Influence of the support offered to breastfeeding by maternity hospitals

Passanha, Adriana; Benício, Maria Helena D'Aquino; Venâncio, Sônia Isoyama; Reis, Márcia Cristina Guerreiro dos

doi:10.1590/S0034-8910.2015049005354

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Sumário

Public Health Practice • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005354 copy

Influence of the support offered to breastfeeding by maternity hospitals

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding.

METHODS

This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance.

RESULTS

Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables.

CONCLUSIONS

We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals.

Breast Feeding; Hospitals, Maternity; Maternal-Child Health Services; Baby-Friendly Hospital Initiative

Variable	n	EB (%)	PR	95%CI	p	PB (%)	PR	95%CI	p
Age group of child					< 0.001 ^a				0.093 ^a
< 1 month	123	62.2	1			8.5	1
1 \|– 2 months	135	45.5	0.73	0.58;0.92		14.4	1.70	0.78;3.68
2 \|– 3 months	152	38.1	0.61	0.48;0.79		17.7	2.08	0.99;4.34
3 \|– 4 months	185	28.7	0.46	0.35;0.60		25.6	3.01	1.51;5.99
4 \|– 5 months	161	23.6	0.38	0.28;0.52		12.6	1.49	0.67;3.29
5 \|– 6 months	160	11.5	0.18	0.12;0.29		16.2	1.91	0.85;4.30
Sex					0.358				0.108
Male	474	31.8	1			14.0	1
Female	442	34.7	1.09	0.91;1.31		18.6	1.33	0.94;1.39
Birth weight					0.158				0.326
< 2,500 g	78	26.0	1			11.9	1
≥ 2,500 g	817	34.1	1.32	0.90;1.95		16.8	1.40	0.71;2.76
Type of delivery					0.992
Cesarean	540	33.2	1			12.2	1		0.001
Vaginal	376	33.2	1.00	0.91;1.10		22.5	1.84	1.31;2.61
Maternal age group
< 20 years	103	22.6	1		0.044 ^a	34.8	1		0.002 ^a
20 \|– 35 years	188	37.3	1.65	1.14;2.40		14.6	0.42	0.28;0.62
≥ 35 years	105	35.3	1.57	1.00;2.44		13.3	0.38	0.20;0.72
Maternal parity					0.001				0.701
Primiparous	415	29.6	1			17.3	1
Multiparous	398	40.9	1.38	1.14;1.68		16.2	0.93	0.65;1.34
Employment status					< 0.001 ^a				0.536^a
Working outside the home	163	23.5	1			15.5	1
Not working outside the home	415	35.5	1.52	1.12;2.06		18.9	1.22	0.74;2.01
On maternity leave	234	42.5	1.81	1.32;2.49		13.4	0.90	0.51;1.59
Education					0.106 ^a				0.001 ^a
≤ 8 years of study	189	32.0	1			25.4	1
9 \|– 12 years of study	444	34.5	1.08	0.84;1.38		16.6	0.65	0.44;0.96
≥ 12 years of study	181	40.2	1.26	0.95;1.66		9.7	0.38	0.21;0.68

Variable	n	EB (%)	PR	95%CI	p	PB (%)	PR	95%CI	p
Steps (tertiles)					0.822^a				< 0.001 ^a
1 to 4	371	32.3	1			10.1	1
5 to 8	315	34.5	1.07	0.86;1.32		18.8	1.87	1.19;2.92
10	230	32.9	1.02	0.80;1.29		23.5	2.32	1.49;3.65
Step 1^b					0.621				0.011
No	563	32.6	1			13.4	1
Yes	353	34.2	1.05	0.87;1.27		20.9	1.56	1.11;2.20
Step 3^c					0.527				0.165
No	140	36.0	1			15.8	1
Yes	405	33.1	0.92	0.70;1.20		22.6	1.43	0.86;2.35
Step 5					0.657				0.016
No	546	32.7	1			13.4	1
Yes	370	34.1	1.04	0.86;1.26		20.5	1.53	1.08;2.16
Step 6^d					0.388				–
No	14	21.4	1			0.0	–
Yes	902	33.4	1.56	0.57;4.27		16.5	–
Step 7					0.113				0.971
No	38	44.4	1			16.0	1
Yes	878	32.8	0.74	0.51;1.08		16.3	1.02	0.41;2.54
Step 9					0.639				< 0.001
No	371	32.3	1			10.1	1
Yes	545	33.8	1.05	0.87;1.27		20.8	2.06	1.38;3.09
Step 10					0.936				< 0.001
No	511	33.3	1			11.6	1
Yes	405	33.1	0.99	0.82;1.20		22.6	1.95	1.37;2.77

	EB				PB

Variable	Model 1^a		Model 2^b		Model 1^a		Model 2^b		Model 3^c

	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI
Steps (tertiles)	p = 0.424		p = 0.101		p = 0.001		p = 0.012		p = 0.057
1 to 4	1		1		1		1		1
5 to 8	1.18	0.96;1.45	1.30	1.05;1.61	1.61	1.01;2.58	1.38	0.82;2.32	1.27	0.72;2.25
10	1.07	0.85;1.35	1.20	0.94;1.54	2.21	1.39;3.50	1.88	1.12;3.15	1.71	0.94;3.11
Step 1^d
No	1		1		1		1		1
Yes	1.05	0.87;1.26	1.10	0.91;1.34	1.49	1.05;2.11	1.30	0.89;1.90	1.19	0.80;1.79
Step 3^e
No	1		1		1		1		1
Yes	0.97	0.76;1.25	1.00	0.77;1.30	1.53	0.89;2.63	1.51	0.88;2.59	1.49	0.87;2.55
Step 5
No	1		1		1		1		1
Yes	1.04	0.87;1.25	1.09	0.91;1.32	1.47	1.03;2.09	1.30	0.89;1.88	1.20	0.80;1.78
Step 6^f
No	1		1		–		–		–
Yes	1.20	0.52;2.75	1.26	0.55;2.88	–		–		–
Step 7
No	1		1		1		1		1
Yes	0.77	0.53;1.11	0.80	0.56;1.16	0.82	0.32;2.07	0.68	0.27;1.70	0.66	0.26;1.66
Step 9
No	1		1		1		1		1
Yes	1.14	0.94;1.36	1.26	1.04;1.54	1.87	1.23;2.85	1.59	0.99;2.54	1.43	0.84;2.45
Step 10
No	1		1		1		1		1
Yes	1.08	0.90;1.29	1.18	0.96;1.44	1.89	1.29;2.76	1.65	1.11;2.47	1.55	1.01;2.39

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence
: Adriana Passanha Departamento de Nutrição – FSP/USP Av. Dr. Arnaldo, 715 01246-904 São Paulo, SP, Brasil E-mail: adriana.passanha@gmail.com