Revista de Saúde Pública
I SSN 0034- 8910 versão im pressa
Rev Saúde Pública 2004; 38(1)
Breastfeeding among teenage and adult mothers in Braz il
Denise At aide Linhar es Fr ot aa and Luiz Fr ancisco Mar copit ob
aUniversidade Est adual de Mont es Claros ( Unim ont es) . Mont es Claros, MG, Brasil. bDepar t am ent o de Medicina Pr event iva da Univer sidade Feder al de São Paulo. São Paulo, SP, Br asil
ABSTRACT
Objective
To est im at e t he pr ev alence of br east feeding am ong t eenage m ot her s ( less t han 20 y ear s old) and adult m ot hers of six - m on t h- old childr en and t o ident ify fact or s associat ed w it h w eaning.
Methods
Th is w as a cr oss- sect ional st udy by m eans of a st r uct ur ed quest ionnair e applied in t he hom e, of a sam ple of 237 t eenage m ot her s and 239 adult m ot her s living in t he cit y of Mont es Clar os, Br azil, w hose babies w er e six m ont hs old at t he t im e of t he int er v iew . To assess fact or s associat ed w it h w eaning, univar iat e and bivar iat e Mant el- Haenszel analyses and m ult iple logist ic r egr ession w er e per for m ed.
Results
of adolescen ce in w ean in g gain ed im por t an ce. Th e fact or s associat ed w it h w eaning w er e: m ar it al st at us, act iv it y out side of t he hom e aft er deliv er y ( bot h of t hese show ed int er act ion w it h adolescence) , difficult y in br east feeding dur ing t he fir st few day s aft er deliv er y and ex clusiv e br east feedin g at t h e t im e of h ospit al dischar ge.
Conclusions
The int er act ions w it h adolescence t hat w er e obser v ed in r elat ion t o w eaning suggest t hat m ot her hood w it hin t his age gr oup has peculiar it ies t hat m ak e it a m at t er for fur t her inv est igat ion.
Keywords
Br east feeding. Adolescent . Mot her s. Pr ev alence. Weaning. Cr oss- sect ional st udies. Age fact or s. Socioeconom ic fact or s. Mot her hood.
I N TRODUCTION
The Wor ld Healt h Or ganizat ion ( WHO) 21 defines adolescence as t he per iod of life w it hin t he age range of 10 t o 19 years. Teenagers represent 20 t o 30% of t he w orld’s populat ion, a figure t hat has been increasing in t he urban regions of em erging count ries. According t o dat a from t he I nst it ut o Brasileiro de Geogr afia e Est at íst ica ( I BGE – Br azilian I nst it ut e of Geogr aphy and St at ist ics) ,8 t eenager s com prised 20.8% of t he t ot al populat ion of Brazil in t he year 2000, 20.4% in t he St at e of Minas Gerais and 22.4% in t he m unicipalit y of Mont es Claros, wit hin t he St at e of Minas Gerais. For m ost people, sexual act ivit y begins dur ing adolescence.2 1 Despit e gr eat social, scient ific and cult ur al pr ogr ess ov er r ecent decades, it is st ill difficult for t eenager s and t heir par ent s t o discuss t he t opic of sex and sexualit y. On t he ot her hand, t his progress – plus t he r educt ion in t he age of t he m enar che2 1 – has been st im ulat ing t eenagers t o begin sexual act ivit y early w it hout , how ever, preparing t hem for w hat it br ings.1 9
Pregnancy am ong t his age group is increasing. The official dat a available from SI NASC ( Sist em a de I nform ações sobre Nascidos Vivos) ,1 6 t he inform at ion syst em for live birt hs) , relat ing t o t he years 1994 t o 1999, alt hough subj ect t o failur es in it s cov er age, allow t he annual r at es of liv e bir t hs per t housand t eenage girls during t his period t o be calculat ed and follow ed up. For t he w hole of Br azil it went from 30.4 t o 42.5; in Minas Gerais, from 5.4 t o 34.1; and in Mont es Claros, from 12.0 t o 39.4. Ex clusiv e br east feeding pr ov ides t he ideal food for t he new bor n up t o t he age of six m ont hs. Ov er r ecent decades, aft er a per iod of decline t hat culm inat ed at t he beginning of t he 1970s, t her e has been an incr ease in nat ur al br east feeding pr act ices.9
Accor ding t o t he I BGE, t he m unicipalit y of Mont es Claros had 306,947 inhabit ant s in 2000, 94.2% of w hom w er e liv ing w it hin t he ur ban zone. The cit y is a cent er of at t r act ion for t he w hole of t he nor t her n r egion of Minas and ev en t he sout h of t he St at e of Bahia, including in r elat ion t o m edical at t endance. Accor ding t o SI NASC,1 6 m ore t han 92% of t he deliveries are done in hospit al.
Am ador et al,1 in t heir lit erat ure review of 1992 regarding breast feeding am ong t eenagers and adult s, show ed t hat t he proport ion of m ot hers exclusively breas t feeding w as low er am ong t eenager s. They also obser v ed t hat t he fr equency of com plet e t er m inat ion of br east feeding by t he end of t he t hir d m ont h was also great er in t his group.
I n Pelot as, St at e of Rio Grande do Sul, in a cohort of children born in 1993,7 t he pr ev alence of breast feeding when t he child was six m ont hs old was lower am ong t eenage m ot hers t han am ong adult s. The m ot her’s age rem ained as a risk fact or for t erm inat ing breast feeding, even aft er adj ust ing for anot her t en socioeconom ic, dem ogr aphic and nut rit ional variables. How ever, t he general pr ev alence of br east feeding at t he age of six m ont hs w as v er y low : only 35.1% .
I n t he cit y of Mont es Clar os, t he gener al pr ev alence of br east feeding w hen t he child w as six m ont hs old increased from 59.3% in 19931 1 t o 65.0% in 1996.4 The pr esent st udy had t he obj ect iv e of v er ify ing w het her adolescence w as associat ed w it h t he pr ev alence of w eaning by t he six t h m ont h of t he child’s life.
M ETHODS
A cr oss- sect ional st udy via sam pling was perform ed using a st ruct ur ed r et r ospect iv e quest ionnair e applied in t he hom es of t eenage and adult m ot her s liv ing in t he cit y of Mont es Clar os, St at e of Minas Gerais, Brazil, six m ont hs aft er t he delivery.
A t ot al sam ple size of 480 m ot her s ( 240 in each gr oup) w as calculat ed, t o enable odds rat ios ( OR) of gr eat er t han or equal t o 1.75, w it h α of 5% and st at ist ical pow er of 80% , t o be dem onst r at ed as significant for w eaning. The sam ple w as select ed sequent ially fr om t he declar at ions of liv e bir t hs r eceived by t he Municipal Healt h Depart m ent , in order of delivery dat e. The crit erion for inclusion in t he sam ple w as t hat t he m ot her s should live w it hin t he ur ban zone of Mont es Clar os. To r each t he calculat ed num ber of 480 m ot her s, 692 addr esses w er e invest igat ed. Of t hese, 212 w er e discarded for t he following reasons: 114 m ot hers ( 53.8% ) were not found; 71 ( 33.5% ) had m oved t o an unknow n locat ion; 16 ( 7.5% ) had t he w rong address; 10 ( 4.7% ) w it h nobody at hom e aft er t w o at t em pt s; and 1 ( 0.5% ) wit h house dem olished.
To av oid losses am ong t he 480 addresses ident ified, t he follow ing procedure w as ut ilized: if t he m ot her w as not pr esent or could not r espond t o t he int er v iew at t he t im e of t he v isit , t he int er v iew er ar r anged anot her t im e t o com e back ; if t he m ot her w as at anot her addr ess, t he int er v iew er w ent t her e. All t he 480 m ot her s found at hom e agr eed t o par t icipat e in t he st udy.
The int er v iew s w er e per for m ed by select ed univ er sit y st udent s, w ho under w ent fiv e full day s of t raining for t his. The m odified quest ionnaire m odel devised by Caldeira4 ( 1998) was applied, which w as t est ed in advance, st andar dized and pr ecoded in or der t o obt ain t he infor m at ion needed in relat ion t o breast feeding. I t t ook an average of 15 m inut es t o apply t he quest ionnaire, and dat a collect ion was perform ed during t he period from January 1 t o June 30, 2000.
Childr en w er e consider ed t o be br east fed w hen t hey w er e exclusively or par t ially r eceiving br east m ilk . They w er e consider ed not t o be br east fed w hen t hey w er e r eceiv ing no breast m ilk at t he age of six m ont hs.
I n t he analysis of associat ions bet w een t he m ot her ’s age cat egor y ( independent var iable) and w eaning ( dependent variable) , t he cont rol variables considered w ere: t he m ot her’s educat ion level, conj ugal life, cohabit at ion w it h t he part ner, num ber of previous children, w het her t he m ot her had br east fed pr eviously, par it y, act ivit y out side of t he hom e aft er t he deliver y, num ber of people living in t he hom e, pr enat al at t endance and num ber of consult at ions, desir e t o breast feed, guidance r egar ding br east feeding dur ing pr enat al and post nat al per iods, t y pe of deliv er y , lengt h of t im e aft er deliv er y for br east feeding t o be st ar t ed, w het her t he m ot her w as able t o st ay t oget her w it h t he child in t he h ospit al, t y pe of feed being given t o t he child at t he t im e of release from hospit al, difficult y in br east feeding dur ing t he fir st few day s, t he child’s sex , low bir t h w eight ( < 2500 g) , and w het her t he child r eceiv ed any child dev elopm ent at t endance. The v ar iable incom e could not be ut ilized because t here were 48 replies of “ I don’t know” .
Th e ch i- squared t est wit h one degree of freedom was applied (χ21 d f) w hen t her e w as no r est r ict ion on it s use. When indicat ed, t he St udent t t est for t w o av er ages com ing fr om independent sam ples and unequal variance w as ut ilized. The Mann- Whit ney t est w as ut ilized in cases w hen nor m alit y could not be assum ed.
The int ensit y of t he associat ions bet w een t he independent v ar iables st udied and t he dependent variable was m easured by m eans of t he odds rat io ( OR) . The possible int er act ions bet w een t he independent v ar iables w er e ev aluat ed t w o- by - t w o using t he st r at ified Mant el- Haenszel analy sis, by apply ing t he hom ogeneit y t est for t he OR of t he st r at a. The cr it er ion for ent er ing t he m ult iv ar iat e logist ic m odel w as t hat p< 0.25 for t he OR in t he univar iat e analysis or for t he int er act ions in t he bivariat e m odel.
I n t he m ult ivar iat e analysis, init ially t he m odel w as t est ed w it h all t he select ed int er act ions against one w it hout int er act ions, using t he likelihood rat ion ( LR) t est . Having defined t he init ial m odel, t he independent variables w ere rem oved one- by - one, using t he cr it er ion of p< 0.05, ex cept if t hey w er e com ponent s of a no- discar dable int er act ion. The adapt at ion of t he use of t he logist ic m odel w as assessed by m eans of t he goodness- of - f i t t est .
The analy ses w er e done by m eans of t he St at a v er sion 6.0 st at ist ical pack age.
The pr esent st udy had appr oval fr om t he Resear ch Et hics Com m it t ee of Univer sidade Est adual de Mont es Clar os and t he Resear ch Et hics Comm it t ee of Universidade Federal de São Paulo.
RESULT S
of children receiving exclusive breast feeding at t he t im e of release from hospit al was sim ilar bet ween t he gr oups, and t hese childr en did not differ in r elat ion t o t he char act er ist ics ev aluat ed.
Table 1 – Personal and sociodemographic, prenatal, perinatal and postnatal characteristics for teenage and adult mothers and their children in Montes Claros, Minas Gerais, 2000.
Mother
Characteristics % % p
Teenager Adult N=237 N=239
Personal and sociodemographic
Average age (in years) 17.5 26.9 <0.001 With more than grade school completed 34.6 43.9 0.037 With conjugal life 69.2 85.3 <0.001 Living together with the partner 68.4 84.5 <0.001 Average* number of children born previously 0.26 1.28 <0.001 Previous breastfeeding experience 17.3 61.9 <0.001
Primiparous 79.7 33.5 <0.001
With activity** outside of the home after the delivery 23.2 34.3 0.007 From a home with up to 4 residents 57.8 52.3 0.227 Prenatal period
Attended in prenatal consultations 95.4 95.0 0.847 Average number of consultations 5.3 5.8 0.022 With the desire to breastfeed 88.2 95.4 0.004 With prenatal guidance on breastfeeding 79.3 77.4 0.611 Perinatal and postnatal periods
With cesarean delivery 22.4 27.2 0.222 With a time until the first breastfeeding >120 min 34.6 46.0 0.011 Able to stay together with child in the hospital 91.6 92.5 0.715 With postnatal guidance on breastfeeding 90.3 87.0 0.261 With exclusive breastfeeding at the time of release from hospital 95.8 97.9 0.184 With difficulty in breastfeeding during the first few days 44.3 31.0 0.003 Child
Male 50.2 51.5 0.784
With birth weight <2,500 g 10.1 7.2 0.253 With child development guidance 93.2 92.0 0.616
* The average is presented only as a reference, considering that the statistical test utilized was non-parametric.
** Study and/or work.
Wit h r egar d t o t he effect on w eaning of each cat egor y of t he v ar iable “ m ot her ’s act iv it y out side of t he hom e during t he first six m ont hs of her child’s life” , it w as obser v ed t hat only t he cat egor y “ j ust st udy ing” had an influence on w eaning befor e t he child r eached 6 m ont hs of age, w hich j ust ifies t he subsequent dichot om izat ion done t hus( Table 2) .
Table 2 – Effect of the variable “mother’s activity outside of the home during the first six months of her child’s life” in relation to weaning, Montes Claros, Minas Gerais, 2000.
Activity N OR 95% CI p
Just working 96 1.04 0.62-1.77 0.870
Both 8 0.45 0.05-3.69 0.455
None* 339 1.00 - -
* Reference category.
At t he t im e of t he int er view , 117 m ot her s ( 24.6% of t he t ot al) w er e exclusively br east feeding, of whom 35 were t eenagers ( 14.8% of all t eenagers) and 82 adult s ( 34.3% of all adult s) , p< 0.001. Wit h r egar d t o w eaning by t he t im e of t he int erview , 68 t eenage m ot hers ( 28.7% ) and 54 adult m ot hers ( 22.6% ) had alr eady w eaned t heir childr en. Table 3 show s t he r aw OR for t he var iables pot ent ially associat ed w it h w eaning, select ed by m eans of t he cr it er ion “ p< 0.25” . The OR values for “ m ot her’s age cat egor y ” , “ conj ugal life” and “ t y pe of act iv it y out side t he hom e aft er deliv er y ” m ust not be int er pr et ed in t he w ay t hey appear in t his t able, since t he OR of t heir st r at a display ed het er ogeneous behavior in t he bivariat e analysis.
Table 3 – Factors potentially associated* with weaning by the sixth month of the child’s life, Montes Claros, Minas Gerais, 2000.
Characteristic ORraw 95% CI p
Teenage mother** 1.38 0.91-2.08 0.128
With conjugal life** 0.54 0.34-0.87 0.010
Previous breastfeeding experience 0.52 0.33-0.82 0.004
Just studying as the activity after the delivery* 2.62 1.28-5.37 <0.001
Prenatal attendance 0.43 0.18-1.00 0.050
Cesarean delivery 1.47 0.93-2.32 0.102
Time until the first breastfeeding > 120 min 1.56 1.03-2.36 0.037
Able to stay together with child in the hospital 0.56 0.28-1.12 0.103
Postnatal guidance 1.83 0.87-3.86 0.114
Exclusive breastfeeding at the time of release from hospital 0.12 0.04-0.37 <0.001 Difficulty in breastfeeding during the first few days 2.76 1.81-4.20 <0.001
Some child development follow -up 1.73 0.70-4.26 0.237
OR raw – Raw odds ratio
*Chosen for subsequent multiple logistic regression analysis through the criterion “p value <0.25”.
**Variables that presented multiple interaction. The interpretation of the respective OR must be done separately within each stratum.
These lat t er int er act ions ar e pr esent ed in Table 4, in w hich it is seen t hat t he “ t eenager ” cat egor y of m ot her ’s age had an ant agonist ic effect on w eaning, in relat ion t o t he “ conj ugal life” st rat um , and a sy ner gic effect on w eaning, in r elat ion t o t he “ t y pe of act iv it y out side t he hom e aft er deliv er y ” .
Table 4 – Interactions associated with weaning by the sixth month of the child’s life, Montes Claros, Minas Gerais, 2000.
Variable Stratum OR for “teenage mother” with “weaning by the sixth month of the child’s life”
Conjugal life With 1.93 0.001
Without 0.36
Activity outside of the home after the delivery
Just studying
5.38 0.184
Others** 1.17
*Probability that the OR of the strata are homogenous.
**Just working, or working and studying, or neither of these activities.
Table 5 show s t he int eract ions and variables t hat rem ained associat ed w it h w eaning aft er perform ing m ult iple logist ic regression analy sis. Fr om t he r esult s, it is seen t hat : a) t he effect of adolescence on w eaning v ar ies accor ding t o t he conj ugal st at us ( it is pr ot ect iv e am ong t eenage m ot her s w it hout conj ugal life and harm ful am ong t hose wit h conj ugal life); b) “ j ust st udy ing” as an act iv it y aft er deliv er y and “ difficult y in br east feeding dur ing t he fir st few day s” hav e an effect t hat fav or s w eaning; c) ex clusiv e br east feeding at t he t im e of r elease fr om hospit al pr ot ect s against w eaning befor e t he child reaches six m ont hs of age.
Ta ble 5 – I nt er act ion fact or s and t er m s associat ed w it h w eaning by t he six t h m ont h of t he child’s life, Mont es Claros, Minas Gerais, 2000.
Category ORadjusted 95% CI p
Teenage mother, without conjugal life 0.21 0.0823-0.5231 <0.001 Teenage mother, with conjugal life 1.67 1.0003-2.7877 0.049 Teenage mother, just studying as the activity after the delivery 2.48 1.1306-5.4342 0.023 Exclusive breastfeeding at the time of release from hospital 0.19 0.0562-0.6531 0.008 Difficulty in breastfeeding during the first few days 2.47 1.5711-1.8912 <0.001
Wit h r egar d t o t he difficult ies in br east feeding dur ing t he fir st few day s, t he difficult y m ost fr equent ly report ed by t he 179 m ot hers w ho had such difficult ies w as “ problem s w it h t he nipples” ( in 51 m ot hers, or 28.5% ) , followed by "pain" in 40 ( 22.3% ) , "cracks" in 35 ( 19.5% ) , “ absence of m ilk” in 24 ( 13.4% ) , “ m ast it is” in eight ( 4.5% ) , and diverse ot her reasons in 21 m ot hers ( 11.8% ) .
D ISCUSSION
Alt hough in t he pr esent st udy no case of r efusal t o be int er v iew ed occur r ed, it w as sur pr ising t hat t he m ot her s w er e not found at 114 of t he addr esses appear ing on t he declar at ions of liv e bir t hs t o m ot her s living in t he cit y of Mont es Clar os. When added t o t he ot her 98 addr esses discar ded for r easons t hat w er e easier t o under st and, t hese am ount ed t o 30.6% of t he liv e bir t h occur r ences declar ed, t he infor m at ion t hat is t r ansm it t ed t o SI NASC. Nonet heless, w it h r egar d t o educat ion lev el, t he m ot her s included in t he st udy w er e sim ilar t o t hose t hat w er e not included, t hus leading t o t he belief t hat t he r esult s obt ained w ould also apply t o t he lat t er .
support from UNI CEF.1 0 This show ed t hat in 1989 61.0% of t he childr en w er e par t ially w eaned at t he age of six m ont hs.
The pr ev alence of breast feeding in Brazil in t he sixt h m ont h was found t o be 59.8% in t he Nat ional Survey on Dem ography and Healt h, perform ed in 1996.* A st udy by t he Minist ry of Healt h* * per for m ed in 1999 show ed t hat 80.5% of Br azilians w ho lived in t he st at e capit als and t he Feder al Dist r ict w er e br east feeding up t o t he six t h m ont h and t hat 13.6% of t he m ot her s int er v iew ed w er e exclusively breast feeding in t he sixt h m ont h. This was a result sim ilar t o t he 10.0% found by Paz1 2 in São Paulo in 1999, but low er t han t he 24.6% obt ained in t he present st udy in 2000.
* BEMFAM. Pesquisa Nacional sobre Dem ografia e Saúde: relat ório de pesquisa. Rio de Janeiro; 1997 ( Unpublished dat a) .
* * Minist ério da Saúde. Prevalência de aleit am ent o m at erno nas capit ais brasileiras e no Dist rit o Federal: relat ório de pesquisa. Brasília, 2001 ( Unpublished dat a) .
A st udy perform ed by Leit e & Nunes,1 1 w it h t he par t icipat ion of UNI CEF, t o assess t he healt h condit ions of children in t he nort hern region of t he St at e of Minas Gerais, in 1993, revealed t hat t h e pr evalence of br east feeding w as 59.3% at t he age of six m ont hs, in t he cit y of Mont es Clar os. I n 1996, in a st udy conduct ed by Caldeir a, t his figur e r ose t o 65.0% .4 Com paring t hese result s wit h t hose obt ained in t he pr esent st udy ( br east feeding pr evalence of 74.4% at t he age of six m ont hs in t he sam e cit y , in 2000) , it can be seen t hat t her e w as a not able incr ease in br east feeding in Mont es Clar os ov er t he cour se of t hose y ear s.
Var ious fact or s ( m edia, aw ar eness cam paigns, w or ld br east feeding w eek and t he Friend of t he Child hospit al init iat ive) m ust have cont ribut ed t owards t his rise, but t he role of int ervent ions during pr enat al at t endance has cer t ainly alr eady been dem onst r at ed. Davies - Adet ugbo et al5 com pared a group of pregnant w om en t o w hom a br east feeding pr om ot ion pr ogr am w as offer ed, w it h anot her group w it hout t his int ervent ion. They observed t he num ber of m ot hers w ho began breast feeding im m ediat ely aft er delivery was great er in t he group wit h t he int ervent ion ( 32.0% vs. 6.0% ) . Four m ont hs af t er t he deliver y, 40.0% of t he m ot her s in t he int er vent ion gr oup w er e st ill br east feeding, v er sus 14.0% of t he m ot her s in t he cont r ol gr oup. Pr enat al at t endance w it h guidance on breast feeding w as st udied by Reifsnider & Eckhart1 5 am ong t wo groups of pregnant wom en, one a cont r ol gr oup and t he ot her an exper im ent al gr oup t hat r eceived educat ion r egar ding br east feeding. This st udy show ed t hat t he gr oup giv en guidance pr esent ed a gr eat er per cent age of m ot her s w ho w er e st ill br east feeding t hr ee t o four m ont hs aft er t he delivery, in com parison wit h t he cont rol group.
I n t he pr esent w or k, 95.2% of t he m ot her s had pr enat al at t endance, w it h an aver age of 5.5 consult at ions, and 88.7% w er e given guidance about br east feeding dur ing t heir confinem ent . This h igh per cen t age of at t endance m ust hav e cont r ibut ed posit iv ely t o t he m aint enance of br east feeding unt il t he dat e of t he int er v iew .
Exclusive br east feeding at t he t im e of r elease fr om hospit al, w hich w as found in 96.8% of t he m ot her s int erviewed, was shown t o be an im p or t ant independent pr ot ect ion fact or against w eaning, bot h am ong t eenage m ot hers and am ong adult s. This pract ice form s part of t he recom m endat ions of t he Nat ional Program for Encouraging Breast feeding. High percent ages like t hose obt ained in t he present st udy are t he result of t he im plem ent at ion of t his program in m at ernit y hospit als, as shown by Rea.1 4 This aut hor also observed an increase in t he durat ion of breast feeding am ong m ot hers w ho w ere ex clusiv ely br east feeding at t he t im e of r elease fr om hospit al.
ot her fact or s. This obser v at ion leads t o t he belief t hat m e asur es dir ect ed t ow ar ds t he per iod j ust aft er release from hospit al should be t ried out , wit h t he aim of m aint aining breast feeding, what ever t he m ot her’s age is. I n a lit erat ure review, Bergm an et al3 observed t hat t he m ain difficult ies in br east feeding w ere " sore nipples" , " child t hat did not lat ch ont o t he breast " and " insufficient m ilk pr oduct ion" . These r esult s ar e concor dant w it h t hose found in t he pr esent st udy .
The differ ence in t he pr evalence of br east feeding at t he age of six m ont hs ( 71.3% am ong adolescent m ot her s and 77.4% am ong adult m ot her s) did not r each st at ist ical significance. I t is possible t hat t he pr esent dissem inat ion of br east feeding encour agem ent pr act ices has br ought t hese figur es t oget her , because in a r ev iew by Am ador et al1 in 1992, t hey report ed a great er frequency of w eaning am ong t eenage m ot hers, in com parison wit h adult m ot hers.
The r esult s obt ained her e, how ev er , suggest t hat m ot her hood dur ing adolescence has peculiar it ies t hat m ake it a special and com plex m at t er t o st udy, going by t he int er act ions obser v ed w it hin t his age group alone.
Conj ugal st at us had differing influence on weaning am ong t eenage m ot hers. The univariat e and biv ar iat e analy ses show ed t hat , am ong t eenage m ot her s, t he ex ist ence of conj ugal life fav or ed w eaning, w hile t he opposit e occur r ed w it hout conj ugal life. One ex planat ion for t his finding is w hat w as pr oposed by exper t s fr om t he Pan- Am erican Healt h Organizat ion:1 2 faced w it h pr egnancy and m ot herhood, t eenagers have a lot of em ot ional t urm oil, t hey are incapable of im agining t hem selves per for m ing t he r ole of a m ot her , and t hey have feelings of denial and isolat ion and t hat t he fat her of t he child has no place in t heir lives. Fer gusson & Woodw ar d,6 st udy ing br east feeding, obser v ed t hat older wom en who were liv ing wit h a part ner breast fed for a longer t im e, which is in agreem ent wit h t he r esult s found in t he pr esent st udy .
The t eenage m ot her s w ho said t hat st udy ing w as t heir only act iv it y aft er t he deliv er y pr esent ed a great er proport ion of weaning by t he child’s sixt h m ont h of life. Com paring t his result wit h ot hers in t he lit er at ur e, Ar lot t i et al2 also observed t hat ret urning t o school dim inished t he prevalence of breast feeding. The possible explanat ion is t hat t hese w om en are st udying m ore, get t ing pregnant during periods of st udy and st aying out side of t he hom e for long periods, and t here is no provision for br east feeding at t he st udy locat ions. Accor ding t o dat a fr om t he pr esent sur v ey , 104 m ot her s w or k ed out side of t he hom e dur ing t he fir st six m ont hs of t heir children’s lives, and 75.9% of t hem did not wean t heir infant s. Thom pson & Bel,1 7 in a qualit at iv e st udy t hat inv est igat ed fact or s t hat facilit at e br east feeding it t he w or k place, suggest ed t hat br east feeding and w or k ing m ay be com pat ible.
Thus, alt hough prenat al assist ance w it h guidance on breast feeding1 4 and being able t o st ay t oget her w it h t he baby in t he hospit al2 0 ar e fact or s r ecognized t o be pr ot ect iv e against ear ly w eaning, t he sim ilarly high exposure of t eenage and adult m ot hers t o such pract ices t hat w as found in t he pr esent st udy m eans t hat t he differ ence in w eaning obser v ed bet w een t he t w o cat egor ies can be ex plained by v ar iables r elat ing t o t he t eenager s’ per sonal char act er ist ics ( conj ugal and st udy st at us) .
I n conclusion, t he r esult s hav e sh ow n t hat pr enat al at t endance w it h guidance on br east feeding and t he possibilit y for t he m ot her t o st ay t oget her w it h t he baby in t he hospit al w er e pr ot ect iv e against ear ly w eaning, independent of t he m ot her ’s age cat egor y ( t eenager or adult ) .
How ev er , t he ex ist ence of conj ugal life and “ j ust st udy ing” as t he act iv it y out side of t he hom e dur ing t he child’s first six m ont hs of life were only risk fact ors for weaning am ong t eenage m ot hers. I f fut ure st udies t hat also ut ilize m ult iv ar iat e t echniques confir m suc h r esult s, t he occur r ence of t his phenom enon should becom e t he subj ect of a qualit at iv e inv est igat ion.
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Address to correspondence
Denise At aide Linhar es Fr ot a Rua I rm ã Beat a, 866
39400 - 110 Mont es Claros, MG, Brasil E- m ail: denisefrot a@b ol.co m.b r
Based on MSc disser t at ion pr esent ed t o Escola Paulist a de Medicina, Univ er sidade Feder al de São Paulo, 2002.
Received on 20/ 9/ 2002. Reviewed on 25/ 7/ 2003. Approved on 15/ 8/ 2003.
© 2 0 0 3 Fa cu lda de de Sa ú de Pú blica da U n iv e r sida de de Sã o Pa u lo
Ave nida D r . Ar na ldo, 7 1 5 0 1 2 4 6 - 9 0 4 Sã o Pa ulo SP Br a zil
