Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis Carlos Alberto Feldens • Ma ´rcia Regina Vitolo • Fernanda Rauber • Luciane Nascimento Cruz • Juliana Balbinot Hilgert Published online: 25 September 2011 Ó Springer Science+Business Media, LLC 2011 Abstract To identify risk factors for discontinuing breastfeeding during an infant’s first year of life. A cohort study recruited mothers in a hospital in Sa ˜o Leopoldo, Brazil, which mainly serves the low-income population. In order to obtain socioeconomic, environmental, and behavioral information, face-to-face interviews with mothers were conducted after birth, and when their infants were 6 and 12 months old. The duration of breastfeeding was investigated at 6 and 12 months, and recorded sepa- rately for each month. Depressive symptoms were assessed using the Beck Depression Inventory. The multivariate model for predicting the discontinuation of breastfeeding, adjusted Kaplan–Meier survival curves and Cox regression were used. Of the 360 participants, 201 (55.8%) discon- tinued breastfeeding within the first 12 months. A multi- variate Cox regression model revealed that symptoms of maternal depression (low levels: RR = 1.59, 95% CI 1.02–2.47; moderate to severe: RR = 2.03, 95% CI 1.35–3.01), bottle feeding (RR = 2.07, 95% CI 1.31–3.28) and pacifier use in the first month of life (RR = 3.12, 95% CI 2.13–4.57) were independently associated with the outcomes after adjusting for confounders. Breastfeeding cessation rates were lower for children who did not use bottle feeding or a pacifier in the first month of life and for the children whose mothers presented with minimal depression. Early pacifier use and bottle feeding must be strongly discouraged to support long-term breastfeeding. In addition, screening maternal depression at a primary care service can be a step forward in promoting a longer dura- tion of breastfeeding. Keywords Breast feeding Á Behavior Á Infant Á Depression Introduction International guidelines recommend that women breastfeed their infants exclusively for the first 6 months and continue breastfeeding into the second year of the child’s life or even longer [1]. The Brazilian Ministry of Health, sup- ported by the Pan American Health Organization, has established breastfeeding and healthy weaning as a public health priority [2]. In 2008, a national survey was con- ducted in Brazil to investigate the prevalence of breast- feeding during the first year of life, based on a sample of 34,366 infants. The results showed that 58.7% of 9–12- month-old children had been breastfed the day before the interview [3]. Epidemiological evidence shows that breastfeeding is associated with a lower frequency of infant mortality and infectious disease, besides also having an effect on the vascular system [4–7]. In addition, there is a significant association between shorter breastfeeding duration and developmental delays [8]. Therefore, the C. A. Feldens (&) Department of Pediatric Dentistry, Universidade Luterana do Brasil, Rua Joa ˜o Telles 185/1301, Porto Alegre, Canoas, Rio Grande do Sul 90035-121, Brazil e-mail: cafeldens@terra.com.br M. R. Vitolo Á F. Rauber Center for Research in Nutrition (NUPEN), Universidade Federal de Cie ˆncias da Sau ´de de Porto Alegre, Porto Alegre, Brazil L. N. Cruz Health Technology Assessment Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil J. B. Hilgert Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil 123 Matern Child Health J (2012) 16:1257–1265 DOI 10.1007/s10995-011-0885-7