.”

Regardless, Dr. Dodds, director of research in the Faculty of Medicine’s Obstetrics and Gynaecology Department, and director of the Perinatal Epidemiology Research Unit at the IWK Health Centre, says that there is “considerable room for improvement – not just in Nova Scotia but across Canada.”

Many hospitals and public health-care facilities across the province are aiming to become more “breastfeeding friendly,” with advertising campaigns creating awareness of the benefits of breastfeeding.

“The IWK Health Centre certainly is,” she states, and visitors to her office in the Perinatal Epidemiology Research Unit on the seventh floor of the hospital will notice the posters along the hallways touting breastfeeding’s benefits. “But many other hospitals [in the province] are also working on becoming breast-friendly and putting in place the steps that go along with that initiative.”

One such provincial initiative is the “First 6 Weeks” program, which provides “learning and support” to women during what is often both the most difficult and the most crucial phase in feeding their babies.

Evaluating success rates

This study was conducted to reveal more than just how many women gave up breastfeeding before the six-month mark. Dr. Dodds and Ms. Brown also aimed to identify predictors: the health, social or other factors that may contribute to a mother’s ceasing to exclusively breastfeeding within this recommended period.

The results of the study reveal four main risk factors that are “potentially preventable in their effects on the duration of breastfeeding,” Dr. Dodds says, though they’re not easy ones to address: smoking before and during pregnancy, obesity, no early breast contact by the infant and no intention to breastfeed in the first place.

“The association between lower breastfeeding rates and smoking and obesity are likely related to a mix of social, physical and physiologic factors,” says Dr. Dodds. “Both of these groups may require additional support to help ensure successful breastfeeding. And, at the population level, continued efforts in smoking cessation and obesity reduction may have the added benefit of longer exclusive breastfeeding.

She says more data will be needed, particularly to help evaluate efforts to promote breasfeeding.

“We need to evaluate how women are doing with breastfeeding after they are discharged from the hospital. Since the World Health Organization and Health Canada recommend that infants be exclusively breastfed for the first six months of life, we should be able to determine how Nova Scotia fares with this important outcome.”

The case for breastfeeding

There are medical reasons why mothers may want to consider breastfeeding. According to many studies, a mother’s breast-milk provides precisely the nutrients an infant needs during this phase of life, as well as immunological protection against disease (e.g., gastrointestinal tract and upper-respiratory infections). And if breast milk is given exclusively — not a drop of water or formula — breastfeeding can reduce the risk of exposure to contaminated food.

Such concerns aren’t relevant in industrialized countries like Canada — don’t we have safe water and high standards of food production? Yet a recent story about expired infant formula on the shelves of a national supermarket chain suggests certain quality assurance processes are amiss. (In the same story, one mother claims her baby became seriously ill after eating baby food that was nine months past its expiration date.)

The mother can benefit as well. “There is evidence to suggest that breastfeeding can improve post-partum weight retention,” Dr. Dodds says.

But to help more mothers and babies see these benefits, Dr. Dodds notes, health-care teams need to see more such data. “By understanding the factors associated with positive breastfeeding practices, health care providers will be better equipped to promote and support breastfeeding.”