OBJECTIVES: to evaluate the implantation of the baby-friendly hospital initiative in Rio de Janeiro. METHODS: an evaluative study was carried out in 2009 at seven baby-friendly hospitals (BFHs) and eight non-accredited hospitals (NAHs) forming part of the Brazilian National Health System. Evaluation of the structure (Steps 1 and 2) was carried out by way of observation and interviews with 215 staff members. Evaluation of the process (steps 3 to 10) involved interviews with a representative sample of 461 pregnant women, 687 mothers on the wards and 148 mothers with a newborn in a neonatal unit. The degree of implantation was assessed in terms of the fulfillment of each step and the parameters covered by it. The correlation between the degree of implantation and outcomes was analyzed using linear regression: breastfeeding (BF) in the first hour of life, exclusive breastfeeding (EBF) and the satisfaction of the women with the care provided. RESULTS: the degree of implantation varied from 9 to 5 steps (90.6% to 70.1% of parameters) completed at the BFHs and 5 to 1 steps (76.1% to 43.9% of parameters) at the NAHs. A significant linear correlation was found between the degree of implantation, expressed in terms of steps and parameters, respectively and BF in the first hour of life (r=0.78 and r=0.74), EBF (r=0.72 and r=0.69), and satisfaction (r=0.69 and r=0.73). CONCLUSIONS: both forms of evaluation were shown to be consistent with the results. The BFHs performed better than the NAHs and there is therefore a need for investment in the sustainability of this initiative.
Breast feeding; Hospital; Program evaluation; Quality of health care; Newborn; Unified Health System
