Breastfeeding by objectives.
BACKGROUND
In many countries, the rates of breastfeeding fall far short of those recommended. National plans to promote breastfeeding are badly needed. We describe the results of a breastfeeding promotion programme planned by objectives and financial penalties in a small region of Italy.


METHODS
This observational study was conducted in all the maternity hospitals and immunisation clinics of the six local health authorities of Friuli Venezia Giulia, in the northeast of Italy. The regional health authority included breastfeeding in its annual plans for 1998 and 1999, and asked local health authorities to develop local workplans and targets. A financial penalty was contemplated for local health authorities not achieving objectives and targets. The rates of exclusive, predominant and complementary breastfeeding were measured at birth and at 16-19 weeks of age. Data were collected, using standard definitions and methods, at discharge from hospitals and at the time of the second mandatory immunisation.


RESULTS
All local health authorities and hospitals set up a breastfeeding reporting system in 1998 and defined breastfeeding promotion activities for 1999. The rate of exclusive breastfeeding at discharge and at 16-19 weeks increased significantly between 1998 and 1999, with a corresponding reduction of complementary breastfeeding.


CONCLUSIONS
Financial penalties may contribute to the promotion of exclusive breastfeeding.
Cattaneo
A
A
Unit for Health Services Research and International Cooperation, Istituto per l'Infanzia, Via dell'lstria 65/1, 34137 Trieste, Italy. cattaneo@burlo.trieste.it
Borgnolo
G
G
Simon
G
G
D001723:Birth Rate; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D019538:Health Care Surveys; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006779:Hospitals, Public / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D012040:Regional Health Planning; D012052:Reimbursement, Incentive