Chapter 3 - Preconception Health, Parenting and Families

Key Messages:

• The birth rate for Algoma in 2022 was 7.1 live births per 1,000 people, a 19.0% decline from 2017
  
  
• Mental health concerns during and post-pregnancy have been increasing in Algoma.
  
  
• Alcohol and tobacco use during pregnancy has declined, but gestational cannabis and drug use has risen
  in the last two years.
  
  
• More than 90% of parents/guardians, in Algoma, reported that their neighbourhood is safe for their
  children to play outside.

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About

 

Preconception health refers to your health before becoming pregnant. Your nutrition, habits, and medication affect your baby before they are even conceived. The preconception and pregnancy stages are foundational to building healthy and resilient communities by making sure all children have the best start to life.

An infant’s first 1000 days of life are a period of profound brain development. Safe, secure, and nurturing relationships, positive childhood experiences, and healthy communities support this development of a child’s brain architecture, which becomes the foundation for all future learning, behaviour, and health throughout the child’s life.

Pregnancies in Algoma

 

In 2021, the pregnancy rate per 1,000 women of reproductive age in Algoma was higher than Ontario and NE PHUs.

 

• Algoma: 47.7%
• NE PHUs: 45.9%
• Ontario: 45.8%

The pregnancy rate per 1,000 women aged 15 to 19 years old in Algoma has decreased over time but as of 2021 is still more than double the Ontario rate.

 

• Algoma: 13.9%
• NE PHUs: 13.9%
• Ontario: 6.3%

In Algoma, women younger than 30 years of age have significantly higher pregnancy rates, compared to Ontario.

 

Pregnancy rate (per 1,000 females of reproductive age) by age group (Figure 1)

Pregnancy rate (per 1,000 women) in 15 to 19 year olds in Algoma and Ontario (Figure 2)

 

Who does a resident in Algoma see for prenatal care? On average (2017 - 2023), pregnant families in Algoma: 

 

• 60% saw an obstetrician - this is a decrease by 16.1%
• 46.6% saw a midwife - this rate has doubled over this period
• 4.1% saw a family physician - this is a decrease by 8.7%

Healthy Pregnancy - Tips & Local Statistics

 

• Folic acid is essential to the optimal development of a baby. Taking it daily can reduce the risk of neural tube defects. Take folic acid at least 3 months before becoming pregnant.
• Approximately 1 in 4 (24.6%) Algoma mothers take folic acid before and during pregnancy. This is significantly lower than mothers in Ontario (35.6%).
• 24.9% (2023) seek prenatal care as soon as possible
• In Algoma, before 2021 1in 3 pregnant families reported having received prenatal education. This reduced to 1 in 4 pregnant families during 2023. 
• 1 in 3 (36.6%) Algoma mothers experience mental health concerns during pregnancy most commonly anxiety and/or depression. This is a higher proportion of mothers compared to Ontario (22.9%).
• On average 7.1% of women in Algoma, who gave birth between 2015 and 2019 reported post-partum depression after a previous birth. This is notably higher than the provincial average of 4.0%.

Substance Use During Pregnancy

 

When a person is pregnant, the placenta physically connects the fetus to the pregnant person and facilitates the exchange of substances. The structural properties of the placenta allow for selective transfer of different substances while providing some protection for the fetus. Most drugs, from all classes, will cross the placental barrier. 

An infant’s exposure to substances in the womb may lead to growth restrictions, poor fetal development, preterm labour, and other harms. Immediate complications after birth include Neonatal Abstinence Syndrome (NAS) causing withdrawal symptoms in a newborn. 

For the health of the newborn, it is strongly recommended to abstain from, or at least reduce, consumption use of substances during pregnancy.

 

Substance use among women in Algoma while pregnant (2021)

 

• Tobacco: 15.1% - Almost 6% lower than 2015, 3x more than Ontario (4.8%)
• Cannabis: 9.5% (1 in 10) - 2x more than Ontario (4.2%)
• Drug & Substance: 9.4% (1 in 10) - 10x more than Ontario (1.0%)
• Alcohol: 2.9% (1 in 30) - Almost the same as Ontario (1.8%)

What does this mean?

• During 2020, the rate of hospitalizations caused due to neonatal withdrawal symptoms from mothers' use of substances was observed at a record high of 26 infants per 1,000 live births in Algoma. This declined to 17.8 infants per 1,000 live births in 2021.
• Long term impacts of prenatal substance exposure have also been found, such as learning delays, difficulties in self-regulating, and development of risky behaviour as the child grows.

 

(Figure 3) - Percentage of pregnant women in Algoma that reported smoking during pregnancy, by age group

 

Births in Algoma

 

The average age of Algoma womenii at birth of their first infant is 28.2 years old. This is similar to NE PHUs (27.9 years old), and significantly younger compared to Ontario (30.4 years old).

Between 2018 and 2022, an average of 870 babies were born each year in Algoma.

 

• Algoma has a declining birth rate from 9 live births per 1,000 residents (2017) to 7.1 births per 1,000 residents (2022)
• In 2022, there were 73 preterm live births in Algoma, with a preterm live birth rate of 8.6 per 100 live births. 4.2% of total births in Algoma are affected by a congenital anomaly, this is similar to the national average of 4% of births.
  
  

Feeding for a Healthy Start

 

New parents spend approximately 1800 hours feeding in the first year. This time can be one of the most rewarding experiences for a parent, as they build a strong attachment with their baby through focused feeding.

Breastmilk protects babies against illness, provides optimal nutrition, is cost-effective, and has lasting health benefits. Any amount of breastmilk provided offers protective antibodies and nutrients for your baby. Cue-based feeding is important, regardless of the method of feeding. Learning to recognize the baby’s signs of hunger and fullness, ensures the baby is getting just the right amount.

 

During 2021, 60.4% of Algoma infants are exclusively breastfed after birth. This is significantly higher than 52.8% of infants in Ontario overall.

 

Adverse Childhood Experiences and Toxic Stress

 

In 2022, a total of 790 screens were completed as part of the Healthy Babies Healthy Children program. An Adverse Childhood Experience (ACEs) are stressful or potentially traumatic events that occur within the first 18 years of life(14):

• Abuse
• Household dysfunction
• Neglect

The number of ACEs an individual has directly influences the likelihood and severity of negative outcomes. The following can be interpreted ACE-like indicators that negatively impact healthy child development in Algoma children.

 

Percentage of infants born into a family that has been involved with child protective services. A downward trend has been observed in Algoma from 2016-2018.

• Algoma: 13.6%
• Ontario: 3.6%
• Peer Group C: 8.7%

Percentage of infants born into a family with concerns about money. A downward trend has been observed in Algoma from 2016-2018.

 

• Algoma: 9.3%
• Ontario: 3.7%
• Peer Group C: 5.3%

 

Percentage of infants born into a family with a parent who has a mental illness. An upward trend has been observed in Algoma from 2016-2019.

 

• Algoma: 44.9%
• Ontario: 19.1%

 

Percentage of children and youth who have experienced separation or divorce of a parent.

 

• Algoma: 21.9%
• Ontario: 16.5%

 

Percentage of households with children and youth who reported experiencing food insecurity in the past 12-months.

 

• Algoma: 11.3%
• Ontario: 15.3%

If a child experiences many ACEs without a supportive relationship with an adult serving as a protective factor, the experiences of ACEs will trigger the toxic stress response.

The toxic stress response occurs when a child experiences frequent and/or prolonged adversity which can have a wear-and-tear effect on the body.

 

Positive Childhood Experiences (PCEs) are Protective Factors

 

Parents can reduce the impacts of ACEs by PCEs. A PCE can be found in the individual or community environments.

 

1. Healthy attachment
2. Breastfeeding
3. Parental resilience
4. Access to nutritious food
5. Positive parenting
6. Coping skills
7. Coping skills
8. Households where basic needs are met
9. Safe home environment

 

Healthy Attachment

 

A responsive relationship between a parent and child is important to a child’s development and well-being. Healthy brain development is built through safe, secure, nurturing relationships with a caring adult.

 

Participating in EarlyON activities can help promote healthy attachment with your child and buffer against adversity. A child's social-emotional development is the foundation to healthy attachment, which is built through responsive relationships with a caregiver/adult. Approximately 40% of children aged 0 to 5 living in the Algoma District attended an EarlyON site located in Algoma District at least once in 2023.

 

Percentage of 5 to 6 year old children that scored below the 10th percentile (in Algoma in 2018): 

 

• 9.9% in social competence
• 11.0% in emotional maturity

 

Safe Neighbourhoods

 

While 91.9% of parents in Algoma with children aged 1 to 17 years old reported that their neighborhood was very safe or reasonably safe for their children to play outside, 8.1% reported it being unsafe for their children.