title: A structured public health approach to increasing rates and duration of breastfeeding in Romania.
abstract: BACKGROUND
  Studies indicate that since 1990, rates of breastfeeding initiation and duration in Eastern Europe, including Romania, have decreased. Most breastfeeding promotion efforts in Romania have focused on in-hospital care, with an emphasis on training clinicians. Prior studies report that about 88% of Romanian mothers initiate breastfeeding in the hospital; however, these same studies report limited breastfeeding duration. We posit that an important problem is lack of support and education in the weeks and months following the birth. The nature of this problem suggests the need for an integrated and structured public health solution.
  
  
  METHODS
  Based on our independent research, the results of an international maternal and child health (MCH) conference, and consultation with Romanian and American experts, we propose use of the public health problem-solving paradigm to support breastfeeding in Romania.
  
  
  RESULTS
  This article presents a conceptual model showing the integration of input, output, and process components and a logic model explicating possible interventions (or needs) and barriers to breastfeeding. We propose a public health solution that begins with a new MCH within the public health training structure at a major Romanian university and a summer course bringing together Romanian and American students to study MCH, including breastfeeding.
  
  
  CONCLUSIONS
  We believe that these two courses will promote enthusiasm and generate ideas to develop community-based interventions as well as policy recommendations to increase breastfeeding duration in Romania. We suggest that this public health problem-solving approach provides an integrated way of maintaining and increasing breastfeeding; furthermore, this approach could be broadly used in Eastern Europe.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa,200 Hawkins Drive, Iowa City, IA 52242, USA. anne-wallis@uiowa.edu
authors.forename: Anne Baber
authors.initials: AB
authors.lastname: Wallis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Brînzaniuc
authors.forename: Florin
authors.initials: F
authors.lastname: Oprescu
authors.forename: Răzvan M
authors.initials: RM
authors.lastname: Cherecheş
authors.forename: Marta
authors.initials: M
authors.lastname: Mureşan
authors.forename: Claibourne I
authors.initials: CI
authors.lastname: Dungy
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008427:Maternal Health Services / Q000458:organization & administration*; D009035:Mothers / Q000193:education*; D009313:National Health Programs / Q000458:organization & administration; D011247:Pregnancy; D011634:Public Health; D012383:Romania / Q000453:epidemiology; D013334:Students