1. DATA COLLECTION – WHAT IS NEEDED FOR BFI DESIGNATION: ARE WE THERE YET? MARINA GREEN RN MSN BREASTFEEDING COMMITTEE FOR CANADA APRIL, 2015 1

2. 2 Data collection and surveillance of key breastfeeding statistics are both requirements for Baby-Friendly designation and strategies for program implementation and evaluation. During this panel discussion the presenter will outline and address questions about the required breastfeeding data collection necessary for Baby-Friendly designation in Canada.

3. BFI DESIGNATION ASSESSMENT What it is recognition of good practice (minimal standard) based on outcomes reliant on mothers and families qualitative quantitative aware that nothing is perfect! What it is not forensic audit! research destination 3

4. ARE WE THERE YET? What is the purpose of data collection? Meet BFI criteria Meet International Child Health Targets Measure progress Assess program effectiveness Determine areas of focus (e.g. caesarean rate) 4

5. DATA COLLECTION Valid Process Initiation Exclusivity Duration 5

6. OVERVIEW OF BFI DATA INDICATORS HOSPITAL COMMUNITY 6

7. BFI HOSPITAL INDICATORS Step 6 Support mothers to exclusively breastfeed for the first six months, unless supplements are medically indicated. 7 “it’s in the book”

8. FOR HOSPITALS AND BIRTHING CENTRES, THE MANAGER PROVIDES ANNUAL DATA FOR THE FACILITY SHOWING : breastfeeding initiation rates exclusive breastfeeding rates of babies from birth to discharge (minimum 75%) supplementation rates (medically-indicated and non-medically indicated) describes a reliable system of data collection 8 P. 9 BFI Indicators

9. APPENDIX 6.1: DATA COLLECTION OF BREASTFEEDING RATES 9 Page 28

10. APPENDIX 6.3: CALCULATION OF BREASTFEEDING RATES – HOSPITALS 10 Page 32

11. APPENDIX 6.3: CALCULATION OF BREASTFEEDING RATES – HOSPITALS 11 p.32

12. DOING THE MATH (WHAT IS THE DENOMINATOR?) 12 100 80 75 3 3 A/T= 80%

13. DOING THE MATH EXAMPLE 2 13 A/T = 73% 73 6 7 A+B= 79% (73+6=79%) T

14. QUESTIONS What: initiation rates what is the mother’s intent? other indicators may require more details (e.g. Step 4) Who: applies to all live babies born in the facility How: reliable method where is the data recorded who records the data 14

15. COMMUNITY FACILITIES: STEP 6 INDICATORS 15 p.9 AND

16. APPENDIX 6.1 DATA COLLECTION 16 * p28

17. APPENDIX 6.4: CALCULATION OF EXCLUSIVE BREASTFEEDING 17

18. 18 IF NO

19. 19 Babies = 100 Exclusive = 75 Percentage = 75% Babies = 75 Exclusive = 65 Percentage = 87% What’s wrong with this picture?

20. 20 Exclusive = 65 Percent = 65%

21. 6.2 MEDICAL INDICATIONS FOR SUPPLEMENTS 21 Page 30

22. SURVEILLANCE THE WHO GLOBAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING 22 A Strategy to promote, protect and support appropriate infant and young child feeding Baby-friendly Hospital Initiative (1991), International Code of Marketing of Breast-milk Substitutes (1981) Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (1990, 2005)

23. ROLES OF CRITICAL PARTNERS governments, organizations and other concerned parties specific responsibilities for each to ensure that the sum of their collective action will contribute to the full attainment of the strategy’s aim and objectives. 23

24. SURVEILLANCE “to develop, implement, monitor and evaluate a comprehensive policy on infant and young child feeding, in the context of national policies and programmes for nutrition, child and reproductive health, and poverty reduction” 24

25. 25 Perinatal Health Indicators for Canada 2013

26. 26 Perinatal Health Indicators for Canada 2013

27. INNOCENTI 2005 Establish sustainable systems for monitoring infant and young child feeding patterns and trends and use this information for advocacy and programming. Monitor progress in appropriate infant and young child feeding practices and report periodically, including as provided in the Convention on the Rights of the Child. 27

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30. BREASTFEEDING DEFINITIONS 30 *what happened to ‘total’ breastfeeding

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37. QUESTIONS 37

38. STRATEGIES ACROSS CANADA How to collect data after the initial contact How are people working to align the data definition and collection periods between hospitals and community health services? Any unique suggestions on how to collect the data (software programs, places to pull the data from)? What time intervals are other health units using to collect infant feeding surveillance. 38

39. HAND OUTS Please print (and read) pages 9-10 and 28-33 BCC Integrated Ten Steps Practice Outcome Indicators May 2012 http://www.breastfeedingcanada.ca/documents/2012-05- 14_BCC_BFI_Ten_Steps_Integrated_Indicators.pdf Breastfeeding Definitions and Data Collection Periods http://www.breastfeedingcanada.ca/documents/BCC_BFI_Breastfeeding_Defi nitions_and_Data_Collection_English.pdf Questions and Answers (attached) 39