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Infant Feeding

Infant Feeding in Simcoe Muskoka

Exclusive breastfeeding for the first six months of life and continued breastfeeding up to two years and beyond with appropriate complementary feeding is recommended by Health Canada and the World Health Organization.1,2 Breastfeeding is important for nutrition, immunologic protection, growth, and development of infants and toddlers. It also has a long-lasting impact on the health of the child and the breastfeeding parent.1 In addition, breastfeeding has also been recognized as an important population health approach to prevent communicable and non-communicable diseases, improve environmental sustainability and food security, and decrease social and economic inequities.3 In order to improve maternal and child health, the World Health Organization has set a target to increase the global rate of exclusive breastfeeding for the first six months from to at least 50% by 2025.4

Why is it important to look at health care policies and practices associated with infant feeding?

Health care organizations and providers can help increase local exclusive breastfeeding rates by addressing barriers to breastfeeding, including implementing evidence informed policies and practices and creating supportive organizational environments.3 Supportive environments can be created by implementing policies and practices that align with maternal and newborn care best practices, including the Baby-Friendly Initiative (BFI), which is recognized as an evidence-based strategy for improving quality healthcare and maternal and infant health outcomes. 5

What do local infant feeding rates tell us?

In Simcoe Muskoka:

  • Over 90% of parents plan to breastfeed, including over 85% of parents who plan to breastfeed exclusively.6
  • At birth, 90% of babies are breastfed, including 70% who are exclusively breastfeed.6
  • The rate of exclusive breastfeeding drops off significantly in the first weeks after birth, with 45% of babies breastfeeding exclusively at two months, 35% at four months.7
  • Almost 1 in 3 babies receive infant formula in hospital, including 25% of all babies who receive infant formula for non-medical reasons.6
  • Up to six months, 65% of babies continue to breastfeed, including 20% who continue to be exclusively breastfed. 7
  • Just over 1 in 3 babies are fed solid foods earlier than about six months.7

The following webpages offer a comprehensive picture of infant feeding and factors associated with infant feeding rates in Simcoe Muskoka, using a combination of data from the

Better Outcomes Registry & Network

(BORN) Information System and the

Simcoe Muskoka District Health Unit Infant Feeding Surveillance

system (SMDHU IFS).

Pregnant mom and toddler
New mom and her newborn immediately after birth
Mother breastfeeding her baby

There are two sources of data presented in this report: the Better Outcomes Registry & Network (BORN) Ontario and SMDHU Infant Feeding Surveillance System (SMDHU IFS). Both sources include data on infant feeding initiation rates. The differences between these rates is explained in the data source page descriptions linked above.

In this report, the term ‘associated’ is often used. If a factor is associated with a breastfeeding rate, then there is a statistically significant relationship between the two variables. This does not mean that the factor directly caused the rate because there may be other confounding variables that were not measured or controlled for in the analysis.

If a factor is ‘independently associated’ with a breastfeeding rate, this means that the confounding variables were controlled for in a regression analysis and the results suggest that this factor has a direct influence on the breastfeeding rate. In other words, there is a causal relationship between the two variables.

This report also contains many percentages followed by two other percentages in parentheses. The percentages in parentheses represent the lower and upper limit of the 95% Confidence Interval (95% CI). The 95% CI is a range that is 95% likely to include the true value of what is being measured if we had data on every member of the target group being represented.

Percentages provided in this report represent the proportion of all babies. This means that percentages are comparable within the same data source because the denominators are consistent

Breastfeeding within the infographics and these webpages refers to all methods of providing breastmilk.

Breastmilk substitute refers to any food that is used as a partial or total replacement for breastmilk (mother or donor). Most breastmilk substitute is infant formula.

Supplementation refers to any food or drink (e.g. expressed breastmilk, donor milk, glucose water or infant formula) other than that received from the breast for the purpose of adding to breastmilk received through feeding at the breast.

Initiation refers to the time period from birth to hospital discharge for all live births discharged home, or three days postpartum for home births.

Infant feeding refers to feeding an infant by providing sustenance defined in the categories below. In this report, infant feeding rates are measured at four time points: initiation, two, four or up to six months. Infant feeding intention rates are also measured in the prenatal period.

  • Any breastmilk : Infant is receiving any breastmilk. This can be exclusive breastmilk, non-exclusive or returned to exclusive breastmilk.
  • Exclusive breastmilk : Infant is receiving, and has received only breastmilk since birth. This includes expressed breastmilk and donor human milk.
  • Non-exclusive breastmilk or Combination Feeding: Infant is receiving breastmilk in combination with a breastmilk substitute, whether medically indicated or not; or is receiving solid food in addition to breastmilk.
  • Returned to Exclusive breastmilk :
  • At initiation: Infant received a breastmilk substitute at some point prior to hospital discharge, but is receiving only breastmilk at discharge.
  • At two months or beyond: Infant received a breastmilk substitute at some point prior to two months (including in hospital), but is receiving only breastmilk at the time point.
  • No breastmilk : Infant is not receiving any breastmilk. This percentage plus the any breastmilk percentage, equals 100% of infants.
  • Never breastmilk : Infant has never received breastmilk.

Adjusted Breastfeeding Rate at Initiation : The number of infants who are exclusively breastfed, fed human milk (maternal or donor) or received breastmilk substitute for documented medical reasons, expressed as a percentage of all live births. This indicator is noteworthy as it is provided to hospitals by BORN.

Venn Diagram of Infant Feeding Definitions

Venn Diagram of Infant Feeding Definitions

  1. Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Nutrition for healthy term infants: Recommendations from birth to six months [Internet]. (2012). Available from: https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html
  2. Victora CG, Bahl, R, Barros AJD, Franca GVA, Horton S, Krasavec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21 st century: epidemiology, mechanisms and lifelong effect. The Lancet. 2016; 387: 475-490.
  3. UNICEF, World Health Organization. Nurturing the Health and Wealth of Nations: The Investment Case for Breastfeeding [Internet]. 2017. New York, Geneva. Available from: https://www.who.int/nutrition/publications/infantfeeding/global-bf-collective-investmentcase.pdf?ua=1
  4. Breastfeeding Committee for Canada. The BFI 10 Steps and WHO Code Outcome Indicators for Hospitals and Community Health Services. 2017. Available at: https://breastfeedingcanada.ca/wp-content/uploads/2020/03/Indicators-we2019-En.pdf
  5. BORN, 2019
  6. SMDHU IFS, 2019
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