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Journal of Human Lactation
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A Method for the Evaluation of Primary Health Care Units' Practice in the Promotion, Protection, and Support of Breastfeeding: Results from the State of Rio de Janeiro, Brazil

Maria Inês Couto de Oliveira, PhD

Rio de Janeiro State Health Office

Luiz Antonio Bastos Camacho, MD, DrPH

department at the Brazilian National School of Public Health, Fundação Oswaldo Cruz

Alison E. Tedstone, PhD

London School of Hygiene and Tropical Medicine

A method to assess the effectiveness of primary health care (PHC) units in enabling mothers to breastfeed was developed from the tool used for accreditation of baby-friendly hospitals. A 10-step scoring system assessed the extent to which procedures known to be effective at extending breastfeeding duration were applied within PHC units. Using this method, 13 PHC units showed a fair performance, whereas 11 performed poorly in the state of Rio de Janeiro. More babies younger than 6 months were being exclusively breastfed in fair performance than in poor performance units (38.6% vs 23.6%, respectively, P < .001). Twice as many pregnant women and mothers in fair performance units (61.9%) were satisfied with the support provided for breastfeeding than in poor performance units (31.4%). The differences were not explained by hospital care or working status of the women. The association found between structure, process, and outcomes support the validity of the method. J Hum Lact. 19(4):365-373.

Key Words: exclusive breastfeeding • evaluation method • effectiveness • personal satisfaction • primary health care

Journal of Human Lactation, Vol. 19, No. 4, 365-373 (2003)
DOI: 10.1177/0890334403258138
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