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In the draft budget for 2015 tabled by the City of Ottawa, one seemingly small but critical program is at risk: Healthy Babies Healthy Children. Launched by the province of Ontario and run by the Ottawa Board of Health, it is program on the proverbial chopping block that is worthy of national attention.
The early years – from birth to age six – are critical in a child’s development. Healthy Babies Healthy Children helps to support pre-natal and post-natal care for all citizens in the city. Three avenues of programs and services provide this support.
First, to help parents learn about pregnancy, preterm labour, breastfeeding, and caring for an infant, free online and in person prental classes are offered in English and French in various locations across the City throughout the year. In addition, public health officials facilitate ‘pregnancy circles’ that are offered in English, French, and Chinese, for expectant parents who may need extra support.
Second, after a baby is born in Ottawa, a public health nurse calls to check in on the health of the newborn. Asking fundamental questions, these simple phone calls connect parents to the outside world at a time of vulnerability and uncertainty. It lets families know that they are not alone and that there is someone out there that they can call if need be.
Third, drop-in centres are open on a rotating basis every day of the week all across the city. Facilitated by public health nurses, nutritionists and lactation consultants, the centres provide a safe and warm environment for parents with young infants to visit. Here, babies are weighed, ‘tummy-times’ are had, and communities are built. Moms having problems with breastfeeding can learn new tricks to make it easier for them, parents worried about the development of their babies can have questions answered, nurses are given face-to-face opportunities to explain the benefits of vaccines (all the more important given the recent measles outbreak), and everyone gets to share their stories about the joys and challenges they are facing with young infants at home.
Individual benefits for babies from such programs are clear. While nothing really prepares you for bringing a baby home, prental classes nevertheless give parents good information to increase infant well-being. Regular weekly weigh-ins that is charted provides early warning signs if something is wrong. Or, weekly weigh-ins may calm nervous young parents keeping them out of doctors’ offices. Even as early as three months, contact with other babies furthers cognitive and emotional development. Such individual benefits for the babies should be enough to convince any government to keep these programs running.
Benefits, however, are not restricted to the individual babies. Collective benefits for families and the community writ large are invaluable.
Post-partum depression, for example, is a major illness that can affect moms, dads, and parents who adopt [1]. Caring for an infant is often extremely isolating, amplifying the symptoms of post-partum depression. Having a safe space to visit and regularly meet with other people can help parents see if they are experiencing the symptoms of post-partum depression and seek the help that they need.
Ottawa, like many cities across Canada, is also filled with families that have just moved who don’t have access to an extended network of aunts, uncles, and grandparents that they can rely on. The drop-in centres held under the Healthy Babies Healthy Children program help build communities. From clothing exchanges to informal parental baby-sitting networks, these centres provide a hub for new residents helping them to integrate into the place that they are now calling home.
That, in a nutshell, is the Healthy Babies Healthy Children program and some of the key benefits that it offers. What, then, is the problem?
In her report submitted to the City, Medical Officer of Health, Dr. Isra Levy draws attention to the fact that Ottawa Public Health faces ‘significant long-term funding shortfalls’ caused by inflation and insufficient support from the Government of Ontario due to caps on provincially funded programs [2]. A funding gap has thus appeared.
To fill the gap, Ottawa Public Health is planning to restrict access to the three avenues of service for clients with ‘identified risk factors’. In other words, a program that was once open and available for all families in the city will now be limited to only those who meet defined criteria.
If the City does this, a universal program will be transformed into what policy wonks call a means-tested service. A poor strategy for two reasons.
First, restricting the program to ‘at-risk’ clients will increase the administrative costs of the programs. Staff members will now need to spend time determining whether or not a person should actually access the service, rather than simply working with everyone who comes through the proverbial door.
Second, universal programs help build solidarity and foster shared understanding. Such programs also have a greater number of people concerned that are ready and willing to fight for them should they be threatened with cuts or cancellation. When services are means tested, such advocates disappear and, overtime, the benefits are at a bigger risk of withering or vanishing altogether.
Contrast this proposal with a long-standing practice in Finland. There, for more than 75 years, expectant mothers are given a box by the state. With clothes, sheets and toys it gives all Finnish children, regardless of their background, the same start in life. And, according to researchers like Mika Gissler, professor at the National Institute for Health and Welfare in Helsinki, the boxes have played a major role in improving family health overall in the country [3].
So what should happen? To start, the Province of Ontario should index the funds to ensure the costs of the programs it launched are sufficiently covered. Ironically, Ontario is subjecting municipalities across the province to the same critique often lobbed at the federal government: the province started a ‘boutique program’ while leaving the other level of government holding the financial bag. The City of Ottawa could be a bellwether for other municipalities across the province, and the entire initiative may be on route to its demise.
Even more importantly, particularly given Canada’s egregious and stubborn rates of child poverty, provinces and territories from coast to coast should offer similar programs and improve on the Ontario model [4]. An integrated yet diversified network of such programs dedicated to young children should be established and made available and accessible for all families regardless of where they live in the country. Healthy babies and healthy children should be a benefit enjoyed by all who live in Canada.
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Jennifer Wallner is an Assistant Professor at the University of Ottawa’s School of Political Studies. She can be contacted at jennifer.wallner[at]uottawa.ca
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