Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil.

Background: In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the "Ten Steps to Successful Breastfeeding", International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods: This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results: Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions: The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.

Contraceptive practices of Brazilian adolescents: social vulnerability in question / Práticas contraceptivas de adolescentes brasileiras: vulnerabilidade social em questão

This article seeks to analyze contraceptive practices of Brazilian adolescents and to discuss associated vulnerability situations. A cross-sectional study was conducted, using the database of the National Survey on Demography and Health of Women and Children _ PNDS 2006. Factors associated with the current use of contraceptive methods were investigated. The analysis included 986 sexually-active adolescents. Bivariate analysis between the outcome and each of the socioeconomic, demographic and reproductive characteristics of women was performed. The associations between variables were evaluated using multivariate logistic regression. Four factors related to outcome were identified in the multivariate analysis: having completed junior high school (aOR=2.29; CI 95% 1.07_4.85); being married or cohabiting with a partner (aOR=2.85; CI 95% 1.45_5.59); having used contraceptives during the first sexual intercourse (aOR=2.77; CI 95% 1.36_5.63); and having access to transportation to get to health center services (aOR=3.33; CI 95% 1.42_7.80). Adolescents with higher social vulnerability are at a disadvantage regarding adoption of contraceptive methods. This points to the need to establish intersectoral articulations of public policies, which could ensure their reproductive rights.

O objetivo deste estudo é analisar práticas contraceptivas de adolescentes brasileiras e discutir situações associadas de vulnerabilidade. Estudo transversal, utilizando banco de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS) 2006. Foram investigados fatores associados ao uso atual de métodos anticoncepcionais. A análise incluiu 986 adolescentes sexualmente ativas. Foi realizada análise bivariada entre desfecho e cada variável independente. Associações entre variáveis foram avaliadas pela regressão logística multivariada. O nível de significância foi de 0,05. Na análise multivariada identificamos quatro fatores associados ao desfecho: ter no mínimo o ensino fundamental completo (p = 0,03; ORajustado = 2,17; IC 95% 1,034,55); união estável (p < 0,01; ORajustado = 2,84; IC 95% 1,455,54); uso de método anticoncepcional na primeira relação sexual (p < 0,01; ORajustado = 2,72; IC 95% 1,375,42); e acesso a transporte para chegar ao serviço de saúde (p < 0,01; ORajustado = 2,90; IC 95% 1,326,36). Adolescentes com maior vulnerabilidade social utilizam menos métodos anticoncepcionais. Isto aponta para a necessidade de estabelecer articulações intersetoriais com políticas públicas que garantam os direitos reprodutivos de adolescentes.

Contraceptive practices of Brazilian adolescents: social vulnerability in question.

This article seeks to analyze contraceptive practices of Brazilian adolescents and to discuss associated vulnerability situations. A cross-sectional study was conducted, using the database of the National Survey on Demography and Health of Women and Children _ PNDS 2006. Factors associated with the current use of contraceptive methods were investigated. The analysis included 986 sexually-active adolescents. Bivariate analysis between the outcome and each of the socioeconomic, demographic and reproductive characteristics of women was performed. The associations between variables were evaluated using multivariate logistic regression. Four factors related to outcome were identified in the multivariate analysis: having completed junior high school (aOR=2.29; CI 95% 1.07_4.85); being married or cohabiting with a partner (aOR=2.85; CI 95% 1.45_5.59); having used contraceptives during the first sexual intercourse (aOR=2.77; CI 95% 1.36_5.63); and having access to transportation to get to health center services (aOR=3.33; CI 95% 1.42_7.80). Adolescents with higher social vulnerability are at a disadvantage regarding adoption of contraceptive methods. This points to the need to establish intersectoral articulations of public policies, which could ensure their reproductive rights.