title: Inadequate prenatal care use and breastfeeding practices in Canada: a national survey of women.
abstract: BACKGROUND
  Previous studies have demonstrated that prenatal care (PNC) has an effect on women's breastfeeding practices. This study aims to examine the influence of adequacy of PNC initiation and services use on breastfeeding practices in Canada.
  
  
  METHODS
  Data for this secondary analysis was drawn from the Maternity Experiences Survey (MES), a cross sectional, nationally representative study that investigated the peri-and post-natal experiences of mothers, aged 15 and above, with singleton live births between 2005 and 2006 in the Canadian provinces and territories. Adequacy of PNC initiation and services use were measured by the Adequacy of Prenatal Care Utilization Index. The main outcomes were mother's intent to breastfeed, initiate breastfeeding, exclusively breastfeed, and terminate breastfeeding at 6 months. Multivariate logistic regression analysis assessed the adequacy of PNC initiation and service use on breastfeeding practices, while adjusting for socioeconomic, demographic, maternal, pregnancy and delivery related variables. Bootstrapping was performed to account for the complex sampling design.
  
  
  RESULTS
  Around 75.0% of women intended to only breastfeed their child, with 90.0% initiating breastfeeding, while 6 month termination and exclusive breastfeeding rates were at 52.0% and 14.3%, respectively. Regression analysis showed no association between adequate PNC initiation or services use, and any breastfeeding practice. Mothers with either a family doctor or a midwife as PNC provider were significantly more likely to have better breastfeeding practices compared to an obstetrician.
  
  
  CONCLUSIONS
  In Canada, provider type impacts a mother's breastfeeding decision and behavior rather than quantity and timing of PNC.
authors.affiliation: School of Kinesiology & Health Science, Bethune College, York University, 4700 Keele Street, M3J 1P3, Toronto, ON, Canada. christycostanian@gmail.com.
authors.forename: Christy
authors.initials: C
authors.lastname: Costanian
authors.affiliation: School of Kinesiology & Health Science, Bethune College, York University, 4700 Keele Street, M3J 1P3, Toronto, ON, Canada.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Macpherson
authors.affiliation: School of Kinesiology & Health Science, Bethune College, York University, 4700 Keele Street, M3J 1P3, Toronto, ON, Canada.
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D055815:Young Adult
keywords: Breastfeeding practices; Canada; Prenatal Care Use; Women’s experiences