Although breastmilk is uniformly accepted as the most complete and effective nourishment to ensure the baby's health and with clear benefits to the mother, it can be seen that the breastfeeding rate is still far from satisfactory. This study aims to identify evidence in the scientific literature about the determinants of breastfeeding interruption within six months of the baby's life. A systematic review was carried out by searching in PUBMED, The Cochrane Library, Scielo data base and Google Academic for studies published between January 2010 and October 2015, based on previously defined inclusion criteria and the selected studies were subsequently evaluated. Two reviewers assessed the quality of the studies to be included, using the grid for critical evaluation. After quality evaluation, four articles were included in the study corpus between 87.5% and 95.0% quality levels. Meta-synthesis and analysis of the articles identified that the factors that lead to the breastfeeding interruption at six months of the baby's life are: concerns about lactation, baby weight loss, mother's disease or her need for taking medication, blocked ducts, problems related to psychosocial management, lifestyle conflicts, inadequate positioning for latching-on, poor or weak milk complaint, breastfeeding pain, nipple cracks, breast engorgement, maternal anxiety and crying baby. Given the scientific evidence, the causes of breastfeeding interruption are multifactorial and are associated with mother's, baby's and health problems. The promotion of breastfeeding requires evidence-based education programs, to improve breastfeeding prevalence rates up at least into the six months of the baby's life.
Keywords: Breastfeedinginterruption at six months
In the last few decades, the evidence of advantages of breastfeeding for health and the recommendations for its practice has intensified. The World Health Organization (WHO) highlights the main advantage the reduction of infant morbidity and mortality and health benefits that extend into adulthood. Breastfeeding is considered one of the fundamental pillars for the promotion and protection of children's health (Sarafana, Abecasis, Tavares, Soares & Gomes 2006), promotes the overall development of the baby and it is a unique moment of affection and exchange between mother and baby.
Although the mother, and the community itself, benefit from breastfeeding, there are still high rates of early abandonment.
The decision to breastfeed is personal and is affected by numerous factors: hospital practices; medical problems that occur before and during pregnancy; complications during childbirth; support structures for breastfeeding; family support, among others.
Even though they are informed of the importance of breastfeeding, many women give up breastfeeding because they are faced with difficulties, especially in the first postpartum days, or are unsuccessful in their maintenance due to specific breastfeeding problems, namely: incorrect handling, pain, discomfort, among others (Cremonese et al., 2011).
Maintaining breastfeeding for the period recommended by the WHO requires knowledge of signs indicating the early terminus. According to Aguiar & Silva (2011), the identified risk factors for abandonment are: the biological conditions of the mother, especially her state of health; the presence of pain or diseases; the social representations about breastfeeding; the woman's own satisfaction with life; social support, specifically the support of health and family services (Greiner, 2014).
Although breastmilk is uniformly accepted as the most complete and effective nourishment to ensure the baby's health and the clear benefits to the mother, it can be seen that the breastfeeding rate is still far from the intended requirements.
What are the determinants of breastfeeding interruption within six months of the baby's life?
Purpose of the Study
The purpose of this study is to identify evidence in the scientific literature about breastfeeding interruption determinants within six months of the baby's life
A systematic review was carried out by searching in PUBMED, The Cochrane Library, Scielo data base and Google Academic for studies published between January 2010 and October 2015, based on previously defined inclusion criteria and selected studies were subsequently evaluated. Two reviewers assessed the quality of the studies to be included, using the established framework for critical evaluation. After a rigorous evaluation, four articles were included in the study corpus. The inclusion criteria included experimental studies, quasi-experimental systematic reviews with and without meta-analysis in the field of breastfeeding in the first 6 months of life.
The findings are presented in Tables
Based on the selected articles, it was verified that, several factors influence the early abandonment of breastfeeding. Sociocultural, professional, educational level and health promotion actions carried out by committed and motivated health professionals stood out as important variables. The articles highlight a high rate of abandonment of breastfeeding, with a significant number of women continuing to breastfeed at six months of the baby's life. The knowledge of this prevalence and possible causes for the abandonment of breastfeeding could be a starting point for the implementation of measures aimed at a better and more effective promotion of breastfeeding for the recommended time.
In Portugal, more than 90% of mothers breastfeed in the first days of the baby's life, but almost half of the mothers abandon breastfeeding in the first month of life of the newborn (Levy & Bértolo, 2012).
Barge & Carvalho (2011), Oakley et al. (2014) and Odom et al. (2015) found that women, where the prevalence of early abandonment before the 6 months of the baby's life was more evident, were predominantly single, multiparous, with less literacy and low socioeconomic level.
The prevalence of breastfeeding has fluctuated over the years, being influenced by several factors. From the articles that constitute the corpus of the sample, it was inferred that the difficulties that lead to the interruption of breastfeeding at 6 months of the baby's life are: concerns about lactation, weight loss of the baby, illness of the mother or need to take medication, blockage of the breast ducts, problems related to psychosocial management, conflicts in their lifestyle, inadequate positioning and handling, milk complaint (insufficient or weak), pain on breastfeeding, fissures, breast engorgement, maternal anxiety and crying of the child.
It was also concluded that mothers with lower ages, especially adolescent mothers, tended to breastfeed for less time, due to the lack of support, lower level of education and greater insecurity. It has been found that in many cases the insufficient approach to breastfeeding in prenatal consultations also underlies a higher propensity for early cessation of breastfeeding. In addition to the adequate training in the prenatal period, it is necessary to include in the preparation for the discharge of the puerperium an informative instrument that facilitates breastfeeding and that, in some way, responds to her doubts and helps her to overcome possible difficulties in breastfeeding (Nelas, Ferreira & Duarte, 2008).
It should be noted that the success of breastfeeding depends more on the mother's desire to breastfeed her child than on any other factor. However, she must be motivated and prepared to do so.
The information / training where women can assimilate the benefits of breastfeeding by helping them to overcome the crises and difficulties that may arise during the process is a significant determinant and of great importance at the beginning and duration of breastfeeding.
This work is financed by national funds through FCT - Fundação para a Ciência e Tecnologia, I.P., under the project UID/Multi/04016/2016. Furthermore we would like to thank the Instituto Politécnico de Viseu, CI&DETS and (UICISA:E) for their support.
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19 November 2018
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Duarte, J., Ferreira, M., Sousa, A., & Aparicio, G. (2018). Determinants Of Breastfeeding Interruption At Six Months Of The Babys Life. In Z. Bekirogullari, M. Y. Minas, R. X. Thambusamy, & C. Albuquerque (Eds.), Health and Health Psychology - icH&Hpsy 2018, vol 48. European Proceedings of Social and Behavioural Sciences (pp. 121-126). Future Academy. https://doi.org/10.15405/epsbs.2018.11.13