A version of this commentary appeared in Policy Options, Vancouver Province and the Huffington Post 

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Hospitals need to stop accepting free or reduced-cost formula and adopt World Health Organization guidelines

An Icelandic Member of Parliament breastfed her baby while delivering a speech in Parliament recently. No one reacted to her breastfeeding, because in Iceland, breastfeeding is the cultural norm. The mother stated that this was the most natural thing in the world.

If only that were the case in Canada.

According to Statistics Canada, while Canada has made significant strides toward breastfeeding as a cultural norm — for example 89 percent of women initiated breastfeeding in 2012, compared to 69 percent in 1982 — we still have a long way to go.

Why is breast feeding so important?

Overwhelming evidence shows breastfeeding is good for babies’ brains and for social development. Breastfed babies are thought to thrive because of the health qualities of breastmilk in combination with the healthy serve and return relationships promoted by close contact between mom and baby.

Breastfeeding is also convenient — just ask any breastfeeding mom.  Breast milk is always available, the right temperature, clean and perfectly timed to infants’ feeding needs, both as the baby grows and even over the course of a single feeding. It’s also free.

What could be more natural?

There are also risks for not breastfeeding — for both mothers and babies. Mothers who don’t breastfeed have an increased risk of cardiovascular disease, type 2 diabetes, breast and ovarian cancers and delayed return to healthy weight. Infants who are not breastfed have a higher risk of sudden infant death syndrome, common childhood illnesses, childhood obesity, cancer and diabetes.

So what’s the barrier?

In countries like Iceland, people grow up seeing breastfeeding in public. By contrast, in Canada baby formula as an alternative to breast milk is promoted widely to parents in many ways: through free samples and coupons, through disguised “educational” materials on baby feeding with an emphasis on formula, and showcased in parenting books and magazines.

The Canadian health care system contributes to a formula feeding culture when some individual hospitals and other health facilities contract with formula companies, whose product is then promoted in the institution, thus providing credibility. Evidence shows that mothers are more likely to initiate breastfeeding and breastfeed longer when their baby is not offered or supplemented with formula in the hospital unless medically indicated.

With such an emphasis on formula, it is difficult for breastfeeding to become the cultural norm in Canada — or for families to make an informed decision about feeding babies, free from commercial influence.

Not surprisingly, even amongst those that decide to breastfeed, data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study showed that only 54 percent of mothers are exclusively breastfeeding by the time their babies are three months of age and only 15 percent by six months of age.

What can be done?

There is a way that our Canadian situation can be turned around.  Canadian hospitals should adopt the World Health’s Organization’s Baby-Friendly Initiative (BFI). Hospitals must achieve 10 Steps to obtain BFI standing.

One of the steps requires hospitals to reject contracts for free or reduced cost formula and they are not permitted to market formula to their patients. In BFI hospitals, formula is only used if medically indicated and, when given, the formula label is removed. To their credit, a few Canadian hospitals (only about five percent) have achieved BFI designation.

Of course, not all moms are able to breastfeed or choose not to.  All the more reason to support all mothers on their journey of finding the best way to nourish their baby.  We can do this by first providing support for women who want to breastfeed and are struggling, as well as promoting healthy alternatives.

Prenatal education should include information on how to access Lactation Consultants — experts trained in the art of breastfeeding — as well as breastfeeding support call centers and healthy alternatives to breast milk. In several locations across Canada, La Leche League provides a free mother-to-mother support call line.

Promoting a breastfeeding culture should not be seen as an affront to women who, for whatever reason, choose to formula feed their babies. We live in a society where multiple approaches are respected. BFI does not advocate one size fits all, rather it advocates promoting the best evidence so everyone can make the most informed decisions about baby feeding.

As funders, provincial governments should direct hospitals and other health facilities to take concrete steps to create a baby-friendly environment, which includes promoting breastfeeding and ceasing contractual arrangements that may provide a modest advantage to the hospital budget, but disadvantage the baby.

Members of the public can help by supporting women’s right to breastfeed in public and lead the way towards demanding baby-friendly standards in our health care settings.


Nicole Letourneau is an expert advisor with EvidenceNetwork.ca and the author of Scientific Parenting: What Science Reveals about Parental Influence. She is a professor in the Faculties of Nursing and Medicine. She also holds the Alberta Children’s Hospital Foundation Chair in Parent-Infant Mental Health at the University of Calgary.

Mary Lougheed is a certified Lactation Consultant (IBCLC) with the BFI Research Group of the Calgary Breastfeeding Matters Group Foundation, and has worked as an IBCLC for over 20 years.  She currently is Board Member of the Calgary Counselling Centre, and past Board Member of the Calgary United Way, the Calgary Women’s Emergency Centre, and past member of the Calgary Poverty Reduction Coalition.

March 2017


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