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Abstract
BackgroundLittle is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age.MethodsIn this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children’s homes, monthly during the first 6 months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2 years of age. Median duration of breastfeeding was estimated using Kaplan-Meier’s survival analysis, and the associations were tested using Cox’s hierarchical multivariate model. Significance was set at 5%.ResultsData from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10–1.56), primiparity (HRa: 1.21; 95%CI: 1.05–1.40), working outside the home (HRa: 1.52; 95%CI: 1.30–1.77), child sex male (HRa: 1.18; 95%CI: 1.03–1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98–4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71–0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52–0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47–0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48–0.70).ConclusionsThe findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO.
Highlights
Little is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years
It was observed that the participants who composed the losses had characteristics common to those who completed the study, at the level of 5%, except for the variables: family income, parity, mother working outside the home when breastfeeding was interrupted, use of a pacifier at the time of breastfeeding interruption and pattern of breastfeeding at 4 months
Family income below two minimum wages, motherinfant bed-sharing, on-demand breastfeeding in the first month after birth and exclusive breastfeeding at 4 months of life were protective factors for breastfeeding maintenance until 2 years or more
Summary
Little is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. In the Croatian study [14], which recruited women from only one maternity hospital, those with low education level, who had not attended a prenatal course and who had not been instructed on how often to feed their children had a higher risk of abandoning breastfeeding before of 2 years. In the study that included mothers of all ages [12], the following factors were negatively associated with maintenance of breastfeeding for 2 years or more: cohabiting with the infant’s father, mother working outside home in the first semester after childbirth, child using a pacifier and earlier introduction of water, tea, and complementary feeding to the infant’s diet. The results of these five studies showed that factors associated with breastfeeding maintenance for 2 years or more differed greatly across the studies, pointing to the need for continued investigation to improve our understanding of this phenomenon
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