Provincial
Breastfeeding Policy
Evaluation
Tina Swinamer, RD
Department of Health and Wellness, Public Health
BFI Symposium, Edmonton, AB
April 16th, 2015
Outline
• Background and Nova Scotia context
• Evaluation
– Purpose
– Methods
– Results
• Response to evaluation…
Initiation rates
Exclusive at 6 months
Provincial Breastfeeding Policy
• Released in 2005 - applies to DHW, District Health
Authorities, IWK Health Centre
Objectives:
– Provide leadership for the protection, promotion,
and support of breastfeeding
– Improve the health of NS mothers and infants by
increasing the initiation and duration of
breastfeeding
– Support the implementation of the Baby Friendly
Initiative
Nova Scotia Context
• Provincial Steering Committee and Working Groups
(BFI, Monitoring and Evaluation, Capacity Building,
Education)
• Examples of work supported by the policy:
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Family Friendly Pledge
First6weeks.ca social marketing campaign
Make Breastfeeding Your Business
Integration of breastfeeding as the norm in Loving Care
MaD breastfeeding training across the system
Thrive! Healthy Start strategic direction
Certificate of participation for BFI
Policy evaluation
Policy Evaluation
Purpose of the evaluation
• To collect meaningful information from across the province to inform
breastfeeding decision making and planning
• To provide a consistent assessment of policy implementation across
the province
• To identify successes, challenges and opportunities related to policy
implementation
• To identify additional supports required to achieve full implementation
• To promote awareness/discussion of the policy and its
implementation
Evaluation components
• Coordination of Breastfeeding & BFI
– Leadership and committee structure
– Communication
• Cross-sectoral integration
• Continuum of breastfeeding support
• BFI implementation and designation
• International Code of Marketing of Breastmilk Substitutes
• Training and education
• Surveillance
• Health education resources
• Social marketing campaign
Methodology
• Facilitated sessions with:
o Provincial Breastfeeding Steering Committee
o District breastfeeding committees/IWK
• Interviews with senior leadership
• Conducted by Applied Research Collaborations
for Health, Dalhousie University
Evaluation Findings
Coordination of Breastfeeding & BFI
• Committees with varied structure, composition and
leadership exist in all districts
• Insufficient resources - off the side of the desk
• Lack of support at senior levels
• Communication structures sufficient for status quo
but ineffective for full policy implementation
“The individuals sitting around the table are passionate
about [breastfeeding] and are willing to go that extra
distance and do the work even if it’s off the side of
our desk…”
“…breastfeeding is the first thing to go” because “I
don’t think they [senior leadership] really see the
benefits.”
“…it’s always a challenge and communication is
always something that we can do a better job on.”
Cross-sectoral integration
• Integration of breastfeeding into other policies and
programs across government and districts
• Challenges:
– Lack of support for breastfeeding mothers and
children in the broader community
– Engaging the broader community takes more
financial and human resources than available
Continuum of Breastfeeding Support
• Support groups/lines available in each district
• DHAs with district breastfeeding policies appeared more
supportive of breastfeeding mothers returning to work
• Key Challenge:
– Continued breastfeeding beyond 6 months due to
unsupportive culture to breastfeeding beyond 6 months
“…there’s work to be done, people don’t look real friendly at
you if you’re running off with a pump and you’re doubling up
work for somebody else while you’re gone…”
BFI Implementation and Designation
Achievements:
• Half of all districts reported having a district specific
policy in place
• Skin to skin contact and 24 hour rooming-in becoming
the norm
• Making a Difference training
• Formula purchased at fair market value
• Connections with breastfeeding supports available in the
community
BFI Implementation and Designation
Structural challenges:
• Lack of enforcement around the steps to achieve
BFI designation
• Concerns for where $ for achieving designation
would come from
• Unsupportive culture for breastfeeding
BFI Implementation and Designation
DHA level challenges:
• Lack of sustained $ for someone to lead
• Lack of awareness within the health system of
the importance of BF support and BFI
designation
• Reluctance from senior leadership to ‘buy in’ to
BFI
• Educating and engaging physicians and acute
care providers
BFI Implementation and Designation
“It would be wonderful to have positions funded to dedicate
time to implementation of those ten steps. And again, I
would, even two would be pie in the sky, so that you’d have
Public Health and Mat/Child people that would work
collaboratively”
“The challenge is in engaging physicians, it’s engaging
other departments to see they have a role to play in BFI,
they don’t always see that…So I think it boils down to a
lack of knowledge and awareness and getting everybody
on board with the same consistent and accurate
messages.”
International Code of Marketing of
Breastmilk Substitutes
• Across the health system a shared understanding of the
Code is lacking
• Numerous suggestions for building understanding of the
code:
– Making a Difference course seen as a way to dispel
myths and address confusion
– Champion to promote the Code among colleagues
– National legislation
Breastfeeding Surveillance
Gaps identified:
• Need for breastfeeding duration data
• Need to ensure consistency of definitions used
when collecting breastfeeding information
Training & Education
• Viewed as a challenge and an opportunity
• Strong theme:
– Importance of engaging physicians
“I’ve had women come and say ‘well I stopped because was on
an antibiotic and the doctor told me I couldn’t breastfeed…’”
“And you can’t counteract that… you can’t tell a patient your
doctor is wrong, you can’t stand there and say your doctor is
wrong, the patient values those physicians, those are their
key person”.
Summary of key themes
Many successes due to the policy, but many challenges
remain:
– Overall unsupportive culture of breastfeeding
– Lack of support at senior levels
– Insufficient resources, particularly for BFI
implementation
– Engaging health care providers whose time and
resources were limited
– Lack of buy-in and enforcement around the steps in
achieving BFI designation
Recommendations
Coordination of Breastfeeding & BFI
• Implement the Baby Friendly Initiative and regularly
monitor progress towards achieving designation
• Strengthen leadership across multiple levels (provincial,
district and community)
• Create more effective communication structures
between the provincial breastfeeding steering committee
and district breastfeeding committees
• Identify a dedicated role within districts/IWK to support
the implementation of the BFI and to provide leadership
for promotion of breastfeeding within districts.
Continuum of breastfeeding support
• Provide dedicated resources to support mothers who
currently breastfeed or are intending to breastfeed, as
well as to support health professionals, community
partners, and volunteers who work with them.
Cross-sectoral integration
• Further integrate the provincial breastfeeding policy with
other provincial and district level strategies and
initiatives (e.g. Thrive!, healthy eating policies)
Breastfeeding training and education
• Engage physicians in education about the importance
of breastfeeding, both for the health of the baby and
for the mother, and identify resources that they can
use within their practice
• Building on the success of the Making a Difference
course, continue to provide training and education
across multiple sectors
• Promote breastfeeding training and education across
a range of professions and learning institutions
Surveillance
• Develop a formal structure for a consistent approach
to capturing data around duration
• Promote greater awareness and uptake of the existing
standard definitions for breastfeeding currently
available across the province
International Code of Marketing of Breastmilk
Substitutes
• Build understanding and support for the
implementation of the International Code of Marketing
of Breastmilk Substitutes by engaging health
professionals
A few thoughts….
• Much has been accomplished
• More needs to be done
• Action on all 16 evaluation recommendations is needed
• Requires collaboration across acute care, primary
health care & public health
• Thrive! : A Plan for a Healthier Nova Scotia opportunity to leverage support
How have we responded?
• Review provincial committee structure
• BFI Coordinator position – building capacity across the
province
• BFI grants to health system
• Community breastfeeding grants
• Code primer
• Incorporate breastfeeding in multiple healthy eating
policies
• Breastfeeding Policy revision
Thank you
Questions?
Email: Tina.Swinamer@novascotia.ca