Determinants of the exclusive breastfeeding abandonment: psychosocial factors

Machado, Mariana Campos Martins; Assis, Karine Franklin; Oliveira, Fabiana de Cássia Carvalho; Ribeiro, Andréia Queiroz; Araújo, Raquel Maria Amaral; Cury, Alexandre Faisal; Priore, Silvia Eloiza; Franceschini, Sylvia do Carmo Castro

doi:10.1590/S0034-8910.2014048005340

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Sumário

Public Health Practice • Rev. Saúde Pública 48 (6) • Dec 2014 • https://doi.org/10.1590/S0034-8910.2014048005340 copy

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To assess the determinants of exclusive breastfeeding abandonment.

METHODS

Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period.

RESULTS

The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care.

CONCLUSIONS

Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.

Breastfeeding; Weaning; Bottle Feeding; Depression, Postpartum; Risk Factors; Socioeconomic Factors; Cross-Sectional Studies

Variable	n	%	2 months				4 months

			Prevalence (%)	PR	95%CI	p^a	Prevalence (%)	PR	95%CI	p^a
Age (years)
≥ 20	34	79.8	47.3	1		0.478	67.16	1		0.165
13 \|- 20	134	20.2	52.9	1.14	0.79;1.65		79.41	1.18	0.95;1.45
Income			Continuous variable	0.99	0.99;1	0.837	Continuous variable	0.99	0.99;1	0.146
Education (years)
≥ 12	28	16.7	32.1	1		0.199	39.3	1		0.000
9 to 11	75	44.6	50.7	1.57	0.87;2.82		72.0	1.83	1.13;2.97
0 to 8	52	31.0	50.8	1.57	0.87;2.85		80.0	2.03	1.26;3.28
Homeownership
Yes	100	59.5	47.0	1		0.846	65.0	1		0.112
No	68	40.5	48.5	1.03	0.74;1.42		76.5	1.17	0.96;1.43
Number of persons in household
2 to 4	116	69.1	42.2	1		0.037	65.52	1		0.082
≥ 5	52	30.9	59.6	1.41	1.03;1.92		78.85	1.20	0.99;1.46
Returned to study or work after 4 months
No	–	–	–	–	–	–	64.3	1		0.013
Yes	–	–	–	–	–		85.5	1.32	1.09;1.59
Smoking
No	159	94.6	46.5	1		0.240	68.55	1		0.197
Yes	9	5.4	66.7	1.43	0.87;2.34		88.89	1.29	1;1.67
Alcoholic beverages
No	154	91.7	45.7	1		0.456	68.83	1		0.448
Yes	14	8.3	57.1	1.22	0.75;1.98		78.57	1.14	0.85;1.53

Variable	n	%	2 months				4 months

			Prevalence (%)	PR	95%CI	p^a	Prevalence (%)	PR	95%CI	p^a
Prematurity
No	169	95.2	47.5	1		0.890	69.4	1		0.736
Yes	8	4.8	50.0	1.05	0.51;2.14		75.0	1.08	0.71;1.63
Birth weight (g)
≥ 3,000	119	70.8	47.0	1		0.821	67.2	1		0.289
< 3,000	49	29.2	48.9	1.04	0.73;1.46		75.5	1.12	0.91;1.37
Delivery type
Normal	57	34.1	49.1	1			78.9	1		0.055
Caesarean section	110	65.9	46.4	0.94	0.67;1.31	0.735	64.5	0.81	0.67;0.99
Traumatic delivery
No	115	76.7	43.5	1		0.021	66.1	1		0.058
Yes	35	23.3	65.7	1.51	1.09;2.07		82.9	1.25	1.02;1.53
Parity
Multiparous	65	38.7	43.0	1		0.349	76.9	1		0.103
Primiparous	103	61.3	50.5	1.17	0.83;1.64		65.0	0.84	0.69;1.02
Received guidance on breastfeeding in prenatal care
Yes	78	46.7	51.3	1		0.413	73.1	1		0.342
No	89	53.3	44.9	0.87	0.63;1.20		66.3	0.90	0.74;1.10
Received guidance on breastfeeding in the postpartum period
Yes	120	71.4	43.3	1		0.079	65.0	1		0.039
No	48	28.6	58.3	1.34	0.98;1.34		81.2	1.25	1.03;1.51

Variable	n	%	2 months				4 months

			Prevalence (%)	PR	95%CI	p^a	Prevalence (%)	PR	95%CI	p^a
Planned Pregnancy
Yes	76	45.2	38.1	1		0.026	61.8	1		0.046
No	92	54.8	55.4	1.45	1.03;2.04		76.1	1.23	0.99;1.51
Partner’s reaction to the news of the pregnancy
Pleased	143	85.1	46.1	1		0.363	76.1	1		0.091
Others	25	14.9	50.0	1	0.82;1.22		84.0	1.25	1.01;1.53
Mother’s reaction to the news of the pregnancy
Pleased	135	80.4	45.1	1		0.201	65.9	1		0.034
Others	33	19.6	57.6	1.09	0.94;1.27		84.8	1.28	1.06;1.55
Partner’s support in pregnancy
Significant/±	157	93.5	43.5	1		0.271^b	68.1	1		0.113^b
Little/None	11	6.5	63.6	1.36	0.84;2.20		90.9	1.33	1.07;1.65
Partner’s help in infant care
Yes	48	28.6	45.7	1		0.800	58.3	1		0.044
No	120	71.4	48.1	1.05	0.70;1.57		74.2	1.27	0.97;1.65
Emotional support from relatives or friends
Yes	161	96.4	47.8	1		0.917 ^b	70.2	1		0.856^b
No	6	3.6	50.0	1.04	0.46;2.37		66.7	0.94	0.53;1.69
PPD Symptoms
No	141	83.9	42.5	1		0.003	66.7	1		0.055
Yes	27	16.1	74.1	1.74	1.29;2.33		85.2	1.27	1.04;1.55

Variable Time in months after delivery	PR_adjusted	95%CI	p^a
2 months
PPD Symptoms
No	1		0.002
Yes	1.61	1.19;2.19
Traumatic delivery
No	1		0.035
Yes	1.40	1.02;2.91
4 months
Education (years)
≥ 12	1
9 to 11	2.01	1.28;3.17	0.002
0 to 8	2.15	1.36;3.38	0.001
Home ownership
Yes	1
No	1.23	1.02;1.48	0.025
Returned to work or study at four months
No	1
Yes	1.33	1.09;1.63	0.004
Received guidance on breastfeeding in the postpartum period
Yes	1
No	1.21	1.01;1.45	0.038
Mother’s reaction to the news of the pregnancy
Pleased	1
Others	1.29	1.09;1.52	0.002
Partner’s help with infant care
Yes	1
No	1.33	1.04;1.70	0.023

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
: Mariana Campos Martins Machado. Departamento de Nutrição e Saúde. Campus Universitário. 36570-000 Viçosa, MG, Brasil. E-mail: maricamposm@yahoo.com.br