Breasffeeding Patterns in Puerto Rico JOSE E. BECERRA, MD, MPH,
AND
JACK C. SMITH, MS
Abstract: In the 1950s, Puerto Rico began an active industrialization program. We used data from the 1982 Puerto Rico Fertility and Family Planning Assessment to describe the trend in the incidence of breastfeeding in Puerto Rico over time and to ascertain some of its determinants. From 1946 through 1982, 5,884 infants were born among this statistically representative sample of reproductiveaged women. The proportion of infants who had ever been breastfed was 59 percent for births before 1960 (mean duration = 7.8 months), dropped to 25 percent for infants born from 1970 to 1974 (mean duration = 4.9), and rose to 38 percent for births delivered from 1980
to 1982 (mean duration = 3.4). Prior breastfeeding experience was an important determinant of breastfeeding a newborn. Infants of mothers who had breastfed a previous baby were 7.3 times more likely to be breastfed (95% confidence interval = 6.6, 8.0) compared with infants of mothers who had not previously breastfed. The 38 percent of infants who were breastfed in Puerto Rico in the early 1980s is below the 74 percent to 97 percent reported in Latin America and below the 54 percent reported in the United States for the same period. This study provides baseline data for any future intervention strategies. (Am J Public Health 1990; 80:694-697.)
Introduction A resurgence in the practice of breastfeeding has occurred throughout the world.' In the United States the downward trend in breastfeeding practice has been reversed since the late 1970s.2 Breastfeeding trends vary in less developed countries, and three basic phases of progression have been described.' The traditional phase is characterized by a high proportion of breastfed infants and a long duration of breastfeeding. In the transformation phase, both the proportion of breastfed infants and the duration of breastfeeding show a decrease. The third, or resurgent phase, is characterized by an increase in both the proportion of breastfed infants and the duration of breastfeeding. The patterns of these trends are not uniform in any country; they vary by geography and by the socioeconomic status of different groups. The relation between the economic development initiated in Puerto Rico in the 1950s and breastfeeding practices among Puerto Ricans has not been studied before. The present study does so, using data from a 1982 survey.
regular basis?" Of the 2,012 mothers queried, only one mother could not provide a response to any of these questions. The total number of live births among the women in the sample was 5,884, all delivered between 1946 through 1982. For our analysis, we divided the study period into six birth delivery periods: 1946-59 (N = 709); 1960-64 (N = 924); 1965-69 (N = 1,135); 1970-74 (N = 1,239); 1975-79 (N = 1,207); and 1980-82 (N = 640). We were unable to determine the year of birth for 30 (0.5 percent) infants. Given the blurred distinction between rural and urban areas in Puerto Rico throughout the study period, the place where the delivery occurred (home, private hospital, and public hospital) was used instead of geographical (urban vs rural) correlates. We used SESSUDAN,4 a standard errors program, to compute standardized rates from sample survey data and to produce weighed estimates with 95% confidence intervals. We then calculated the proportion of infants who were ever breastfed and the proportion of infants who were exclusively breastfed for at least the first month of life for each birth delivery period stratified by place of delivery (home, private hospital, and private hospital) and by years of maternal education (15) reported at the time of the interview (1982). We also used the life table analysis program in BMDP5 to calculate the mean duration of breastfeeding for each birth delivery period and for the three categories of maternal education for births occurring between 1975 and 1982. Infants of mothers still breastfeeding at the time of the interview and infants who had died while still breastfeeding were considered (statistically) censored observations. We also used SAS6 to calculate the breastfeeding percent ratio of multiparous mothers with and without previous breastfeeding experience, adjusted for years of maternal education and birth delivery period. In addition, we used the logistic regression program in BMDPF to simultaneously determine the strength of association (measured by the odds ratio [OR]) between the infant's breastfeeding status (ever breastfed or not) and maternal age in years (
AND
JACK C. SMITH, MS
Abstract: In the 1950s, Puerto Rico began an active industrialization program. We used data from the 1982 Puerto Rico Fertility and Family Planning Assessment to describe the trend in the incidence of breastfeeding in Puerto Rico over time and to ascertain some of its determinants. From 1946 through 1982, 5,884 infants were born among this statistically representative sample of reproductiveaged women. The proportion of infants who had ever been breastfed was 59 percent for births before 1960 (mean duration = 7.8 months), dropped to 25 percent for infants born from 1970 to 1974 (mean duration = 4.9), and rose to 38 percent for births delivered from 1980
to 1982 (mean duration = 3.4). Prior breastfeeding experience was an important determinant of breastfeeding a newborn. Infants of mothers who had breastfed a previous baby were 7.3 times more likely to be breastfed (95% confidence interval = 6.6, 8.0) compared with infants of mothers who had not previously breastfed. The 38 percent of infants who were breastfed in Puerto Rico in the early 1980s is below the 74 percent to 97 percent reported in Latin America and below the 54 percent reported in the United States for the same period. This study provides baseline data for any future intervention strategies. (Am J Public Health 1990; 80:694-697.)
Introduction A resurgence in the practice of breastfeeding has occurred throughout the world.' In the United States the downward trend in breastfeeding practice has been reversed since the late 1970s.2 Breastfeeding trends vary in less developed countries, and three basic phases of progression have been described.' The traditional phase is characterized by a high proportion of breastfed infants and a long duration of breastfeeding. In the transformation phase, both the proportion of breastfed infants and the duration of breastfeeding show a decrease. The third, or resurgent phase, is characterized by an increase in both the proportion of breastfed infants and the duration of breastfeeding. The patterns of these trends are not uniform in any country; they vary by geography and by the socioeconomic status of different groups. The relation between the economic development initiated in Puerto Rico in the 1950s and breastfeeding practices among Puerto Ricans has not been studied before. The present study does so, using data from a 1982 survey.
regular basis?" Of the 2,012 mothers queried, only one mother could not provide a response to any of these questions. The total number of live births among the women in the sample was 5,884, all delivered between 1946 through 1982. For our analysis, we divided the study period into six birth delivery periods: 1946-59 (N = 709); 1960-64 (N = 924); 1965-69 (N = 1,135); 1970-74 (N = 1,239); 1975-79 (N = 1,207); and 1980-82 (N = 640). We were unable to determine the year of birth for 30 (0.5 percent) infants. Given the blurred distinction between rural and urban areas in Puerto Rico throughout the study period, the place where the delivery occurred (home, private hospital, and public hospital) was used instead of geographical (urban vs rural) correlates. We used SESSUDAN,4 a standard errors program, to compute standardized rates from sample survey data and to produce weighed estimates with 95% confidence intervals. We then calculated the proportion of infants who were ever breastfed and the proportion of infants who were exclusively breastfed for at least the first month of life for each birth delivery period stratified by place of delivery (home, private hospital, and private hospital) and by years of maternal education (15) reported at the time of the interview (1982). We also used the life table analysis program in BMDP5 to calculate the mean duration of breastfeeding for each birth delivery period and for the three categories of maternal education for births occurring between 1975 and 1982. Infants of mothers still breastfeeding at the time of the interview and infants who had died while still breastfeeding were considered (statistically) censored observations. We also used SAS6 to calculate the breastfeeding percent ratio of multiparous mothers with and without previous breastfeeding experience, adjusted for years of maternal education and birth delivery period. In addition, we used the logistic regression program in BMDPF to simultaneously determine the strength of association (measured by the odds ratio [OR]) between the infant's breastfeeding status (ever breastfed or not) and maternal age in years (
