Maternal Breastfeeding Self-Efficacy and Employment-Related Social Protection as Determinants of Exclusive Breastfeeding Duration: A Brazilian Prospective Cohort Study.
Description
This prospective cohort study examined the associations of maternal and paternal breastfeeding self-efficacy, breastfeeding performance, and employment-related social protection with the duration of exclusive breastfeeding during the first six postpartum months in southern Brazil. A total of 293 mother–father dyads were recruited in the immediate postpartum period and followed monthly until six months postpartum. The study evaluated the influence of psychosocial and structural determinants, including maternity leave duration and labor conditions, on exclusive breastfeeding continuation using survival analysis and Cox proportional hazards regression models. Findings demonstrated that shorter maternity leave and informal or unprotected employment were associated with earlier interruption of exclusive breastfeeding, whereas higher maternal breastfeeding self-efficacy was associated with longer breastfeeding duration.
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Steps to reproduce
1. Recruit eligible mother–father dyads within 24–36 hours postpartum in a public maternity hospital. 2. Assess maternal and paternal breastfeeding self-efficacy using validated Brazilian versions of the Breastfeeding Self-Efficacy Scale–Short Form. 3. Assess breastfeeding performance using the LATCH Scoring System. 4. Collect baseline sociodemographic, obstetric, neonatal, and employment-related social protection data. 5. Conduct monthly follow-up assessments via WhatsApp until six months postpartum or interruption of exclusive breastfeeding. 6. Define exclusive breastfeeding according to World Health Organization criteria. 7. Estimate exclusive breastfeeding continuation using Kaplan–Meier survival analysis. 8. Compare survival curves using the log-rank test. 9. Examine factors associated with interruption of exclusive breastfeeding using crude and adjusted Cox proportional hazards regression models controlling for maternal age, education, and mode of delivery. Statistics 1. Inspect and clean the dataset, checking for duplicate records, missing values, and inconsistencies in follow-up data. 2. Recode breastfeeding outcomes according to World Health Organization criteria for exclusive breastfeeding. 3. Calculate descriptive statistics for sociodemographic, obstetric, neonatal, psychosocial, and employment-related variables. 4. Assess maternal and paternal breastfeeding self-efficacy scores and LATCH scores using validated scoring procedures. 5. Estimate monthly prevalence of exclusive breastfeeding during the six-month follow-up period. 6. Calculate Spearman correlation coefficients between maternal self-efficacy, paternal self-efficacy, breastfeeding performance, and exclusive breastfeeding duration. 7. Construct Kaplan–Meier survival curves to estimate time to interruption of exclusive breastfeeding according to employment-related social protection categories. 8. Compare survival curves using the log-rank test. 9. Fit crude and adjusted Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals for factors associated with interruption of exclusive breastfeeding. 10. Adjust multivariable models for maternal age, maternal education, and mode of delivery based on theoretical relevance and prior literature. 11. Evaluate proportional hazards assumptions using Schoenfeld residuals and graphical inspection of log(-log) survival curves. 12. Perform complete-case analysis because missing outcome and covariate data were limited (<2%). 13. Compare baseline characteristics between participants retained and lost to follow-up to assess potential attrition bias.