Breastfeeding in Brazil / Aleitamento materno no Brasil

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Introduction: Until the age of six months, the feeding of an infant should be restricted to maternal breast milk. Although the proportion of women unable to breast feed their babies for biological reasons is no greater than 10%, the frequency of breastfeeding is usually rather low. In Brazil, since 1981 a combination of measures, specific actions and legal mechanisms have guided, organized and regulated the activities of health service providers and of other economic agents to promote breastfeeding. As a consequence, studies into the prevalence and trends amongst different population groups in relation to breastfeeding and its different forms have intensified, as have investigations into non-biological factors related to breastfeeding. Various ages are used to estimate breastfeeding prevalence. The lack of uniformity limits the possibility of making direct comparisons between the results of different studies and of time series analyses. A set of basic indicators for breastfeeding and exclusive breastfeeding was established in Brazil in 2002, by experts from the Interagency Network for Health Information (Ripsa). On the international front, specialists from the World Health Organization (WHO) announced another indicator of exclusive breastfeeding in 2003. The WHO proposes the classification of prevalence into four levels: poor (0% to 11%), fair (12% to 49%), good (50% to 89%) and very good (90% or more) Objectives. Four objectives were defined: 1. adapt the information about breastfeeding in Brazil to the indicators established by Ripsa; 2. equally adapt the information about exclusive breastfeeding in Brazil to the WHO-proposed indicator; 3. verify the trend of breastfeeding practice in Brazil in the final quarter of the 20th century; and 4. analyze the association between mothers working out of the home and exclusive breastfeeding. Methods. Four studies were carried out to achieve the established objectives. All of them were based on new analyses of the database from the first specific national survey into breastfeeding executed on National Infant Vaccination Day; the 16th of October 1999, in the urban regions of the Brazilian state capitals and the Federal District (Brasília), coordinated by the author of this thesis. The information is presented in the standard fashion of scientific articles with the title, summary, abstract, introduction, method, results, discussion and references. The prevalence of breastfeeding and exclusive breastfeeding were obtained for the ages of 30, 120 and 180 days, as set forth by Ripsa, and for exclusive breastfeeding for the age range of 0 to 180 days, as suggested by WHO specialists. Breastfeeding trends were researched by comparison against three population surveys carried out in 1974-1975, 1989 and 1999. The results of the first two surveys, 1974-1975 and 1989, were taken from a study that analyzed the evolution of breastfeeding during the corresponding period. The measurement of risk used for the study of the association between working mothers (yes or no) and exclusive breastfeeding (yes or no) was the odds ratio (OR). The ORs were calculated for each region of the country according to the number of years for which the mother attended school (0, 1 to 8, 9 to 11 and 12 or more). The prevalence levels were estimated by simple regression, logit and probit models, and the ORs by multivariate logistic regression. All the statistics were calculated as point and interval estimates (95% confidence interval), with the use of the statistics program SAS, version 8.2. Results. Breastfeeding prevalence in Brazil for 30, 120 and 180 days old respectively was: 87.3% (86.8 87.7), 77.5% (77.1 78.0) and 68.6% (68.2 69.1); and, for exclusive breastfeeding at the same ages: 47.5% (46.4 48.5), 17.7% (17.2 18.3) and 7.7% (7.2 8.2). In the Brazilian state capitals, the frequency of exclusive breastfeeding at 30 days ranged from 73.4% (Fortaleza) to 25.2% (Cuiabá). At 180 days old, the levels range from 16.9% in Belém to 2.8% in Cuiabá. In the first six months of the infants life, there was a moderate reduction in breastfeeding prevalence and an acute drop in exclusive breastfeeding. Significant differences in exclusive breastfeeding frequency were observed between the capital cities surveyed. In the age group established by the WHO, from 0 to 179 days, the estimated prevalence for the country was 26.6%. For the cities studied, the rates varied from 12.5% to 43.7%. These numbers classify the prevalence of exclusive breastfeeding in Brazil as fair. The trend of increased breastfeeding verified in Brazil in the 1970s and 80s continued in the 1990s. The increase in breastfeeding frequency corresponded to 40% in the group of one month-old infants, to 150% at four months, 200% at six months, and to 240% at twelve months. In the study of variable association, all the ORs were greater than one. There is a trend showing an increased OR with more years of schooling completed by the mother, although only in the northeast and southeast regions were these increases statistically significant. In these regions, non-working mothers and those with better schooling have more chance of performing exclusive breastfeeding compared to working mothers and those with 0 years of study. Conclusion. According to the Ripsa and WHO indicators, exclusive breastfeeding prevalence in Brazil is low, although there has been a growing trend for breastfeeding over the last decades. The inequality between the chance of exclusive breastfeeding by working mothers and those with less schooling compared to those who do not work out of the home and have more years of schooling should be taken into account in action to promote this feeding practice.

ASSUNTO(S)

epidemiology ciencias da saude breastfeeding brazil amamentação - brasil cross-sectional studies working mothers

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