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

Alison Mildon, Jane Francis, Stacia Stewart, Bronwyn Underhill, Yi Man Ng, Christina Rousseau, Erica Di Ruggiero, Cindy-Lee Dennis, Deborah L O'Connor, Daniel W Sellen, Alison Mildon, Jane Francis, Stacia Stewart, Bronwyn Underhill, Yi Man Ng, Christina Rousseau, Erica Di Ruggiero, Cindy-Lee Dennis, Deborah L O'Connor, Daniel W Sellen

Abstract

Exclusive breastfeeding (EBF) for 6 months is a global public health goal, but measuring its achievement as a marker of population breastmilk feeding practices is insufficient. Additional measures are needed to understand variation in non-EBF practices and inform intervention priorities. We collected infant feeding data prospectively at seven time points to 6 months post-partum from a cohort of vulnerable women (n = 151) registered at two Canada Prenatal Nutrition Program sites in Toronto, Canada. Four categories of breastmilk feeding intensity were defined. Descriptive analyses included the (i) proportion of participants in each feeding category by time point, (ii) use of formula and non-formula supplements to breastmilk, (iii) proportion of participants practising EBF continuously for at least 3 months; and (iv) frequency of transitions between feeding categories. All participants initiated breastmilk feeding with 70% continuing for 6 months. Only 18% practised EBF for 6 months, but 48% did so for at least 3 continuous months. The proportion in the EBF category was highest from 2 to 4 months post-partum. Supplemental formula use was highest in the first 3 months; early introduction of solids and non-formula fluids further compromised EBF at 5 and 6 months post-partum. Most participants (75%) transitioned between categories of breastmilk feeding intensity, with 35% making two or more transitions. Our data show high levels of breastmilk provision despite a low rate of EBF for 6 months. Inclusion of similar analyses in future prospective studies is recommended to provide more nuanced reporting of breastmilk feeding practices and guide intervention designs.

Trial registration: ClinicalTrials.gov NCT03589963.

Keywords: breastfeeding; breastmilk; exclusive breastfeeding; infant and child nutrition; infant feeding; infant formula; post-partum.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Participant flow diagram
Figure 2
Figure 2
Feeding practices of participants providing any breastmilk at seven post‐partum time points.Note: Breastmilk + formula may include non‐formula fluids and/or solids; breastmilk + solids may include non‐formula fluids. Sample sizes: 2 weeks n = 136; 1 month n = 130; 2 months n = 125; 3 months n = 113; 4 months n = 112; 5 months n = 103; 6 months n = 10
Figure 3
Figure 3
Breastmilk feeding intensity classification. (a) Total sample. Sample sizes: 2 weeks n = 139; 1 month n = 140; 2 months n = 144; 3 months n = 140; 4 months n = 143; 5 months n = 142; 6 months n = 144. (b) Participants providing any breastmilk. Sample sizes: 2 weeks n = 136; 1 month n = 130; 2 months n = 125; 3 months n = 114; 4 months n = 110; 5 months n = 102; 6 months n = 101. Note: Categories defined by proportion of milk feeds as breastmilk (Exclusive: 100%; Predominant > 75%; Partial < 75%; None) with additional criteria related to solids and non‐formula fluids

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