摘要：Objectives. We examined trends in breastfeeding promotion investments, breastfeeding promotion activities, and breastfeeding duration in Latin America and the Caribbean from the 1980s to the 2000s. Methods. We obtained financial data from the United States Agency for International Development and the International Code Documentation Center, and we obtained breastfeeding promotion data from surveys of breastfeeding coordinators with ministries of health and with the International Baby Food Action Network. We obtained breastfeeding data from nationally representative surveys conducted between 1986 and 2008. Results. Investment in breastfeeding promotion declined in the 2000s relative to earlier years. For all countries, breastfeeding duration increased between the first and last survey. Of the 12 countries represented in the interval when investment in breastfeeding promotion was high, breastfeeding duration decreased in 1 country. Of the 12 countries represented in the interval when investment was low, breastfeeding duration decreased in 3 countries. Nonetheless, the average annual change in breastfeeding duration for the 2 intervals was positive and similar (0.16 months and 0.21 months). Conclusions. Breastfeeding promotion likely resulted in large improvements in breastfeeding. Investments in breastfeeding promotion have declined, but this does not appear to have adversely affected breastfeeding duration. Breastfeeding is one of the best values among investments in child survival, recognized for both the magnitude of its effect on mortality 1 , 2 and the effectiveness of interventions to promote it. 3 , 4 Early initiation of breastfeeding reduces neonatal mortality 5 , 6 (an increasingly important component of infant mortality 7 ) and has many other short- and long-term benefits for maternal and child health and child development. 8 , 9 Failure to promote breastfeeding, coupled with inadequate attention to the safety of replacement formulas, can have serious health consequences. 10 , 11 International concern about declining rates of breastfeeding in the 1970s 12 led national and international health authorities to make a concerted effort to promote breastfeeding. 13 Many breastfeeding interventions focused on improving health worker training and support for breastfeeding in hospitals because of the perception that these services were not providing skilled support for and environments conducive to breastfeeding. Few evaluations of the impact of these interventions are available, although in Latin America the duration of breastfeeding increased from the 1980s to the 1990s, coinciding with breastfeeding promotion efforts. 14 Disentangling the impact of national promotion programs is challenging because traditional epidemiological models do not lend themselves to the analysis of such a relationship. The extent to which public health interventions have the potential to improve behaviors measurable at the national level depends on coverage as well as quality. 15a Both are difficult to measure systematically, and neither has been documented in national programs. However, given the importance of breastfeeding for achieving the Millennium Development Goal related to child survival (goal 4), 15b a better understanding of the relationship between promotion of breastfeeding and changes in breastfeeding is important. We examined trends in breastfeeding promotion investments, trends in breastfeeding promotion activities, and changes in breastfeeding from the 1980s to the 2000s in 19 Latin American and Caribbean nations. We sought to answer 3 questions: (1) What is the evidence that policies and programs in support of breastfeeding were implemented? (2) How have investments in breastfeeding promotion changed over time? (3) How have exclusive breastfeeding and breastfeeding duration changed over the same period?
