Creating exclusive breastfeeding knowledge translation tools with First Nations mothers in Northwest Territories, Canada

Abstract

Background

Breastfeeding is an ideal method of infant feeding affecting lifelong health, and yet the uptake of breastfeeding in some Indigenous communities in Canada's north is low.

Objective

The aims of this project were to determine the rate and determinants of exclusive breastfeeding in a remote community in the Northwest Territories and to create knowledge translation tools to enhance breastfeeding locally.

Methods

The study methodology followed three steps. Firstly, a series of retrospective chart audits were conducted from hospital birth records of Tł chǫ women (n=198) who gave birth during the period of 1 January 2010 to 31 December 2012. A second follow-up chart audit determined the rate of exclusive breastfeeding and was conducted in the local Community Health Centre. Chart audit data included the following factors related to breastfeeding: age of mother, parity, birthweight and Apgar scores. Secondly, semi-structured interviews with a purposive sample of Tł chǫ mothers (n=8) and one Elder were conducted to identify breastfeeding practices, beliefs and the most appropriate medium to use to deliver health messages in Tł chǫ. Third, based on the information obtained in Step 2, two knowledge translation tools were developed in collaboration with a local community Advisory Committee.

Results

The rate of exclusive breastfeeding initiation in the Tł chǫ region is less than 30%. Physiological and demographic factors related to breastfeeding were identified. Thematic analysis revealed two overarching themes from the data, namely, “the pull to formula” (lifestyle preferences, drug and alcohol use, supplementation practices and limited role models) and “the pull to breast feeding” (traditional feeding method, spiritual practice and increased bonding with infant).

Conclusion

There are a myriad of influences on breastfeeding for women living in remote locations. Ultimately, society informs the choice of infant feeding for the new mother, since mothers’ feeding choices are based on contextual realities and circumstances in their lives that are out of their control. As health care providers, it is imperative that we recognize the realities of women's lives and the overlapping social determinants of health that may limit a mother's ability or choice to breastfeed. Further health promotion efforts, grounded in community-based research and a social determinants framework, are needed to improve prenatal and postnatal care of Indigenous women and children in Canada.

• breastfeeding
• rates of breastfeeding
• remote settings in Canada
• health promotion
• knowledge translation

This paper is part of the Special Issue: Sexual and Reproductive Health Promotion in the Circumpolar North, guest edited by Cornelia Jessen, Brenna Simons, Jessica Leston and Elizabeth Rink. More papers from this issue can be found at www.circumpolarhealthjournal.net

This paper is part of the Special Issue: Sexual and Reproductive Health Promotion in the Circumpolar North, guest edited by Cornelia Jessen, Brenna Simons, Jessica Leston and Elizabeth Rink. More papers from this issue can be found at www.circumpolarhealthjournal.net

Acknowledgements

We appreciate the assistance of Elder Rosa Mantla and CART, especially Mason Mantla, George Bailey and Anita Daniels, and Community Health Nurse Jacqueline DeCoutere. We would like to thank the Public Health Agency of Canada for the placement of a Student Public Health Officer at Aurora Research Institute.

Notes

This paper is part of the Special Issue: Sexual and Reproductive Health Promotion in the Circumpolar North, guest edited by Cornelia Jessen, Brenna Simons, Jessica Leston and Elizabeth Rink. More papers from this issue can be found at www.circumpolarhealthjournal.net

¹Exclusive breastfeeding is described by the World Health Organization as feeding whereby the infant receives only breast milk for the first 6 months of life. After 6 months, solid food may be introduced but mothers are encouraged to continue to breastfeed up to 2 years and beyond.

²Tł chǫ are First Nations people who fall within the broader designation of Dene, Indigenous people of the widespread Athapaskan language family. Their name for themselves is Doné, meaning “the People.” Retrieved from http://www.thecanadianencyclopedia.ca/en/article/tlicho-dogrib/ The Tł chǫ are Dene people who traditionally inhabited the lands from the borders of Nunavut in the east, the shores of Great Slave Lake in the north, the southern shores of Great Bear Lake and west towards the Mackenzie River in Canada's Northwest Territories. They are a self-governing nation with a population that includes the communities of Behchok , Whatì, Gamètì and Wekweètì and is approximately 3,000 people (12). The Tł chǫ nation is over 39,000 km², the largest block of land owned by First Nations in Canada.

³Baby-Friendly Hospital Initiative (BFHI) is a movement that was started in 1991 by the World Health Organization to promote and support breastfeeding in institutions around the world by implementation of the best tools, education and processes. Retrieved from http://www.who.int/nutrition/topics/bfhi/en/ The BFHI was initiated in the NWT in 2014 after this research was conducted and reported to the GNWT breastfeeding network. Both the photobook and the video were presented to members of the breastfeeding network along with an oral presentation of the results. It should be noted that the BFHI was pursued for many years in the NWT before coming to fruition.

⁴The Apgar score is estimated at 1 and 5 minutes following birth to evaluate the physiologic status of the newborn. The score is derived from five parameters including heart rate, respiratory effort, response to irritation stimulus and colour (16).

⁵Custom adoption has occurred for generations as a means of fortifying kinship ties, accommodating lifestyle requirements, keeping children in the community, gifting of a baby between relatives, and perhaps even more significant is the openness and contact that continues between the biological parents and the adopted parents. Custom adoption continues today and since 1995, a local Adoption Commissioner appointed through the Aboriginal Custom Adoption Recognition Act accepts applications from local people so that a certificate can be issued. This is needed so legal documents can be obtained, such as health care cards (27).

⁶Proximal determinants of health “include conditions that have a direct impact on physical, emotional, mental or spiritual health” (28, p. 5). Examples were provided, such as overcrowding and family violence. In terms of breastfeeding, these barriers of overcrowding and family violence take an emotional toll on mothers attempting to feed their infants without the quiet space or support they require. Also there is a need to overcome sociopolitical barriers such as the easy access, promotion and marketing of infant formula. The Lancet Breastfeeding Group (29) has published a series of papers that relate to all three levels of determinants.

⁷Intermediate determinants are those that create the proximal determinants, such as poor infrastructure and limited resources (28, p. 15). The cost of formula places an added burden on mothers who already have limited funds.

⁸Distal determinants are those that construct the proximal and intermediate levels, such as “colonialism, racism and social exclusion” (28, p. 20). The colonial system has created the need for NWT mothers to travel for birth out of their communities to regional centres which causes isolation from families and interferes with supports that they need from their families and their community for breastfeeding. Also mothers do not have access to lactation consultants who could assist them with interventions to address physical discomforts associated with breastfeeding.

⁹Weaning is defined as a process of a young infant to take food from a source other than a mother's breast.