Why aren’t more women breastfeeding?

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MONTREAL: Breastfeeding reduces infections in babies, boosts their immune system and prevents obesity. Breastfeeding may even help mothers by lowering the risk of developing diabetes, high blood pressure and cardiovascular disease as they age.

So why aren’t more women doing it?

Health experts are increasingly concerned about the lack of increase in breastfeeding rates in Canada, which they say is tied to a lack of support for mothers from the medical community and the influence of formula manufacturers.

Many mothers seek advice on breastfeeding from family doctors, but they often don’t have answers about techniques or other specific breastfeeding issues. “They don’t necessarily know how to counsel the mother on how to breastfeed,” said Catherine-Maude Pound, assistant professor of pediatrics at the University of Ottawa and consulting pediatrician at Children’s Hospital of Eastern Ontario, who participated in a discussion of the challenges to Canada’s breastfeeding rates at a conference held by the Canadian Paediatric Society last month.

In Canada, about 90 per cent of new mothers start breastfeeding when their children are born – an excellent rate. . But by three months, only half of them are still exclusively breastfeeding, while about two-thirds combine breast and bottle feeding, according to a study of more than 6,400 Canadian mothers published in the journal Birth in June, 2009.

By six months, just 14 per cent of Canadian mothers are exclusively breastfeeding their babies, the study found. Only 54 per cent of mothers were doing any breastfeeding by that time.

A Statistics Canada report released last month came to different conclusions, and found that about 24 per cent of Canadian women breastfed their children exclusively for six months or longer in 2009. Regardless of the discrepancy, the figures are “terribly low” and are a sign of problems with Canada’s approach, Dr. Pound said.

The World Health Organization and Health Canada recommend exclusive breastfeeding for the first six months of a baby’s life to achieve the benefits, and say it can continue until a baby turns 2.

Breastfeeding can become a divisive topic, pitting proponents against those who feed their babies formula.

Some women aren’t able to breastfeed because of a C-section, premature birth or other medical condition, or their baby has a medical issue. Meanwhile, research indicates that about 10 per cent of women in Canada simply have no desire to try breastfeeding.

For the majority of women who do want to breastfeed, not finding support when they encounter problems - such failing to get the baby to latch on, or pain during nursing - can cause them to turn to formula. The situation needs to be addressed by policy-makers if anything is to change, experts say.

The key issue is that mothers often don’t receive sufficient guidance on proper methods of breastfeeding from the health-care system, said Jean Kouba, president of the Canadian Lactation Consultant Association. Although there are lactation consultants in Canada, there aren’t enough to meet the need, Ms. Kouba said.

That’s why Dr. Pound believes doctors should receive some formal training in breastfeeding techniques.

Instead, doctors may encourage mothers to use formula, in order to ensure the baby is gaining weight properly. Although their intention is good, introducing formula throws off the breastfeeding process and makes it hard to get back on track, Dr. Pound said.

One solution that is gaining traction in countries including Canada is the “baby-friendly hospital initiative” launched by the World Health Organization and Unicef in 1991. Hospitals must meet 10 criteria, such as helping mothers start breastfeeding within a half-hour of birth and having a clearly stated breastfeeding policy.

Some requirements are challenging, Dr. Pound said. Under the initiative, hospitals aren’t allowed to give newborns anything other than breast milk unless medically required. Pacifiers are prohibited, as is the practice of hospitals accepting free formula products or promoting them to patients.

That’s a contentious issue because many hospitals receive free products, funding or other incentives from formula-makers that are difficult to turn away. But that relationship raises ethical questions, said Judy Shearer, associate vice-president of mental health and addictions programs at Grand River Hospital in Kitchener, Ont.

“If a formula company is paying for something or giving you money, what obligation do you have to that formula company?” said Ms. Shearer, who used to be clinical director of the childbirth program at Grand River, a hospital designated baby-friendly in 2008.

Nestle Canada Inc., which sells Good Start and Alsoy formulas, said in a statement that it believes breast milk is the best option for infants, but that formula is the next best alternative. The company also only provides free samples to families on request, Nestle said.

Only about a dozen hospitals in Canada are designated as baby-friendly, a status that is evaluated by the Breastfeeding Committee for Canada.

While hospitals don’t need to participate in the program to have sound breastfeeding policies, it helps ensure there’s a consistent message that women hear from their first appointment to after their delivery, said Kimberley Ross, nurse manager for neonatal intensive care and maternal-newborn ambulatory care at St. Joseph’s Healthcare Hamilton, which is designated baby-friendly.

“The goal really is to normalize breastfeeding,” Ms. Ross said.