Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis

Abstract

To identify risk factors for discontinuing breastfeeding during an infant's first year of life. A cohort study recruited mothers in a hospital in São Leopoldo, Brazil, which mainly serves the low-income population. In order to obtain socioeconomic, environmental, and behavioral information, face-to-face interviews with mothers were conducted after birth, and when their infants were 6 and 12 months old. The duration of breastfeeding was investigated at 6 and 12 months, and recorded separately for each month. Depressive symptoms were assessed using the Beck Depression Inventory. The multivariate model for predicting the discontinuation of breastfeeding, adjusted Kaplan-Meier survival curves and Cox regression were used. Of the 360 participants, 201 (55.8%) discontinued breastfeeding within the first 12 months. A multivariate Cox regression model revealed that symptoms of maternal depression (low levels: RR = 1.59, 95% CI 1.02-2.47; moderate to severe: RR = 2.03, 95% CI 1.35-3.01), bottle feeding (RR = 2.07, 95% CI 1.31-3.28) and pacifier use in the first month of life (RR = 3.12, 95% CI 2.13-4.57) were independently associated with the outcomes after adjusting for confounders. Breastfeeding cessation rates were lower for children who did not use bottle feeding or a pacifier in the first month of life and for the children whose mothers presented with minimal depression. Early pacifier use and bottle feeding must be strongly discouraged to support long-term breastfeeding. In addition, screening maternal depression at a primary care service can be a step forward in promoting a longer duration of breastfeeding.

Weaning and associated factors in children from low-income communities

“…Confirming previous studies 7,25 , the precocious introduction of the bottle was a risk factor for weaning in the population studied. Children who use the bottle are more prone to the interruption of breastfeeding and the introduction of new foods in the diet 25 .…”

“…At 6 months of age, the cumulative probability of breastfeeding was 54.9%, the approximate value of the prevalence found in a 2012 study conducted in the state of Rio Grande do Sul (56.4%) 7 . Contrasted to the results of the present study, a 2009 study performed in Curitiba with children from low-income families showed that 54.2% of children up to 2 years of age were still being breastfed 15 .…”

“…Items, such as bottles and pacifiers, are culturally accepted for weaning the child, replacing the maternal nipple 22 . The fact that precocious weaning and bottle use may increase the risk of obesity 7 , childhood diabetes 26 and dental caries 27 make the educational measures focused on this aspect highly important.…”

“…Its success depends on several variables and not only on the maternal desire to breastfeed. Cultural practices such as the introduction of other liquids, use of a pacifier and bottle may influence the reduction of the duration of the breastfeeding 7 . Factors related to the child such as low birth weight may also contribute to early weaning 8 .…”

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome

“…A negative correlation between the use of a dummy and successful breastfeeding was found in all 14 studies 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47 published between 1999 and 2012 (Table 3). …”