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Breastfeeding trends in Canada

Statistics Canada Catalogue no. 82-624-X
by Linda Gionet

The importance of breastfeeding for both baby and mother is well-recognized.^{Note 1,2} Breast milk is a custom-made form of nutrition that changes as a baby grows, and is easier to digest than formula. Breastfeeding helps protect against multiple infectious diseases in infancy, sudden infant death syndrome, and may also have a protective effect against obesity.^{Note 3-6} For mothers, breastfeeding can contribute to post-pregnancy weight loss and delay menstruation. It may reduce the risk of chronic diseases, such as ovarian and breast cancers.^{Note 7-9}

For healthy-term infants, exclusive breastfeeding for the first six months is recommended by the World Health Organization, Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Public Health Agency of Canada. Around six months, they also recommend introducing complementary foods and continuing to breastfeed for two years or more.^{Note 10,11}

This article presents the latest data on breastfeeding from the Canadian Community Health Survey (CCHS).^{Note 12} It also highlights the characteristics of mothers who breastfed and some of their breastfeeding challenges. “Mothers,” in this article, refers to women, aged 15 to 55, who had a child in the five years before the survey was taken.

Most women breastfed their baby soon after birth

In 2011–2012, 89% of Canadian mothers initiated breastfeeding soon after their child’s birth, up slightly from 85% in 2003.^{Note 14} Canada’s rate was higher than that of the United States, 77%,^{Note 15,16} but lower than the rate in Norway, 95%,^{Note 17,18} and Australia, 92%.^{Note 19,20}

Among Canada’s provinces and territories, breastfeeding rates ranged widely, from 57% in Newfoundland and Labrador to 96% in such regions as British Columbia and the Yukon in 2011–2012. The rates of mothers who initiated breastfeeding changed little since 2003, except in Quebec where it rose from 76% to 89%.

Mothers who did not breastfeed, 11%, tended to be younger, had less formal education and were more likely to be single than those who initiated breastfeeding.^{Note 21} Two of the main reasons for not breastfeeding were that bottle feeding was easier, 25%, and a medical condition of the mother or child, 23%.

More women breastfed exclusively for six months

Health Canada and its partners encourage mothers to breastfeed their infants exclusively for the first six months. Prior to 2004, the recommendation had been to do so for the first four to six months.^{Note 23} In 2011–2012, 26% of mothers in Canada breastfed exclusively for six months (or more), up from 17% in 2003. Meanwhile, over half of mothers breastfed exclusively for four months (or more); up from 42% in 2003 (Chart 1).   

Characteristics of mothers who breastfed exclusively

This section compares the age, education and marital status of mothers who:

• breastfed exclusively for six months (or more),
• those who breastfed (partially or exclusively) for less than six months, and
• those who did not breastfeed.^{Note 24}

About 77% of mothers who breastfed exclusively for six months (or more) were aged 30 years and older (Chart 2). Also in this age group were 60% of mothers who breastfed less than six months (partially or exclusively), and 58% who did not breastfeed.

In 2011–2012, 76% of mothers who breastfed exclusively for six months (or more) had postsecondary qualifications, compared with 65% of all mothers who breastfed less than six months (partially or exclusively), and 52% of those who did not breastfeed. Other Canadian research shows that the rates of breastfeeding increased with maternal age and education level.^{Note 25}

In 2011–2012, 91% of mothers, who breastfed exclusively for six months (or more), were in a married or common-law relationship, compared with 70% of mothers who did not breastfeed.

British Columbia had the highest rate of exclusive breastfeeding

Across Canada, mothers in British Columbia had the highest rate of breastfeeding exclusively for six months (or more) in 2011–2012.

Most provinces, nonetheless, saw increases in exclusive breastfeeding rates from 2003 to 2011–2012. During that time, British Columbia also had the largest increase from 28% in 2003, to 41% in 2011–2012 (Chart 3).

Why women stopped breastfeeding

The CCHS also asked women why they stopped breastfeeding. Among mothers who tried breastfeeding for any duration, the most reported reasons for stopping were insufficient breast milk, 26%; and that the baby was ready for solids, 18%.

“Not enough breast milk” was the main reason for stopping breastfeeding in both 2003 and 2011–2012. There were changes, however, in some of the other key reasons for stopping breastfeeding during that time. For example, in 2003, 14% reported “returned to work or school” compared with 10% in 2011–2012. Job-protected and compensated parental leave was extended in most provinces from six months to one year in 2001.^{Note 28} This change may have given some mothers the chance to breastfeed longer at home.^{Note 29,30}

Mothers who stopped breastfeeding before the six-month mark

Among mothers who breastfed for less than six months, about 44% stopped because they felt they had insufficient breast milk, while 18% cited difficulty with breastfeeding technique. In addition to improper latching or feeding technique, low milk supply can be associated with introducing the breastfeeding baby to other foods too early. Babies who consume other liquids and solids tend to breastfeed less which, in turn, reduces the mother’s breast milk production.^{Note 34}

According to the CCHS, the third most common reason for breastfeeding less than six months was owing to a medical condition of the mother or baby, 9%. There are a few diseases or medications that prevent a mother from breastfeeding.^{Note 35} In some instances, however, mothers with unique challenges may benefit from customized breastfeeding support.^{Note 36-38}

Adding liquids and solids

Although it is recommended that breastfed infants receive only breast milk in the first six months, a proportion of mothers still gave their breastfed infants other liquids and solids before the six-month mark (Chart 4).^{Note 39}

Among all mothers who tried breastfeeding, 45% introduced other liquids to their infants when they were three months old or younger, and 13% at four to five months old.^{Note 40}

As for solid foods, 11% of infants consumed them at three months old or younger and 32% at four to five months old. Over half, 57%, consumed solid foods at the six-month mark (or later).

The main reasons that all breastfeeding mothers gave for introducing other liquids and solids were: “baby was ready for solids,” 44%, and “not enough breast milk,” 23%.

Summary

The majority of mothers in Canada breastfed their baby. One in four mothers breastfed exclusively for six months (or more), which is an increase from a decade ago.

“Not enough breast milk” was the main reason that women stopped breastfeeding, even though low milk supply is a rare medical condition. Many mothers reported that they introduced other liquids and solids to the baby before the six-month mark, a practice that may interrupt breast milk production.

Efforts have been made to promote and support breastfeeding in Canada.^{Note 41} More research, however, is needed to explore the challenges faced by breastfeeding mothers.

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Linda Gionet is an analyst with the Health Statistics Division

The author wishes to thank Teresa Janz and Brenda Wannell for their contributions.

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Notes

1. See Canadian Paediatric Society 2012.
2. See Horta 2007.
3. See Heinig 2001.
4. See Duijts 2010.
5. See Hauk 2011.
6. See Arenz 2004.
7. See Kramer 2002.
8. See Rosenblatt 1993.
9. See Collaborative Group on Hormonal Factors in Breast Cancer 2002.
10. See World Health Organization 2003.
11. See Health Canada (Nutrition) 2012.
12. The latest CCHS data are based on 130,000 responses collected over two years, 2011 and 2012. The 2003 data were based on 130,000 responses collected over 12 months.
13. Infants who are exclusively breastfed may still receive vitamin and mineral supplements or medicines, in the form of drops or syrups. They may be given oral rehydration solution, if needed. See World Health Organization, 2008.
14. See Statistics Canada 2013.
15. See Centers for Disease Control and Prevention 2009.
16. Breastfeeding rate for the United States is based on a 2009 survey of households with children aged 19 to 35 months that asks if they were ever breastfed or fed breast milk. 
17. Norway’s breastfeeding data is based on a 2008 survey of a nationwide sample of 3,000 six-month-old infants regarding infant nutrition. The rate of 95% refers to women who breastfed their infant for at least four weeks.
18. See NHMRC Clinical Trials Centre 2011.
19. Australia’s breastfeeding data is based on children aged 0 to 3 years who received breast milk.
20. See Australian Bureau of Statistics 2011–2012.
21. In 2011–2012, 14% of mothers who did not breastfeed were aged 15 to 24 years compared with 8% of those who breastfed. Mothers who breastfed were more likely to have postsecondary qualifications as those who did not (74% versus 52%). Mothers who did not breastfeed were nearly twice as likely to be single as those who breastfed (22% versus 10%).
22. See Statistics Canada 2012.
23. See Health Canada (Trends) 2012.
24. The sample sizes were too small to compare mothers who breastfed exclusively for six months (or more) with those who breastfed exclusively for 5 months or less, by marital status. Therefore, the latter group was expanded to comprise mothers who breastfed both partially and exclusively.
25. See Public Health Agency of Canada (What Mothers Say), 2009.
26. See Health Canada (Vitamin D) 2012.
27. See Butte 2002.
28. See Marshall 2003.
29. See Baker 2008.
30. The women who responded to the breastfeeding portion of the CCHS questionnaire had had a baby in the previous five years. The 2003 CCHS data results, therefore, include women who had their babies prior to the 2001 extension of paid parental leave.
31. See Public Health Agency of Canada (data tables) 2009.
32. See Public Health Agency of Canada 2012.
33. Canada's Baby-friendly Initiative recommends that healthcare providers giving direct breastfeeding care should receive at least 20 hours of education, including three hours of supervised clinical instruction. See Breastfeeding Committee for Canada 2011.
34. See Gatti 2008.
35. These include Galactosemia, HIV infection, herpes lesions on both breasts, untreated, infectious tuberculosis and a severe illness that prevents a mother from caring for her infant. A mother's use of certain drugs or treatments may also stop or interrupt breastfeeding. See Health Canada (Nutrition), 2012.
36. See Berg 2012.
37. See O'Brien 2013.
38. See Maia 2010.
39. For the first time, the 2011–2012 Canadian Community Health Survey asked mothers one question as to when they added other liquids to babies' feeds and a separate question for when they added other solids. Previously, data for these variables were from one survey question. The CCHS defines "other liquids� as milk, formula, water, juice, tea or herbal mixture while "other solids� include cereals and mashed or pureed meat, vegetables or fruits.
40. The data comprises of babies who received other liquids and solids to supplement breast milk or to replace it.
41. See Breastfeeding Committee for Canada, 2012.