Hospital practices and breastfeeding in Rio de Janeiro: data from the Nascer no Brasil II Survey.

OBJECTIVE: To investigate the association between hospital practices and breastfeeding and exclusive breastfeeding at two months of age, and the main reasons for pre-lacteal feeding. METHODS: This is an analysis of the state of Rio de Janeiro, 2021-2023, from Pesquisa Nascer no Brasil II, a hospital-based cohort. We collected data during hospitalization for delivery and at two months of age. Logistic regression was used to analyse factors associated with breastfeeding and exclusive breastfeeding. RESULTS: 959 mothers and babies were included and calibrated to represent 1,537 puerperal women at baseline. Around 60% of women breastfed at first hour of life, and almost 90% breastfed in the first 24 hours and practiced exclusive breastfeeding at hospital discharge. Around 95% of women were breastfeeding at two months, 61.4% exclusively. The chance of breastfeeding was significantly higher among women who had given birth in BFHI hospitals (OR = 2.35), had ≥ 12 years of schooling (OR = 1.96), had ≥ 3 previous births (OR = 4.35), intended to breastfeed for ≥ 1 year (OR = 1.58) and felt supported after discharge (OR = 6.91). While the chance of exclusive breastfeeding was higher among women with public funding for childbirth (OR = 1.33), with ≥ 16 years of schooling (OR = 2.27), who lived with a partner (OR = 1.33), and who intended to breastfeed for ≥ 1 year (OR = 1.49). Pre-lacteal feeding PLF at hospital discharge was negatively associated with breastfeeding (OR = 0.04) and exclusive breastfeeding (OR = 0.15), and was more frequent in the private sector (20.4%), among "early-term" (18.3%), and caesarean sections (15.6%). CONCLUSION: Breastfeeding promotion policies have been effective in almost universalizing breastfeeding at two months of age. However, in order to increase the prevalence of exclusive breastfeeding, it is necessary to expand and qualify support, management and information on exclusive breastfeeding, focus on vulnerable populations, reduce caesarean sections and improve hospital practices such as regulating the use of pre-lacteal feeding.