Abstract
BackgroundIdentifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.Research aimQuantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time.MethodsSecondary data analyses of two nationally representative cross-sectional surveys conducted in States’ capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis.ResultsFrom 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points’ exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points.ConclusionsAbout one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.
Highlights
Evidence of both short- and long-term benefits of breastfeeding on infant survival, health, and development, as well as on maternal health and human capital, are well documented [1, 2]
From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months
About one-third of the improvements in exclusive breastfeeding (EBF) prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use
Summary
Evidence of both short- and long-term benefits of breastfeeding on infant survival, health, and development, as well as on maternal health and human capital, are well documented [1, 2]. Over the last two decades, the prevalence of exclusive breastfeeding (EBF) in infants under 6 months increased worldwide, from 24.9% in 1993 to 35.7% in 2013 [1]. In an effort to further improve EBF prevalence, the 2012 World Health Assembly (WHA) endorsed breastfeeding as one of the key global nutrition targets to foster a healthy, equitable, and sustainable future for individuals and nations. This target calls for increasing the prevalence of EBF among infants up to six months of age to at least 50% by 2025. The proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.
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