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. Chile has implemented two policies aiming to promote and support EBF: twelve extra weeks of maternity leave (ML); and pay for performance (P4P) primary health care (PHC) goal for EBF at six months. Evidence shows that regardless of EBF promotion strategies, lack of healthcare access on account of geographic isolation might affect EBF. This study aims to examine possible differences between urban and rural, and between topographical zones locations, after the implementation of the extended ML, the PHC goal, and COVID-19 on EBF at three and six months in Chile.
Methods. Aggregated public health care national data was collected from January 2009 to November 2020. Unadjusted and adjusted models of interrupted time series analyses were performed by urban and rural areas and by 5 geographical zones, from Northern to Southern Chile, to quantify changes in EBF outcomes attributable to the extension of ML in 2011, implementation of P4P in 2015, and COVID-19 pandemic. Heterogeneity analyses were done to measure differences in EBF within rural and urban and geographic zones locations.
Results. Only the PHC goal reported an effect in EBF at three months by urban/rural areas, with an increase of 3,18 (CI 95%: 2,10-4,26) and 3,35 (CI 95%: 0,77- 5,89), respectively. Conversely, the PHC showed an increase in EBF at three months in all the macrozones, but with a larger increase in the Small North. The extended ML increased EBF at three months only in the Small North zone. For EBF at six months, the implementation of ML showed an increase only in rural areas of 4,61 (CI95%:0,84- 8,38) and only in the Central Zone. The implementation of the PHC reported an increase in EBF at six months in both, urban (10,65) and rural (9,49) areas and in all geographic zones. COVID-19 had a negative effect only in urban areas.
Discussion. Our results showed differences in EBF at three and six months by urban and rural areas, and by geographic zones, despite the implementation of national strategies to promote EBF.
Keywords: exclusive breastfeeding, interrupted time series, health policy, COVID-19, health inequalities, Chile.