Assessing Quality of Breastfeeding Support and Care in Two Public Hospitals in Yucatán, Mexico

Objectives: The objective of this study is to examine quality of breastfeeding support and care in 2 public hospital facilities in Yucatán, Mexico. Methods: Semi-structured interviews with healthcare providers were conducted in two public hospitals in Yucatán. The interview guide consisted of questions on provider characteristics, professional experience and training, breastfeeding knowledge and attitudes, and knowledge of hospital policies and procedures. Vignettes were used to understand provider counseling practices and potential cognitive biases. In-hospital observations of care provided within 1-2 hours after vaginal, uncomplicated delivery were conducted at one of the 2 hospitals, and infant feeding communication or counseling materials that were used within the hospitals were collected. In addition, postpartum women were surveyed before discharge from the hospitals to ask about their experiences within the hospitals and the breastfeeding support that they received after delivery. Results: A total of 32 healthcare providers (8 doctors, 14 nurses, 10 nutritionists) were interviewed. Based on preliminary analyses of provider interviews and 6 observations, women and their infants are separated for about 1 hour after delivery before breastfeeding is initiated. Upon reunion, women are not encouraged to practice skin-to-skin contact. However, nurses offer breastfeeding support at this time, with more support given to first-time mothers, and less support offered when nurses were changing shifts. Few infant feeding communication materials (n=15) were found, and their use in hospitals was limited. From the preliminary survey results (n=323), only 57.9% of women reported that they felt supported to breastfeed at the hospital and that they did not need any additional support. Conclusions: This study identified gaps and room for improvement in the quality of breastfeeding care and support in public hospitals in Yucatán to provide optimal breastfeeding support to mothers, including limited use of breastfeeding communication and counseling materials and a need for provider training. Funding Sources: The Initiative to Advance Implementation Science in Nutrition (a collaboration between the Johns Hopkins Bloomberg School of Public Health and Vitamin Angel Alliance).