Breastfeeding Initiation

Overall
By Maternal Age
By Parity
Other Factors

Health Canada recommends that children are fed only breast milk until the age of six months, with complementary foods added at that time and continued breast milk to two years and beyond. Infant feeding at initiation is defined as what baby is fed from birth to discharge from hospital or three days post-partum for home births. Multiple factors can affect breastfeeding initiation including intrapartum factors (type of birth, skin-to-skin contact, supplementation) and social determinants of health such as income. For more information on how to breastfeed and where to find support, see the health unit’s website on breastfeeding. The data on this page are from the Better Outcomes Registry & Network (BORN).

Overall

A large majority of new parents in Simcoe Muskoka provide breast milk to their infants at initiation.  In 2019, 91.5% (90.7% - 92.3%) of babies in Simcoe Muskoka received ‘any’ breastmilk at initiation, including almost 70% (68.9% (67.5%, 70.2%)) who received exclusive breastmilk.

Ontario has a similar ‘any’ breastfeeding initiation rate of 92.5% (92.4%, 92.7%), however the exclusive breastfeeding rate (58.6% (58.3%, 58.9%) is lower than that of Simcoe Muskoka. Consequently, a higher proportion of babies in Ontario are combination fed at initiation (34.0% ( 33.7%, 34.3%) than in Simcoe Muskoka (22.7% (21.5%, 23.9%)).  Less than 10% of babies in Simcoe Muskoka and Ontario receive no breast milk at initiation.

The prevalence of infant medical supplementation has more than doubled in the last five years, from 2.8% (2.3% - 3.3%) in 2014 to 7.4% (6.7% - 8.2%) in 2019. The reasons most commonly noted include “hypoglycemia”, “inadequate weight gain” or “significant weight loss in the presence of clinical indications”, and “other clinical indications”.

There have been no significant trends in breastfeeding initiation rates between 2013 and 2019 in Simcoe Muskoka. Across Ontario, there has been a small (2.5%) increase in ‘any’ breastfeeding initiation rate, a corresponding decrease in ‘no breastfeeding’ initiation rate, a 7% increase in combination feeding initiation rate and a 4.5% decrease in exclusive breastfeeding initiation rate between 2013 and 2019.

Prior to 2013, initiation data was collected using the CCHS, which show that the ‘any’ breastfeeding initiation rates increased by 5% in Ontario between 2000/01 and 2011/12.

By Maternal Age

Babies born to  parents in the youngest age group (15-24 years old) have a higher ‘no breastfeeding’ initiation rate (13.4% (10.6%, 16.7%)) than those born to parents in the older the age groups (25-34 years: 7.5% (6.7%, 8.5%); and 35+ years: 7.5% (5.9%, 9.3%)). The differences across age groups in the other feeding type categories is not significant.

Analysis on another source of initiation data (SMDHU Infant Feeding Surveillance data) showed that when all other factors were held constant, babies born to parents in the oldest age group (35+ years) were less likely to initiate exclusive breastfeeding than babies born to mothers in the youngest age group (15-24 years). This is not reflected in the graph below because exclusive breastfeeding initiation and age are also influenced by factors such as parity, birth type and income so the relationship between exclusive initiation and age is clouded (confounded) by these factors.

By Parity

Despite their lower intention rates, second time parents have similar exclusive initiation and higher exclusive duration rates compared to first time parents, likely because intention is informed by experience with the previous baby and therefore intention is a more accurate predictor of feeding type with second babies. Babies born to first time parents have a higher combination feeding rate (26.9% (25.0%, 28.9%)) compared to second time parents (20.3% (18.5%, 22.2%)), and a lower ‘no breastfeeding’ rate (5.5% (4.6%, 6.8%)) compared to second time parents (9.2% (7.9%, 10.6%)).

Other Factors

Analysis on another source of initiation data (SMDHU Infant Feeding Surveillance data) showed that when all other factors were held constant, the following five factors were independently associated with higher exclusive breastfeeding initiation rates in addition to maternal age (explained above) and parity. These are the same factors that are independently associated with breastfeeding duration)

• Income: babies born into families with an annual after-tax income of less than $60,000 were less likely to be exclusively breastfed at initiation than those born to families with higher incomes.
• Birth Type: babies born by caesarean section are less likely to be exclusively breastfed than those who were born vaginally
• Gestational Age: babies born before 37 weeks gestation are less likely to be exclusively breastfed at initiation than those born full term (37+ weeks gestation)

Technical Notes:

There are two sources of local data for infant feeding at initiation: BORN and SMDHU Infant Feeding Surveillance (IFS) System.  The “any” breastfeeding rates at initiation are very similar between the two sources, therefore so too are the complementary “no breastfeeding” rates at initiation.  However, the two sources differ in the exclusive breastfeeding rates and the combination feeding rates (breast milk and a substitute) at initiation: BORN exclusive initiation rates are approximately 10% higher than SMDHU IF.

Possible explanations for this difference include recall bias of SMDHU IFS respondents who may not accurately remember what baby was fed at initiation, and/or breast milk substitute fed to babies in hospital that is not being reflected in BORN. The sampling frame for IFS is all Simcoe Muskoka residents who have a completed Healthy Babies Healthy Children (HBHC) screen received by SMDHU so if that group is systematically different than those who do not have a completed screen, this could create a biased sample.