Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE To assess the determinants of exclusive breastfeeding abandonment. METHODS Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period. RESULTS The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care. CONCLUSIONS Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.

研究目的：评估纯母乳喂养（exclusive breastfeeding）终止的影响因素。研究方法：本研究为一项基于巴西东南部米纳斯吉拉斯州维索萨市出生队列的纵向研究。2011/2012年，对168名使用公共卫生服务体系的初产妇进行随访。分别于产后30天、60天及120天开展三次产妇访谈，分析产后第1、2、4个月的纯母乳喂养终止情况。采用爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale）在首次及第二次访谈中评估产妇抑郁症状，以得分≥12分作为判定界值。本研究调查了社会经济、人口统计学及产科相关变量，同时纳入妊娠与产后阶段的情绪状态及产妇社交网络相关因素。研究结果：产后30天、60天和120天时，纯母乳喂养终止的患病率分别为53.6%（n=90）、47.6%（n=80）及69.6%（n=117）；相较于第1个月，第4个月的纯母乳喂养终止发生率为48.7%。产后第2个月，抑郁症状与分娩创伤均与纯母乳喂养终止存在显著关联。产后第4个月，以下变量与纯母乳喂养终止显著相关：产妇受教育程度较低、无自有住房、重返职场、产后未获得母乳喂养指导、产妇对妊娠消息持负面反应，以及未获得配偶的婴儿照护协助。研究结论：社会心理与社会人口学因素是早期纯母乳喂养终止的强预测因子。因此，需尽早识别并为存在抑郁症状的哺乳母亲提供干预措施，以降低相关不良健康结局发生率，延长纯母乳喂养持续时间。卫生专业人员的支持，以及家庭与工作场所提供的支持，均可助力这一目标的实现。