Provincial and municipal initiatives (Halvorson)
The provinces largely follow the federal approach to advice and programming, primarily focusing on information provision for voluntary uptake by health care providers and prospective parents.
| Table 1: Additional Recommendations or Support Provided by Provincial Jurisdictions | |||
| Jurisdiction | Prenatal Nutrition | Breastfeeding | Relevant Links |
| Alberta | Recommendations
Consume additional foods every day in the 2nd and 3rd trimesters of pregnancy in amounts appropriate to meet healthy pregnancy weight gain recommendations. 400 IU of vitamin D daily Limit caffeine intake to 300 mg/day and drink 10 cups (2.5 L) of fluid each day (ideally water) Support The province offers prenatal classes (in-person, online) and nutrition counselling (on healthy pregnancy weight gain) in some locations within the province (Calgary, Edmonton) Developed a Prenatal Nutrition Tool for prenatal care providers comprised of a questionnaire (pregnancy weight gain, multivitamins, life circumstances, overall food intake, 2019) and a conversation guide (revised in 2021); Provides multiple nutrition education materials specific to pregnant people (on dairy foods, fish, iron, nutrition specific for pregnancy with twins, triplets, and more) |
Support
Alberta Health Services provides an online course for healthcare professionals to support patients breastfeeding, as well as developed a provincial Breastfeeding Strategy with the aim to "promote, protect, and support breastfeeding in Alberta within a patient and family centred care approach". |
Prenatal Nutrition Tool for Health Care Professionals
Nutrition Education Materials (Pregnancy and Breastfeeding) |
| British Columbia | Recommendations
Consume a balanced, nutritious diet, including an increased caloric intake of one to two vegetables, fruits, whole grain, or protein snacks. Vitamin C and calcium should accompany other supplements Support Supplies eligible pregnant individuals (income assistance, disability assistance, or hardship assistance and to family units with a dependent child under the age of seven months) free natal supplements from the confirmation of pregnancy up to 6 months following birth Pregnant individuals in Northern BC can receive nutrition assessments and support from registered dieticians through HealthLink |
Support
BC endorses the Baby-Friendly Initiative The five regional health authorities "provide extensive breastfeeding information including guidelines, FAQs, and infographics for health care providers and patients, as well as encouragement and support services for new mothers. The BC Women's Provincial Milk Bank screens, collects, and heat-treats (pasteurize) donated milk and distributes it to hospitals throughout BC |
Natal Supplement
Prenatal Nutrition (Northern Health) Review of Breastfeeding Practises and Programs
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| Manitoba | Recommendations
Take 600 IUs of vitamin D/day along with other supplements Limit caffeine intake to <300 mg/day.
Support Manitoba Healthy Baby program provides a pre-natal benefit of $10.00 - $81.41/month to buy healthy foods starting in the second trimester to when the baby is due for eligible individuals (net family income of <$32,000/year). Community support programs also exist to connect pregnant people to other parents, families, and healthcare professionals; group sessions "offer information, support and resources on prenatal and postnatal nutrition and health, breastfeeding, parenting tips and lifestyle choices" |
Recommendations
Introduce iron-rich foods at 6 months Have guidelines for pumping, bottling, collecting and storing breastmilk (4 hours at room temp, 3 days in a fridge, 1 month in freezer compartment within fridge, 6 months in separate-door freezer fridge, and 6-12 months in a deep freeze (-20°C)). They state to not refreeze breastmilk, or heat on the stove or in the microwave. Recommend babies have vitamin D drops (400-800 IU/day). Support Provides reading resources for new parents, as well as a support hotline.
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Making Connections: You and Your Growing Baby
Baby Friendly Manitoba: Information for Parents
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| New Brunswick | Recommendations
Be active for 10 - 30 mins/day Eat "twice as healthy" instead of "twice as much Pregnant people should avoid caffeine, artificial sweeteners, and highly processed foods Supplements should also include calcium, fibre, and vitamin D
Support The New Brunswick Prenatal Benefit Program provides pregnant residents of NB, earning <$29,000/year, with a maximum of $80/month from the fourth month of pregnancy (onward up to 6 months) Prenatal classes are offered in some clinics around the province |
Support
New Brunswick endorses the Baby-Friendly Initiative Provides pre-recorded, online breastfeeding classes and a list of clinics organized by region that offer online and in-person breastfeeding support groups, help lines, programs, and breast pump rentals Establishments can register as breastfeeding friendly if they post the provincial "breastfeeding is encouraged here" sign and train their staff to be knowledgeable and support the right to breastfeed in the space |
Prenatal Benefit Program
Breastfeeding and Baby-Friendly Initiative (BFI) |
| Newfoundland | Support
BABIES (Before Birth and Beyond: Information, Education and Support), a program which provides prenatal education and support program for pregnancy, birth and early parenting Prenatal education and support is also offered through some hospitals which provide maternity care and through online resources The Mother Baby Nutrition Supplement is available to low income (<$25,499/year) families, and provides $100/month to help with food costs during pregnancy and infancy up to one year. Throughout the Western Health region, the Healthy Baby Club, a prenatal nutrition support program, is offered by Family Resource Centres. |
Support
Newfoundland endorses the Baby Friendly Initiative Online support groups, lactation consultants, physicians, public health nurses, and health care professionals are available throughout the province Baby Friendly NL also has resources for teachers, communities, and municipalities |
Prenatal and Postnatal Resources, Services, & Benefits
Mother Baby Nutrition Supplement (MBNS) Healthy Eating During Pregnancy
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| Nova Scotia | Recommendations
Consume extra calories based off of the trimester (350 calories/day in 2nd, 450 calories/day in 3rd) Avoid artificial sweeteners, some types of fish, and to limit caffeine intake Support Multiple prenatal programs are available based on region, which range in offerings from supplements, group support, nutrition counselling, home visits, workshops, resources, and education. Many such programs are targeted towards teens and low-income people from Acadian, black, and rural communities Some culturally and linguistically specialized programs are offered for Indigenous peoples. Support hotlines are also available
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Support
Nova Scotia also endorses the Baby Friendly Initiative The province has a Breastfeeding Policy which "holds a firm and unequivocal position in favour of breastfeeding and communicates its position both within government, the health system, to health system providers as well as the general population" Government programs relating to child health promote breastfeeding, and provide tools such as infant feeding/nutrition assessments, care planning, individual breastfeeding support, and community capacity building e.g., peer support groups, local coalitions/networks The province also affirms a person’s right to breastfeed in public |
Healthy Eating During Pregnancy
Pre Natal Program (CPNP) Projects |
| Nunavut | Support
Nunavut released a Maternal and Newborn Health Care Strategy for 2009-2014 that sought to increase the number of pregnant people receiving "early, comprehensive and culturally relevant prenatal care" Implemented the Canada Prenatal Nutrition Program in all communities to improve access to nutritional foods, both traditional and store bought. Provide increased access to prenatal supplements Increased screening for anemia in pregnant people and improved monitoring and surveillance of prenatal progress and health outcomes The Baker Lake Nutrition Program provides prenatal information and support, food/vitamin supplements/ vouchers, and nutrition consultation and education for eligible individuals (Aboriginal/Metis/Inuit, Isolated, Low Income, Rural/Remote, Single Parents, Teen Pregnancy/Parent) Offers education and tips about healthy shopping, cooking, and eating |
Recommendations
Babies should take BabyDdrops™ for the first six months Support The Canada Prenatal Nutrition Program available in Nunavut provides "breastfeeding education, tips, and support" |
Nunavut Maternal and Newborn Health Care Strategy 2009 – 2014
Baker Lake Prenatal Nutrition Program Kanatami Hingaiyaqtun Niritjutikhangit Havaahaq, Canada Prenatal Nutrition Program |
| Northwest Territories | Recommendations
Contact a health care provider before taking any supplement NWT provides both a traditional and vegetable food fact sheet for healthy eating during pregnancy |
Support
The Northwest Territories endorses the Baby Friendly Initiative Link to resources such as in-person breastfeeding support groups and reading material |
Eating Advice for Pregnant and Breastfeeding Women |
| Ontario | Recommendations
In the 2nd and 3rd trimesters, Ontario recommends 2-3 more servings from any food group Foods to avoid during pregnancy include foods likely to cause listeriosis, fish with high levels of mercury, excess caffeine, and liver/liver products Recommends talking to a healthcare provider about the safety of herbal teas, artificial sweeteners, and natural health products Weight gain is expected during the second and third trimesters, at about 0.4 kg or 1 pound/week (any more or less the individual should contact their health care providers) Support Ontario includes links to supporting evidence, resources, and helplines. They also have a section specific to health care professionals with tools to help with prenatal care |
Recommendations
It is better to breastfeed for a short time than no time at all Ontario recommends reaching out for help if needed to start breastfeeding; from nurses, midwives, partners, family, friends, peer support groups, doulas, lactation consultants, and other health care experts Support They provide breastfeeding support and information through hotlines and regional services through ontariobreastfeeds.ca . |
Prenatal Education |
| Prince Edward Island | Support
PEI has the Community Nutrition Program that facilitates individual and group-based prenatal nutrition education including nutrition assessment and counselling (by phone, online, or in-person) to promote healthy pregnancies Healthy Mother Healthy Baby program has hotlines to call based on region for this information, as well as a list of family resource centres that can provide information, support groups, and snacks/home-cooked meals |
Recommendations
PEI recommends if/when babies are introduced to solid food after 6 months, they be nutrient, specifically iron-rich.
Support PEI endorses the Baby Friendly Initiative The Community Nutrition Program staffs public health nurses who can help with breastfeeding needs, offering a prenatal breastfeeding class, and can connect pregnant people to lactation consultants (by phone, online, or in-person) if necessary The Milk Ticket Program is available for some pregnant women and breastfeeding mothers up to 6 months post-partum who experience financial challenges. This program provides 1 litre of milk per day for the duration of the program to eligible pregnant and postpartum women PEI has a Breastfeeding Coalition with online resources and peer support for breastfeeding |
Community Nutrition Program |
| Quebec | Recommendations
Drink mostly water throughout the day
Support Offer a general telephone consultation service for more information about prenatal nutrition and pregnancy The Olo approach is offered as a resource, which helps pregnant people experiencing socioeconomic hardship to access nutrition-based care like food vouchers and vitamin supplements, as well as follow-up care from a nurse, nutritionist, or community organizations Pregnant individuals are eligible for a $55/month benefit to buy nutritious foods.
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Support
Prenatal classes are offered virtually, beginning at 28 weeks of pregnancy that cover breastfeeding Extra resources from the federal government, Canadian paediatric society, WHO, and UNICEF Canada are provided Individuals breastfeeding a baby under 12 months of age are eligible for a special benefit of $55/month |
Prenatal Nutrition |
| Saskatchewan | Support
Saskatchewan offers the Canadian Prenatal Nutrition Program, which provides support in the form of nutritional counselling, prenatal vitamins, milk coupons, lifestyle counselling, home visits, and breastfeeding promotion to improve the health of eligible pregnant people Food for Thought is a prenatal support program facilitated by a registered social worker, nutritionist, and program assistant that focusses on cooking low-cost nutritious food during pregnancy. It is designed for individuals or families experiencing poverty, food insecurity, social isolation, inadequate housing, illiteracy, relationship issues/family violence, substance use/mental health issues, lack of medical care, and for new immigrants, refugees and Indigenous women |
Support
Provides information hotlines for general public health offices; for more information they redirect to the federal government Individual regions like Regina and Saskatoon have more support groups and resources |
Canadian Prenatal Nutrition Program |
| Yukon | Support
The Yukon participates in the Canada Prenatal Nutritional Program and matches federal funds Pregnant people can attend prenatal classes in Whitehorse |
Support
The Yukon provides breastfeeding support through the Whitehorse Health Centre facilitated by community health nurses A breastfeeding support group and on-call nurse is available for help with breastfeeding, as well as some hotlines and brochures |
Additional funding for prenatal and infant supports in the Yukon
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Most municipalities are essentially delivery vehicles for provincial programming. A few municipalities are exceptions, including the City of Toronto, in that the breadth of programs extends beyond strictly provincial requirements, with multiple programs parents can apply and participate in including Healthiest Babies Possible, Healthy Babies Healthy Children, Welcome to Parenting, and Young Parent Prenatal Program. Toronto also offers multiple breastfeeding clinics, counselling, and groups around the city.
Limited lactation education for health professionals (Campbell, 2021)
The provinces have responsibility for both education and health care. In combination with various medical colleges and professional bodies, they set standards for health care education. Lactation, however, is an underdeveloped area in health care education, particularly in medical and nursing education. Many learn skills in lactation instruction and support through NGOs and private associations, or in college continuing education programs. A patchwork of requirements contributes to a lack of knowledge and support from health care professionals, and/or inconsistencies in information provided, and this is regularly identified as a factor in breastfeeding cessation (Chalmers, 2013; Campbell et al., 2020).
