MHLU - Health Status Resource

Infant feeding

Infant feeding

Key Findings: 

Infant feeding practices are an important determinant of a child’s growth and development. Exclusive breastfeeding is recommended for the first six months of life, with continued breastfeeding recommended for up to two years and beyond. Some mothers may be unable to feed breast milk to their baby for medical reasons, or may choose to use a breast milk substitute for other reasons. Ontario public health units provide infant feeding support to all families regardless of the type of feeding. From 2013 to 2017, most newborns in Middlesex-London were fed breast milk and the percent exclusively fed breast milk went up over time. Over 60% of infants were fed breast milk until six months of age, however, less than 15% were exclusively breastfed during this period. Breastfeeding was lowest among mothers under the age of 25.

Intention to breastfeed Breastfeeding duration
Infant feeding at the hospital or midwifery practice group  

Intention to breastfeed

Over 90% of women who gave birth in Middlesex-London from 2013 to 2017 reported that they intended to feed breast milk to their baby (Fig. 12.2.1).

The percent was slightly lower in Middlesex-London compared to Ontario, but the difference was not statistically significant. When broken down by age group for Middlesex-London, mothers under the age of 25 had the lowest reported intention to feed breast milk to their baby (Fig. 12.2.2).

Interpretation:

Breastfeeding is the biologically natural way to provide infants with the nutrition they need for healthy growth and development, and has many benefits for the baby and mother. Maternal intention to breastfeed is a strong predictor of breastfeeding initiation and duration after birth.1

Some mothers may be unable to feed breast milk to their baby for medical reasons, or may choose to use a breast milk substitute for other reasons. As a designated Baby-Friendly organization, the Middlesex-London Health Unit supports all families regardless of their infant feeding choices.

Infant feeding at the hospital or midwifery practice group

The percent of infants in Middlesex-London fed breast milk at the hospital or midwifery practice group (MPG) prior to discharge after birth was 91.4% in 2017 (Fig. 12.2.3). Of these infants, 62.7% were exclusively fed breast milk while 28.7% were fed breast milk in combination with a substitute (formula or other).

The percent of infants in Middlesex-London exclusively fed breast milk at the hospital or MPG was 62.7% in 2017, up from 56.7% in 2013 (Fig. 12.2.4). In 2016, the most current year for which Ontario data are available, 62.6% of infants in Ontario were exclusively fed breast milk compared to 60.0% in Middlesex-London; however, the difference was not statistically significant.

Women aged 25 to 34 years had the highest percent of exclusive breastfeeding at the hospital or MPG in Middlesex-London from 2013 to 2017 (Fig. 12.2.5). The lowest percent was among mothers under the age of 25.

Exclusive breastfeeding of infants at the hospital or MPG was significantly higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017 (Fig. 12.2.6).

The percent of infants in Middlesex-London fed a combination of breast milk and substitute at the hospital or MPG was 28.7% in 2017, down from 31.1% in 2013 (Fig. 12.2.7). The decline over time is likely due to the increase in infants exclusively fed breast milk at the hospital or MPG.

The percent of infants in Middlesex-London fed exclusively a breast milk substitute (formula or other) at the hospital or MPG was 8.5% in 2017, down from 12.2% in 2013 (Fig. 12.2.8). The percent also decreased over time for Ontario and the Peer Group from 2013 to 2017. In 2016, 9.3% of infants in Middlesex-London were exclusively fed a breast milk substitute, which was significantly higher compared to Ontario (7.8%).

Mothers under the age of 25 had the highest percent of infants exclusively fed a breast milk substitute at the hospital or MPG from 2013 to 2017 (Fig. 12.2.9). The percent among this age group (<25 years) was significantly higher compared to the other age groups. 

Interpretation:

The World Health Organization (WHO) recommends initiating breastfeeding within the first hour after birth to ensure that the infant receives the colostrum, the first milk which is rich in nutrients and protective factors. Breastfeeding within the first hour after birth has been found to decrease the risk of death among infants and to improve exclusive breastfeeding at six weeks to six months of age.2

Breastfeeding duration

For mothers who gave birth in 2017 and participated in the Middlesex-London Infant Feeding Surveillance System (MLIFSS), 13.7% reported having exclusively fed their infant breast milk for the first six months after birth (Fig. 12.2.10). The percent of infants who were fed any breast milk up to six months after birth was 63.1%.

Among the rural participants of the MLIFSS, a higher percent exclusively fed breast milk to their infant and for a longer duration compared to urban participants in 2017, although the difference was not statistically significant (Fig. 12.2.11).

For the 2017 birth cohort of the MLIFSS, the duration of exclusive breastfeeding was lowest among mothers under the age of 25 compared to the other age groups (Fig. 12.2.12). For mothers under the age of 25, fewer reported feeding their infant breast milk at two weeks after birth and the percent dropped more rapidly over time.

At two weeks after birth, a higher percent of urban participants reported feeding any breast milk to their infant compared to the rural population, although the difference was not statistically significant (Fig.12.2.13). However, the decrease over time was smaller among the rural population, resulting in higher percentages of any breastfeeding over time.

The duration of any breastfeeding was similar among mothers aged 25–34 and 35 or older, but lowest among those under the age of 25 (Fig. 12.2.14). For mothers under the age of 25, fewer reported feeding their infant any breast milk at two weeks after birth and the percent dropped more rapidly over time.

Interpretation:

For healthy term infants, exclusive breastfeeding is recommended from birth to the first six months.3 By six months of age, solid foods should be introduced to meet the baby’s growing nutritional needs and continued breastfeeding is recommended for up to two years or longer.4

In Middlesex-London, breastfeeding duration is monitored through the Middlesex-London Infant Feeding Surveillance System (MLIFSS). The surveillance system consists of surveying mothers of infants at three different time points after birth: 6 months, 12 months, and 18 months. The survey includes questions about current breastfeeding status, formula use, concerns about feeding their baby, and more. The MLIFSS gathers data aligned with the requirements of the Baby-Friendly Initiative (BFI) designation.

Ontario Public Health Standard: 

Healthy Growth and Development Guideline, 2018

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability

References:

1. Colaizy TT, Saftlas AF, Morriss FH, Jr. Maternal Intention to Breast-Feed and Breast-Feeding Outcomes in Term and Preterm Infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003. Public Health Nutr [Internet]. 2012 [cited 2019 Mar 21];15(4):702-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21936968 DOI: 10.1017/S1368980011002229

2. World Health Organization. Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services [Internet]. Geneva: World Health Organization; 2017 2019 Mar 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK487819/.

3. Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months [Internet]. Ottawa, ON: Government of Canada; 2012 [cited 2019 Mar 25]. Available from: https://www.canada.ca/en/health-canada/services/canada-food-guide/resour...

4. Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months [Internet]. Ottawa, ON: Government of Canada; 2014 [cited 2019 Mar 25]. Available from: https://www.canada.ca/en/health-canada/services/canada-food-guide/resour...

Last modified on: May 7, 2019

Jargon Explained

Intention to breastfeed
Mothers who intend to feed breast milk to their infant; self-reported during pregnancy or at time of birth.

Exclusive breastfeeding
When an infant is only fed breast milk, and no other formula, water, substitute, or food is given.

Any breastfeeding
When an infant is fed breast milk in combination with other formula, water, substitute, or food.