Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva: World Health Organization.

    Google Scholar 

  2. Brasil Ministerio da Saude. (2010). Dez passos para alimentação saudavel para crianças menores de dois anos, 2nd edn. Brasília (DF): Ministerio da Saude.

  3. Venancio, S. I., Escuder, M. L., Saldiva, S. R. D. M., & Giugliani, E. R. J. (2010). Breastfeeding practice in the 333 Brazilian capital cities and the Federal District: Current status and advances. Jornal de Pediatria, 86(4), 317–324.

    PubMed  Google Scholar 

  4. Evelein, A. M., Geerts, C. C., Visseren, F. L., Bots, M. L., Van der Ent, C. K., Grobbee, D. E., et al. (2001). The association between breastfeeding and the cardiovascular system in early childhood. American Journal of Clinical Nutrition, 93(4), 712–718.

    Article  Google Scholar 

  5. Plenge-Bönig, A., Soto-Ramírez, N., Karmaus, W., Petersen, G., Davis, S., & Forster, J. (2010). Breastfeeding protects against acute gastroenteritis due to rotavirus in infants. European Journal of Pediatrics, 169(12), 1471–1476.

    Article  PubMed  Google Scholar 

  6. Hetzner, N. M., Razza, R. A., Malone, L. M., & Brooks-Gunn, J. (2009). Associations among feeding behaviors during infancy and child illness at two years. Maternal and Child Health Journal, 13(6), 795–805.

    Article  PubMed  Google Scholar 

  7. Huffman, S. L., Zehner, E. R., & Victora, C. (2001). Can improvements in breast-feeding practices reduce neonatal mortality in developing countries? Midwifery, 17, 80–92.

    Article  PubMed  CAS  Google Scholar 

  8. Kramer, M. S., Aboud, F., Mironova, E., et al. (2008). Breastfeeding and child cognitive development. New evidence from a large randomized trial. Archives of General Psychiatry, 65(5), 578–584.

    Article  PubMed  Google Scholar 

  9. Renfrew, M. J., Dyson, L., McCormick, F., et al. (2009). Breastfeeding promotion for infants in neonatal units: A systematic review and economic analysis. Health Technology Assessment, 13(40), 1–146.

    PubMed  CAS  Google Scholar 

  10. Scott, J. A., Binns, C. W., Oddy, W. H., Graham, K. I., & Grad Dip Nutr Diet. (2006). Predictors of breastfeeding duration: Evidence from a cohort study. Pediatrics, 117, e646–e655.

    Article  PubMed  Google Scholar 

  11. Dennis, C. L., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736–e751.

    Article  PubMed  Google Scholar 

  12. Karabulut, E., Yalçın, S. S., Özdemir-Geyik, P., & Karaagaoglu, E. (2009). Effect of pacifier use on exclusive and any breastfeeding: A meta-analysis. Turkish Journal of Pediatrics, 51, 35–43.

    PubMed  Google Scholar 

  13. Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., & Lieu, T. A. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112, 108–115.

    Article  PubMed  Google Scholar 

  14. World Health Organization, & Department of Nutrition for Health and Development. (1998). Complementary feeding: Family foods for breastfed children. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  15. Brazil Ministry of Health. (2001). Breastfeeding prevalence in Brazilian capitals. Brasília Annual report of health statistics in Brazil. Brasília: Ministry of Health, Portuguese.

  16. Vitolo, M. R., Bortolini, G. A., Feldens, C. A., & Drachler, M. L. (2005). Impacts of the 10 steps to healthy feeding in infants: A randomized field trial. Cadernos de Saude Publica, 21, 1448–1457. Portuguese.

    Article  PubMed  Google Scholar 

  17. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    Article  PubMed  CAS  Google Scholar 

  18. Cunha, J. A. (2001). Manual da versão em português das Escalas Beck. São Paulo, SP: Casa do Psicólogo.

    Google Scholar 

  19. Vieira, G. O., Martins, C. C., Vieira, T. O., Oliveira, N. F., & Silva, L. R. (2010). Factors predicting early discontinuation of exclusive breastfeeding in the first month of life. Jornal de Pediatria, 86(5), 441–444.

    Article  PubMed  Google Scholar 

  20. Santos Neto, E. T., Oliveira, A. E., Zandonade, E., & Molina, M. C. B. (2008). Pacifier use as a risk factor for reduction in breastfeeding duration: A systematic review. Revista Brasileira de Saude Materno Infantil, 8(4), 377–389.

    Google Scholar 

  21. Howard, C. R., Howard, F. M., Lanphear, B., Eberly, S., Deblieck, E. A., Oakes, D., et al. (2003). Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics, 111, 511–518.

    Article  PubMed  Google Scholar 

  22. Silveira, F. J., & Lamounier, J. A. (2006). Factors associated with breastfeeding duration in three cities in the region of Alto Jequitinhonha, Minas Gerais, Brazil. Cadernos de Saude Publica, 22, 69–77.

    Article  PubMed  Google Scholar 

  23. Soares, M. E., Giugliani, E. R., Braun, M. L., Salgado, A. C., de Oliveira, A. P., & de Aguiar, P. R. (2003). Pacifier use and its relationship with early weaning in infants born at a Child-Friendly Hospital. Jornal de Pediatria, 79, 309–316.

    PubMed  Google Scholar 

  24. Nascimento, M. B. R., Reis, M. A., Franco, S. C., Issler, H., Ferraro, A. A., & Grisi, S. J. (2010). Exclusive Breastfeeding in Southern Brazil: Prevalence and Associated Factors. Breastfeeding Medicine, 5(2), 79–85.

    Article  PubMed  Google Scholar 

  25. França, M. C. T., Giugliani, E. R., Oliveira, L. D., Weigert, E. M., Santo, L. C., Köhler, C. V., et al. (2008). Bottle feeding during the first month of life: Determinants and effect on breastfeeding technique. Revista de Saude Publica, 42(4), 607–614. Portuguese.

    Article  PubMed  Google Scholar 

  26. Moimaz, S. A., Zina, L. G., Saliba, N. A., & Saliba, O. (2008). Association between breast-feeding practices and sucking habits: A cross-sectional study of children in their first year of life. Journal of Indian Society of Pedodontics and Preventive Dentistry, 26, 102–106.

    Article  PubMed  Google Scholar 

  27. Araújo de França, G. V., Brunken, G. S., da Silva, S. M., Escuder, M. M., & Venancio, S. I. (2007). Breast feeding determinants on the first year of life of children in a city of Midwestern Brazil. Revista de Saude Publica, 41, 711–718. Portuguese.

    Article  PubMed  Google Scholar 

  28. Binns, C. W., & Scott, J. A. (2002). Using pacifiers: What are breastfeeding mothers doing? Breastfeeding Review, 10(2), 21–25.

    PubMed  Google Scholar 

  29. Kramer, M. S., Barr, R. G., Dagenais, S., Yang, H., Jones, P., Ciofani, L., et al. (2001). Pacifier use, early weaning, and cry/fuss behavior: A randomized controlled trial. JAMA, 286, 322–326.

    Article  PubMed  CAS  Google Scholar 

  30. Bogen, D. L., Hanusa, B. H., Moses-Kolko, E., & Wisner, K. L. (2010). Are maternal depression or symptom severity associated with breastfeeding intention or outcomes? Journal of Clinical Psychiatry, 71(8), 1069–1078.

    Article  PubMed  Google Scholar 

  31. Wei, G., Greaver, L. B., Marson, S. M., Herndon, C. H., Rogers, J., Robeson Healthcare Corporation, et al. (2008). Postpartum depression: Racial differences and ethnic disparities in a tri-racial and bi-ethnic population. Maternal and Child Health Journal, 212(6), 699–707.

    Article  Google Scholar 

  32. Dennis, C. L., & McQueen, K. (2007). Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatrica, 96, 590–594.

    Article  PubMed  Google Scholar 

  33. Akman, I., Kuscu, M. K., Yurdakul, Z., et al. (2008). Breastfeeding duration and postpartum psychological adjustment: Role of maternal attachment styles. Journal of Paediatrics and Child Health, 44, 369–373.

    Article  PubMed  Google Scholar 

  34. Hasselmann, M. H., Werneck, G., & Silva, C. V. C. (2008). Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life. Cadernos de Saude Publica, 24(Suppl 2), S341–S352.

    Article  PubMed  Google Scholar 

  35. Galler, J. R., Harrison, R. H., Ramsey, F., Chawla, S., & Taylor, J. (2006). Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados. Infant Behaviour and Development, 29, 189–203.

    Article  Google Scholar 

  36. Falceto, O. G., Giugliani, E. R., & Fernandes, C. L. (2004). Influence of parental mental health on early termination of breast-feeding: A case-control study. Journal of the American Board of Family Practice, 17, 173–183.

    Article  PubMed  Google Scholar 

  37. Henderson, J. J., Evans, S. F., Straton, J. A., Priest, S. R., & Hagan, R. (2003). Impact of postnatal depression on breastfeeding duration. Birth, 30, 175–180.

    Article  PubMed  Google Scholar 

  38. Edhborg, M., Friberg, M., Lundh, W., & Widström, A. (2005). “Struggling with life”: Narratives from women with signs of postpartum depression. Scandinavian Journal of Public Health, 33(4), 261–267.

    Article  PubMed  Google Scholar 

  39. Dennis, C. L., Janssen, P. A., & Singer, J. (2004). Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatrica Scandinavica, 110(5), 338–346.

    Article  PubMed  Google Scholar 

  40. Flores-Quijano, M. E., Córdova, A., Contreras-Ramírez, V., Farias-Hernández, L., Cruz Tolentino, M., & Casanueva, E. (2008). Risk for postpartum depression, breastfeeding practices, and mammary gland permeability. Journal of Human Lactation, 24(1), 50–57.

    Article  PubMed  Google Scholar 

  41. Picciano, M. F. (2001). Nutrient composition of human milk. Pediatric Clinics of North America, 48(1), 53–67.

    Article  PubMed  CAS  Google Scholar 

  42. Sheehan, A., Schmied, V., & Barclay, L. (2009). Women’s experiences of infant feeding support in the first 6 weeks post-birth. Maternal and Child Nutrition, 5, 138–150.

    Article  PubMed  Google Scholar 

  43. Dewey, K. G., Nommsen-Rivers, L. A., & Heining, M. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation and excess neonatal weight loss. Pediatrics, 112, 607–619.

    Article  PubMed  Google Scholar 

  44. Bonuck, K. A., Huang, V., & Fletcher, J. (2010). Inappropriate bottle use: An early risk for overweight? Literature review and pilot data for a bottle-weaning trial. Maternal and Child Nutrition, 6, 38–52.

    Article  PubMed  Google Scholar 

  45. Dewey, K. G., Peerson, J. M., Brown, K. H., et al. (1995). Growth of breast-fed infants deviates from current reference data: A pooled analysis of US, Canadian and European data sets. Pediatrics, 96, 495–503.

    PubMed  CAS  Google Scholar 

  46. Nommsen-Rivers, L. A., Chantry, C. J., Cohen, R. J., & Dewey, K. G. (2010). Comfort with the idea of formula helps explain ethnic Disparity in Breastfeeding intentions among expectant first-time mothers. Breastfeeding Medicine, 5, 25–33.

    Article  PubMed  Google Scholar 

  47. Kavanagh, K. F., Cohen, R. J., Heinig, M. J., & Dewey, K. G. (2008). Educational intervention to modify bottle-feeding behaviors among formula-feeding mothers in the WIC Program: Impact on infant formula intake and weight gain. Journal of Nutrition Education and Behavior, 40, 244–250.

    Article  PubMed  Google Scholar 

  48. Lorant, V., Deliège, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003). Socioeconomic Inequalities in Depression: A Meta-Analysis. American Journal of Epidemiology, 157, 98–112.

    Article  PubMed  CAS  Google Scholar 

  49. Ritsher, J. E., Warner, V., Johnson, J. G., & Dohrenwend, B. P. (2011). Inter-generational longitudinal study of social class and depression: A test of social causation and social selection models. British Journal of Psychiatry, 40, s84–s90.

    Google Scholar 

  50. Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026–1032.

    PubMed  CAS  Google Scholar 

  51. Victora, C. G., Behague, D. P., Barros, F. C., Olinto, M. T., & Weiderpass, E. (1997). Pacifier use and short breastfeeding duration: Cause, consequence, or coincidence? Pediatrics, 99, 445–453.

    Article  PubMed  CAS  Google Scholar 

  52. Rothman, K. J., & Greenland, S. (1998). Modern Epidemiology (2nd ed.). Philadelphia: Lippincott Williams and Wilkins.

    Google Scholar 

Download references

Acknowledgments

This study was funded by the Brazil CNPq (National Funding for Research).

Author information

Authors and Affiliations

  1. Department of Pediatric Dentistry, Universidade Luterana do Brasil, Rua João Telles 185/1301, Porto Alegre, Canoas, Rio Grande do Sul, 90035-121, Brazil

    Carlos Alberto Feldens

  2. Center for Research in Nutrition (NUPEN), Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Márcia Regina Vitolo & Fernanda Rauber

  3. Health Technology Assessment Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Luciane Nascimento Cruz

  4. Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Juliana Balbinot Hilgert

Authors
  1. Carlos Alberto Feldens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Márcia Regina Vitolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fernanda Rauber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luciane Nascimento Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juliana Balbinot Hilgert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Alberto Feldens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feldens, C.A., Vitolo, M.R., Rauber, F. et al. Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis. Matern Child Health J 16, 1257–1265 (2012). https://doi.org/10.1007/s10995-011-0885-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-011-0885-7

Keywords

Search

Navigation