Factors Associated with Age at Breastfeeding Cessation in Amazonian Infants: Applying a Proximal-Distal Framework.

Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25 months and collected information on maternal and child characteristics. Survival analysis based on a proximal-distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120 days. Almost two-thirds (63 %) of these children stopped breastfeeding before 6 months of age. In the larger sample of 209 children, 74.6 % had previously been bottle-fed. Considering the full proximal-distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88 % sooner than one who was never bottle-fed (p < 0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile (p < 0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2 years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding.

Improved maternal health since the ICPD: 20 years of progress.

BACKGROUND: The 1994 Conference on Population and Development (ICPD) was a turning point in the field of sexual and reproductive health--repositioning population and development programs globally in the context of reproductive rights, gender equity, and women's empowerment. PROGRESS SINCE ICPD: ICPD solidified the importance of women's health and safe motherhood alongside other health and development priorities while laying the groundwork for the Millennium Development Goals. CHALLENGES: Some goals envisioned by ICPD have been met. Others still need to be addressed. Global declines in maternal mortality are indicative of success, although improving measurement, quality of care and access to services, while addressing the social determinants that influence maternal health remain priorities. RECOMMENDATIONS: Renewed political will to address the remaining challenges is necessary for the post-2015 development agenda so that women's health throughout the world continues to be supported with ambitious, yet feasible goals that take into account the world's evolving development priorities.