Marina Ferreira Rea

A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration

In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account.

Benefícios da amamentação para a saúde da mulher e da criança: um ensaio sobre as evidências

This paper provides a literature review on breastfeeding, selecting studies that have helped explain its benefits for maternal and child health. A search for articles published since 2000 was conducted, including relevant studies for the advancement of knowledge in previous decades. An Internet search of the PubMed and SciELO databases was performed to select the studies. Besides the aspects on which there is widespread agreement, controversial results were also included, as well as intriguing ones from the field of neurobiology. Public policy recommendations have undergone substantial changes following those new discoveries. Some studies have also been conducted to search for the most cost-effective measures to promote breastfeeding practices. This paper highlights: current recommendations on child feeding; the importance of breastfeeding for early childhood; the implications of breastfeeding for health of both the infant and mother; and the effectiveness of key interventions to encourage breastfeeding.

Possibilidades e limitações da amamentação entre mulheres trabalhadoras formais

INTRODUCAO: Pesquisas sobre a amamentacao e a questao do trabalho da mulher sao de dificil comparabilidade. A pratica de amamentar entre mulheres com um emprego formal no Brasil tem sido pouco estudada, em que pesem as mudancas havidas como a extensao da licenca maternidade para 120 dias. Decidiu-se realizar estudo com o objetivo de descrever o padrao de amamentacao de mulheres empregadas em empresas, as limitacoes que elas enfrentam e que fatores contribuem para que elas possam conciliar trabalho e amamentacao. MATERIAL E METODO: Estudo exploratorio realizado em 13 industrias de Sao Paulo em 1994, onde todas as mulheres no terceiro trimestre da gestacao (76) foram entrevistadas e reentrevistadas (69) na volta ao trabalho (em torno de 5,4 meses pos-parto). RESULTADOS: Iniciaram a amamentacao 97% das mulheres, apresentando uma duracao mediana de 150 dias; quanto ao Aleitamento Materno Exclusivo, a duracao mediana foi de 10 dias, e a Amamentacao Predominante, a mediana foi de 70 dias. As mulheres de melhor nivel socioeconomico e as que tinham creche no local de trabalho ou sala de coleta e estocagem de leite materno, foram as que amamentaram por mais tempo. A possibilidade de flexibilizar seu horario e nao trabalhar na linha de producao tambem mostraram ser fatores significantes que levam as mulheres dessas industrias a amamentar mais. CONCLUSOES: A licenca-maternidade tem sido util e usada pela maioria das trabalhadoras para amamentar, mas ha outros fatores que sao fundamentais para que a manutencao da lactacao seja facilitada, tais como aqueles que permitem a proximidade mae-crianca e/ou a retirada periodica de leite materno durante a jornada de trabalho.INTRODUCTION Studies carried out on breastfeeding and working women are difficult to compare. Breastfeeding practices among formally employed women in Brazil have not been much studied, despite important changes in public policies such as the extension of maternity leave to 120 days. OBJECTIVES A description of breastfeeding patterns among women employed in factories and the constraints and opportunities involved in conciliating breastfeeding and work. MATERIAL AND METHOD An exploratory study was carried out in 13 factories in S. Paulo city in 1994, where all women in the 3rd trimester of pregnancy were interviewed (76), and re-interviewed (69) when they went back to work (around 5,4 months after delivery). RESULTS Breastfeeding initiation was found in 97% of women and the median duration was 150 days. The exclusive breastfeeding and predominant breastfeeding rates were, respectively, 10 and 70 days of median duration. Higher socio-economic status and nursery facilities and the existence of a place in which to extract and store the mothers milk at the workplace were factors associated with longer duration of breastfeeding. Other factors such as flex-time and work out of the production-line also showed a significant relation to longer duration of breastfeeding in the factories studied. CONCLUSION Maternity leave is widely taken advantage of and highly beneficial for the majority of working women as regards breastfeeding, but other factors are important in maintaining lactation, such as circumstances which permit closer mother-child contact and/or the extraction of human milk during the working day.

Breastfeeding in two Brazilian state capitals: a comparative analysis.

This paper describes rapid assessment of infant feeding practices based on surveys conducted on National Immunization Day in the cities of Florianópolis and João Pessoa, Brazil. Two different infant feeding patterns emerge clearly in the data analysis. Most infants begin breastfeeding, but exclusive breastfeeding (EBF) from 0-4 months (46.3% in Florianópolis and 23.9% in João Pessoa) and timely complementary feeding rates (32.2% in Florianópolis and 24.8% in João Pessoa) are below recommended standards. EBF and breastfeeding duration medians were 53 and 238 days, respectively, in Florianópolis and 16.5 and 195 days, respectively, in João Pessoa. The results pointed to increasing breastfeeding rates and duration medians in Florianópolis as compared to João Pessoa. Use of these data could improve planning and monitoring of breastfeeding activities and infant nutrition policies.

A prática de amamentar entre mulheres que exercem trabalho remunerado na Paraíba, Brasil: um estudo transversal

Paid work should not be an obstacle to womens breastfeeding. The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months. In Brazil, women are legally entitled to 4 months of maternity leave, but in practice few women enjoy such benefits. How is it possible to practice exclusive breastfeeding for 6 months? We analyzed both the breastfeeding rates and whether paid jobs interfere with breastfeeding in Paraíba State, Northeast Brazil. We conducted a cross-sectional study in 70 of 223 municipalities (counties) during the annual immunization campaign in 2002. Among 11,076 infants (< 12 months of age), the exclusive breastfeeding rate at 0-4 months was 22.4% and was significantly higher among working women receiving maternity leave as compared to those who did not. The prevalence of total and predominant breastfeeding for 4 months was significantly lower among working women. In rural areas, having paid work was associated with a reduction in exclusive breastfeeding. The results show that breastfeeding practices in Paraíba fall far short of WHO recommendations, especially when mothers return to their paid jobs.

Breast-milk substitutes: past and present

The historical development of industrialized products used as breast-milk, substitutes a process begun in the 18th century, is studied. The marketing strategy currently adopted infant formula companies is stressed and the different commercial practices used in the search for new markets in third world countries are described. A warning is given as to the precise instructions giver for the use of the so-called breast-milk substitutes, and the attention of health professionals and consumer groups is called to the low level of awareness regarding this subject, a factor which led the World Health Organization and United Nations Childrens Fund to recommend the preparation of an appropriate marketing code and to its adoption by Brazil.

Breastfeeding patterns and energy adequacy

To analyze caloric adequacy in infant feeding six months of age or under, the volume of breast milk consumed was estimated through a regression equation as proposed by Drewett. Energy adequacy was estimated according to World Health Organization guidelines for developing countries and the recommended daily allowance of the Food and Nutrition Board. A cross-sectional analysis was conducted on data from a cohort of 118 infants in a neighborhood around a health center in Campinas, São Paulo, Brazil, with home interviews by trained students. Data were gathered on social and demographic characteristics, infant feeding patterns, duration of breastfeeding, frequency of feedings, and age when breast milk substitutes were introduced. On average, weaning began early, with a 2.7-month median duration of exclusive breastfeeding. Mean breast milk volume was estimated (from frequency of feeding) as 561.0 ml, 558.9 ml and 565.5 ml for children in exclusive, predominant, and supplemented breastfeeding, respectively. Mean energy consumption was adequate for all exclusively breastfed children regardless of age and above the recommended level for infants with supplemented breastfeeding and those already weaned.

Determinants of the Breastfeeding Pattern Among Working Women in São Paulo

The needs of breastfeeding women who work away from home differ from those of other women, particularly those who breastfeed exclusively. Sixty-nine factory workers were interviewed in Sdo Paulo, both during pregnancy and when they returned to work. Median durations of exclusive (EBF), predominant (PBF), and any breastfeeding (BF) were found to be 10 days, 70 days, and 150 days, respectively. Despite having used the 4-month leave to which they were entitled, by 1 month, 86% of the respondents had given tea, 50% water, and 42% artificial baby milk. Only 2 women were still exclusively breastfeeding when they returned to work. Various personal characteristics were associated with longer duration of breastfeeding. Maternity ward routines were generally not supportive, but duration of PBF was longer where better support was received. Duration of EBF was longer among women with support for breastfeeding at work, and shorter for those working on weekends or doing shift work. Thus, women may have adjusted their feeding patterns based on whether or not they anticipated workplace support. Only weekend work and socioeconomic status were linked to shorter duration of breastfeeding. Stronger social and health care support for EBF may be needed before the full impact of workplace support can be usefully studied in Brazil.

Advances in the Brazilian norm for commercialization of infant foods.

OBJECTIVE To assess the advances in the Brazilian norm for commercialization of infant foods from 1988 to 2002, comparing the different texts with each other and with the International Code of Marketing of Breast-Milk Substitutes. METHODS This was a descriptive study based on data collected from documents, reports, ordinances and resolutions from the Brazilian Ministry of Health. The versions utilized in the comparison were from 1992 and 2002. RESULTS Comparative analysis made it possible to identify important advances in the legislation. In 1992, liquid and powdered milk were included in the scope, along with teats and dummies (pacifiers), and also warning phrases in advertising and on product labeling. In 2002, regulations for products were published by the National Agency for Sanitary Surveillance, thereby strengthening supervisory actions and including regulations for baby foods, nutrient formulae for high-risk newborns, and nipple protectors. The phrases used in commercial advertising and on product labeling, including dummies, teats and bottles, became Ministry of Health warnings. The labeling was defined according to product types, on the basis of more restrictive rules. CONCLUSIONS Significant modifications in the control over the marketing of products aimed at mothers during the lactation period. However, there are still some legislative questions that would make it possible to improve the Brazilian norm, in order to protect breastfeeding. There is also a need for the government to implement systematic monitoring routines to supervise this legislation.

Breast feeding in the first six months.

Virtually all mothers in developing countries tend to supplement breast milk with water or teas, often during the infants 1st week, thinking that these fluids have therapeutic effects. Moreover many physicians encourage this practice. It is unnecessary and could adversely affect infant health. Exclusively breast fed infants are less likely to suffer from diarrhea. For example, studies in the Philippines and Peru show that 6 month old breast fed infants who also received other fluids suffered from diarrhea at twice the rate of those who were exclusively breast fed. Further a study in Brazil reveals that these infants were more likely to die than those who only received breast milk. Moreover infants who received fluids other than breast milk consume less breast milk and breast feed for shorter duration than exclusively breast fed infants. In Brazil, breast fed infants who received supplements in the 1st days of life were 2 times as likely to not breast feed after 3 months than exclusively breast fed infants. Thus growth in infants who receive water or teas will not be optimal. Another benefit of breast feeding that supplements erode include increased birth intervals. Moreover research consistently shows that healthy infants who receive enough breast milk to meet their energy needs also receive enough fluid to meet their requirements, even in hot and dry environments. Improved maternity services following delivery increases exclusive breast feeding rates during the 1st few weeks of life. These services include telling all pregnant women how and why to breast feed, helping mothers start breast feeding soon after delivery, rooming in 24 hours/day, encouraging breast feeding on demand, and giving no other fluids, except for required medications. Further working mothers should have the right to breast feed. Support groups and health workers should encourage mothers to exclusively breast feed for the 1st 6 months.