2. Healthy Pregnancy, Birth and Infancy

Pregnancy, birth and the early months of infancy are critical to a child's continuing healthy growth and development. Providing the conditions that enable women to have healthy pregnancies, that support babies' healthy births, and that enable infants to be nurtured and well cared for is critically important to children's well-being. In turn, it facilitates their growth into healthy adulthood.³,⁴

The Government of Canada continues to invest in a number of programs and initiatives to promote health during this critical time through education, support and monitoring. In addition to the activities discussed in this chapter, the Child Health Record and the Canadian Perinatal Surveillance System, covered in Chapters 3 and 7 respectively, also have an impact on healthy pregnancies, births and babies.

Health Canada - Highlights

Canada Prenatal Nutrition Program

In 2002-2003, the number of pregnant and postpartum women attending the Canada Prenatal Nutrition Program (CPNP) across Canada grew for the eighth consecutive year. Women come to the CPNP to access comprehensive services including food supplements, nutrition counselling, social support and breastfeeding support. About one in five women who come to the CPNP is under 20 years old. Approximately 23 percent identify themselves as being Aboriginal, and about 30 percent have lived in Canada for fewer than 10 years.

Building community capacity is an underlying principle of the CPNP. In 2002-2003, CPNP projects indicated that they increased community participation and awareness within the communities they serve. Community capacity was developed by forming partnerships, increasing awareness and meeting needs within the community, and increasing participation within projects.

To ensure that programs and services are of high quality, education and training of project staff are an important part of the CPNP. For example, during 2002, project staff from six CPNP projects in Alberta participated in a 10-month prenatal tobacco cessation pilot project. The purpose of the pilot was to train project staff to intervene more effectively with those women who smoke during pregnancy. The evaluation component of this pilot is now under way.

Evaluation is a critical component of the CPNP and data are gathered on an annual basis. The Welcome Card provides information about program participants to measure outcomes and the Individual Project Questionnaire provides program-level information to measure project implementation, community involvement and partnerships, and assess program relevancy.

In 2002, the CPNP and the Community Action Program for Children (CAPC) in Atlantic Canada published At the Heart of Our Work. This is the result of an ongoing, participatory process with parents, staff, volunteers, community partners, governments and researchers. The purpose of the document is to outline a theoretical framework for CPNP and CAPC in Atlantic Canada, as a foundation for the development of new reporting and evaluation systems for these programs. It can be found at www.pph-atlantic.ca. In 2003, the Atlantic Region began pilot testing the resulting innovative, empowerment-based tools based on this framework — the Resource Kit on the Evaluation and Reporting System for CAPC and CPNP.

Canada Prenatal Nutrition Program – First Nations and Inuit Component

The Canada Prenatal Nutrition Program – First Nations and Inuit Component (CPNP-FNIC) emphasizes ongoing training. In 2002-2003, about 500 community workers were trained on core competencies of prenatal and infant nutrition, building their capacity to deliver evidence-based, community-driven programming regionally. Key reference and resource materials were introduced and the training focused on these resources.

A departmental evaluation of the CPNP-FNIC has been completed, assessing the process and impact of the program. Data are being collected to undertake a global evaluation of the impact and process of the First Nations and Inuit Component of the CPNP. Inuit CPNP projects have been evaluated and an additional First Nations — specific evaluation report is under development. Both of these evaluations consider process and impact, and will be available in 2003-2004.

Fetal Alcohol Spectrum Disorder Initiative

The Fetal Alcohol Spectrum Disorder (FASD) initiative has two components — one is pan-Canadian and the other focuses on First Nations and Inuit populations. An increased investment from the Federal Strategy on Early Childhood Development for First Nations and Other Aboriginal Children (see Chapter 6) resulted in the Fetal Alcohol Syndrome/Fetal Alcohol Effects initiative being expanded into the FASD Program in First Nations and Inuit communities.

The FASD First Nations and Inuit Component (FASD-FNIC) was developed under the advice of a National Steering Committee made up of representatives from Health Canada, the Assembly of First Nations and Inuit Tapiriit Kanatami and as a result of broad consultations with First Nations and Inuit community representatives. The need for community capacity building as it relates to FASD emerged as one of the key priorities during the consultations.

Both components of the FASD initiative address the prevention of FASD and interventions to increase the quality of life for those affected. Programming is undertaken in several areas, such as public and professional awareness and education; the development of tools for community-based program use; early identification, assessment and diagnosis, and the development and implementation of national guidelines for diagnosis; and supports for parents and families of children affected by FASD.

In 2002-2003, the focus of the FASD awareness activities shifted from general public awareness relating to prevention to developing the awareness, knowledge and skills of health care professionals. This involved efforts to increase the capacity for diagnosis among professionals across Canada and the development of screening tools for front-line workers.

During 2002-2003, a number of general public awareness activities were undertaken. Two examples are:

• "Pregnant: No Alcohol" reached women pregnant or planning a pregnancy through the distribution of information pamphlets in Thyme Maternity store locations and specialized trade shows. Materials were also distributed to health care professionals through C'est Pour Quand and Expecting magazines across Canada.
• Health Canada's partnership with Parents d'Aujourd'hui⁸ successfully reached its target audience — women 25 to 40 years old. Activities included programming on television and radio, Internet exposure on famillesdaujourdhui.com and articles in Le Journal de Montréal.

During 2002-2003, the Government of Canada collaborated on funding community projects to build capacity on FASD and on research. The voluntary sector was involved in consultations regarding the design of the initiative, the development of a National Framework for Action on FASD and the National Advisory Committee for FASD.

Folic Acid Awareness Campaign

The Folic Acid Awareness Campaign is a partnership between Health Canada, the Spina Bifida and Hydrocephalus Association of Canada and the Folic Acid Alliance of Ontario. Materials produced in 2001-2002 continue to be distributed through the Healthy Pregnancy Social Marketing Campaign.

An evaluation of the effectiveness of the campaign was done in 2002, replicating a 2001 benchmark study. The evaluation assessed change over the year and found that more work was needed to increase awareness of the importance of folic acid. Key findings included:

• Few Canadian women of childbearing age were aware of neural tube defects. This finding was similar to the previous survey.
• Most women of childbearing age continued to lack a good understanding of what folic acid is and what it is used for.
• Women's use of folic acid did not change over the year. Forty percent of women 18 to 40 took folic acid, although a large proportion of this group was unaware of its purpose.

Healthy Pregnancy Social Marketing Campaign

In 2002-2003, baseline research was conducted to obtain background information for the Healthy Pregnancy Social Marketing Campaign. This baseline research examined awareness levels and behaviours of pregnant women or those considering a pregnancy with respect to several issues — alcohol consumption, tobacco use, physical activity, nutrition and folic acid intake. The survey found that pregnant women demonstrated a higher degree of knowledge of the factors that contribute to a healthy pregnancy and baby than those who were not yet pregnant. Given the importance of planning a pregnancy, the baseline research concluded that women who are not yet pregnant and their partners need to be engaged in learning about, and acting on, the factors that will increase their likelihood of a healthy pregnancy and a healthy baby.

Postpartum Parent Support Program

In 2002-2003, Health Canada was involved in preparing updated Postpartum Parent Support Program (PPSP) content for publication. A series of 15 parent information sheets covering issues such as bathing, breastfeeding, cord care, jaundice, postpartum depression and others will be published later in 2003. In addition, the program's Reference Manual for health professionals was revised and is expected to be published in 2004.

Reducing the Risk of Sudden Infant Death Syndrome

Over the past decade, Health Canada, the Canadian Foundation for the Study of Infant Deaths, the Canadian Paediatric Society and the Canadian Institute of Child Health have worked together as a coalition to address sudden infant death syndrome (SIDS) in Canada. The major activity was the development of professional and public awareness materials on the risk factors of SIDS. Since the launch of the "Back to Sleep" campaign in 1999, Health Canada has continued to disseminate the materials that are in constant demand from the public.

Along with the success of the "Back to Sleep" campaign (reported in the 2001-2002 Activities and Expenditures Report), there was public concern over positional plagiocephaly ("flat head") in infants who sleep on their back, and a reported increase of these cases in paediatric institutions. To address these concerns, in 2002-2003 Health Canada and its three partners developed and disseminated information for health professionals and parents identifying how this condition can be prevented.

Human Resources Development Canada – Highlights

Employment Insurance: Maternity and Parental Benefits

During 2002-2003, the number of families accessing Employment Insurance (EI) maternity benefits and the number of parental benefits claims increased, as did expenditures on the program. Results from the 2002 Monitoring and Assessment Report indicate that Canadians responded enthusiastically to recent enhancements to the program (reported in the 2001-2002 Activities and Expenditures Report). In fact, data show that Canadians are using more of their parental benefits and over a longer period.

A pilot project was introduced in September 2002 to ensure that women can access all of their EI maternity and parental benefits. The pilot project is available to pregnant women who, under a provincial compensation plan, stop working to protect their health or the health of their unborn child. New investments were made for the training of Human Resources Development Canada (HRDC) employees to enhance implementation of this pilot project.

The efficiency and effectiveness of the EI program is continually being evaluated. In 2001, HRDC began an evaluation of the extended parental benefits program, which continued in 2002-2003. The goal of this evaluation is to determine the impact and outcomes of the program. A number of key outcomes will be evaluated — the duration of parental leave and unpaid leave following parental benefits, the likelihood of returning to the same job, and the incidence and duration of employment following parental benefits. Changes in uptake, impact on children, client satisfaction and use by fathers will also be examined. Results of this evaluation will be available in 2004.

The EI program is reviewed every year through a monitoring process to assess the impact on individuals, communities and the economy. The 2002 Monitoring and Assessment Report was tabled in Parliament in the spring of 2003. It indicated that on average, women were using over 97 percent of their maternity duration entitlement. From 2000-2001 to 2001-2002, the number of maternity claims increased by almost 10 percent and the number of parental claims increased by 18 percent; for men that increase was nearly 80 percent.

Healthy Pregnancy, Birth and Infancy Activities and Expenditures Tables
Programs Providing Direct Support
	Who does the activity reach?						What is the expenditure on children under 6 and their families?
	Number of:
	Sites			Children under 6 and families
	2000-2001	2001-2002	2002-2003	2000-2001	2001-2002	2002-2003	2000-2001	2001-2002	2002-2003
Health Canada
Canada Prenatal Nutrition Program (CPNP)	301 projects	325 projects	320 projects	34,000 women	45,600 women	44,000 women	$27,366,000	$31,000,000	$31,000,000
CPNP: First Nations and Inuit Component	> 550 projects	439i projects	N/A	7,500ii children> 6,000 families	6,000 children	N/A	$14,200,000	$14,200,000	$14,200,000
Human Resources Development Canada
Employment Insurance: Maternity Benefits	--	--	--	176,000 new claims	193,020 new claims	N/A	$752,000,000	$848,000,000	$859,000,000ii
Employment Insurance: Parental Benefits	--	--	--	178,000 new claims	196,000 new claims	N/A	$502,000,000	$1,311,000,000	$1,930,000,000iii
Total expenditures							$1,295,566,000	$2,204,200,000	$2,834,200,000

Other Supporting Programs
	Who mediates the activity?		Who does the activity reach?			What is the expenditure on children under 6 and their families?
	Intermediaries	Number of intermediaries	Children under 6	Families	Other
	2002-2003	2002-2003	2002-2003	2002-2003	2002-2003	2000-2001	2001-2002	2002-2003
Health Canada
Fetal Alcohol Spectrum Disorder	Community-based program workers Health professionals	N/A	X	X	Stakeholders who serve families and children	$2,650,000	$3,300,000	$3,300,000
Fetal Alcohol Spectrum Disorder: First Nations and Inuit Component	--	--	X	X	Stakeholders who serve families and children	$1,350,000	$1,700,000	$1,700,000iv
Fetal Alcohol Spectrum Disorder Social Marketing Campaign	--	--			Women 25 to 40	--	$240,000	$120,000ix
Folic Acid Awareness Campaign	Family physicians Neonatologists, obstetricians, midwives, hospitals Pharmacists, dieticians, geneticists, nursing schools Public health units	26,000 2,800 21,500 800		X	Health professionals	--	$600,000	$85,000v
Healthy Pregnancy Social Marketing Campaign	N/A	N/A			Women who are pregnant or planning a pregnancy	--	$12,000	$125,000vi
Postpartum Parent Support Program	Hospitals, public/community health centres	600		X	Health professionals	$100,000	$35,000	$5,500vii
Reducing the Risk of Sudden Infant Death Syndrome	Nurses, midwives, physicians Hospitals, public and community health centres	N/A		X	Health professionals	$40,000	$50,000	$5,000viii
Total expenditures						$4,140,000	$5,937,000	$15,340,500

Note: N/A refers to "not available" at the time of publication; -- refers to "not applicable."

i. The decrease is due to the way programs are counted — there may be satellite communities served by numerous programs.
ii. Estimate.
iii. Estimate. Increase due to the success of the enhancements to benefits — Canadians are using more of their benefits over a longer period.
iv. Due to the late announcement (October 2002) and the need to plan and consult before allocating funding, full additional funding of $10 million could not be allocated in fiscal year 2002-2003. All available funding was allocated to meet regional health program needs including support to those services which First Nations have made a priority.
v. There were no new materials produced in 2002-2003 resulting in a decrease in expenditure.
vi. The increase in expenditure was a result of contributions from the Fetal Alcohol Spectrum Disorder initiative and the Folic Acid Awareness Campaign.
vii. Health Canada's role changed from supporting implementation and monitoring to providing resource materials to the program, resulting in a decrease in expenditure.
viii. Health Canada continues to disseminate materials; however, no new materials were developed in 2002-2003, resulting in a decrease in expenditure.
ix. Decrease in expenditure due to fiscal pressure.