Breastfeeding

Sex and Gender-based Analysis of this topic

Definition

Breastfeeding prevalence refers to the number of mothers who breastfeed their children expressed as a percentage of all live births in a given place and time [1]. Breastfeeding initiation occurs when a baby goes to the breast usually immediately after birth for healthy term infants.  Exclusive breastfeeding is the practice of breastfeeding without the addition of other liquids or solids, with the exception of medications, vitamins or mineral supplements, either directly from the breast or with expressed breast milk (EBM) [2].

Breastfeeding is recognized worldwide as the normal and optimal infant feeding practice. The World Health Organization (WHO) and Health Canada recommend exclusive breastfeeding for the first six months after birth, with the addition of complementary nutritious foods at about six months with breast milk to remain in the child’s diet for two years and beyond. [3, 4]. In 2005, the rate of breastfeeding initiation in Canada was 87%, a rate that has steadily increased from 82% over the past five years [5,6]. The duration rates fall quickly with many mothers not meeting their breastfeeding goals due to a lack of support [7], sore nipples, and perceived low milk supply.

 
 
Sex Issues

Breastfeeding has positive health effects on the mother and the baby. In mothers, breastfeeding helps reduce postpartum bleeding and delays ovulation and pregnancy, which can increase positive maternal and infant health outcomes [8,9]. A lack of breastfeeding may have negative health outcomes for the mother and child. Research suggests that breastfeeding may also increase bone remineralization and decrease mothers’ risk of ovarian and breast cancer and cardiac disease [1,2, 10]. In the infant, breast milk can reduce infection, delay the onset of allergies, prevent sudden infant death syndrome (SIDS), and improve physical and cognitive development [11-14]. Research into maternal and child benefits of breastfeeding is ongoing.

 
 
Gender Issues

There are a number of barriers to breastfeeding. A 2003 Canadian study reported that 23% of Canadian women did not breastfeed because they thought it was “unappealing” or “disgusting” whereas 22% found bottle-feeding more convenient [15]. Women’s participation in the workforce is also a barrier to breastfeeding, in particular, the duration of breastfeeding [16]. About 40% of Canadian women have non-standard work arrangements (seasonal, part-time, temporary or contract) which do not accommodate breastfeeding, which means mothers may have to decide to stop breastfeeding so that they can return to work. These barriers need to be addressed in using strategies like the Baby-Friendly Initiative (BFI); the purpose of which is to promote, protect, and support the initiation and continuation of breastfeeding [2].

 
 
Diversity

Overall, the breastfeeding rates decline with younger ages, as well as lower socioeconomic status, and lower levels of education [15]. The breastfeeding rate is lower for Aboriginal women compared to the general population. In 2004, the breastfeeding initiation rates among Aboriginal women were: 66% in the Inuit population; 62% and 72% in on- and off- reserve First Nations populations; and 66% in Métis population compared to 80% in the general population [17].  Data from the 2003 CCHS data show that immigrants have a higher rate of breastfeeding initiation than the general population [18].

 
 
Critique

Canadian breastfeeding initiation and duration rates may be inaccurate when based on patient recall and over-reported due to the social desirability of reporting breastfeeding [19]. Increased data collection about breastfeeding duration (particularly exclusive breastfeeding up to six months), breastfeeding knowledge, complementary feeding, formula feeding, and barriers to breastfeeding are needed. To support informed choice when babies are in need of supplementation due to medical conditions, support of donor milk banks need to be explored. Canada currently has only one milk bank located in Vancouver, British Columbia [20]. Research into the disparity in breastfeeding rates across the country, including differences in hospital and public health breastfeeding services, are also needed to understand and adequately address the low breastfeeding rates in some provinces.

 
 
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health determinants > breastfeeding