https://doi.org/10.37527/2021.71.S1
1Programa Doctorado en Salud Pública, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile, 2Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
Background. It has been established that exclusive breastfeeding (EBF) is a primary source of nutrition and proper development for children, as well as providing health benefits to mothers. Previous studies have shown how Maternity leave (ML) can successfully promoted EBF; yet this has not been evaluated in the context of Chile. Pay for performance (P4P) in primary health care (PHC) have been shown to have an impact on various health outcomes. However, there is no available evidence about their possible effects on EBF. Furthermore, the COVID-19 pandemic has been a burden to the whole population, particularly women, which could affect EBF. Aims. This study aims to examine the impact of the extended ML policy, the PHC goal, and the COVID-19 pandemic on EBF at three- and six-months trend.
Methods. Monthly national public services EBF data, per municipality, were collected from January 2009 to November 2020. We performed unadjusted and adjusted (adjusted by seasonality, months and years, access to ML) models of interrupted time series analyses to quantify the changes in EBF attributable to the two policies (ML in 2011 and PHC goal in 2015) and to the COVID-19 pandemic.
Results. EBF prevalence at six months changed from 49,2% to 51,5% after the implementation of the extended ML, from 50,5% to 63,1% after the PHC and from 62,9% to 64,8% after the first wave of COVID-19. Adjusted analyses showed that only the PHC goal had an impact on EBF at three months, with an increase of 3,63 (95% CI:2,62- 4,64). Extended ML reported an increase of 1,89 (95% CI:0,49-3,29) in EBF at six months. The PHC goal was associated with 10,43 (95% CI: 9,29-11,57) rise in EBF at six months. No impact in EBF at six months was observed during COVID-19 pandemic.
Discussion. Our study showed that P4P policies targeting EBF at six months was a successful strategy to increase EBF at six months, even more effective that ML. The COVID-19 pandemic reported no impact in EBF trend.
Keywords: exclusive breastfeeding; interrupted time series; health policy; COVID-19, maternity leave; P4P; Chile.