Neighborhood social capital and exclusive breastfeeding duration: a multilevel survival analysis in Brazil
Exclusive breastfeeding for the first six months of life would prevent substantial morbidity and mortality in children. Exclusive breastfeeding duration varies widely within and between cities suggesting that social contextual factors such as social capital may shape exclusive breastfeeding practices. Objective: we examined the association of neighborhood social capital with exclusive breastfeeding duration.
METHODS:
A prospective cohort study of mothers recruited from all the public prenatal care units in two middle size cities in Rio de Janeiro State, Southern Brazil (2008-2010), were followed to 6 months post-partum (n=1318). Random effects Cox survival models were employed to quantify the relations of neighborhood social capital and individual perception of social capital with exclusive breastfeeding duration.
RESULTS:
The median duration of exclusive breastfeeding was of 90 days, and the prevalence at six months was 10%. Low neighborhood social capital was associated with increased risk of exclusive breastfeeding cessation (RR=1.19 for a 1 standard deviation difference, 95%CI=1.04-1.36), adjusting for individual perception of social capital, socioeconomic status, and skin color/race.
CONCLUSIONS:
The results suggest that social capital in the community increases exclusive breastfeeding duration, and that exclusive breastfeeding promotion that targets neighborhood level social capital may be effective.