Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study

Abstract

Background In Canada, 91% of all mothers initiate breastfeeding, but 40–50% stop by 6 months and only 34% breastfeed exclusively for 6 months, with lower rates among socially and/or economically vulnerable women. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women, but there is no formal framework or funding for sites to integrate proactive postnatal breastfeeding support. This research aimed to i) describe infant feeding practices among clients of one Toronto CPNP site using charitable funds to offer a lactation support program (in-home lactation consultant visits, breast pumps); ii) determine whether breastfeeding outcomes at 6 months differ based on maternal sociodemographics and food insecurity; and iii) assess utilization of the lactation support program. Methods Infant feeding practices were collected prospectively at 2 weeks, 2, 4 and 6 months postpartum via telephone questionnaires (n = 199). Maternal sociodemographics were collected at 2 weeks and food insecurity data at 6 months postpartum. Program monitoring records were used to determine utilization of the lactation support program. Results Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump. Conclusions This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women. Study registered at clinicaltrials.gov as NCT03400605.

Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

“…Study A was a prospective cohort study of infant feeding practices among clients of a CPNP site offering skilled postnatal lactation support with additional charitable funding from The Sprott Foundation. 18 Study B was a pre/post intervention study designed to examine the effectiveness of implementing similar lactation support services in two other CPNP sites. 19 The target sample size for Study B was 210, based on an anticipated 20 percentage point difference in exclusive HM feeding at 4 months postpartum between the pre-intervention and post-intervention groups, with 80% power, alpha=0.05, and allowance for 10% attrition.…”

High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada

“…We identified 4 months post‐partum as a transition point following which participants who were previously practising EBF began to provide solids and non‐formula liquids in addition to breastmilk. Research at another CPNP site in Toronto that implements a lactation support programme offering in‐home post‐partum visits by International Board Certified Lactation Consultants found very high rates of continued breastfeeding at 6 months post‐partum (84%) as well as high uptake of the lactation services, with 75% of study participants ( n = 199) having received at least one lactation support visit (Francis et al, 2021 ). There is a need for further testing of delivery models for integrating post‐partum lactation support with the CPNP and other community perinatal services targeting vulnerable women.…”

“…Breastmilk feeding intentions were assessed prenatally using the validated Infant Feeding Intentions scale (Nommsen‐Rivers & Dewey, 2009 ). Post‐discharge infant feeding data were collected prospectively at 2 weeks post‐partum and monthly to 6 months using a standardized and validated questionnaire used previously with CPNP clients (Francis et al, 2021 ; O'Connor et al, 2008 ). At each time point, participants reported the average daily number of breastmilk and formula feeds provided to their infant, including formula provision as a top‐up after feeding at the breast.…”

Interventions and policy approaches to promote equity in breastfeeding

“…As highlighted by Rhodes et al [ 19 ], postnatal lactation support services, are easier to support and sustain if they are embedded or linked to already existing maternal-child nutrition programs or healthcare services. Francis et al [ 20 ] provide further evidence in this respect by describing infant feeding practices and service use of a postnatal lactation support initiative for vulnerable mothers enrolled in the Canada Prenatal Nutrition Program. Findings from one site in Toronto indicated a high uptake of the lactation support program by the target women.…”