# Hospital practices and breastfeeding in Rio de Janeiro: data from the Nascer no Brasil II Survey

## TL;DR

This study examines how hospital practices in Rio de Janeiro affect breastfeeding and exclusive breastfeeding rates at two months of age.

## Contribution

The study identifies key factors and hospital practices associated with breastfeeding success and pre-lacteal feeding in a Brazilian cohort.

## Key findings

- Breastfeeding at two months was nearly universal (95%), but exclusive breastfeeding was only 61.4%.
- Women who gave birth in BFHI hospitals were more likely to breastfeed, and pre-lacteal feeding was negatively associated with breastfeeding.
- Public funding and higher education levels were linked to higher rates of exclusive breastfeeding.

## Abstract

To investigate the association between hospital practices and breastfeeding and exclusive breastfeeding at two months of age, and the main reasons for pre-lacteal feeding.

This is an analysis of the state of Rio de Janeiro, 2021–2023, from Pesquisa Nascer no Brasil II, a hospital-based cohort. We collected data during hospitalization for delivery and at two months of age. Logistic regression was used to analyse factors associated with breastfeeding and exclusive breastfeeding.

959 mothers and babies were included and calibrated to represent 1,537 puerperal women at baseline. Around 60% of women breastfed at first hour of life, and almost 90% breastfed in the first 24 hours and practiced exclusive breastfeeding at hospital discharge. Around 95% of women were breastfeeding at two months, 61.4% exclusively. The chance of breastfeeding was significantly higher among women who had given birth in BFHI hospitals (OR = 2.35), had ≥ 12 years of schooling (OR = 1.96), had ≥ 3 previous births (OR = 4.35), intended to breastfeed for ≥ 1 year (OR = 1.58) and felt supported after discharge (OR = 6.91). While the chance of exclusive breastfeeding was higher among women with public funding for childbirth (OR = 1.33), with ≥ 16 years of schooling (OR = 2.27), who lived with a partner (OR = 1.33), and who intended to breastfeed for ≥ 1 year (OR = 1.49). Pre-lacteal feeding PLF at hospital discharge was negatively associated with breastfeeding (OR = 0.04) and exclusive breastfeeding (OR = 0.15), and was more frequent in the private sector (20.4%), among "early-term" (18.3%), and caesarean sections (15.6%).

Breastfeeding promotion policies have been effective in almost universalizing breastfeeding at two months of age. However, in order to increase the prevalence of exclusive breastfeeding, it is necessary to expand and qualify support, management and information on exclusive breastfeeding, focus on vulnerable populations, reduce caesarean sections and improve hospital practices such as regulating the use of pre-lacteal feeding.

Investigar a associação entre as práticas hospitalares e o aleitamento materno e o aleitamento materno exclusivo aos 2 meses de idade e os principais motivos para a alimentação pré-láctea.

Coorte de base hospitalar, um recorte da Pesquisa Nascer no Brasil II no estado do Rio de Janeiro, 2021–2023. Coletamos dados durante a internação para o parto e aos 2 meses de idade. Para a análise dos fatores associados ao aleitamento materno e ao aleitamento materno exclusivo, utilizamos regressão logística.

Foram incluídos 959 mães e bebês, calibrados para representar 1.537 puérperas do baseline. Cerca de 60% das mulheres amamentaram na primeira hora de vida, e quase 90% amamentaram nas primeiras 24 horas e praticavam aleitamento materno exclusivo na alta hospitalar. Cerca de 95% das mulheres amamentavam aos 2 meses, sendo 61,4% exclusivamente. A chance de aleitamento materno foi significativamente maior entre mulheres com parto em hospitais Iniciativa Hospital Amigo da Criança (odds ratio — OR = 2,35), com ≥ 12 anos de estudo (OR = 1,96), com ≥ três partos anteriores (OR = 4,35), que tinham a intenção de amamentar ≥ um ano (OR = 1,58) e se sentiram apoiadas após a alta (OR = 6,91), enquanto a chance de aleitamento materno exclusivo foi maior nas mulheres com financiamento público do parto (OR = 1,33), com ≥ 16 anos de estudo (OR = 2,27), que viviam com companheiro(a) (OR = 1,33) e que tinham a intenção de amamentar ≥ 1 ano (OR = 1,49). A alimentação pré-láctea na alta hospitalar se mostrou negativamente associada ao aleitamento materno (OR = 0,04) e ao aleitamento materno exclusivo (OR = 0,15), sendo mais frequente no setor privado (20,4%), entre termo precoce (18,3%), e nas cesarianas (15,6%).

A política de promoção do aleitamento materno tem sido eficaz na quase universalização do aleitamento materno aos 2 meses de idade, entretanto para aumentar a prevalência do aleitamento materno exclusivo é necessário ampliar e qualificar o apoio, o manejo e as informações sobre o aleitamento materno exclusivo, focar nas populações vulneráveis, reduzir cesarianas e aprimorar práticas hospitalares como a regulação do uso de alimentação pré-láctea.