OBJECTIVE Update breastfeeding indicators trend in Brazil for the last three decades, incorporating more up-to-date information from the National Health Survey.METHODS We used secondary data from national surveys with information on breastfeeding (1986, 1996, 2006, and 2013) to construct the time series of prevalence for the following indicators: exclusive breastfeeding in children under six months of age (EBF6m), breastfeeding in toddlers under 2 years of age (BF), continued breastfeeding at one year of age (BF1year), and continued breastfeeding at two years of age (BF2years).RESULTS The prevalence of EBF6m, BF, and BF1year increased until 2006 (rising from 4.7%, 37.4%, and 25.5% in 1986 to 37.1%, 56.3%, and 47.2% in 2006, respectively). For these three indicators, there was relative stabilization between 2006 and 2013 (36.6%, 52.1%, and 45.4%, respectively). The BF2years indicator had a distinct behavior – relatively stable prevalence, around 25% between 1986 and 2006, and a subsequent increase, reaching 31.8% in 2013.CONCLUSIONS The time series of breastfeeding indicators in Brazil shows an upward trend until 2006, stabilizing from that date onwards on three of the four indicators evaluated. This result, which can be considered as a warning sign, requires evaluation and revision of policies and programs to promote, protect and support breastfeeding, strengthening existing ones and proposing new strategies so that the prevalence of breastfeeding indicators returns to an upwards trend.

OBJETIVO: Em resposta à necessidade sentida por municípios brasileiros de informação referente às práticas de amamentação com vistas ao planejamento em saúde, realizou-se estudo com o objetivo de descrever a situação da amamentação e identificar fatores associados ao desmame nesses municípios. MÉTODOS: De uma convocação aberta a todos os municípios do Estado de São Paulo, 84 aderiram a um treinamento para coleta de dados no Dia Nacional de Vacinação, em 1998. Para cada município, foi desenhada uma amostra compatível com o tamanho de sua população infantil, aplicando-se um questionário padronizado com questões referentes à alimentação da criança nas 24 horas precedentes. Além de estatísticas descritivas sobre a freqüência de amamentação, foram analisados pela regressão logística fatores de risco para interrupção da amamentação exclusiva em menores de quatro meses e para o desmame em menores de um ano. RESULTADOS: O aleitamento exclusivo nos primeiros quatro meses raramente alcançou índices superiores a 30%. Como fatores de risco para essa situação, identificaram-se: baixa escolaridade materna, ausência de programa Hospital Amigo da Criança, primiparidade e maternidade precoce. Com relação aos menores de um ano, a amamentação ficou em torno de 50%. CONCLUSÃO: A ausência do programa Hospital Amigo da Criança, primiparidade, trabalho informal ou desemprego materno foram os fatores de risco para o desmame. As taxas municipais de amamentação diferem amplamente no Estado de São Paulo, o que reforça a importância de diagnósticos locais, rápidos e de fácil apropriação por profissionais de saúde.

There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.

Objective: To identify individual and contextual factors associated with the practice of exclusive breast-feeding (EBF). Methodology: We analysed 34 435 children under 6 months of age living in 111 municipalities in the state of São Paulo, south-eastern Brazil, who participated in a survey investigating feeding practices during the first year of life, carried out during the 1999 national vaccination campaign. The questionnaire employed included questions on the consumption, in the last 24 h, of breast milk, water, tea, other types of milk and other foods, in addition to mother and child characteristics. Information on the pro-breast-feeding measures implemented in the municipalities was also collected. The effects of individual and contextual characteristics on EBF were analysed using multilevel models.Results: The final model showed a greater chance of EBF in women with tertiary education (odds ratio (OR) ¼ 1.91; 95% confidence interval (CI) 1.75-2.06); women aged between 25 and 29 years (OR ¼ 1.52; 95% CI 1.41 -1.63); multiparae (OR ¼ 1.42; 95% CI 1.33 -1.49); female babies (OR ¼ 1.12; 95% CI 1.05-1.18); birth weight $ 3000 g (OR ¼ 1.73; 95% CI 1.49-1.97); child follow-up in the private healthcare network (OR ¼ 1.10; 95% CI 1.02-1.18); and municipalities with four or five probreast-feeding measures (OR ¼ 2.4; 95% CI 2.19 -2.88). An analysis of the interactions between individual and contextual variables showed that the presence of at least four pro-breast-feeding measures in the municipality attenuated the risk of early termination of EBF associated with low maternal schooling and low birth weight, and transformed child follow-up in the public network into a protective factor against the early termination of breast-feeding. Conclusions: The presence of measures aimed at protecting, promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast-feeding. KeywordsBreast-feeding Exclusive breast-feeding Exclusive breast-feeding determinants Breast-feeding policies Multilevel analysisThe advantages of exclusive breast-feeding (EBF) during the first 6 months of life have become increasingly evident since the 1980s. A study carried out in Brazil showed that non-breast-fed children had a 14-fold risk of dying from diarrhoea and a 3.6-fold risk of dying from respiratory disease in the first year of life compared with children who were exclusively breast-fed 1 . César et al. 2 showed that the probability of hospital admission due to pneumonia among non-breast-fed children was 17 times greater in the first year and 61 times greater in the first 3 months of life compared with exclusively breast-fed children. In an analysis of the effect of breast-feeding on infant mortality in 16 Latin-American countries, Betrán et al.3 concluded that 66% of deaths caused by diarrhoea and respiratory infections in the region could be prevented by EBF in the first 4 months of life. After reviewing the costs and benefits of EBF in Br...

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.

The BFHI has had an impact on several indicators of breast feeding. The authors hope the results of this study will make policy makers and health professionals aware of the importance and potential of this strategy.

A prática da amamentação sofreu um declínio em todo o mundo, levando a conseqüências desastrosas para a saúde das crianças e suas mães. A partir da década de 70 iniciou-se um verdadeiro movimento mundial para o retorno à amamentação, sendo que no Brasil, estudos realizados em algumas cidades indicam o possível sucesso deste movimento no País. Este estudo teve por objetivo descrever a trajetória recente do aleitamento materno no Brasil, em diferentes estratos populacionais, compa-rando duas pesquisas nacionais (ENDEF/75 e PNSN/89). Empregou-se a análise de probitos, que permite estimar freqüências da amamentação a partir de regressões lineares ponderadas, utilizando o teste de aderência de Kolmogorov-Smirnov para verificar a adequação dos modelos obtidos. Verificou-se uma expansão considerável da prática da amamentação no País. Esta tedência ocorreu em todos os estratos da população, porém o aumento da prática da amamentação foi mais acentuado na área urbana, na região Centro-Sul do país, entre as mulheres de maior poder aquisitivo e de maior escolaridade.

Explanations for increased cesarean section rates in Brazil have focused on the organization of obstetric care, training of health professionals, and women's demand for