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Numerous studies have documented the benefits of breastfeeding for both mother and baby.1,2 Professional organizations, therefore, widely recommend exclusive breastfeeding until the age of six months, and continued breastfeeding up to 12 months and beyond as optimal infant nutrition.3-7 Yet breastfeeding rates around the world fall alarmingly short of these goals.8 Newfoundland and Labrador, Canada’s easternmost province, is no exception. In fact, a recent study based on information from 20069 showed Newfoundland and Labrador to have the country’s second-lowest breastfeeding initiation rate (75%, compared with the national average of 90%), and its lowest rate of exclusive breastfeeding at six months (6%, compared with the national average of 14%). A study done in Newfoundland 20 years ago provides some historical context:10 while breastfeeding initiation per se was not captured, less than half (42%) of mothers reported breastfeeding exclusively while in hospital, 57% were formula feeding, and 1% were breastfeeding with formula supplementation; only 11% remained breastfeeding exclusively at six months. No published studies of current infant feeding practices in hospital are available. Therefore, we set out to do a chart review of the question at the Janeway Children’s Hospital-Health Sciences Centre in St. John’s, the provincial capital (population approximately 100,000). Between June 1, 2007 and May 30, 2008, 2,550 infants were born at the hospital. Charts of live infants were randomized and the first 250 were requested from Eastern Health. Feeding information was taken from the Infant Data Flow Sheet. The research was approved by Memorial University’s Human Investigations Committee (approval number 09.226), and the chart review was conducted January through July, 2010. One hundred and seventy infants (68%) received breast milk at least once during their admission (the criterion for breastfeeding initiation), consistent with recent national data.9 However, only 64 (26%) infants received breast milk exclusively throughout their hospital admission, either directly from the breast or in expressed form; in contrast, Matthews et al. found that 42% of infants were exclusively breastfed during the 1990s.10 We also found that breastfeeding with formula supplementation occurred with more than one third of infants (n=89, 36%); this is much higher than the 1% supplementation rate found in the Matthews et al. study. Eighty (32%) infants were given formula exclusively from birth, and a further 17 (7%) began with breastfeeding, but switched to exclusive formula feeding. Though this study is somewhat limited by a small sample size, it confirmed that the rate of breastfeeding initiation in St. John’s (68%) is consistent with that reported recently from national survey data.9 However, it also provided important new information that 20 years on in Newfoundland and Labrador, in-hospital formula supplementation rates have climbed and exclusive breastfeeding rates both at discharge from hospital and at six months have in fact dropped. While disappointing, this means that targeting hospital infant feeding practices continues to matter, and represents a real opportunity for improving maternal and child health in this province and elsewhere.

Breastfeeding and hospital infant feeding practices in Newfoundland, 20 years on: more work to do.