title: The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study.
abstract: BACKGROUND
  Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome).
  
  
  METHODS
  Data came from the "Birth in Brazil" survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI.
  
  
  RESULTS
  Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome.
  
  
  CONCLUSIONS
  The chance of being breastfed in the first hour after birth in Baby-Friendly hospitals was twice as high as at non-accredited hospitals, which shows the importance of this initiative for timely initiation of breastfeeding.
authors: Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 806 - Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil. marcialazaroc@gmail.com.
authors: Márcia Lazaro de
authors: ML
authors: Carvalho
authors: Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Av. Brasil, 4.365 - Pavilhão Haity Moussatché - Manguinhos, Rio de Janeiro, CEP: 21040-900, Brazil.
authors: Cristiano Siqueira
authors: CS
authors: Boccolini
authors: Departament of Epidemiology and Biostatistics. Institute of Public Health, Fluminense Federal University, Rua Marques de Paraná, n° 303, anexo, 3° andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900, Brazil.
authors: Maria Inês Couto de
authors: MI
authors: Oliveira
authors: Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 806 - Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil.
authors: Maria do Carmo
authors: MD
authors: Leal
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006293:Health Promotion; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D036801:Parturition; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D055815:Young Adult
keywords: Baby-Friendly Hospital Initiative; Breastfeeding; Cross-Sectional Studies; Maternal-Child Health Services; Maternity Hospitals; Postpartum Period