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Exclusive Breast-Feeding Duration Is Associated with Attitudinal, Socioeconomic and Biocultural Determinants in Three Latin American Countries^1,2,3,4,

Rafael Pérez-Escamilla^*,5, Chessa Lutter, Maria Segall^**, Ada Rivera, Sandra Treviño-Siller and Tina Sanghvi

^* Department of Nutritional Sciences, University of Connecticut, Storrs, CT Wellstart International, Washington, DC ^** Department of Epidemiology, University of Campinas, Brazil Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico Latin American and Caribbean Health and Nutrition Sustainability Project (LAC\HNS), Washington, DC.

International health organizations have recommended exclusive breast-feeding (EBF) (i.e., breast milk as the only source of food) as the optimal infant feeding method during the first 4–6 mo of life. Therefore, it is important to document the determinants of EBF in different populations. Low-income urban women from Brazil (n = 446, 2 maternity wards), Honduras (n = 1582, 3 maternity wards) and Mexico (n = 765, 3 maternity wards) were interviewed at birth and in their homes at 1 mo and 2–4 mo after delivery. Multivariate survival analyses (Cox model) indicated that planned duration of EBF (all 3 countries), having a female Infant, and not being employed (Brazil and Honduras), lower socioeconomic status (Honduras and Mexico) and higher birth weight (control hospital in Brazil and Honduras) were positively associated (P 0.10) with EBF. Women who delivered in the maternity wards that had more developed breast-feeding promotion programs were more successful with EBF. The association between maternal education and EBF was modified by the maternity ward in Mexico and Honduras. Being 18 y and having a partner living (Brazil) or not (Mexico) living at home were positively associated with EBF. These findings can contribute toward the design of EBF promotion efforts in Latin America.

KEY WORDS: • exclusive breast-feeding • human lactation • infant feeding determinants • Latin America

¹ Portions of this paper were presented at the 122nd annual meeting of the American Public Health Association. Pérez-Escamilla, R., Lutter, C.K., Segall, A., Teruya, K., Rivera, A., Philipps, M., Treviño-Siller, S., Wickham, C. & Sanghvi, T. (1994) When and why women stop exclusive breastfeeding in low-income urban areas from Latin America, Abstract no. 1068, p. 37. American Public Health Association, Washington, DC.

² Supported by the United States Agency for International Development under Contract No. LAC-0657-C-00-0051 Health and Nutrition Sustainability, University Research Corporation/International Science and Technology Institute.

³ The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

⁴ Scientific Contribution No. 1629, Storrs Agricultural Experimental Station, University of Connecticut, Storrs.

⁵ To whom correspondence should be addressed.

Manuscript received 19 April 1995. Revision accepted 22 August 1995.