Adequacy of Prenatal Care Utilization Index and Breastfeeding Practices in Romania

Background. The pregnancy age when prenatal care begins and the number of medical prenatal visits, expressed by Kotelchuck (Adequacy of Prenatal Care Utilization) Index, and breastfeeding practices are essential for mother and child health. Objective. Assessment of Kotelchuck Index and infants feeding practices in Romania between 1945 and 2009. Methods. A questionnaire regarding the prenatal care visits and the breastfeeding features was applied on a random selected sample of 471 Romanian women from urban and rural areas (Project 72/2008, financially supported by CNCSIS-UEFISCSU). Data were compared with those coming from previous similar studies. Results. About 51.2% of the subjects had inadequate Kotelchuck Index, 87.2% started breastfeeding more than one hour after the birth and 65.7% exclusively breastfed less than 4-6 months. In rural areas inadequate Kotelchuck Index and the practice of less than 4-6 months breastfeeding prevailed; three fourth of the women with bad ratings for these indicators came from rural areas (Chi-Square p<0.01). Kotelchuck Index assessment in three cohorts showed a decrease of the inadequate index proportion from 64.8% before 1975 to 25.5% after 1999 (p<0.01). Conclusion. The study shows the necessity to increase efforts for education and counseling of the Romanian women, especially in rural areas, in respect to start prenatal care visits in the first month of pregnancy, to attend at least ten prenatal care visits, to initiate the breastfeeding in the first hour of birth and to understand the benefits of exclusive breastfeeding for at least six months.