Family and Community Health, Pan American Health Organization, Washington, DC 20037, USA.
Health Policy Plan. 2011 May;26(3):257-65. doi: 10.1093/heapol/czq046. Epub 2010 Sep 28.
Breastfeeding has large benefits for mothers and infants. The short-term benefits for child survival and reduced morbidity differ by population subgroup because of differences in underlying risk factors. Although breastfeeding is more common among poor than well-off women, how breastfeeding patterns change between these subgroups is important from a policy perspective as the poor will benefit more from increased duration of breastfeeding.
We use nationally representative data from eight countries in Latin America and the Caribbean to document changes in breastfeeding duration between 1986 and 2005, and separate the overall change into the portion attributable to changing population characteristics and the portion resulting from changing breastfeeding behaviour within population subgroups.
Breastfeeding duration increased in six out of the eight countries and the changes observed are largely explained by changing behaviour within population subgroups rather than changing population characteristics. Changes in breastfeeding duration did not tend to be equitably distributed, but in four countries (Bolivia, Brazil, Colombia and Peru) the population subgroups whose children are most at risk for mortality and increased morbidity from not being breastfed were least likely to show improvements in breastfeeding duration. Between 1986 and 2004 in Peru, breastfeeding duration declined by 0.6 months among rural women while increasing by 9.7 months among urban women; it increased by 6.3 months among women with prenatal care but only by 3.7 months among women with no prenatal care. Changes in breastfeeding in Guatemala and Haiti tended to favour the well-off compared with the poor, though not consistently. In Nicaragua changes in breastfeeding duration tended to favour the less well-off.
While promoting breastfeeding is a must for all women, to maximize its benefits for child survival and health, additional efforts are needed to reach poorly educated and rural women with little access to health care.
母乳喂养对母亲和婴儿都有很大的好处。儿童生存和减少发病率的短期益处因人群亚组中潜在风险因素的不同而有所不同。虽然母乳喂养在贫困妇女中比富裕妇女更为常见，但从政策角度来看，这些亚组之间的母乳喂养模式如何变化很重要，因为贫困妇女将从母乳喂养时间的延长中获益更多。
我们使用拉丁美洲和加勒比地区八个国家的全国代表性数据，记录了 1986 年至 2005 年期间母乳喂养持续时间的变化，并将整体变化分为归因于人口特征变化和人口亚组内母乳喂养行为变化的两部分。
八个国家中有六个国家的母乳喂养持续时间增加，观察到的变化主要是由于人口亚组内行为的变化，而不是人口特征的变化。母乳喂养持续时间的变化并没有趋于公平分配，但在四个国家（玻利维亚、巴西、哥伦比亚和秘鲁）中，那些其子女最有可能因未母乳喂养而死亡和发病率增加的人群亚组，最不可能改善母乳喂养持续时间。在秘鲁，1986 年至 2004 年期间，农村妇女的母乳喂养持续时间减少了 0.6 个月，而城市妇女增加了 9.7 个月；有产前保健的妇女增加了 6.3 个月，而没有产前保健的妇女仅增加了 3.7 个月。危地马拉和海地的母乳喂养变化趋势有利于富裕人群，而不是贫困人群，但并非始终如此。在尼加拉瓜，母乳喂养持续时间的变化趋势有利于不太富裕的人群。
尽管所有妇女都必须提倡母乳喂养，但为了最大限度地提高母乳喂养对儿童生存和健康的益处，还需要额外努力，为教育程度较低、受教育程度较低的农村妇女提供母乳喂养，并为她们提供获得医疗保健的机会。
