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Breastfeeding Promotion and Support Policies in Brazil
Claudio M A O Lima,Waldyr Maymone 대한소아소화기영양학회 2019 Pediatric gastroenterology, hepatology & nutrition Vol.22 No.4
To the Editor: In a recent publication in Pediatric Gastroenterology, Hepatology & Nutrition, Basrowi et al. [1] made several comments on the importance of breastfeeding in the workplace for female workers in Indonesia. In the discussion, the breastfeeding policy and support for workers in Indonesia were mentioned, noting the policies adopted in the United States of America, the United Kingdom, Scandinavia, and Asian countries. Being the largest country in South America, both geographically and politically, and recognized worldwide as an exemplar for breastfeeding, Brazil has achieved prominence in this area, and I therefore wish to add some comments. In issue No. 408, the French magazine La Santé de l'homme (Human health), edited by the National Institution for Prevention and Health Education in France, reported on the experience of the Brazilian government in the management of breastfeeding public policies. Brazil has the largest and most complex network of milk banks in the world, with 221 units and 186 collection points. Between 2009 and 2016, the Brazilian Network of Human Milk Banks benefited more than 1.8 million newborns and had support from 1.3 million donors, reducing child mortality by more than 70% and representing an economy of R$180 million. The profile of the Brazilian family changed during the 1980s, when the number of families headed by women almost doubled. As a result, there was a significant increase in the participation of women in the labor market, contributing directly or indirectly to the composition of family income and being forced to assume a triple life: mother, housewife, and salaried worker [2]. Many women are unable to successfully adapt to this triple life, leading to an interruption in breastfeeding. Women with greater purchasing power and more education tend to have few difficulties in reconciling breastfeeding with a return to work because they rely on private service assistance for the baby and the household. On the other hand, Brazilian women with less schooling and low purchasing power face more obstacles in adapting the life of a mother to that of work. Regardless of maternal labor, another aspect that has relevance in the early weaning process is the number of hours worked. Weaning rates are higher when work is over 20 hours per week. In 2013, Valduga [3] observed in a study with ten mothers that the relationship with employment was one of the reasons for weaning. Of the ten participants, eight had formal paid work and soon after the end of maternity leave were already introducing supplements to their children. In 2008, according to a study by Damião et al. [4] in Rio de Janeiro, the frequency of exclusive breastfeeding in non-working women was double than that of mothers who were salaried employees [5, 6]. Brazilian legislation has a postpartum leave of up to four months and two half-hour intervals during working hours or the option to leave one hour early so that the mother can breastfeed her baby until she is six months old. When the child’s health requires, the period of six months may be extended at the discretion of the competent authority. Even so, the right to maternity leave of 120 days is considered insufficient time to promote the practice of exclusive breastfeeding, which should be six months, a factor detrimental to the continuity of breastfeeding [5, 6]. In 2008, a law created the Citizen Company Program, which, through the granting of a tax incentive, encourages companies to increase the duration of maternity leave to six months. In 2010, the Brazilian Ministry of Health, together with the National Health Surveillance Agency, regulated the implementation of breastfeeding support rooms in companies through a technical note aimed at women workers to comply with the recommendation of exclusive breastfeeding up to the first six months and supplemented up to two years or more. Also in 2010, the Ministry of Health developed the “Supporting Working Women and Breastfee...
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