Evaluation of the effectiveness and equity of the maternity protection reform in Chile from 2000 to 2015

The impact of health policies and the COVID-19 pandemic on exclusive breastfeeding in Chile during 2009-2020

In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by  - 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.

Sleep problems are related to commuting accidents rather than to workplace accidents

Background

This study aimed to verify the relationships between sleep problems and both commuting and workplace accidents in workers of both sexes.

Methods

The study was carried out with a sample of workers (n = 2993; 50.2% female) from the Chilean Quality of Life Survey (ENCAVI) 2015–2016, while the rates of both workplace and commuting accidents were extracted from the statistics of the Superintendence of Social Security (SUSESO 2015; 180,036 and 52,629 lost-time accidents, respectively).

Results

Chilean workers sleep less than the rest of the people in the country (M_W = 7.14 vs. M_O = 7.33; t (6789) = − 5.19; p < .001), while the Chilean people as a whole sleep less compared to those of other countries (7.24 h per day). Likewise, it was found that sleep problems are more strongly related to commuting than to workplace accidents. In this vein, sleep quantity can explain 24% of the variance in commuting accidents’ rates (Stepwise Method; R² = .30, F (1.14) = 5.49, p < .05; β = −.55, p < .05), by using aggregated data with all types of commuting roles (driver of a vehicle, a passenger of public or private transport, or as a pedestrian).

Conclusions

Our findings show that sleep quantity has a more robust relationship with commuting than workplace accidents, a neglected issue so far. Future prevention programs should emphasize sleep hygiene and focus on commuting to and from work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10737-5.