The concern to reduce infant and maternal morbidity and mortality has motivated public policies in Brazil that encourage exclusive breastfeeding. Breastfeeding rates had their increase observed in research on the subject carried out after the creation of the National Breastfeeding Incentive Program in 1981. Since then the prevalence of EBF has grown gradually, but it is still far from what would be considered satisfactory [15] .
In the present study, the mothers reported the time they considered ideal for breastfeeding, where it was found that 51.2% considered the ideal time for breastfeeding (BF) to be 2 years and 75.6% to consider the ideal time for EBF to be 6 months, the the same recommended by the WHO (2002) and the Ministry of Health (2015) [42].
The study by Silva et al. showed similar data to the present study, in which 93.3% of mothers admitted to a private hospital in the city of Uberaba had knowledge about EBF to be performed until the infant was 6 months old, a higher percentage than found in this study. In addition to this result, it was also pointed out that 100% of mothers breastfed their children soon after birth, but only 70% maintained exclusive breastfeeding. Additionally, in our sample, 85.4% of the mothers reported the intention to continue breastfeeding for the period they considered adequate [35].
Santos et al. [32] identified that the prevalence of early weaning in children under two years of age was 58.5% and points out that it occurred more frequently in the age groups of one to two months (24.8%) and from two to three months ( 20.57%), which indicates that most children were not breastfed for the ideal time recommended by the WHO. The present study identified that 68% of the sample had not yet been weaned, however, when infants were stratified by age, it was observed that 86.7% of infants younger than 6 months and 57.7% of infants older than 6 months had not yet gone through the weaning process [42].
Rocha and Costa [31] point out that several factors can lead to early weaning and highlight the influences that lactating women suffer in their way of thinking and acting in relation to breastfeeding. Added to this, erroneous behaviors can contribute to the early introduction of water and other liquids, such as juices and other types of milk. In addition, the mother's return to the work environment is also a potential factor for weaning before the recommended time.
According to the Brazilian Society of Pediatrics (SBP), cow's milk is not recommended for children under 12 months, since its composition differs in many aspects from human milk. Cow's milk has inadequacies in relation to whey and casein proteins, limited amounts of carbohydrates, essential fatty acids, vitamins and minerals, as well as a high content of sodium, chloride, potassium and phosphorus. Thus, cow's milk should not be considered a nutritionally adequate food for this age group [12, 37, 38].
Infant formulas are recommended for babies who are not breastfed for some reason. Although this type of formulation is derived from cow's milk, it has adjustments in the nutrient content, however some elements such as anti-infective and bioactive factors found in breast milk are not contained in this type of compound. Although the nutritional content is adequate, formulas are not sterile and thus become a concern in relation to infant food safety [37, 42].
Family income and maternal schooling are considered socioeconomic determinants that can affect family well-being conditions, especially for the mother and baby. Individuals with a low socioeconomic level tend to have less assistance and greater difficulty in accessing health services and information about the importance of professional monitoring during prenatal care [25,27].
There is a relationship between knowledge about the practice and benefits of breastfeeding, with family income, and mothers who have higher family income have greater knowledge on the subject5. In the study by Escobar et al. [14], it was noted that maternal schooling can interfere with the duration of breastfeeding, revealing that the higher the maternal schooling, the longer the breastfeeding period. The level of maternal education may also be associated with the lack of information on the benefits of this practice.
The promotion of breastfeeding during pregnancy can be carried out through counseling and health education activities. Educational strategies in prenatal care that promote and clarify the importance of breastfeeding, support from family members and health professionals are evidenced as determinants of adherence to this practice, especially by low-income mothers [35, 15].
Only 61% of the mothers in the present study received guidance on breastfeeding. Of the guidelines received, the most cited were about the attachment of the nipple and areola (65.8%), position of the baby (63.4%), importance of breastfeeding and alternation of breasts (58.5%). Less than half of the interviewees received guidance on the frequency of free demand (43.9%), use of artificial nipples (46.3%) and time in each breast (48.8%).
It is of paramount importance that health professionals have a technical background and acquire skills to use them in clinical practice and counseling in various sectors of public health. Also, according to Silva et al. “the guidelines in relation to BF are not limited to prenatal care, but extend to the hospital, prepartum, delivery and postpartum areas”. Therefore, health professionals must be present and know the social context of the mother and family, clarifying their doubts, fears and expectations, as well as demystifying beliefs and myths consolidated by society that negatively impact the duration of breastfeeding [35].
The study by Ferreira, Gomes and Fracolli was carried out precisely with the aim of identifying the guidelines that women received during pregnancy. Similar results to the present study were observed, so that the most prevalent orientation reported was on “importance of breastfeeding” with 88.3%, and “duration of exclusive breastfeeding for six months” with 79.2% [16 ].
Over the years, it has become evident how much breastfeeding has contributed to the reduction of infant mortality. According to research carried out in Brazil, in 14 municipalities in the state of São Paulo, the percentage of influence of breastfeeding on the reduction of infant mortality was 9.8%. The reasons for the reduction of this situation are the potential that human milk has in protecting and fighting diseases, such as diarrhea that threatens more than three non-breastfed children, leading to dehydration and consequently death. In cases of diseases caused by respiratory infections, the positive effects are clear in the reduction of occurrences in babies who receive maternal milk, due to the high availability of iron, in addition to reducing the risk of developing allergies to cow's milk protein, asthma and even atopic dermatitis and ear infections [7, 11].
Breastfeeding also allows other positive aspects about the health and evolution of infants, such as development of the oral cavity through suction, organizing the bones and strengthening the musculature, which provides correct dental disposition, chewing, breathing and swallowing, as well as joint articulation. of speech sounds [16].
The benefits are not limited to childhood, in the current literature there are indications that nutritional and metabolic conditions in the early stages of the human organism's development can reflect throughout life, a process called metabolic programming (programming). Thus, breastfeeding in the early stages of life is related to the prevention and reduction of the risks of chronic non-communicable diseases, such as obesity [38].
The advantages that breastfeeding provides to the neurological system and to the development of cognition lead to higher levels of intelligence. The mechanisms that involve this association between breastfeeding and the baby's intellectual development have not yet been clearly elucidated, but it is believed that it is a behavioral issue and due to the presence of substances in breast milk that make up the central nervous system, such as fatty acids. polyunsaturated, taurine and galactose, capable of impacting the intellective capacity [7, 11, 33,41].
On the other hand, despite the many benefits reported on breastfeeding, it was observed that there are benefits little known by mothers. The benefits best known by most lactating women in the present study (97.6%) were “protects the baby against infections, diarrhea and allergies”, “strengthens the mother-child bond” and “reduces the mother's weight”. The lesser known benefits are “reduces malformations in the baby’s dentition” (56.1%), “increased the baby’s intelligence” (53.7%) and “reduces the risk of bone fractures in the mother” (19.5%).
Breastfeeding may be related to the physical and emotional health of the lactating woman during the lactation period, in addition to promoting several health benefits, such as uterine involution and reduction of postpartum bleeding. Breastfeeding also favors the return of pre-gestational weight, promoting greater self-esteem and satisfaction with body image and the effect against fractures due to this lactation period increasing intestinal and renal calcium absorption [13, 40]. The benefits of breastfeeding for women's health during the breastfeeding period are of great importance, but they are rarely mentioned in recent studies. In the present study, in relation to the benefits of breastfeeding for the lactating woman, 97.6% reported knowing that it reduces the mother's weight, 68.3% reported knowing that it reduces the risk of breast and ovarian cancer and 19.5% reported knowing that it reduces the risk of breast and ovarian cancer. know that it reduces the risk of bone fractures in the mother [23].
Among the motivations that lead the lactating woman to breastfeed, the influence of the family can be highlighted, with its traditions and conceptions passed from generation to generation about this practice. Myths and beliefs existing in society can provoke some thoughts and feelings of incapacity, fear, anxiety and even guilt [18].
In view of this reflection, a study identified that these assertions are directly related to the supply of other types of milk, bottles, pacifiers and explain the early introduction of food and even early weaning [22].
Lahós, Pretto and Pastore et al. [19] identified that 66.7% of the mothers interviewed had already heard about the myth “weak milk”, but that only 35.9% actually believed in this myth. These results are in agreement with the findings of the present study, in which 14.6% of the mothers believe that there is weak milk and 19.5% that the milk does not support it.
According to a study by Borges and Philippi [6], which aimed to identify maternal knowledge about milk production, it was found that 82.9% of mothers believed in the existence of insufficient milk production. Comparing these results to those of the present study, the numbers are not similar, considering that only 43.9% of nursing mothers in our sample have the same belief. Therefore, it is essential that lactating women are well oriented by health teams on issues relevant to breastfeeding, as it contributes to the demystification of beliefs, myths and taboos that can compromise the duration of breastfeeding.
The prevalence of breast complications varies from 11 to 96% in women who breastfeed during the first week after delivery. Silva et al. [35] state that about 30% of lactating women have difficulties in breastfeeding due to cracked nipples, breast pain, tiredness and also because of problems with milk production. These data coincide with those of the present study, in which 39.0% of the mothers interviewed reported having bruised breasts, 39.0% cobbled milk and 36.6% had pain when breastfeeding.
The difficulties encountered during breastfeeding are considered important causes for weaning. In the present study, we found that 4.8% of mothers point out that breast problems and persistent pain when breastfeeding are reasons for weaning the baby [18].
Therefore, the correct practice of breastfeeding becomes a fundamental factor for achieving the adequate duration of breastfeeding and preventing breast complications. Among the guidelines, it should be prioritized that the child has his/her body close and facing the mother, the head and body aligned, with the mouth at breast height and in front of the areola1.