Article

Maternal and Child Health Journal

, Volume 16, Issue 6, pp 1257-1265

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

  • Carlos Alberto FeldensAffiliated withDepartment of Pediatric Dentistry, Universidade Luterana do Brasil Email author 
  • , Márcia Regina VitoloAffiliated withCenter for Research in Nutrition (NUPEN), Universidade Federal de Ciências da Saúde de Porto Alegre
  • , Fernanda RauberAffiliated withCenter for Research in Nutrition (NUPEN), Universidade Federal de Ciências da Saúde de Porto Alegre
  • , Luciane Nascimento CruzAffiliated withHealth Technology Assessment Institute, Universidade Federal do Rio Grande do Sul
  • , Juliana Balbinot HilgertAffiliated withDepartment of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul

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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.

Keywords

Breast feeding Behavior Infant Depression