Evaluation of a Health Mediation Program in the Maternity Ward.

The first months of life are considered a critical period that has a lasting impact on a child's future health.

Breastfeeding is one of the fundamental factors contributing to healthy growth in children. Its benefits are well established in the literature in terms of preventing infections, reducing infant mortality, and supporting neurocognitive development.

As part of the Nutri Pou Ti'moun program, a study on breastfeeding practices was conducted in French Guiana in 2024 to assess the current state of affairs. Between March and October 2024, 382 mother-child pairs were included in this study. The results revealed that the majority of mothers had breastfed their children (91.6%) during the first year of life, but only 1 in 2 mothers had breastfed exclusively. Nearly 40% practiced mixed feeding upon discharge from the maternity ward. The study revealed that one in two women had received breastfeeding support from healthcare professionals at the maternity ward. This support tended to have a positive impact on the continuation of breastfeeding beyond 6 months. The use of formula milk supplements during the hospital stay, however, had a negative impact on the continuation of exclusive breastfeeding for at least 4 months.

A complementary qualitative study of 15 mothers in situations of multidimensional vulnerability revealed barriers to exclusive breastfeeding, such as the perception of a lack of milk, the newborn's perceived refusal to breastfeed, or a lack of support from family and friends.

These findings therefore encourage the investigators to support mothers in their choice to breastfeed from the moment they give birth, so that infant feeding practices align more closely with national and international recommendations and are as beneficial as possible for the child's health.

Furthermore, the sociodemographic characteristics of pregnant and breastfeeding women in French Guiana, as revealed by previous studies, highlight numerous vulnerabilities: one in three women experiences food insecurity during pregnancy; 12.5% of pregnancies occur before the age of 20 (compared to 1.3% in mainland France); 26% of pregnancies are not covered by PUMa, and 39% have a high multidimensional vulnerability index (compared to 5.3% in mainland France). Thus, the context of high vulnerability in perinatal care in French Guiana calls for the implementation of measures to combat social health inequalities. Health mediation is one such measure.

The investigators therefore propose the early integration of health mediation around childbirth in maternity wards.

The objective of this study is to compare the rate of exclusive breastfeeding at 1 month between women who received the intervention (exposed group) and those who did not (unexposed group).

The study hypothesis is that the health intervention will improve the rate of exclusive breastfeeding.

Inclusion criteria

• Women who gave birth at the French Guiana University Hospital Center

Exclusion criteria

• Women refusal to participate to the study or lack of opposition collected
• lack of authorization from legal representatives for underage women or from legal guardians for women under legal protection
• foetal death, stillbirth, or neonatal death
• feeding with formula from birth