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FACT SHEET 1 Breastfeeding in Ontario Notable Trends within the Province In order to gain a greater understanding of breastfeeding in Ontario, breastfeeding data was retrieved from the Better Outcomes Registry and Network (BORN) Ontario database (2012/13). The information retrieved highlighted the impact of factors on exclusive breastfeeding rates among mothers who gave birth to live, full-term infants in the province of Ontario: • Individual and neighbourhood demographics. • Childbirth outcomes. • Prenatal care. • Health status. • Substance use. This factsheet highlights noteworthy trends in the provincial data. All statistics presented in this factsheet refer to exclusive breastfeeding at hospital discharge unless otherwise indicated. Some data in this fact sheet is presented for all of Ontario and some data is presented for specific Local Health Integration Networks (LHINs). Ontario LHINs are not-for-profit corporations who work with local health providers and community members to determine the health service priorities of their regions. Funded by MOHLTC, LHINs plan, integrate and fund local health services. There are 14 LHINs in Ontario (www.lhins.on.ca). A more detailed summary of information can be found in Health Nexus’ publication Populations with Lower Rates of Breastfeeding: A Summary of Findings. Notable Trends within the Province 1 FACT SHEET 1 Maternal Age Within Ontario, being a teenage mother is generally associated with lower rates of exclusive breastfeeding (50.2% compared to a provincial average of 61.8%). This difference tends to be especially pronounced among teenage mothers living in both the Champlain and North West LHINs. When compared to 30-34 year olds (who have the highest rate of breastfeeding within both LHINs), teens in the Champlain LHIN are 20.9% less likely to breastfeed and teens within the North West LHIN are 35.3% less likely to breastfeed. However, among teenage mothers within the Central West LHIN, the opposite effect has been found. Teenage mothers have been found to have the highest rate of breastfeeding of all age groups (57.6%), while other age groups have rates of breastfeeding that range from 44.5% (among women age 40 and older) to 55.6% (among 25 to 29 year olds). Percent Exclusive Breastfeeding at Discharge by Age of Mother 80% 70% 60% 50% 40% 30% 20% 10% 0% Ontario Less than 20 North West 20 – 24 25 – 29 Champlain 30 – 34 Central West 35 – 39 40+ Parity After giving birth, Ontario women who have only one child and women who have more than one child are almost equally as likely to breastfeed (61.4% vs 61.5%). Unemployment Within Ontario, neighbourhoods with lower rates of unemployment have been found to have higher rates of exclusive breastfeeding in all LHINs (65.3%). When neighbourhoods are stratified according to unemployment level, compared to the provincial average, all quartiles of neighbourhoods within the Erie St. Clair LHIN, have lower rates of breastfeeding. Notable Trends within the Province 2 FACT SHEET 1 Income Consistently across all 14 LHINs in Ontario, neighbourhoods with higher median household incomes have been found to have higher rates of exclusive breastfeeding. When neighbourhoods are stratified according to income level, the Ontario neighbourhoods with the lowest incomes have a breastfeeding rate of 54.7% and those with the highest incomes have a breastfeeding rate of 68.4%. Immigration Within Ontario, neighbourhoods with the highest proportion of immigrants tend to have lower rates of exclusive breastfeeding. However within the South East LHIN, this trend is reversed. Within this LHIN, the neighbourhoods with the lowest concentrations of immigrants were found to have the lowest rates of breastfeeding (57.9%) and those with the highest concentration of immigrants were found to have the highest rates of breastfeeding (76.5%). Percent Exclusive Breastfeeding at Discharge by Neighbourhood Concentration of Immigrants 80% 70% 60% 50% 40% 30% 20% 10% 0% Ontario 1 (Lowest) South East 2 3 4 (Highest) Visible Minorities Within the province, the neighbourhoods with the highest concentration of visible minorities tend to have lower rates of exclusive breastfeeding. However, similar to immigration within the South East LHIN, this trend is reversed. The neighbourhoods with the highest concentrations of visible minorities had the highest rates of breastfeeding (74.1%) and those with the lowest concentrations of visible minorities had the lowest rates of breastfeeding (57.6%) in 2012/13. Notable Trends within the Province 3 FACT SHEET 1 Mode of Delivery With respect to exclusive breastfeeding, within Ontario there is a pronounced difference between women who deliver by cesarean and those who have vaginal deliveries (48.0% vs 66.5%). Types of Vaginal Birth Ontario women who have assisted vaginal births and those who have spontaneous vaginal births have similar rates of exclusive breastfeeding (61.1% respectively). Perineal Lacerations Within Ontario, the rate of exclusive breastfeeding among women who had no perineal lacerations, or had 1st or 2nd degree lacerations following birth (66.6%) is comparable to that of women who had 3rd, 4th or cervical lacerations (65.9%). Pain Management during Labour and Birth Women in Ontario who use pain management during labour and birth, including epidurals, narcotics, inhalants and non-medical pain relieving methods have lower rates of exclusive breastfeeding (62.5%) than women who receive no pain management during childbirth (70.4%). Due to some missing data, particularly in larger centres, this information should be treated with caution. In the North East LHIN the difference between both groups (13.3%) was most pronounced. Percent Exclusive Breastfeeding at Discharge Related to Pain Management 80% 70% 60% NO NO YES 50% YES 40% 30% 20% 10% 0% Ontario North East Notable Trends within the Province 4 FACT SHEET Prenatal Health Care Provider 1 Percent Exclusive Breastfeeding at Discharge by Health Care Provider Within Ontario, 83.3% of women who receive prenatal care from a midwife breastfeed exclusively at hospital discharge. 100% Women who receive prenatal care from other providers (such as obstetricians, family physicians, or nurses) are much less likely to breastfeed exclusively than those who receive care from a midwife (58.7%). 80% Midwife 60% Other Prenatal Care Provider 40% 20% 0% Ontario Diabetes in Pregnancy Within Ontario, 62.8% of women without diabetes during pregnancy breastfeed exclusively, while only 43.7% of women with diabetes during pregnancy breastfeed exclusively after delivery. Compared to the provincial average, women within the Waterloo Wellington LHIN who have diabetes during pregnancy are much more likely to breastfeed exclusively after delivery (66.1%). Women within the North Simcoe Muskoka LHIN who have diabetes during pregnancy are also much more likely to breastfeed exclusively after delivery (60.3%). However, with an exclusive breastfeeding rate of 28.8%, women with diabetes during pregnancy living in the South East LHIN are much less likely to breastfeed exclusively when compared to the provincial average. Percent Exclusive Breastfeeding at Discharge Related to Maternal Diabetes 80% 70% 60% 50% 40% 30% 20% 10% 0% Ontario Waterloo/ Wellington NO South East North Simcoe/ Muskoka YES Notable Trends within the Province 5 FACT SHEET 1 Mental Health Conditions Within Ontario, women without mental health conditions and women who have mental health conditions have similar breastfeeding rates (61.8% vs 59.3%). However, there are considerable differences between LHINs. In some LHINs slightly more women with a mental health condition breastfed exclusively, in other LINS there was hardly any difference between both groups. Some LHINs had large differences of up to 18.5 percentage points (see graph below for details). Percent Exclusive Breastfeeding at Discharge by Maternal Mental Health Concerns 80% 70% 60% 50% 40% 30% 20% 10% 0% Ontario Waterloo/ Wellington HNHB North Simcoe/ Muskoka NO North East South East North West YES Notable Trends within the Province 6 FACT SHEET 1 Substance Use Following delivery, there is a large difference between the rates of breastfeeding among women who use drugs and illicit substances, not including alcohol use during pregnancy and those who do not (42.1% vs 61.9%). Smoking Within Ontario, women who do not smoke during pregnancy are more likely to breastfeed than those who smoke throughout their pregnancy (63.3% vs 47.5%). This difference is especially pronounced within the North Simcoe Muskoka LHIN where women in both groups have higher breastfeeding rates than the provincial average, but the difference between groups is wider. Women who do not smoke during pregnancy have an exclusive breastfeeding rate of 74.1%, and women who smoke during their entire pregnancy are almost 20% less likely to breastfeed exclusively with a rate of 54.9%. What Can Service Providers Do? While the statistics presented in this factsheet highlight noteworthy trends within the provincial data, they also highlight differences between LHINs and within LHINs. Service providers should explore their own communities in order to identify community specific, breastfeeding related strengths and weaknesses and develop effective strategies to improve breastfeeding. Notable Trends within the Province 7 FACT SHEET 1 References Best Start Resource Centre. (2014). Populations with Lower Rates of Breastfeeding: A Summary of Research Findings. Toronto, Ontario, Canada: author. BORN Ontario1, 2014. Breastfeeding data for 2011/12. Data requested from: www.bornontario.ca 1 This report is based in part on data provided by Better Outcomes Registry and Network (BORN) Ontario, a provincial program housed at the Children’s Hospital of Eastern Ontario. The interpretation and conclusions contained herein do not necessarily represent those of BORN Ontario. Data to inform this report came from the historical Niday Perinatal Database and from the new BORN Information System (BIS). This document has been prepared with funds provided by the Government of Ontario. The information herein reflects the views of the authors and is not officially endorsed by the Government of Ontario. 2014 Notable Trends within the Province 8