Breastfeeding in Toronto: Promoting Supportive Environments

Transcription

1 Breastfeeding in Toronto: Promoting Supportive Environments Jan Fordham, Linda Wood, Karen Wade, Jill Mather & Olga Jovkovic CPHA 2011 Annual Conference Montreal, QC, June 21, 2011

2 Background Exclusive breastfeeding recommended to six months Canadian rates of exclusive breastfeeding are low TPH mandated to promote breastfeeding and work with community partners to develop healthy policies/create supportive environments

3 Research Study Com ponents Self-report survey of Toronto birthing hospitals breastfeeding policies and practices, 2007/08 Telephone survey of first-time Toronto mothers at two weeks postpartum, 2007/08 (n=1518) Follow-up telephone survey at six months postpartum, 2008/09 (n=910) Self-assessment of Toronto Public Health s breastfeeding polices and practices, 2008

4 Characteristics ofmothers Surveyed Variable Percent of Mothers Place of birth Born outside of Canada 62.3% Length of time in Canada 5 years or less 33.6% Language of interview Not English 14.1% Age 25 to 40 years 81.6% Marital status Legally married/common-law 90.6% Annual family income Less than $20,000 $80,000 or more Education Less than high school Post-secondary degree/certificate/diploma or higher Source: TPH New Mother Breastfeeding Survey, Time 1, 2007/ % 37.9% 6.0% 69.9%

5 Any and Exclusive Breastfeeding athospital Discharge,Tw o W eeks,and Six M onths Rates are based on mothers who initiated breastfeeding in hospital. Error bars (I) denote 95% confidence intervals. Sources: TPH New Mother Breastfeeding Survey, Time 1, 2007/08; Time 2, 2008/09

6 WHO/UNICEF Baby-Friendly HospitalInitiative (BFHI) The Ten Steps to Successful Breastfeeding (The Ten Steps) 1. Written breastfeeding policy communicated to all health care staff/volunteers. 2. Train all health care providers to implement the policy. 3. Inform pregnant women/families about breastfeeding. 4. Help mothers initiate breastfeeding within a half-hour of birth. 5. Show mothers how to breastfeed/maintain lactation, even if separated from baby. 6. Give newborns no food/drink other than breastmilk unless medically indicated. 7. Practice rooming in - mothers and infants remain together 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats/pacifiers to breastfeeding infants. 10. Foster establishment of support groups and refer mothers on discharge. The WHO International Code of Marketing of Breastmilk Substitutes (WHO Code) Not receiving infant formula or breastmilk substitutes when leaving hospital.

7 Hospitals Reports ofall48 Requirem ents Related to the Ten Steps,by Hospital Source: TPH Hospital Survey of Breastfeeding Policies and Practices, 2007/08

8 Hospitals Reports ofrequirem ents Related to Each ofthe Ten Steps Most Toronto birthing hospitals reported low levels of implementation of requirements of: o Written breastfeeding policy communicated to all health care staff (Step 1) o Newborns given no food/drink other than breastmilk, unless medically indicated (Step 6) o Breastfeeding infants given no artificial teats/pacifiers (Step 9) Source: TPH Hospital Survey of Breastfeeding Policies and Practices, 2007/08

9 Mothers Reports ofhospitalbreastfeeding Policies and Practices Indicator of the Ten Steps 1 Percent of Mothers Responding Yes 1. Read/saw hospital s written breastfeeding policy 41.0% 3. Informed about breastfeeding during hospital s pre-admission visit 40.8% 4. Skin-to-skin contact immediately after birth 68.8% Attempted to breastfeed baby within one hour of birth 70.8% 6. Staff refrained from giving baby food/drink other than breastmilk 62.4% 9. Hospital staff refrained from giving baby artificial nipples/pacifiers 70.9% 10. Told how to contact breastfeeding support group before discharge 73.4% Indicator of the WHO Code No infant formula/breastmilk substitutes received at discharge 61.0% 1 Indicators where 80% mothers responded yes are not displayed in the table. These were indicators of steps 2, 5, 7, 8 and overall hospital support. Source: TPH New Mother Breastfeeding Survey, Time 1, 2007/08

10 StatisticalAnalysis Hierarchical logistic regression: Mothers nested within hospital of delivery Outcome measures: Any breastfeeding (vs. stopping) to six months postpartum Exclusive breastfeeding (vs. feeding breastmilk & other fluids) at hospital discharge and two weeks postpartum Predictors: Sociodemographic/sociocultural factors Birth-related factors Hospital breastfeeding policies and practices (hospital & mother reports) Community-related factors *All models adjusted for maternal age, annual family income, education, and length of time in Canada

11 Variables Independently Associated with Any Breastfeeding to Six Months Significant Variables AOR 95% CI P-value Maternal age Less than 20 years to 24 years 3.72 (1.19, 11.67) to 30 years 4.72 (1.45, 15.29) More than 30 years 7.88 (2.20, 28.24) Length of time in Canada Born in Canada 0.62 (0.42, 0.91) Born outside of Canada - lived in Canada 6 years 0.54 (0.31, 0.95) Born outside of Canada - lived in Canada 5 years No food/drink other than breastmilk (Step 6-mother reports) a Yes 1.71 (1.14, 2.56) No/Don t know Encourage breastfeeding on demand (Step 8-hospital reports) 3.47 (1.85, 6.50) < Breastfeeding in frequently reported public locations b Comfortable breastfeeding in public locations 2.85 (2.05, 3.96) < Not comfortable/did not breastfeed in public locations a Low levels of implementation in most Toronto birthing hospitals. b Malls, restaurants, recreational facilities, parks, and/or workplaces. Sources: TPH New Mother Breastfeeding Survey, Time 1, 2007/08; Time 2, 2008/09; TPH Hospital Survey of Breastfeeding Policies and Practices, 2007/08

12 Variables Independently Associated with Exclusive Breastfeeding athospitaldischarge Significant Variables AOR 95% CI P-value Length of time in Canada Born in Canada 1.93 (1.20, 3.08) Born outside of Canada - lived in Canada 6 years 1.46 (1.02, 2.08) Born outside of Canada - lived in Canada 5 years Method of delivery Vaginal 2.50 (1.53, 4.10) < Caesarean Have a written breastfeeding policy (Step 1-hospital reports) a 1.58 (1.23, 2.04) < No food/drink other than breastmilk (Step 6-mother reports) a Yes 4.28 (2.98, 6.15) < No/Don t know Rooming-in, no more than 1hr apart daily (Step 7-mother reports) Yes 1.65 (1.03, 2.65) No/Don t know Encourage breastfeeding on demand (Step 8-hospital reports) 3.00 (1.78, 5.04) < Overall hospital support (mother reports) Yes 1.76 (1.11, 2.80) No/Don t know a Low levels of implementation in most Toronto birthing hospitals. Sources: TPH New Mother Breastfeeding Survey, Time 1, 2007/08; TPH Hospital Survey of Breastfeeding Policies and Practices, 2007/08

13 Variables Independently Associated with Exclusive Breastfeeding to Tw o W eeks Significant Variables AOR 95% CI P-value Length of time in Canada Born in Canada 1.82 (1.18, 2.80) Born outside of Canada - lived in Canada 6 years 1.27 (0.84, 1.91) Born outside of Canada - lived in Canada 5 years Annual family income 1.05 (1.00, 1.10) Method of delivery Vaginal 1.63 (1.14, 2.34) Caesarean Attempted to breastfeed within 1hr of birth (Step 4-mother reports) a Yes 2.02 (1.23, 3.32) No/Don t know No food/drink other than breastmilk (Step 6-mother reports) a Yes 2.44 (1.93, 3.10) < No/Don t know Encourage breastfeeding on demand (Step 8-hospital reports) 3.97 (2.88, 5.46) < No infant formula/breastmilk substitutes received at discharge (WHO Code-mother reports) a Yes 3.47 (2.21, 5.45) < No/Don t know a Low levels of implementation in most Toronto birthing hospitals. Sources: TPH New Mother Breastfeeding Survey, Time 1, 2007/08; TPH Hospital Survey of Breastfeeding Policies and Practices, 2007/08

14 Conclusions Exclusive breastfeeding rates in Toronto are low in the early postpartum period, declining significantly by six months postpartum Toronto birthing hospitals vary in their degree of implementation of the BFHI requirements A number of sociodemographic, sociocultural, hospital policies and practices, and community factors were independently and positively associated with breastfeeding outcomes Supportive environments in hospital and community settings are essential to improve breastfeeding outcomes

15 TPH Activities Working with hospital and community partners to develop and implement a breastfeeding action plan Working with Toronto birthing hospitals to support their efforts to achieve Baby-Friendly designation Strengthening TPH breastfeeding policies and practices to achieve the Baby-Friendly designation Working with stakeholders to develop and implement strategies to engage public facilities in breastfeeding friendly initiatives

16 More Information Jan Fordham Manager Healthy Public Policy Linda Wood Principal Investigator Research Consultant Healthy Public Policy Toronto Breastfeeding Study summary and technical reports are available at: