Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
News

Why are parents in Canada less likely to breastfeed than those in poorer nations?

Allison Daniel
CMAJ February 24, 2020 192 (8) E197-E198; DOI: https://doi.org/10.1503/cmaj.1095849
Allison Daniel
Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

No countries fully meet internationally accepted recommendations for breastfeeding of infants. But wealthy nations like Canada are further from achieving these goals than many poorer countries.

More than one in five infants are never breastfed in wealthier countries, compared to just one in 25 infants in poorer countries, according to UNICEF.

Paradoxically, within Canada, the poorest parents are the least likely to breastfeed. This means that Canadian mothers who have the greatest difficulty in affording infant formula are the ones most likely to use it.

The World Health Organization (WHO) recommends that parents exclusively feed their children breastmilk for the first six months of life, starting within one hour of birth, and continue giving them breast-milk until at least two years after birth.

The benefits to babies are well known, with breastfed infants being less vulnerable to infection and malnutrition, as well as some chronic diseases, like type 2 diabetes, later in life. Parents who breastfeed also benefit, with faster recovery and weight loss after giving birth, lower risks of breast and uterine cancers, and reduced likelihood of early menopause, as shown by new research.

In countries like Madagascar, Nepal, and Sri Lanka, more than 99% of infants are breastfed, compared to 89% in Canada. Partly this difference comes down to access to formula — in poorer countries, many parents cannot afford a consistent supply. But these countries also have cultures and policies that support breastfeeding.

According to WHO reports, virtually all infants in Sri Lanka are born in hospitals and clinics that meet Baby-Friendly Hospital Initiative standards aimed at promoting breastfeeding and close relationships between parents and babies. And in Madagascar, 88% of hospitals and clinics are designated Baby-Friendly.

Figure

Many low- and middle-income countries have higher breastfeeding rates than Canada.

Image courtesy of iStock.com/Enzo Nguyen

In contrast, just 2% of hospitals and clinics in Canada have a Baby-Friendly designation, despite support from groups like the Canadian Paediatric Society.

Owen Sound Hospital is one of the few Canadian facilities with this designation; it now has a 92% breastfeeding rate after delivery, up from 73% in 2013, the last year before it became a Baby-Friendly hospital.

One of the prerequisites for a Baby-Friendly designation is enforcing the WHO code on limiting marketing of breastmilk substitutes, including free samples and in-hospital promotion of formula. Madagascar, Nepal and Sri Lanka have all fully incorporated the code into law.

But Canada has not cracked down on the marketing of formula in almost four decades since the introduction of the WHO code. Companies that make formula face few restrictions, self-imposed or legal. One company, Nestlé Canada, says it “voluntarily and unilaterally applies the WHO Code in all developing countries,” although aid agencies have accused its parent company of violating the code.

“It’s hard not to see the effects of marketing in terms of how it has gradually eaten away at the whole value of breastfeeding,” says Dr. Nigel Rollins of the WHO Department of Maternal, Newborn, Child and Adolescent Health. “Many women will say they appreciate the information that they get from these marketing sites on infant feeding because they are not getting information and support from anywhere else.”

In Canada, some social supports for Indigenous families may unintentionally promote bottle-feeding by routinely providing formula, says Jaime Cidro, an anthropology professor at the University of Winnipeg. Indigenous parents may also experience discrimination when they give birth in hospitals, often far away from their home communities.

“They wouldn’t necessarily have all that family support in those first few days when you really need to get a handle on breastfeeding,” Cidro says. “In many cases, women are travelling home shortly after they give birth, in buses, travelling for long distances in ways that also impede breastfeeding.”

Canada has also seen a backlash against “breast is best” messaging in recent years, as more parents have spoken out about the social pressure they faced because they were unable to breastfeed or chose to bottle-feed.

A supportive environment is essential to reach higher breastfeeding rates. But all new parents need support, not just those who breastfeed, says Dr. Jessica Ranjani, a Toronto-based pediatrician and mother of two. “Caring for a new baby is an extremely difficult job,” she says. “The culture needs to be supportive of that and acknowledge that, as opposed to making more expectations.”

According to Owen Sound registered nurse Colleen Ford, “we would still give the same level of education and care for a mother who has come in and decided to formula feed as a mother who is breastfeeding.”

Footnotes

  • Posted on cmajnews.com on February 7, 2020

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (8)
CMAJ
Vol. 192, Issue 8
24 Feb 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Why are parents in Canada less likely to breastfeed than those in poorer nations?
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Why are parents in Canada less likely to breastfeed than those in poorer nations?
Allison Daniel
CMAJ Feb 2020, 192 (8) E197-E198; DOI: 10.1503/cmaj.1095849

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Why are parents in Canada less likely to breastfeed than those in poorer nations?
Allison Daniel
CMAJ Feb 2020, 192 (8) E197-E198; DOI: 10.1503/cmaj.1095849
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Saying goodbye to CMAJ News
  • National survey highlights worsening primary care access
  • How Canadian hospitals are decreasing carbon emissions
Show more News

Similar Articles

Collections

  • Topics
    • Breastfeeding & infant nutrition
    • Global health
    • Health policy

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire