Breastfeeding Statement of the Breastfeeding Committee for Canada

The Breastfeeding Committee for Canada endorses exclusive breastfeeding to the age of six months and provision of safe, appropriate, and locally available complementary foods, with continued breastfeeding for up to two years of age and beyond.^1,2,3,4

The Breastfeeding Committee for Canada recognizes that:

exclusive and sustained breastfeeding, and the use of human milk when breastfeeding is not possible, is the normal way to nurture all children including premature and sick newborns, from birth to two years of age and beyond.⁵
exclusive and sustained breastfeeding provides a biologically efficient system that provides nutritional, immunological, and emotional nurturing for normal growth and development during the vulnerable first years of a child’s life. The unique nutrients, enzymes, growth factors, hormones and immunological and anti-inflammatory properties of human milk decrease the incidence/severity of respiratory disease, otitis media, gastroenteritis, bacteremia, bacterial meningitis, urinary tract infections, botulism, necrotizing enterocolitis and low iron stores and anemia. There is a possible protective effect of breastfeeding on Sudden Infant Death Syndrome, Crohn’s Disease, ulcerative colitis, insulin dependent diabetes, lymphoma, and allergic disease. Beyond infancy the ongoing benefits contribute to protection against obesity and to improved cognitive development.^6-9
breastfeeding contributes to women’s health by contributing affirmatively to women’s social and economic equality as well as to women’s self esteem and body image. Breastfeeding offers protection for some women against breast cancer, ovarian cancer, endometrial cancer, osteoporosis and anemia, and by increasing the spacing between pregnancies.^10-14
breastfeeding is a basic human right.^15,16 For children breastfeeding provides the highest attainable standard of health; a basic human right. For women the right to breastfeed in public and the right to be accommodated by the employer or educational institution to continue to breastfeed on returning to work or school is a human right.
breastfeeding provides positive economic advantages to both families and society. It ensures a safe, secure and self-reliant food source that is ecologically sound, nutritionally efficient and complete. As a result of breastfeeding, the improved health status of both children and mothers means substantial savings in health costs.^17,18
breastfeeding initiation and duration rates in Canada are variable.^19,20 The Breastfeeding Committee for Canada recommends that breastfeeding initiatives focus on increasing initiation rates regionally in families living in high risk circumstances, and increasing duration rates across Canada.
breastfeeding protection, promotion, and support must be practiced by all sectors of society: all levels of government, policy makers, administrators, health professional associations, health care institutions, health professionals, community health services, public facilities, work places, educational institutions, women’s groups, unions, parent groups, religious organizations, social agencies and all individuals.^21,22,23
implementation of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes (1981) and relevant World Health Assembly (WHA) Resolutions concerning infant and young child nutrition (The Code), the Baby- Friendly™ Hospital Initiative and the Baby-Friendly™ Initiative are integral to moving Canada towards a culture in which breastfeeding is the biological norm.^24-27

The Breastfeeding Committee for Canada aims to establish breastfeeding as the cultural norm for infant feeding in Canada. To achieve this aim the Breastfeeding Committee for Canada

endorses and works to implement the standards held within these publications:

The International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly (WHA) Resolutions concerning infant and young child nutrition (The Code) ^1,2
Protecting, Promoting and Supporting Breast-Feeding: The special role of maternity services ⁴
Innocenti Declaration On the Protection, Promotion and Support of Breastfeeding ²⁸
The Baby-Friendly™ Hospital Initiative (BFHI) ²⁴
The Evidence for the Ten Steps to Successful Breastfeeding ²⁵
The Baby-Friendly™ Initiative in Community Health Services: An Implementation Guide ²⁷

works to implement strategies that advance public awareness and acceptance of the importance of breastfeeding and enable women to continue breastfeeding into their child’s second year of life and beyond, anytime and anywhere.^15,16,18
advocates that health professional associations²² and health care agencies develop and adopt breastfeeding policy statements and educate their membership/personnel on these policies. Health care professionals working with pregnant women and new parents should receive accurate and continuous education/information about breastfeeding, lactation and infant nutrition and support research to monitor and improve breastfeeding practices.²¹
advocates that all levels of government give full support to The Code and develop appropriate social and legislative measures to implement The Code and monitor compliance; support the WHO/UNICEF Baby-Friendly™ Hospital Initiative²⁴ in all hospitals and maternity services and The Baby-Friendly™ Initiative in Community Health Services;²⁷ develop health care policies that endorse breastfeeding as the biological and cultural norm for feeding infants; support human milk banking; sanction the right to breastfeeding as a human right;^15,16 and implement legislation that ensures a breastfeeding woman is enabled to breastfeed when resuming her position in the work place or educational institution.
advocates that educational institutions ensure that curricula at all levels, preschool to post secondary, include appropriate breastfeeding information and that post secondary institutions facilitate research to improve breastfeeding.
advocates that non-governmental organizations and consumer groups monitor the implementation of public policy on infant feeding and identify consumer and community needs to support breastfeeding and that they play an advocacy role and develop educational tools and programs to educate the public on the importance of breastfeeding.
advocates the development of peer support networks to protect, promote, and support breastfeeding. A peer network provides breastfeeding knowledge in an atmosphere respectful of women’s life experience and culture.^4,25,30,31
advocates that public institutions and the commercial sector educate employees on women’s rights to breastfeed and have policies to ensure that these rights are respected.^15,16

Summary of the International Code of Marketing of Breastmilk Substitutes (The Code) and Relevant World Health Assembly (WHA) Resolutions

World Health Organization (WHO), Geneva, Switzerland, 1981, 1986, 1994, 1996, 2001 ^1,2

The Code and WHA Resolutions concerning infant and young child nutrition (The Code) include these important provisions:

No advertising of products under the scope of the Code to the public.
No free samples to mothers.
No promotion of products in health care facilities, including the distribution of free or low-cost supplies.
No company representatives to advise mothers.
No gifts or personal samples to health workers.
No words or pictures idealizing artificial feeding, including pictures of infants, on the labels of the products.
Information to health workers should be scientific and factual.
All information on artificial feeding, including the labels, should explain the benefits of breastfeeding and all costs and hazards associated with artificial feeding.
Unsuitable products such as sweetened condensed milk should not be promoted for babies.
All products should be of a high quality and take account of the climatic and storage conditions of the country where they are used.
Promote and support exclusive breastfeeding for six months as a global public health recommendation with continued breastfeeding for up to two years of age or beyond.
Foster appropriate complementary feeding from the age of six months recognizing that any food or drink given before nutritionally required may interfere with breastfeeding.
Complementary foods are not to be marketed in ways to undermine exclusive and sustained breastfeeding.
Financial assistance from the infant feeding industry may interfere with professionals’ unequivocal support for breastfeeding.

The Ten Steps to Successful Breastfeeding ⁴

A Joint WHO/UNICEF Statement, Geneva, Switzerland, 1989

Every facility or agency providing maternity services and care of newborn infants should:

Have a written breastfeeding policy that is routinely communicated to all health care staff.
Train all health care staff in skills necessary to implement this policy.
Inform all pregnant women about the benefits and management of breastfeeding.
Help mothers initiate breastfeeding within a half-hour of birth.
Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
Give newborn infants no food or drink other than breast milk, unless medically indicated.
Practice rooming-in -- allow mothers and infants to remain together 24 hours a day.
Encourage breastfeeding on demand.
Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

The Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Services ²⁷

Have a written breastfeeding policy that is routinely communicated to all staff and volunteers.
Train all healthcare providers involved in the care of mothers and babies in the skills necessary to implement the policy.
Inform all pregnant women and their families about the benefits and management of breastfeeding.
Support mothers to initiate and sustain exclusive breastfeeding.
Encourage sustained breastfeeding beyond 6 months with appropriate introduction of complementary foods.
Provide a welcoming atmosphere for breastfeeding families.
Promote collaboration between healthcare providers, breastfeeding support groups and the local community.

Adapted from the UK The Baby-Friendly™ Initiative in the Community-A Seven Point Plan.

References

WHO International Code of Marketing of Breastmilk Substitutes. Document HA34/1981/REC/1,Annex 3. Geneva: WHO, 1981. Available from URL: http://www.ibfan.org/english/resource/who/fullcode.html
World Health Organization. WHA Resolutions 32.32; 34.22; 35.26; 37.30; 39.28; 41.11; 43.3; 45.34; 47.5; 49.15; 54.2. Available from URL: http://www.ibfan.org/english/resource/who/whares3332.html
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