Report No. 060-12

TO:  Chair and Members of the Board of Health
FROM:  Graham L. Pollett, MD, FRCPC, Medical Officer of Health
DATE:     2012 April 19

Baby Friendly Initiative

Recommendation

It is recommended that Report No. 060-12 re Baby Friendly Initiative be received for information.

Background

As part of the Performance Management Framework for Public Health, Accountability Agreements and Performance Indicators were set by the province in 2011.  Last year, the Board of Health signed the Agreement, committing to work towards achievement of specific indicators (see Item No. 3 Report No. 054-12, this agenda).One of the indicators calls for each health unit to attain the Baby Friendly Initiative (BFI) designation.  A Certificate of Intent for the Health Unit has been received from the Ontario Breastfeeding Committee (Appendix A(PDF 91.7KB)).

The BFI is an international initiative established by the World Health Organization (WHO)/UNICEF in 1991 to promote, protect, and support the initiation and continuation of breastfeeding. This program encourages and recognizes organizations that offer an optimal level of care for mothers and infants. A Baby Friendly facility focuses on the needs of the newborns and empowers mothers to give their infant the best possible start in life. The foundation of the BFI is the acknowledgement that breastfeeding is the healthiest choice for mothers and infants, and families need to be supported to make informed feeding decisions without the influence of formula marketing.  Epidemiological evidence highlights the positive health impacts of breastfeeding during childhood (i.e., better visual acuity, protection against gastrointestinal and ear infections and SIDS), and beyond (i.e., decreased allergies and obesity, and enhanced cognitive and social development).   

The BFI outlines ten steps and outcome indicators for hospitals and community health services.  These steps include policy development; staff education; revision of prenatal curriculum; postpartum education and support; encouragement of exclusive and sustained breastfeeding; discouragement of the use of artificial teats or soothers; seamless service provision between hospitals, community health services and peer support programs; compliance with the WHO Code of Marketing of breast milk substitutes. In addition, there are a number of steps with direct relevance to hospital practices and protocols (Appendix B(PDF 26.9KB)).  Currently, 7 of Ontario’s 36 health units are BFI-designated, with one of these health units completing the re-designation process after 5 years.  The remaining health units are at various stages of progress towards designation. 

Status of BFI at This Health Unit

Over the past few years, a workgroup within Family Health Services has been working at the early steps of Baby Friendly designation.  The Health Unit Workplace Breastfeeding Policy has been revised and expanded, an organizational policy has been drafted, and some staff breastfeeding education has been provided.  Because of this earlier work, the Health Unit is well positioned to move forward to achieve a BFI designation.

With the recent realignment in Family Health Services, the leadership for moving the Health Unit towards BFI designation will come from the Reproductive Health and Early Years Program Team.  A multidisciplinary BFI Task Force will develop a logic model and implementation plan, with clear deliverables set out for 2012, 2013, and beyond.  An Advisory Group will be established to support and guide the work of the BFI Task Force, and will include a broad range of community partners and Health Unit stakeholders.  BFI Task Force members will provide leadership to smaller workgroups that are focused on specific requirements as set out by the Ministry of Health and Long-Term Care (MOHLTC) and BFI (Appendix C(PDF 26.2KB)).  These workgroups will consist of staff with related expertise and experience.

Requirements of the Board of Health

The MOHLTC requirements identify key activities needed from the Board of Health to achieve BFI designation.  These activities include reading of reports and acquiring knowledge related to the BFI, formal endorsement of the designation process, and orientation to the Health Unit BFI policy.  There will be a presentation to the Board in the fall with an update about the implementation process, and a formal request for endorsement from the Board for the project plan. Board of Health members will be oriented to the BFI policy once the policy is completed, and on an annual basis moving forward.

Conclusion

Baby Friendly designation, an initiative originating with the WHO, has been selected as an accountability indicator for public health units in Ontario.  This Health Unit is well-positioned to move this work forward as it has a strong breastfeeding foundation.  Family Health Services staff will provide leadership for this initiative, working with a Baby Friendly Initiative task force, and Advisory Group, and ad hoc workgroups to ensure implementation.

This report was prepared by Ms. Laura Dueck, Public Health Nurse, and Ms. Heather Lokko, Manager, Reproductive Health Team.

Graham L. Pollett, MD, FRCPC

Medical Officer of Health

This report addresses the following requirement(s) of the Ontario Public Health Standards:

Child Health, Requirement #4, #7 and an Area of Focus: Facilitate the effective and efficient implementation of the Public Health Accountability Agreement.