The World Health Organization recommends exclusive breastfeeding up to 6 months of age. We conducted a study to verify the impact of an effective set of breastfeeding promotion, protection and support strategies and procedures, conducted during prenatal and pediatric care, on the prevalence of exclusive breastfeeding in the first 6 months of life. The strategies evaluated included breastfeeding support groups and home visits, while the procedures included information on the importance of early initiation, breastfeeding on demand, hazards of bottle-feeding and pacifiers to babies; guidance on positioning, attachment, breast milk expression and family planning; and providing emotional support. This set of strategies and procedures was derived from a systematic review and led to a proposal of "Ten steps to successful breastfeeding in Primary Health Care (PHC)". Based on the Baby-Friendly Hospital Initiative, an evaluation method was developed and applied in the assessment of 24 PHC units located in the State of Rio de Janeiro. Thirteen units showed a fair performance, while eleven showed a poor performance. Among infants below 6 months of age, exclusive breastfeeding expectancy was 1.6 months in units with a fair performance, and 1.1 months in units with a poor performance. No significant social or demographic differences were observed between women attending both performance categories. This study led us to conclude that the implementation of a Primary Health Care Initiative to promote, protect and support breastfeeding would contribute to intensify the practice of exclusive breastfeeding among babies under 6 months of age.
Exclusive breastfeeding; Primary health care; Effectiveness; Impact evaluation
