It aims to access all 68.3 million living births certificates from Brazil, from 1994 to 2016, and compare them with breastfeeding policies in all Brazilian hospitals to assess the impact of the initiatives on infant health. The study also plans to estimate the number of avoidable deaths in this period, if those initiatives were adopted. The study also plans to estimate the number of avoidable deaths in this period, if those initiatives were adopted.
First, data from Brazilian birth and death certificate systems, hospital infrastructure, and breastfeeding technologies were combined into a single dataset. The study was then divided into three main analysis axes: trends in neonatal mortality, mapping and clustering of maternity hospitals, and the evolution and coverage of hospital policies and initiatives that support breastfeeding.
After this initial step, these axes were integrated for a more in-depth analysis to address the following questions: How is the coverage of hospital policies and initiatives that support breastfeeding related to neonatal mortality? Are breastfeeding-supportive technologies effectively implemented in regions and hospitals with high neonatal mortality rates? How are hospital maternity groups distributed across Brazil?
Finally, an algorithm was created to pair similar maternity hospitals based on their infrastructure and neonatal mortality rates. This was done to evaluate the impact of implementing hospital policies and initiatives that support breastfeeding on neonatal death rates.
Neonatal mortality in Brazil has been decreasing since 2001; however, around 2014, this decline stabilized, showing little change. Despite the overall improvement, significant regional inequalities persist. The North and Northeast regions experience the highest neonatal mortality rates, while the South and Southeast regions have the lowest rates during this period. A seasonal pattern in neonatal mortality has also been observed, with peaks occurring in December and January and troughs in June and July.
In Brazil, there are 425 maternity hospitals that have either the Baby-Friendly Hospital Initiative, Human Milk Bank, or both, with a higher concentration of these hospitals in the Northeast region. From 2008 to 2017, there has been a steady increase in the coverage of hospital policies and initiatives that support breastfeeding. By 2017, 32.5% of Brazilian births took place in hospitals that implemented these policies and initiatives.
In conclusion, the implementation of hospital policies and initiatives supporting breastfeeding has a more significant impact in regions with high neonatal mortality rates and in maternity hospitals where more than ten deaths occur per 1,000 births. Both breastfeeding initiatives have proven effective in reducing neonatal mortality in these high-mortality settings.
Optimal breastfeeding levels can prevent 13% of all preventable child deaths worldwide, saving over 800,000 lives annually, mainly by reducing infectious diseases and preventing chronic illnesses in adulthood. Despite national coverage, significant investments, and the potential impact of the Baby-Friendly Hospital Initiative, Human Milk Bank, and breastfeeding support on child health and breastfeeding promotion, there is no official mapping that consolidates data from these three programs and initiatives. Nor has the impact of having one, two, or all three in the same hospital been studied