Al-Sahab et al.

BMC Pediatrics 2010, 10:20

http://www.biomedcentral.com/1471-2431/10/20

RESEARCH ARTICLE Open Access

Prevalence and predictors of 6-month exclusive

breastfeeding among Canadian women:
a national survey
Ban Al-Sahab1*, Andrea Lanes1, Mark Feldman2, Hala Tamim1

Abstract
Background: In spite of the evidence supporting the importance of breastfeeding during the first year of life, data
on breastfeeding practices remain limited in Canada. The study aimed to examine the prevalence and predictors of
6-month exclusive breastfeeding among Canadian women.
Methods: The analysis was based on the Maternity Experience Survey targeting women aged ≥ 15 years who had
singleton live births between February 2006 - May 2006 in the Canadian provinces and November 2005 - February
2006 in the territories. The main outcome was exclusive breastfeeding based on the World Health Organization
definition. Socioeconomic, demographic, maternal, pregnancy and delivery related variables were considered for a
multivariate logistic regression using stepwise modeling. Bootstrapping was performed to account for the complex
sampling design.
Results: The sample size in this study was 5,615 weighted to represent 66,810 Canadian women. While ever
breastfeeding was 90.3%, the 6-month exclusive breastfeeding rate was 13.8%. Based on the regression model,
having higher years of education, residing in the Northern territories and Western provinces, living with a partner,
having had previous pregnancies, having lower pre-pregnancy body mass index and giving birth at older age were
associated with increased likelihood of 6-month exclusive breastfeeding. Moreover, smoking during pregnancy,
Caesarean birth, infant’s admission to the intensive care unit and maternal employment status before 6 months of
infant’s age were negatively associated with exclusive breastfeeding. Mothers choosing to deliver at home were
more likely to remain exclusively breastfeeding for 6 months (Odds Ratio: 5.29, 95% Confidence Interval: 2.95-9.46).
Conclusions: The 6-month exclusive breastfeeding rate is low in Canada. The study results constitute the basis for
designing interventions that aim to bridge the gap between the current practices of breastfeeding and the World
Health Organization recommendation.

Background subject to energy and micronutrients deficiency (particu-

Epidemiological research provides compelling evidence larly iron and zinc) [6,7], the Canadian Paediatric
for the effect of human milk in decreasing the risk of Society, Health Canada and Public Health Agency of
infant mortality and morbidity from acute and chronic Canada have adopted the WHO 6-month exclusive
diseases [1-3]. The World Health Organization (WHO) breastfeeding recommendation [8].
advocates for breastfeeding as the best source of food The prevalence of breastfeeding among women has
for optimal infant growth and development. They been shown to vary substantially across the provinces of
recommend that infants should be exclusively breastfed, Canada. The initiation of breastfeeding ranges from
receiving no other foods or liquids besides breast milk, 91.1% in Ontario [9] to 85.6% in Alberta [10] and 72%
until 6 months of age [4,5]. Although there is a debate in Quebec [11]. Breastfeeding continuation up to 6
that infants exclusively breastfed for 6 months are months was reported to be 22.8% in Southwestern
Ontario [12], 37.2% in Alberta [10] and 32% in Montér-
* Correspondence: bsahab@yorku.ca
égie, Quebec [13]. The prevalence of exclusive breast-
1
Kinesiology & Health Science, York University, Toronto, Ontario, Canada feeding at 6 month, however, is much lower. Millar &
© 2010 Al-Sahab et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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Maclean (2005) reported that only 17% of women in computer-assisted telephone interview application. Inter-
Canada conform with the 6-month exclusive breastfeed- views were conducted between the 5th and 14th month
ing recommendation of the WHO. Based on the Cana- after delivery and lasted on average 45 minutes. The
dian studies, exclusive breastfeeding was significantly majority (96.9%) of the interviews, however, were per-
more common among urban residents [14], women with formed between the 5th and 9th month postpartum. The
high education [11,14] and older mothers [11,14]. Risk MES has been previously described in other references
factors for early breastfeeding termination were also [22].
found to be associated with early hospital discharge, The present study considered the 5615 MES mothers
minimal breastfeeding support and receiving advice on (87.4%) who had babies aged ≥ 6 month at the time of
formula feeding [9]. interview. Mothers were weighted to represent 66,810
Acquiring information on the predictors of breastfeed- Canadian women. The main outcome of the study was
ing may better equip policy makers and public health exclusive breastfeeding based on the WHO definition as
practitioners in designing programs for at-risk groups the intake of breast milk only without any other drink
and may help to bring the entire population closer to the or food for the first 6 months of infant’s age [5]. This
infant feeding practices recommended by Health Canada outcome was dichotomous (<6 months, ≥ 6 months)
and the WHO. In spite of the evidence supporting the and was calculated using information about breastfeed-
importance of breastfeeding during the first year of life ing termination and timing of introduction of liquids,
and the variety of health outcomes that are related to semi-solid and solid foods. Other breastfeeding variables
breastfeeding, data on breastfeeding practices remain lim- that were considered were, ever breastfeeding assessed
ited in Canada. Canadian studies are mostly representa- by the question “did you breastfeed or try to breastfeed
tive of specific regions/provinces [10,12,13,15-17] and even if only for a short time?” and breastfeeding inten-
specific populations such as teenagers [18], low income tion measured by the question “prior to giving birth, did
mothers [19], female physicians [20] and primipara you intend to feed by formula alone, breastfeeding alone
mothers [21]. To our knowledge, only one nationwide or a combination of both?”
study, using data from 2003, assessed the prevalence and A wide range of variables were investigated as potential
predictors of breastfeeding across the Canadian provinces predictors of exclusive breastfeeding. Socio-economic sta-
[14]. The study, however, excluded mothers in the north- tus, such as maternal years of education, total household
ern territories. It also assessed breastfeeding status within income and place of residence, and demographic factors,
the previous 5 years thereby increasing the chance of consisting of immigration status and province of resi-
recall bias. The study, as well, investigated limited demo- dence, were considered. Information about maternal
graphic and socio-economic predictors. The present characteristics including marital status, age at first preg-
study, however, used data from a recent specialized sur- nancy, number of previous pregnancies, age at selected
vey on pre and post delivery experiences among mothers birth, pre-pregnancy maternal body mass index (BMI)
residing in both the Canadian provinces and territories. It and mother’s perceived health were also assessed.
aimed to examine the prevalence of exclusive breastfeed- Furthermore, pregnancy related factors composed of: self
ing at 6 months and the potential socio-economic, demo- reported weight gain during pregnancy, ever taking alco-
graphic, maternal, pregnancy and delivery related hol during pregnancy, ever smoking during the third tri-
predictors. mester of pregnancy, support during pregnancy, mother’s
reaction to pregnancy, mother’s stress level before and
Methods during pregnancy, health problems during pregnancy,
The analysis of this study was based on the Maternity attendance of prenatal classes, number of prenatal care
Experience Survey (MES) that was sponsored by Public visits and type of prenatal care provider were explored as
Health Agency of Canada and conducted by Statistics well. Finally, delivery related factors (type of delivery, type
Canada in 2006. The MES study is the first nationwide of birth setting, birth weight, gestational age and baby’s
survey that assessed pregnancy, delivery and postnatal admission to neonatal intensive care unit) and postpar-
experiences of mothers and their children. The study tum variables (hospitalization of baby, support after birth,
sample was selected from the Canadian Census of Popu- work status after birth and postpartum depression) were
lation to include women aged ≥ 15 years who had sin- examined. All the variables, except for mother’s stress
gleton live births between February 15, 2006 and May, level and postpartum depression, were directly self-
2006 in the provinces of Canada and November 1, 2005 reported by the mother. The mother’s stress level was
and February 1, 2006 in the territories of Canada. A measured through a set of 13 questions that examined
total of 8,542 Canadian women were selected, out of the mother’s experience of stressful events in the past
which 6,421 (75.2%) responded to the survey. The data 12 months before the birth of her selected child. The
was collected through telephone interviews using a questions were adapted by Pregnancy Risk Assessment
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Monitoring System (PRAMS) from Newton and Hunt’s around 90% of the women intended to breastfeed their
Life Events Inventory [23]. The answers for these ques- child. Exclusive breastfeeding rates from 1 to 6 months
tions were categorised as “Yes” or “No”. Consequently, are illustrated in Figure 1. At 1 month, the exclusive
the sum of the “Yes” responses was calculated for each breastfeeding rates were 63.6% (95% CI: 62.3%-64.9%). By
mother to represent her stress level [24]. Postpartum 3 months, half of the Canadian women were exclusively
depression, on the other hand, was assessed using the breastfeeding (50.4%, 95% CI: 48.2%-50.9%). The 6-month
Edinburgh Postpartum Depression Scale [25]. The scale exclusive breastfeeding rate was 13.8% (95% CI: 12.9-14.8)
consists of 10 items with four response categories scored while more than half of the women remained breastfeed-
from 0 to 3, whereby the highest values represent ing at 6 months of infant’s age. Figure 2 compares the
depressed moods. The sum of scores represents the breastfeeding rates across the Canadian provinces and
mother’s level of postpartum depression [24]. territories (P-value < 0.001). The Northern Territories
The prevalence of exclusive breastfeeding was estimated and British Columbia demonstrated the highest preva-
through population weights and examined across all the lence of exclusive breastfeeding at 6 months (21.2% and
Canadian provinces and territories. At the bivariate level, 19.2%, respectively). The rate in Newfoundland and Lab-
differences in the proportion of exclusive breastfeeding rador and Prince Edward Islands, on the other hand, was
were assessed among the different levels of each predictor the lowest at 6.5%.
using normalized weights. Chi square tests and odds Unadjusted associations between exclusive breastfeed-
ratios (OR) using 95% confidence intervals (95% CI) were ing and potential predictors are shown in Table 2. Out
performed for categorical variables. Differences in means of the 30 variables that were considered for stepwise
and 95% confidence interval estimations were employed logistic regression, 12 variables were retained in the final
for continuous variables. All the independent variables model (Table 3). Years of education was the only signifi-
were considered for a multivariate logistic regression ana- cant socioeconomic variable (OR: 1.08, 95% CI: 1.05-
lysis using stepwise modeling. Adjusted OR and 95% CI 1.12). Out of the demographic variables tested, province
were reported for the final model. To account for the of residence remained in the model. As compared to
complex sampling design, bootstrapping was performed Eastern Atlantic provinces, the residents of Northern
to calculate the 95% CI estimates. Population weights, Territories and British Columbia were 3.01 (95% CI:
normalized weights and bootstrap weights were all cre- 2.21-4.12) and 1.94 (95% CI: 1.42-2.64), respectively,
ated by Statistics Canada and provided with the MES more likely to exclusively breastfeed for the first 6
data file. All analyses, in exception to bootstrapping, were months of the infant’s life. Mothers with partners,
conducted using the Statistical Package for Social mothers with lower BMI before pregnancy, mothers
Sciences (SPSS, version 17.0). Bootstrapping was per- who had more pregnancies and mothers who had their
formed using the Statistical Analysis Software (SAS, ver- first pregnancy at an older age also had an increased
sion 9.2). Statistical significance for all analyses was set at likelihood of breastfeeding exclusively for 6 months.
alpha <0.05 for a two tailed tests. Furthermore, smoking during pregnancy was negatively
associated with exclusive breastfeeding (OR: 2.11, 95%
Results CI: 1.36-3.27). Women giving birth at home were 5
Table 1 presents the estimated population and distribu- times more likely to exclusively breastfeed than those
tion of breastfeeding related outcomes. During pregnancy, who gave birth at hospitals or clinics. Vaginal delivery
was also found to increase the exclusive breastfeeding
Table 1 Estimated frequency distribution of rates at 6 months by 25% as compared to Caesarean
breastfeeding related variables delivery (OR: 1.25, 95% CI: 1.01-1.53). Finally, mothers
N* % (95% CI)† who had their babies admitted to neonatal intensive
Intention of breastfeeding before child birth care unit after birth and mothers who returned to work
Formula feeding alone 6,610 9.9 (9.2-10.7) within the first 6 postpartum months were less likely to
Breastfeeding alone 49,850 75.0 (73.8-76.1) achieve 6-month exclusivity of breastfeeding.
Combination of formula & breastfeeding 10,027 15.1 (14.1-16.1)
Ever breastfeeding 60,309 90.3 (89.6-91.1) Discussion
Liquids were first introduced at ≥ 6 months 17,182 25.8 (24.6-27.0) The present study aimed to investigate the prevalence
Solids were first introduced at ≥ 6 months 21,306 31.9 (30.6-33.2) and predictors of exclusive breastfeeding at 6 months
Breastfeeding termination at ≥ 6 months 35,946 53.9 (52.6-55.2) among mothers throughout the Canadian provinces and
Exclusive breastfeeding for ≥ 6 months 9,217 13.8 (12.9-14.8) territories. Although ever breastfeeding was 90.3%, half
of the Canadian mothers exclusively breastfed their
* Sample size is estimated using population weights
† 95% CI were calculated using bootstrapping technique babies for 3 months and only 13.8% of the mothers
remained exclusively breastfeeding for 6 months.
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Figure 1 Exclusive breastfeeding rates during the first 6 months of life across the Canadian provinces and territories (2005/06).

Figure 2 Distribution of 6-month exclusive breastfeeding rates across the Canadian provinces and territories (2005/06). Note: P-value <
0.001
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Table 2 Unadjusted associations between 6-month exclusive breastfeeding and potential predictors
Sample size Exclusive breast-feeding Unadjusted odds ratio
N* N* (%) OR (95% CI)†
Household income (Canadian dollar)
<$30,000 908 98 (10.8) 1
$30,000 to less than $60,000 1,640 194 (11.8) 1.11 (0.84-1.47)
$60,000 to less than $100,000 1,657 231 (13.9) 1.35 (1.02-1.77)
≥ $100,000 1,052 213 (20.2) 2.11 (1.60-2.79)
Place of residence
Rural area 973 129 (13.3) 1
Urban, population ≤ 499,999 1,976 247 (12.5) 0.93 (0.75-1.17)
Urban, population ≥ 500,000 2,436 363 (14.9) 1.15 (0.92-1.43)
Immigrant mother
No 4,334 559 (12.9) 1
Yes 1,239 207 (16.7) 1.36 (1.12-1.64)
Marital status
No partner 473 27 (5.7) 1
Have a partner 5,105 743 (14.6) 2.79 (1.86-4.18)
Moms perceived health
Excellent/very good 4,022 596 (14.8) 2.11 (1.30-3.43)
Good 1,274 154 (12.1) 1.67 (0.99-2.80)
Poor/Fair 304 23 (7.6) 1
Reaction when discovered pregnancy
Very happy/happy 5,184 722 (13.9) 1
Indifferent 238 27 (11.3) 0.78 (0.50-1.21)
Very unhappy/Unhappy 164 21 (12.8) 0.89 (0.54-1.48)
Smoking during pregnancy
No 4,982 740 (14.9) 3.15 (2.12-4.68)
Yes 607 32 (5.3) 1
Alcohol drinking during pregnancy
No 4,982 677 (13.6) 0.82 (0.64-1.06)
Yes 586 94 (16.0) 1
Health problems during pregnancy
No 4,232 610 (14.4) 1.23 (1.01-1.50)
Yes 1,365 164 (12.0) 1
Support during pregnancy
None/Little of time 289 37 (12.8) 0.92 (0.61-1.40)
Some of the time 448 69 (15.4) 1.14 (0.86-1.52)
Most/All of time 4,846 666 (13.7) 1
Attended prenatal classes
No 3,770 520 (13.8) 1
Yes 1,830 253 (13.8) 1.00 (0.85-1.18)
Prenatal care provider
Non-physician 397 102 (25.7) 2.34 (1.81-3.02)
Physician 5,175 668 (12.9) 1
Type of setting of baby’s birth
Hospital or clinic 5,485 728 (13.3) 1
Birthing centre 43 7 (16.3) 1.22 (0.44-3.39)
Private home 71 37 (52.1) 7.13 (4.24-11.98)
Type of delivery
Vaginal 4,146 605 (14.6) 1.31 (1.08-1.58)
Caesarean 1,456 168 (11.5) 1
Baby’s admission to NICU
No 4,875 711 (14.6) 1.83 (1.38-2.44)
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Table 2: Unadjusted associations between 6-month exclusive breastfeeding and potential predictors (Continued)
Yes 722 62 (8.6) 1
Baby’s hospitalization after birth
No 5,167 727 (14.1) 1.46 (1.03-2.07)
Yes 432 44 (10.2) 1
Mother’s work status <6 months of delivery
No 5,084 715 (14.1) 1.30 (0.97-1.74)
Yes 491 55 (11.2%) 1
Support after birth
None/Little of time 322 61 (18.9) 1.50 (1.07-2.09)
Some of the time 583 80 (13.7) 1.02 (0.77-1.33)
Most/All of time 4,687 633 (13.5) 1
Province‡
Eastern- Atlantic 323 28 (8.7) 1
Eastern- Central 3,523 448 (12.7) 1.52 (1.21-1.91)
Western- Prairies 1,056 163 (15.4) 1.89 (1.46-2.45)
Western- British Columbia 668 128 (19.2) 2.46 (1.83-3.30)
Northern territories 33 7 (21.2) 2.69 (2.06-3.53)
Unadjusted Mean difference§
(95% CI)†
Mother’s education level (years) 5,538 1.20 (0.97-0.43)
Age at first pregnancy (years) 5,527 1.88 (1.47-2.29)
Number of past pregnancies 5,581 0.16 (0.04-0.28)
Mother’s age at selected birth (years) 5,581 2.04 (1.67-2.41)
Weight gained during pregnancy (Kg) 5,535 -0.41 (-0.94-0.12)
BMI before pregnancy (Kg/m2) 5,508 -0.90 (-1.31–0.48)
Infant’s birth weight (grams) 5,590 44.39 (0.05-0.30)
Gestational age (weeks) 5,419 0.17 (0.95-87.84)
Number of stressful events 5,556 -0.23 (-0.33–0.12)
Number of prenatal visits 5,364 -0.07 (-0.41-0.27)
Edinburgh Postnatal Depression Scale 5,529 -0.28 (-0.63-0.08)
* Sample size is estimated using normalized weights
† 95% CI were calculated using bootstrapping technique
‡ Eastern Atlantic: Newfoundland & Labrador, Nova Scotia, Prince Edward Island & New Brunswick; Eastern Central: Quebec & Ontario; Western Prairies: Manitoba,
Saskatchewan, & Alberta; Western British Columbia: British Columbia; and Northern Territories: Yukon Territory, Nunavut & Northwest Territories.
§Represents the difference between the mean of exclusive breastfeeders and non- exclusive breastfeeders (Meanexclusive breastfeeders - Meannon-exclusive breastfeeders).

The exclusive breastfeeding rates decreased consider- Ontario, were reported to be 28%, 22% and 18% respec-
ably from 1 month to 6 months among Canadian tively, while, in the present study, they were been mea-
mothers. In Norway the 1-month and 4-month exclusive sured as 19.2%, 15.3% and 14.5% respectively. Only
breastfeeding rates were 90% and 44% as compared to Quebec illustrated a fixed rate of 10% in both surveys
63.3% and 41.4% in the present study [26]. In Quebec while New Brunswick reported an increase from 8% in
(1999/2000), the exclusive breastfeeding rates were 62% 2003 to 10.9% in our study. While no data is available
and 35% for 1 and 4 months of infant’s age [13]. The in 2003 for the Northern territories, the prevalence of
Canadian 6-month exclusive breastfeeding rate is com- exclusive breastfeeding in this study was the highest
parable with other developed countries. In the United (21.2%) as compared to all other provinces. The differ-
States, the prevalence of exclusive breastfeeding at 6 ences between the two studies might either be attributed
months was 11.3% [27], whereas it was 10.1% in Sweden to variations in study designs, sample selection and vari-
[28] and 7% in Norway [26]. The study rate, however, is able definitions or to an actual decline in the rate of
lower than the rate (17%) reported earlier in Canada in exclusive breastfeeding in Canada.
2003 by Millar & Maclean (2005). Similarly, the provin- At the multivariate analysis, years of education was
cial rates reported in the present study are lower than the only significant socio-economic predictor of 6-
the 2003 Canadian study [14]. The 2003 prevalence month exclusive breastfeeding. The results are in accor-
rates, for example, in British Columbia, Alberta and dance with the international [26,29] and Canadian
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Table 3 Stepwise logistic regression model for the With regard to maternal characteristics, living with a
potential predictors of 6-month exclusive breastfeeding partner, having had previous pregnancies, older age at
Adjusted odds ratio pregnancy and lower pre-pregnancy BMI was found to
OR (95% CI)† be significantly associated with 6-month exclusive
Marital status breastfeeding. The presence of a partner is likely to pro-
No partner 1 vide increased support for the mother, which may ease
Have a partner 1.61 (1.03-2.52) the feeding process and the choice to exclusively breast-
Moms perceived health feed for 6 months. Although studies regarding the asso-
Excellent/very good 1.59 (0.92-2.75) ciation between marital status and breastfeeding are
Good 1.45 (0.82-2.57) inconsistent [26], the result of the present study is in
Poor/Fair 1 agreement with studies from Norway and Germany
Smoking during pregnancy [26,29]. Previous Canadian studies, however, failed to
No 2.11 (1.36-3.27) demonstrate this association [11,14]. High parity was
Yes 1 also found to be positively associated with 6-month
Type of setting of baby’s birth exclusive breastfeeding. A dose response relationship
Hospital or clinic 1 between parity and breastfeeding has been previously
Birthing centre 1.20 (0.42-3.39) documented in the literature [26,30]. Multipara mothers
Private home 5.29 (2.95-9.46) are suggested to have increased knowledge and self con-
Type of delivery fidence from earlier breastfeeding experiences. By the
Vaginal 1.25 (1.01-1.53) same token, young age at first pregnancy decreased the
Caesarean 1 likelihood of 6-month exclusive breastfeeding. Evidence
Baby’s admission to NICU in the literature provide consistent results of a positive
No 1.51 (1.12-2.03) association between breastfeeding duration and maternal
Yes 1 age [11,26,29,31]. Study results are also in agreement
Mother’s employment status <6 months of delivery with the literature whereby maternal pre-pregnancy
No 1.55 (1.14-2.10) BMI was found to be negatively associated with breast-
Yes 1 feeding [32-35]. It has been postulated that heavy weight
Province‡ might interfere with prolactin production [32]. The psy-
Eastern- Atlantic 1 chological factors associated with heavy weight may also
Eastern- Central 1.15 (0.90-1.47) have an impact on breastfeeding initiation and duration
Western- Prairies 1.81 (1.38-2.38) [33].
Western- British Columbia 1.94 (1.42-2.64) Evidence of the present study suggests that smoking
Northern territories 3.02 (2.21-4.12) during pregnancy decreases the likelihood of 6-month
Mother’s education level (years) 1.08 (1.05-1.12) exclusive breastfeeding. Lande et al. (2003) also reported
Age at first pregnancy (years) 1.05 (1.03-1.07) the association between exclusive breastfeeding at 4
Number of past pregnancies 1.16 (1.09-1.23) months and maternal smoking status after delivery to be
BMI before pregnancy (Kg/m2) 0.97 (0.95-0.99) OR = 0.40 (95% CI: 0.32, 0.50). In Canada, Albertan
† 95% CI were calculated using bootstrapping technique mothers who smoked during pregnancy were less likely
‡ Eastern Atlantic: Newfoundland & Labrador, Nova Scotia, Prince Edward to continue breastfeeding for longer periods [10]. In
Island & New Brunswick; Eastern Central: Quebec & Ontario; Western Prairies:
Manitoba, Saskatchewan, & Alberta; Western British Columbia: British Southwestern Ontario, the presence of a smoker at
Columbia; and Northern Territories: Yukon Territory, Nunavut & Northwest home after delivery increased the risk of early breast-
Territories.
feeding termination [12].
In the present study, the place of delivery was asso-
literature [9,11,14]. Nationally, Millar and Maclean ciated with the 6 month duration of exclusive breast-
(2005) revealed that postsecondary education was posi- feeding. Mothers giving birth at home were 5 times
tively associated with exclusive breastfeeding for the first more likely to exclusively breastfeed than mothers giving
6 months of life. Similarly in Quebec, having a univer- birth at hospitals. This relationship can be attributed to
sity diploma increased the odds of 4-month exclusive the negative influence of formula supplementation in
breastfeeding [11] and not completing high school was a the hospital [9]. A study in a Canadian university teach-
risk factor for early breastfeeding termination in Ontario ing hospital reported that 47.9% of the infants received
[9]. A higher level of maternal education seems to allow formula milk during hospital stay [36]. It is noteworthy,
mothers to formulate well-informed decisions regarding as well, that the characteristics of women giving birth at
the feeding practices used for their infant. home are substantially different from their counterparts
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[37,38] which might reflect on their breastfeeding Abbreviations

BMI: Body mass index; CI: Confidence interval; MES: Maternity Experience
choices. Besides the place of delivery, the type of deliv-
Survey; OR: Odds Ratio; SAS: Statistical Analysis Software; SD: Standard
ery was also related to exclusive breastfeeding status. deviation; SPSS: Statistical Package for Social Sciences; WHO: World Health
Vaginal deliveries increased the odds of exclusive breast- Organization.
feeding at 6 months. Pain and discomfort associated Acknowledgements
with Caesarean section may prevent the mother from While the research and analysis are based on data from Statistics Canada,
breastfeeding. Results from the literature, however, are the opinions expressed do not represent the views of Statistics Canada.
The authors would like to thank the Maternity Experiences Study Group of
in disagreement about the relationship between the type
the Canadian Perinatal Surveillance System, Public Health Agency of Canada
of delivery and breastfeeding duration [30,39-41]. and the staff at the Toronto Region - Statistics Canada Research Data Centre,
Infant’s admission to intensive care unit and employ- in particular, Angela Prencipe and Dave Haans, for their valuable help and
support.
ment before 6 months from birth were negatively asso-
No funding was available for this project.
ciated with exclusive breastfeeding. It has been reported
by Jakobsen et al. (1996) that child illness is a common Author details
1
Kinesiology & Health Science, York University, Toronto, Ontario, Canada.
risk factor for shorter duration of breastfeeding. The 2
Community Paediatrics, University of Toronto & Department of Paediatrics,
impact of working shortly after delivery on breastfeeding St Joseph’s Health Centre, Toronto, Ontario, Canada.
termination has also been documented in previous stu-
Authors’ contributions
dies [30,39]. The proximity of the nonworking mother
BAS performed the analysis and the write up of the manuscript. AL assisted
to her child makes breastfeeding more accessible during in the analysis and write up of the manuscript. MF provided technical
the first 6 months of life. support and advice on breastfeeding and reviewed the article. HT generated
the idea of the research and supervised the analysis and write up of the
The response rate in the present study was 75.2%. The manuscript.
main reason for non-response was the inability to estab- All authors read and approved the final manuscript.
lish contact with the mothers who were initially selected
Competing interests
from the Canadian Census of Population. However, the
The authors declare that they have no competing interests.
population weights created by Statistics Canada and
used in the analysis accounted for this non-response. Received: 8 July 2009 Accepted: 8 April 2010 Published: 8 April 2010
The cross-sectional nature of the study and inability to
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