Exciting Policy Changes at the Provincial and National Levels Improve Support for Breastfeeding Nancy E. Watters RN, BScN, MScN Posted on Nov 1, 2012

These are exciting and rewarding times for the many maternal-child nurses and other professionals who have been working for years to improve health outcomes for infants, children, mothers and families through better breastfeeding outcomes.

I have had the privilege, over the past few years, of working on several provincial and federal committees which have made significant policy changes in Ontario and Canada which will improve the promotion, protection and support for breastfeeding. These changes have created significant momentum and consistent messaging for the implementation of the evidenced based policies and practices of the WHO/UNICEF and Breastfeeding Committee for Canada's Baby Friendly Initiative (BFI).

These include:

  • The revised Ontario Public Health Standards (2008) which set a public health objective of increased rates of exclusive and sustained breastfeeding for all children to attain and sustain optimal health and developmental potential (Ministry of Health and Long Term Care, 2008).
  • The Provincial Council of Maternal Child Health's (an advisory group to the MOHLTC) Breastfeeding Services and Supports Work Group (2010) which firmly recommended the implementation of the Baby-Friendly Initiative for all hospital and community health services in Ontario.1
  • As part of the dissemination and implementation of the WHO Growth Charts, an evidence-based, 5-module, on-line learning package designed for primary care and public health practitioners was developed in 2011 through a collaboration led by Dietitians of Canada and other professional groups including the Community Health Nurses of Canada. The WHO Growth Standards are based on the growth of healthy breastfed infants and clearly establish breastfeeding as the normative model for healthy growth and development. The content of the WHO Growth Chart Training Program - reviews the importance of breastfeeding for infant and young child growth, identifies the Baby-Friendly Initiative as an avenue for increasing breastfeeding rates and includes several case studies related to the breastfed infant. The content is consistent with the principles and practices of the BFI.
  • Health Canada has just released (September 2012) the revised national infant feeding guidelines Nutrition for Healthy Term Infants Recommendations from Birth to Six Months. This work began 2.5 years ago, replacing the last complete guidelines (1998). Work will continue on the next stage of the document which will cover 6 months to 2 years. These new guidelines include many changes aimed at improving the support provided by health care providers for the protection, support and promotion of breastfeeding including a full endorsement of all components of the Baby-Friendly Initiative (See details below).

1 Some of the recommendations and tools to support BFI implementation developed by the Breastfeeding Supports and Services Work Group are available at the link below. These include breastfeeding policy templates for both hospitals and community services (Step 1 BFI) and a Curriculum and Learning Resources package to support Step 2 (Staff Education). http://pcmch.on.ca/ClinicalPracticeGuidelines/ BreastfeedingSupportsandServicesWorkGroup.aspx

Policy Translated into Action: The Status of the Baby Friendly Initiative (BFI) in Ontario

As many MCNIG members will be aware, in the Fall of 2011 the Ministry of Health and Long-Term Care established the requirement for each of Ontario's Public Health Units to pursue Baby Friendly status as part of their 2011-2013 accountability agreements. The Ministry will be measuring each health unit's progress in working towards, achieving and/or maintaining Baby Friendly designation. The principles of the Baby Friendly Initiative align closely with the Ontario Public Health Standards and this work represents a very exciting and encouraging step.

The Baby Friendly Initiative is also referenced in the Accreditation Canada's Qmentum Program - Obstetrics Services Standards for hospitals, as of September 4, 2012. In section three of this document, the Baby Friendly Initiative is identified as a resource/guideline that provides: "structured education promoting a collaborative interdisciplinary team approach to safety and quality improvement." To clarify, Baby Friendly designation is not specified as a requirement for accreditation, however, it is encouraged by Accreditation Canada.

The Breastfeeding Committee for Canada reports that there are currently three hospitals, seven public health units and two community health centres in Ontario that have received the BFI designation. There are many other organizations working diligently through the application/designation process (including all 36 public health units). No doubt, the recent publication of the new Health Canada guidelines along with the recommendation from the Accreditation Canada will provide a boost for BFI implementation in hospitals.

RNAO is also very excited about the Spring 2012 launch of a Breastfeeding elearning offering to assist nurses and health-care professionals to develop the knowledge and skills required to implement internationally recognized best practices in breastfeeding. This e-learn, an amalgamation of RNAO's Breastfeeding Best Practice Guideline for Nurses and the WHO/UNICEF Baby-Friendly Hospital Initiative's 20-hour course for maternity staff (http://elearning.rnao.ca) is being used by many agencies as part of their Staff Training requirements (BFI Step 2) as they work towards achieving official BFI designation (including my own health unit - City of Ottawa).

MCNIG should be proud of the work we have done as individual professionals, and as a group, in providing better support for families to optimize their health through breastfeeding. Some members may recall that it was a resolution from this RNAO Interest Group with collaborative support from CHNIG and PedNIG which took a resolution related to the implementation of the Baby Friendly Initiative to the 2006 RNAO AGM which was unanimously approved by the members. This seems like a long time ago now - but it was certainly an important step along the way as RNAO has used its considerable political and practice influence in a variety of realms to work towards this common goal.

Although we have much improved breastfeeding initiation rates - about 88% in Canada, we have a long way to go before we meet the objectives. There is a sharp drop off in breastfeeding rates in the first few months, only 25% of babies are exclusively breastfed for 6 months and the minority are breastfed into the second year. But - it is important to focus on progress and recent policy changes at the highest levels are extremely encouraging.

I have had the privilege of serving as an expert advisor on these provincial and national groups and bring you this news with pleasure!! This summary should be helpful to any agency staff attempting to take the initial steps towards becoming Baby Friendly and in convincing a team of colleagues that BFI is a proven approach to improving child and maternal health outcomes by increasing breastfeeding rates - initiation, exclusivity and duration. The Ontario Breastfeeding Committee is actively supporting these efforts in our province. Please feel free to share and disseminate this information.



This e-learn has been created as a means to assist nurses, other health-care professionals and organizations to access education that is appropriate to their role in promoting breastfeeding. As such, it aims to develop the knowledge, skills and attitude required to implement internationally recognized best practices in breastfeeding to create a baby-friendly environment.


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