Socio-economic inequalities in the effect of public policies and the COVID-19 pandemic on exclusive breastfeeding in Chile.

OBJECTIVE: To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN: Interrupted time-series analyses (ITSAs). METHODS: Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS: The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION: The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.

Right to food and COVID-19: A qualitative study of key actors' perceptions in Chile

The COVID-19 pandemic and the sanitary measures to control it have affected people's diets, which is likely to lead to high rates of malnutrition in all its forms. The objective of this study was to describe the perceptions of a group of key actors on the assurance of the right to food in the context of a pandemic. This was a qualitative study conducted in Chile. The interviewees were selected by convenience with a transdisciplinary approach. We conducted 26 semi-structured interviews online, during September and October 2020. Data analysis was carried out using an inductive approach and a thematic analysis. We organized information using Atlas.ti 9.0 software. From the participants' narratives, we obtained 4 themes: 1. Food security in times of pandemic, 2. Appreciation of government food strategies, 3. Community response to the pandemic and 4. Other perspectives for facing the pandemic. We concluded that access to food is the dimension of the right to food most affected during the pandemic. State strategies are recognized as maintaining the population's nutrition;however, these are perceived as insufficient. On the other hand, the relevance of community organization stands out. It is necessary to monitor the actions taken to guarantee the right to food in the country and learn about the experience of other Latin American and Caribbean countries to prepare for future crises.