Meira Camila Abadia Rodrigues, Buccini Gabriela, Azeredo Catarina Machado, Conde Wolney Lisbôa, Rinaldi Ana Elisa Madalena
School of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
School of Public Health, University of Nevada, Las Vegas, NV, United States.
Front Nutr. 2023 Oct 4;10:1239503. doi: 10.3389/fnut.2023.1239503. eCollection 2023.
Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF).
Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s.
Cross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995-2010), Haiti (1994-2017), and Peru (1996-2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section).
Factors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16).
DISCUSSION/CONCLUSION: Factors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.
拉丁美洲的研究主要集中在分析与纯母乳喂养（EBF）或婴儿配方奶粉（IF）相关的因素上。
分析20世纪90年代、21世纪初和21世纪10年代三个拉丁美洲和加勒比国家中经济、社会人口统计学和健康因素与纯母乳喂养、混合奶喂养（MixMF）以及单纯使用婴儿配方奶粉之间的关联。
采用横断面时间序列研究，使用1990年代至2010年代哥伦比亚（1995 - 2010年）、海地（1994 - 2017年）和秘鲁（1996 - 2012年）人口与健康调查的数据，样本包括12,775名6个月以下婴儿。使用分层逻辑多水平回归模型来估计婴儿喂养结果（纯母乳喂养、混合奶喂养、单纯使用婴儿配方奶粉）与背景水平的人口与健康调查十年期（1990年代、2000年代和2010年代）以及经济因素（购买力平价计算的国内生产总值、女性工资和受薪工人、女性劳动力参与率）以及个体水平的社会人口统计学因素（母亲年龄、母亲教育程度、家庭子女数量、财富指数、与伴侣同住的母亲、居住地区、外出工作的母亲）和健康因素（出生后第一小时内母乳喂养、剖宫产）之间的调整关联。
与停止纯母乳喂养相关的因素有剖宫产（比值比：0.76；95%置信区间：0.64，0.92）、外出工作的母亲（比值比：0.79；95%置信区间：0.69，0.90）、收入最高五分位数的家庭（比值比：0.64；95%置信区间：0.49，0.84）以及女性工资和受薪工人（比值比：0.92；95%置信区间：0.91，0.94）。混合奶喂养与受过高等教育的女性（比值比：1.54；95%置信区间：1.21，1.97）、外出工作的母亲（比值比：1.26；95%置信区间：1.10，1.43）、剖宫产（比值比：1.37；95%置信区间：1.15，1.62）、收入最高五分位数的家庭（比值比：2.77；2.10，3.65）以及女性工资和受薪工人（比值比：1.08；95%置信区间：1.05，1.09）有关。单纯使用婴儿配方奶粉与外出工作的母亲（比值比：2.09；95%置信区间：1.41，3.08）、剖宫产（比值比：1.65；95%置信区间：1.09，2.51）、收入最高五分位数의家庭（比值比：12.08；95%置信区间：4.26，34.28）、2010年代（比值比：3.81；95%置信区间：1.86，7.79）以及女性工资和受薪工人（比值比：1.12；95%置信区间：1.07，1.16）有关。
讨论/结论：与妇女赋权和性别平等相关的因素危及拉丁美洲的纯母乳喂养，并有利于单纯使用婴儿配方奶粉。因此，促进、保护和支持母乳喂养做法的工作场所干预措施是减少单纯使用婴儿配方奶粉的关键。
