Twelve years of the Baby-Friendly Hospital Initiative in Brazil

To evaluate implementation of the Baby-Friendly Hospital Initiative (BFHI) in Brazil from 1992 to 2004. This retrospective descriptive study of the BFHI in Brazil examined the number of Baby-Friendly Hospitals (BFH) accredited per year from 1992 to 2004, state and regional distribution of the hospitals, the number of municipalities with a BFH, and the number of births at the 294 BFH that were participating in Brazil's universal, public health care system (Serviço Unico de Saúde) in 2004. Data were obtained from the Ministry of Health's Hospital Information System, from state health departments, and from Ministry of Health's reports on breastfeeding. From 1992 to 2004, a total of 312 hospitals were BFH-accredited across 24 of Brazil's 26 states and the Federal District. Of these, one had lost accreditation and 10 had been deactivated by the end of the study period. The regional distribution of the 301 remaining BFH in 2004 was: 139 in the Northeast, 59 in the Southeast, 50 in the South, 37 in the Midwest, and 16 in the North. A sharp drop in the accreditation rate was recorded in certain years: 1997, 2003, and 2004. In 2004, 294 (6.8%) of the 4,347 public hospitals with maternity beds were BFH. Of the 3 346 municipalities that had public hospitals with maternity beds, 205 (6.1%) also had BFH. In 2004, there were 2,227,971 births in public hospitals, of which 565,990 (25.4%) occurred in BFH. The number of BFH in Brazil is relatively small when compared to the number of public hospitals with maternity beds. The decreased accreditation rate and the deactivation of accredited BFH, especially in the latter years of the study, indicate the need for measures that will bolster and grow the BFHI in Brazil.