Reproductive, Family, and Child Health

 Births and Fertility Rates

In Ottawa:

• A total of 9,553 babies were born in 2018, down from 9,983 live births in 2013 (Figure 1).
• Fertility rates (number of live births per 1,000 females aged 15 to 49 years) have consistently declined over the past six years, from 42.2 births per 1,000 females aged 15 to 49 years in 2013 to 38.2 births per 1,000 females aged 15 to 49 years in 2018 - the lowest rate observed during this time (Figure 1). Fertility rates were lower in Ottawa than the Ontario average between 2013 and 2017. [1]
• Fertility rates were highest among women aged 30 to 34 years (98.7 births per 1,000 females), followed by women aged 35 to 39 years (64.3 births per 1,000 females) and women aged 25 to 29 years (50.6 births per 1,000 females) (Figure 2).
• The number and rate of live births among teenagers dropped 50% in the past six years from 158 births (5.5 births per 1,000 females aged 15 to 19 years) in 2013 to 72 births (2.6 births per 1,000 females aged 15 to 19 years) in 2018, [2] and was lower compared to Ontario (5.7 births per 1,000 women 15 to 19 years). [3]
• The majority (95.8%) of women delivered at a hospital and 1.6% delivered at home in 2018. [4] The proportion of women delivering at a birth centre increased from 1.2% in 2014 to 2.5% in 2018. [2]

 Figure 1. Number of live births and fertility rates in Ottawa from 2013 to 2018

 Figure 2. Age-specific fertility rates in Ottawa from 2013 to 2018

Prenatal Class Attendance and Prenatal Care

In Ottawa:

• Three out of ten (31.5%) women attended a prenatal class during their last pregnancy in 2018. This was higher than the Ontario-less-Ottawa average of 22.2%. [4]
• During their first trimester of pregnancy, in 2018, 93.2% of women visited a health care provider, similar to the Ontario-less-Ottawa slightly more than Ontario-less-Ottawa average of 92.0%. [4]

Mental Health Concerns During Pregnancy

In Ottawa:

• In 2018, 17.4% of postpartum mothers self-reported a mental health concern during pregnancy to their health care provider, similar to Ontario-less-Ottawa (18.1%). Mental health concerns included anxiety (12.5%) and depression (6.7%). Among postpartum mothers who had previously given birth, 4.3% reported a history of postpartum depression. [4]
• In 2018, 17% of families screened through the Healthy Babies Healthy Children program reported that the mother or parenting partner had a history of depression, anxiety or other mental illness. [5]

Smoking, Alcohol and Drug Use During Pregnancy

In Ottawa:

• One in twenty-five (4.0%, 361 women) women who gave birth in 2018 reported smoking close to the time of their child’s birth, lower compared to Ontario-less-Ottawa (6.7%). [4]
• Nearly one out of twenty (4.5%, 412 women) women who gave birth in 2018 reported drinking alcohol during their pregnancy, higher than Ontario-less-Ottawa (2.2%). [4]
• Approximately three in 200 (2.1%, 194 women) women who gave birth in 2018 reported one or more other drug/substance use during pregnancy. The reported substances included marijuana (1.8%), cocaine (0.3%), opioids (0.1%) and other substances (0.2%). [4]

Pregnancy (Gestational) Weight Gain

In Ottawa:

• Similar to 2017, in 2018, just over half (52.8%) of women who gave birth had a ‘normal weight’ Body Mass Index (BMI, 18.5 – 24.9) before their pregnancy, 25.2% began their pregnancy with an ‘overweight’ BMI (25.0 – 29.9), 18.1% began their pregnancy with an ‘obese’ BMI (≥ 30.0), and 3.9% with an ‘underweight’ BMI (< 18.5). [4]
• Similar to 2017, in 2018, nine out of twenty (44.7%) women who gave birth gained more than the recommended amount of weight during their pregnancies, as per the Canadian gestational weight gain recommendations, 31.6% gained within the recommended amount of weight, and 23.7% gained below the recommended amount of weight during pregnancy. [4]
• Nearly three out of five women who began their pregnancies as overweight (58.5%) or obese (57.6%) gained more than the recommended amount of weight during their pregnancies in 2018, a similar pattern to that of 2017 (Figure 3).

Figure 3. Gestational weight gain per Canadian recommendations by pre-pregnancy body mass index, Ottawa women who gave birth in 2018

• In 2018, the majority of births in Ottawa were [4]:
  • singleton (96.7% vs. 3.2% multiple);
  • born full-term (92.4%, vs. 7.6% preterm); and
  • born with an appropriate weight for their gestational age (81.6%).
• Compared to Ontario-less-Ottawa in 2018, Ottawa had a lower proportion of small for gestational age babies born (Ottawa: 8.4% vs. Ontario-less-Ottawa: 9.8%) and a slightly higher proportion of large for gestational age babies born (Ottawa: 9.9% vs. Ontario-less-Ottawa: 9.3%). [4]
• Similar to the Ontario-less-Ottawa average (28.9%), in 2018, 29.1% of Ottawa women delivered via Cesarean section - the highest proportion over the past six years, of which, 57.3% were a first-time Cesarean section and 38.6% were repeat Cesarean sections. [4]

Infant mortality is the death of an infant before their first birthday (days 0-364). The infant mortality rate is the number of infant deaths per 1,000 live births.

Neonatal mortality is the death of an infant aged 0-27 days. Post-neonatal mortality is the death of an infant aged 28-364 days.

In Ottawa:

• From 2013 to 2015, there was an annual average of 38.4 infant deaths. This includes an average of 32.3 neonatal deaths and an average of 6.3 post-neonatal deaths (Figure 4).
• Infant mortality rates in Ottawa have declined over the past 15 years from a high of 6.6 deaths per 1,000 live births from 1998-2000 to 3.9 deaths per 1,000 live births from 2013-2015. On average, infant mortality rates in Ottawa are lower than in the Ontario-less-Ottawa average (Figure 5).

Figure 4. Number of infant deaths broken down by neonatal (age 0 to 27 days) and post-neonatal (age 28 days to 364 days) deaths in Ottawa from 1986 to 2015

Figure 5. Infant mortality rate (3-year moving average) in Ottawa and Ontario-less-Ottawa from 1986 to 2015

Ottawa Public Health (OPH) offers a variety of services to parents with children 0 to 6 years of age, including Parenting in Ottawa (PiO) (e.g., website, Facebook page, and drop-ins), Ottawa Breastfeeding Buddies, the OPH telephone line, and prenatal education.

In Ottawa:

• 85% of parents with children 0 to 6 years of age in 2016 and 2017 had heard of at least one of these services or programs and 56% had made use of at least one of them. [9]
• The most known OPH parenting resources were the OPH telephone line (63%) and OPH prenatal education (55%) (Figure 6). The most used services, by parents with children 0 to 6 who were aware these services existed, were the OPH telephone line (46%), the PiO website (46%), and OPH’s prenatal education service (44%) (Figure 6).
• Parents of children 0 to 6 years of age most often identified “websites/ internet” (65%), “Ottawa Public Health” (13%), and “Ontario Early Year Centres” (now known as EarlyON Child and Family Centres) (7%) as their primary source of parenting information. “Magazines, newsletters, or other written material”, “telephone information lines”, and “schools” were very infrequently selected as the primary source of parenting information. [9]

Figure 6. Awareness and use of select Ottawa Public Health (OPH) parenting programs by Ottawa residents (18+ years of age) with children 0 to 6 years of age, 2016 to 2017

Breast milk feeding 

In Ottawa:

• Nearly all (96%) mothers who gave birth in 2018 intended to feed breast milk to their infant and 86% intended to exclusively feed breast milk to their infant, slightly higher than in the rest of Ontario (81%) (Table 1).
• Nine out of ten (90%) mothers who gave birth in 2018 fed breast milk on discharge from hospital or three days after giving birth with a midwife. [2] 

• There has been a decrease in the proportion of Ottawa mothers who exclusively fed breast milk to their infant at discharge from hospital or three days after giving birth with a midwife, from 66.0% in 2013 to 59.8% in 2018 (Figure 7).

• After hospital discharge or giving birth with a midwife, there is a large drop in exclusive breast milk feeding from 61% at a few days after birth to 38% at two weeks of age, among those who gave birth in 2016. [2, 10]

• At six months of age, seven out of ten (70%) mothers were feeding breast milk and nine percent of mothers reported exclusively feeding breast milk for six months, in 2016. [10]

 Table 1. Breast milk feeding intent and breast milk feeding (any or exclusive) at discharge, 2 weeks, and 6 months in Ottawa and Ontario-less-Ottawa from 2016 to 2018

Figure 7. Any and exclusive breast milk feeding on discharge from hospital or three days after giving birth with a midwife in Ottawa from 2013 to 2018

 Social Determinants of Health Among Families at Birth

 In 2018, among Ottawa families screened at birth through the Healthy Babies Healthy Children program: [5]

• 5% reported that the mother and baby did not have a designated primary care provider;
• 4% reported that they had concerns about money to pay for basic necessities such as housing/rent, food, clothing or utilities;
• 4% needed newcomer support;
• 3% reported that the father/partner or support person was not involved in the care of the baby;
• 3% were a single parent;
• 3% had not completed high school; and
• <1% reported that at least one parent had a disability that could impact their parenting.

 18-month Well-Baby Visits

The 18-month enhanced well-baby visit provides healthcare providers an opportunity to determine whether a child is meeting important developmental milestones such as motor, speech and language skills, social and emotional development, to review immunizations, healthy eating, dental care, hearing and vision, and to refer to specialized services for early intervention, as needed.

• In Ottawa, the proportion of children aged 17 to 24 months who had a well-baby visit with a healthcare provider increased from 58% in 2011 to 67% in 2015, but decreased to 64% in 2016. Compared to Ottawa, a smaller proportion (57%) of Ontario-less-Ottawa children aged 17 to 24 months had a well-baby visit with a healthcare provider in 2016. [11]

Early Child Development 

From birth to six years there exist critical periods during which particular physical, emotional, social, language and communication skills are developed. The Early Development Instrument (EDI) is a population-based measures of children’s developmental health across five domains, which in turn are divided into 16 sub-domains. Five EDI cycles have been completed in Ottawa, starting in 2005/06. For more information on the EDI and Ottawa results, please refer to the Our Kids, Their Story...Snapshot of Developmental Health at School Entry in Ottawa 2005-2015 report published by the Parent Resource Centre.

In Ottawa:

• In 2015/16, 26% of senior kindergarten (SK) children were vulnerable in at least one of five Early Development Instrument (EDI) domains. This percent has not changed over time and Ottawa children have fared slightly better than the provincial average. [12]
• The percent of SK children “not on track” was higher than the provincial average in only one domain, Emotional Maturity (26% Ottawa vs. 25% Ontario). [12]
• Of concern, the percent of SK children vulnerable in the Physical Health and Well-Being, Social Competence and Emotional Maturity domains has increased over time. On the other hand, there were improvements with a lower percentage of SK children vulnerable in the Language and Cognitive Development and the Communication Skills and General Knowledge domains (Table 2).
• The most common five sub-domains where children were "not on track" include [12]: 
  • Prosocial and Helping Behaviour (34%), 
  • Communication Skills and General Knowledge (24%), 
  • Gross and Fine Motor Skills (18%), 
  • Interest in Literacy/Numeracy (13%), 
  • Advanced Literacy (12%), and 
  • Hyperactive and Inattentive Behaviour (12%). 
• The percentage of children vulnerable in at least one EDI domains ranged from 7% to 48% across Ottawa neighbourhoods. The percentage of children vulnerable in at least one EDI domain generally increased with decreasing socioeconomic status. [12]
• Neighbourhoods with a high proportion of children vulnerable in at least one EDI domain include Sandy Hill (48%), Overbrook (46%), Carleton Heights (46%), Pinecrest/Queensway (43%), Hunt Club West (40%), Lower Town (40%), and Riverview/Hawthorne (39%). [12]

Table 2. Early Development Instrument (EDI) domains and sub-domains with significant changes to the percent of vulnerable children over the past 4 cycles in Ottawa, 2005 to 2015

 Infant Feeding in Ottawa 2012 to 2014

This infant feeding report is the first to present statistics on selected infant feeding indicators for Ottawa mothers from Ottawa Public Health's Infant Feeding Surveillance System (IFSS), the Better Outcomes Registry & Network (BORN) Ontario and Statistics Canada's Canadian Community Health Survey (CCHS).

• Infant Feeding in Ottawa 2012 to 2014 - Full Report [ PDF 694.79 KB ]
• Facts on Infant Feeding in Ottawa - Infographic [ PDF 1.89 MB ]
• Infant Feeding in Ottawa 2012 to 2014 - Video https://youtu.be/3LCrtmCSbWs

References 

1. Public Health Ontario. Reproductive Health Snapshot (2013-2017). https://www.publichealthontario.ca/en/DataAndAnalytics/Snapshots/Pages/Reproductive-health.aspx. Accessed September 12, 2019.
2. Ottawa Public Health. Ottawa births, Better Outcomes Registry & Network (BORN) Ontario 2013-2018. Extracted September 12, 2019.
3. Statistics Canada. Table 12-10-0418-01 Crude birth rate, age-specific fertility rates and total fertility rate (live births). 2013 to 2017. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310041801. Accessed November 1, 2018.
4. Ottawa Public Health. Better Outcomes Registry & Network (BORN) Ontario Information System 2018. Extracted September 12, 2019.
5. Ottawa Public Health. Integrated Services for Children Information System (ISCIS) 2018. Extracted September 19, 2019. 
6. McCain MN, Mustard, J.F., Shanker, D.S. Early years study 2 - Putting science into action. 2007.
7. Crill Russell C. Parenting in the beginning years: priorities for investment. Toronto, Canada: Invest in Kids; 2003. 
8. Patterson J, Mockford, C., Barlow, J., Pyper, C., Stewart-Brown, S. Need and demand for parenting programmes in general practice. Archives of Diseases in Childhood. 2002;9:468-71.
9. Ottawa Public Health. Rapid Risk Factor Surveillance System, 2016-2017.
10. Ottawa Public Health. Infant Feeding Surveillance System 2016. 

11. Ottawa Public Health. 18-month well-baby visits, Ontario Health Insurance (OHIP) claims 2010-2016. Toronto: Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario. Extracted: September 19, 2019.

12. Millar C, Lafrenière A, Lebreton J, de Quimper C. Our Kids, Their Story...Snapshot of Developmental Health at School Entry in Ottawa 2005-2015. Data Analysis Coordinators PRC, editor. Ottawa, ON; 2016.