Breastfeeding: what changed after a decade?

analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%.

Results:

an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions.

Conclusions:

advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.

Descriptors:
Breast Feeding; Child Health; Primary Care Nursing; Primary Health Care; Epidemiologic Factors; Epidemiology; Cross-Sectional Studies

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Áurea Tamami Minagawa Toryiama Universidade de São Paulo. Escola de Enfermagem Rua Dr. Enéas de Carvalho Aguiar, 419 Bairro: Cerqueira César CEP: 05403-000, São Paulo, SP, Brasil E-mail: aureatmt@usp.br

Characteristics		2013 (%)	Percent difference between 2013 and 2001, and p-value
Characteristics		2013 (%)	(%)	p*
Family ^†
	Family income per capita: ≥1.8 minimum wages	95.7	+13.3	<0.001
	Father’s level of education: ≥3 years of study	80.5	+3.5	0.157
Maternal
	Age: >20 years	82.1	-2.6	0.707
	Marital status: with partner	81.5	-5.5	0.316
	Level of education: ≥3 years of study	67.2	-22.4	<0.001
	Working: yes	61.9	+33.5	<0.001
Children
	Sex: male	57.6	+3.6	0.392
	Birth weight: ≥2500grams	89.1	-3.2	0.418
	Birth order:			0.210
	1 ^st child	45.0	+7.1
	2 ^nd child	29.5	-5.4
	3 ^rd child or more	25.5	-1.7
	Pacifier use: yes	45.0	-8.2	0.052
Actions to Promote breastfeeding ^‡
	Counseling on breastfeeding ^‡ in prenatal and childbirth periods: yes	70.2	+20.0	<0.001
	Breastfeeding ^‡ in the first hour of birth: yes ^§	22.2	-	-
	Exclusive breastfeeding ^‡ in the maternity unit: yes ^§	24.2
	Follow-up in childcare: yes	74.8	-	-
	Counseling on breastfeeding ^‡ during childcare appointments: yes ^§	23.2	-	-

Age group (month)		Prevalence in 2013 (%)	(CI 95%)	Percent differences in prevalence of breastfeeding (2013-2001), and p-value
Age group (month)		Prevalence in 2013 (%)	(CI 95%)	%	p*
Exclusive breastfeeding ^†
	<4	58.6	(48.3-69.0)	+40.8	0.003
	<6	46.1	(37.5-54.7)	+33.4	<0.001
Breastfeeding ^‡
	<4	88.5	(81.8-95.2)	+10.7	0.103
	<6	82.0	(75.4-88.7)	+10.2	0.094
	6-9	68.4	(56.3-80.5)	+53.5	<0.001
	12-15	42.9	(27.9-57.8)	+27.7	0.090
	20-24	27.0	(12.7-41.3)	-4.6	0.665
	0-24	61.9	(56.3-67.4)	+20.9	<0.001

Characteristics			Median duration of breastfeeding (in months)	p-value*	Difference in breastfeeding duration (2013-2001) (in months)
Family ^†
	Family income per capita (minimum wage)			0.457
		<1.8	8		1.2
		>1.8	10		1.2
	Father’s level of education (years of study)			0.292
		<3	17		-7
		>3	13		5.4
Maternal characteristics
	Age (years)			0.093
		<20	7		-3.8
		>20	13		5.5
	Marital status			0.004
		with partner	7		2.5
		without partner	13		5.0
	Level of education (years of study)			0.171
		<3	12		-0.6
		>3	12		4.5
	Working			0.474
		No	13		5.1
		Yes	11		4.9
Children’s characteristics
	Sex:			0.847
		Male	13		6.1
		Female	10		2.2
	Birth weight (grams)			0.764
		<2500	12		4.7
		≥2500	13		5.4
	Birth order			0.058
		1 ^st child	9		2.9
		2 ^nd child	11		2.7
		3 ^rd child or more	17		6.8
	Pacifier use			<0.001
		No	7		2.4
		Yes ^‡	-		-
Actions to Promote breastfeeding
	Counseling on breastfeeding in prenatal and childbirth periods			0.400
		No	11		3.2
		Yes	12		4.7
	Breastfeeding within the first hour of birth ^§			0.098
		No	8		-
		Yes	12		-
	Exclusive breastfeeding in the maternity unit ^§			0.069
		No	11		-
		Yes	12		-
	Follow-up in childcare ^§			0.854
		No	12		-
		Yes	13		-
	Counseling on breastfeeding during childcare appointments ^§			0.656
		No	10		-
		Yes	13		-

Variables*		Model 1 ^†			Model 2 ^†
Variables*		HR ^‡	(CI 95%)	p value ^§	HR ^‡	(VI 95%)	p value ^§
Pacifier use
	No	1			1
	Yes	4.886	(3.08-7.74)	<0.001	5.604	(3.38-9.30)	<0.001
Birth order
	1 ^st child	1.652	(1.02-2.68)	0.042	1.737	(1.01-2.98)	0.044
	2 ^nd child	1.129	(0.65-1.97)	0.667	1.182	(0.65-2.16)	0.587
	3 ^rd child or more	1			1
Counseling on breastfeeding in prenatal and childbirth periods
	No				1
	Yes				1.134	(0.75-1.72)	0.554
Breastfeeding within the first hour of birth ^\|\|
	No				1
	Yes				1.070	(0.65-1.76)	0.788
Exclusive breastfeeding in the maternity unit ^\|\|
	No				1
	Yes				0.963	(0.58-1.60)	0.885
Follow-up in childcare ^\|\|
	No				1
	Yes				0.941	(0.45-1.95)	0.870
Counseling on breastfeeding during childcare appointments ^\|\|
	No				1
	Yes				1.231	(0.74-2.05)	0.425

Brasil

Brasil

Breastfeeding: what changed after a decade?1 1 Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process #2011/509309.

ABSTRACT

Objective:

Method:

Results:

Conclusions:

Breastfeeding: what changed after a decade?¹ 1 Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process #2011/509309.