Introduction (5000)

3. Problem description

In Spain and in Valencia, most mothers initiate breastfeeding but many abandons occur early (Jiménez-Navarro, 2016). Public insurance allows all Spanish residents to receive healthcare without direct payment. Universal healthcare coverage is offered by the autonomic communities’ health services through administrative units that are called Health Departments (HD). Each HD serves a subsector of the population, is governed by a board of directors and has an allocated annual budget. Healthcare services are offered at one or more hospitals and several outpatient specialty policlinics and primary care health centers (PCHC). Most Spanish mothers initiate breastfeeding but many abandon early {AM:2016wy} (Jiménez-Navarro A.M., & Comité de Lactancia de la Asociación Española de Pediatría, 2017). Breastfeeding clinical care and support fall within the role of different professionals in both primary and specialized care. However, breastfeeding training is not specifically required and lactation specialists are not officially recognized.  Both prenatally and after discharge from the maternity ward, the care of mother-infant dyads is on the PCHC team:  family medicine doctors, pediatricians, midwives and nurses. Antenatal education is included in the midwives’ portfolio{IHAN:2018wj}. A few neonatal units offer individual breastfeeding clinical care for their clients.  There are more than 200 independent breastfeeding-mothers support-groups (BMSG) in the country and rising demand for breastfeeding care services pointing to a gap in care in our national public healthcare system.  Several privately owned breastfeeding clinics have opened in the last years, all around the country but fees-for-service exclude many families from this care.