title: Rates and determinants of exclusive breastfeeding in first 6 months among women in Nova Scotia: a population-based cohort study.
abstract: BACKGROUND
  Despite compelling evidence that exclusive breastfeeding for the first 6 months of life provides important health benefits to both mothers and their infants, most mothers do not follow this practice. We conducted a study to identify predictors of early cessation of exclusive breastfeeding (before 6 months after delivery).
  
  
  METHODS
  For this population-based longitudinal cohort study, we linked data from a perinatal database and a public health database for infants born between 2006 and 2009 in 2 regions in the province of Nova Scotia, Canada. The cohort was followed from the mother's first prenatal visit until her infant was 6 months old. Hazard ratios (HRs) for early cessation of exclusive breastfeeding were determined through Cox proportional hazards regression modelling.
  
  
  RESULTS
  Overall, 64.1% (2907/4533) of the mothers in the cohort initiated breastfeeding. Only 10.4% (413/3957) exclusively breastfed for the recommended 6 months. The largest drop in exclusive breastfeeding occurred within the first 6 weeks after birth. Among the mothers who initiated breastfeeding, significant predictors of early cessation of exclusive breastfeeding identified by multivariable modelling included less than high school education (HR 1.66, 95% confidence interval [CI] 1.35-2.04), lowest neighbourhood income quintile (HR 1.35, 95% CI 1.13-1.60), single motherhood (HR 1.24, 95% CI 1.10-1.41), prepregnancy obesity (HR 1.43, 95% CI 1.23-1.65), smoking throughout pregnancy (HR 1.39, 95% CI 1.21-1.60), no early breast contact by the infant (< 1 hour after birth) (HR 1.44, 95% CI 1.29-1.62) and no intention to breastfeed (HR 1.78, 95% CI 1.44-2.16).
  
  
  CONCLUSIONS
  We found that most predictors of early cessation of breastfeeding were intertwined with social determinants of health. However, we identified potentially modifiable risk factors. Providing opportunities for early breast contact by the infant and continued efforts in smoking cessation and obesity reduction may contribute to a longer duration of exclusive breastfeeding.
authors: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
authors: Catherine R L
authors: CR
authors: Brown
authors: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS ; Departments of Obstetrics and Gynecology and of Pediatrics, Dalhousie University, Halifax, NS.
authors: Linda
authors: L
authors: Dodds
authors: Reproductive Care Program of Nova Scotia, Halifax, NS.
authors: Rebecca
authors: R
authors: Attenborough
authors: School of Nursing, University of Prince Edward Island, Charlottetown, PEI.
authors: Janet
authors: J
authors: Bryanton
authors: Reproductive Care Program of Nova Scotia, Halifax, NS.
authors: Annette Elliott
authors: AE
authors: Rose
authors: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
authors: Gordon
authors: G
authors: Flowerdew
authors: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS.
authors: Donald
authors: D
authors: Langille
authors: Reproductive Care Program of Nova Scotia, Halifax, NS.
authors: Leeanne
authors: L
authors: Lauzon
authors: School of Nursing, McGill University, Montréal, Que.
authors: Sonia
authors: S
authors: Semenic