Acta Pñ diatr 90: 544± 551.

2001

Premature cessation of breastfeeding in infants: development and

evaluation of a predictive model in two Argentinian cohorts: the
CLACYD study*, 1993–1999
S Berra1 , L Rajmil2 , R Passamonte1 , E Fernandez3 and J Sabulsky1
Escuela de Nutrición1 , Universida d Nacional de Córdoba, Argentina, Agència d’Avaluació de Tecnologia i Recerca Mèdiques2 ,
Barcelona, Spain; Institut Català d’Oncologia3 , L’Hospitalet, Barcelona, Spain

Berra S, Rajmil L, Passamonte R, Fernandez E, Sabulsky J. Premature cessation of breastfeeding

in infants: development and evaluation of a predictive model in two Argentinian cohorts: the
CLACYD study, 1993–1999. Acta Pædiatr 2001; 90: 544–551. Stockholm. ISSN 0803-5253
The objective of this study was to develop a model to predict premature cessation of breastfeeding
of newborns, in order to detect at-risk groups that would beneŽ t from special assistance
programmes. The model was constructed using 700 children with a birthweight of 2000 g or more,
in 2 representative cohorts in 1993 and 1995 (CLACYD I sample) in Córdoba, Argentina. Data
were analysed from 632 of the cases. Mothers were selected during hospital admittance for
childbirth and interviewed in their homes at 1 mo and 6 mo. To evaluate the model, an additional
sample with similar characteristics was drawn during 1998 (CLACYD II sample). A questionnaire
was administered to 347 mothers during the Ž rst 24–48 h after birth and a follow-up was
completed at 6 mo, with weaning information on 291 cases. Premature cessation of breastfeeding
was considered when it occurred prior to 6 mo. A logistic regression model was Ž tted to predict
premature end of breastfeeding, and was applied to the CLACYD II sample. The calibration
(Hosmer–Lemeshow C statistic) and the discrimination [area under the receiver operating charac-
teristics (ROC) curve] of the model were evaluated. The predictive factors of premature end of
breastfeeding were: mother breastfed for less than 6 mo [odds ratio (OR) = 1.84, 95% conŽ dence
interval (CI) 1.26–2.70], breastfeeding of previous child for less than 6 mo (OR = 4.01, 95% CI
2.58–6.20), the condition of the Ž rstborn child (OR = 2.75, 95% CI 1.79–4.21), the Ž rst mother–
child contact occurring after 90 min of life (OR = 1.88; 95% CI 1.22–2.91) and having an
unplanned pregnancy (OR = 1.50, 95% CI 1.05–2.15). The calibration of the model was acceptable
in the CLACYD I sample (p = 0.54), as well as in the CLACYD II sample (p = 0.18). The areas
under the ROC curve were 0.72 and 0.68, respectively.
Conclusion: A model has been suggested that provides some insight onto background factors for
the premature end of breastfeeding. Although some limitations prevent its general use at a
population level, it may be a useful tool in the identiŽ cation of women with a high probability of
early weaning.
Key words: Breastfeeding, cohort study, infant, lactation, predictive model
L Rajmil, Agència d’Avaluació de Tecnologia i Recerca Mèdiques, Pavelló Ave Maria, Trav. de
les Corts 131-159, ES-08028 Barcelona, Spain (Tel. ‡34 93 2272900, fax. ‡34 93 2272998,
e-mail. lrajmil@olimpia.scs.es)

There is no doubt that maternal milk should be the only
nourishment that children receive during the Ž rst
months of life (1). Nevertheless, the majority of women
stop breastfeeding their children early, and the use of
non-human milk in the feeding of infants continues to
be a major public health problem (2), since it is
associated with higher morbidity and mortality rates
(3, 4).
The production of milk, and the maintenance and
* CLACYD study: Córdoba Lactation, Feeding, Growth and Devel-
opment study.
duration of the speciŽ c feeding of each species are
regulated by physiological mechanisms and common
behaviours in mammals (5). In humans, however,
breastfeeding habits are determined in every age and
culture by a combination of multiple factors (6),
including the attitude of the mother and familial and
social support (7), institutional medical care (8),
professional health advice (9), commercialization stra-
tegies targeting women and children (10), and health
legislation and governmental policies (11).
The planning of preventive measures to protect
against premature cessation of breastfeeding requires
diagnosis with a multidimensional focus, permitting the

Ó 2001 Taylor & Francis. ISSN 0803-525 3

ACTA PÆDIATR 90 (2001)
capture of all associated factors. The gestation–birth–
puerperium process provides an ideal opportunity to
implement promotion and prevention strategies in the
area of institutional childbirth assistance (12). The
targeting of high-risk groups for breastfeeding support
activities is a strategy to be developed further; in
particular, groups at risk of premature end of breast-
feeding are poorly identiŽ ed, partly because of the lack
of adequate instruments to predict early weaning.
The Córdoba Lactation, Feeding, Growth and Devel-
opment (CLACYD) study was a representative cohort
study of children born in the city of Córdoba, Argentina.
In this population 98% of mothers began breastfeeding
in 1993, while at 30 d and 6 mo, only 76% and 32%,
respectively, of these mothers continued with partial or
complete breastfeeding (13, 14).
The aim of this study was to develop a model to
predict cessation of breastfeeding before 6 mo in
newborns, and to evaluate its performance in a further
large cohort. The study was based on the hypothesis that
the length of breastfeeding is associated with demo-
graphic, social and cultural phenomena, as well as the
institutional process of birth and puerperium. Thus, an
adequate combination of variables of these dimensions
would provide acceptable levels of prediction.
Methods
Data from the CLACYD I study, carried out in 1993 and
1995, were used to construct a model that could be used
to predict premature cessation of breastfeeding. The
model’s predictive capacity was evaluated in a later
study, the CLACYD II, conducted in 1998.
Sample selection
Data for the construction of the model to predict
premature end of breastfeeding came from the follow-
up carried out on 2 samples of women and their
children, called CLACYD I. The Ž rst sample was
selected in 1993 and consisted of 654 children with a
birthweight ¶2500 g, who were born in any of the urban
institutions with obstetric services (public, social
services and private) during May 1993. The second
sample, collected between June and August 1995, was
derived exclusively from children with a low birth-
weight (<2500 g). In both samples, families living
outside the urban area, multiple births (2 or more) and
children with major congenital anomalies were ex-
cluded. Of the total of 167 children of the low
birthweight sample, 46 were randomly selected to be
added to the sample for analysis of duration of
breastfeeding, and for the construction of the instru-
ments for prediction of premature cessation of breast-
feeding. Thus, the sample included 700 children, of
whom 6.6% were children of low birthweight (2000–
2499 g). This proportion of low birthweight births was
similar to that of the city of Córdoba in 1993. Five cases
Predictive model of premature cessation of breastfeedin g 545
were excluded because of a lack of information
regarding breastfeeding, 15 were excluded because
breastfeeding was not initiated, and 48 cases were lost
before 6 mo and therefore the age at which breastfeed-
ing was stopped was unknown. The data analysed
corresponded to 632 mother–child observation units.
The mothers were selected during their admission to
hospital, immediately after birth, for inclusion in the
study. After informed consent was obtained, mothers
were interviewed in their homes at 1 and 6 mo from
baseline at birth. The collection of data was carried out
using structured questionnaires administered by trained
healthcare professionals and students.
To evaluate the model, a new sample, CLACYD II,
was selected using the same inclusion and exclusion
criteria as in the previous sample. The sample was
gathered from the registry of 475 births during
November 1998. Of the initial sample, 128 were
excluded (29 cases were discharged within 24 h post-
partum; 79 cases were resident outside the metropolitan
area, had birthweight <2000 g, were stillbirths or
multiple births, or the mother was in an intensive care
unit; and 20 cases refused to participate in the study).
Thus, 347 pairs were included in the Ž nal sample.
In an interview conducted 24–48 h postpartum, a
questionnaire was administered containing the variables
from the model designed in the previous sample. At 6
mo after the birth, a home interview was conducted to
gather information on weaning, which obtained re-
sponses of 84% (291 interviews) of the initial sample.
Variables analysed
A child was considered to be breastfed when it received
maternal milk, regardless of the introduction or non-
introduction of additional feeding (15). In the analysis,
the dependent variable was the age at which cessation of
breastfeeding occurred, registered as the number of
months of life at the time of the last feeding. Premature
end was considered to be a last breastfeeding before 6
mo of age. The variable was recoded as dichotomous for
analysis (cessation of breastfeeding before 6 mo: yes/
no).
To analyse factors associated with premature cessa-
tion of breastfeeding, the following variables were
incorporated.
Sociodemographi c and cultural factors.. These factors
comprised: maternal and paternal age; maternal age at
birth of Ž rst child; maternal education level (non-
completed primary education or less/completed primary
education or more); marital status of the mother (single
or separated/married or in a stable union); family
composition (nuclear/extended or monoparental); pri-
mary breadwinner (mother/other person responsible);
living conditions (good or normal/bad, using housing
and environmental hygiene indicators) (13); overcrowd-
ing index (the relation between the number of indivi-
546 S Berra et al.
duals in the home and the number of rooms in the home,
excluding bathrooms, kitchen, hallways and garage);
mother’s work before pregnancy (yes/no); mother’s
work during pregnancy (yes/no); health coverage with a
health insurance company (yes/no); birth order of the
child (Ž rst/second or more); intergenerational interval
from the previous child (in months); institution where
the birth occurred (public/private); smoking before and
during pregnancy (yes/no); and pregnancy planning
(planned/unplanned). Social strata were deŽ ned using
the occupation of the principal breadwinner, taking into
account the activity, occupational categories, job func-
tions, and the sector and branch of activity. Initially, 45
socioeconomic positions were created, which were later
regrouped into 6 socioeconomic strata (SES) and
recoded for analysis as upper–middle SES and lower–
very low SES (13).
Perinatal factors.. These factors were: sex; birthweight
(2000–2499 g/¶2500 g); gestational age (<38 wk/¶
38 wk); APGAR 1 min (<7/¶7); history of abortion
(yes/no); history of caesarean section (yes/no); history
of children born with low birthweight (yes/no); begin-
ning of pregnancy care (Ž rst trimester/second trimester
or third trimester); weight gain during the pregnancy
(in kg); duration of labour (in hours); type of birth
(vaginal/caesarean); rooming in maternity ward (room-
ing-in/nursery or intensive care unit); time passed
between birth and Ž rst contact between mother and
child (µ90 min/>90 min); and Ž rst food received
(maternal milk/other food).
Breastfeeding antecedents.. These comprised: history of
breastfeeding of previous child (¶6 mo/no previous
children/<6 mo), mother having been breastfed (does
not remember or ¶6 mo/<6 mo). The last variable was
recoded, as the risk of premature cessation of breast-
feeding was similar in the group that did not remember
and in the basal group that was breastfed for 6 mo or
longer. The model has improved with this approach.
Statistical analysis
A logistic regression model (16) was constructed with
data from the CLACYD I sample to predict premature
weaning, whilst controlling for the simultaneous effect
of sociodemographic and perinatal factors, and incor-
porating those variables that were statistically signiŽ -
cant in the bivariate analysis (at the 5% level), as well as
those that were considered to be of interest (e.g. SES,
pregnancy planning).
After Ž tting the best model (in terms of goodness-of-
Ž t and explanatory variables), the probabilities of
premature end of breastfeeding were calculated for
each case using the combination of factors included in
the Ž nal model, given p = 1/1 ‡ exp¡z . The calibration
of the model was evaluated using the Hosmer–Leme-
show C statistic (17). The Hosmer–Lemeshow C
ACTA PÆDIATR 90 (2001)
statistic estimates the degree of correspondence be-
tween the probability of premature cessation of breast-
feeding estimated by the model, and premature end of
breastfeeding observed in the sample, grouped by
deciles of risk. The model’s ability to discriminate
was analysed by calculating the area under the receiver
operating characteristics (ROC) curve (18). The ROC
curve represents the proportion of pairs in which the
weaned children have a greater probability of premature
cessation than the children who continued breastfeed-
ing, for all possible pairs formed by 1 child from the
sample being breastfed and 1 who was not breastfeeding
at the age of 6 mo.
The constructed model was then evaluated in the
CLACYD II sample using the coefŽ cients obtained with
the CLACYD I sample. The above-mentioned calibra-
tion and discrimination tests were repeated. To improve
the calibration of the model, it was adapted using a
linear logit transformation, taking the logit [ln(p/1 ¡ p)]
of the probability of premature weaning (p) obtained in
the original model as the independent variable. Once the
model had been adjusted, its calibration was evaluated
again.
Results
The CLACYD I and CLACYD II samples were similar
in their sociodemographic and cultural characteristics,
and in antecedents of breastfeeding (Table 1). However,
statistically signiŽ cant differences were found between
CLACYD I and CLACYD II samples in the perinatal
variables, which showed a lower percentage of births by
caesarean section, as well as of delay in the Ž rst
mother–child contact, of administration of artiŽ cial
milk or glucose syrup as Ž rst food, and of lodging of the
child separately from the mother. The proportion of
cessation of breastfeeding at 6 mo was 13% points
lower in the CLACYD II sample (p < 0.05).
In the bivariate analysis of the CLACYD I sample,
the proportion of duration of lactation less than 6 mo
was greater in women who had completed primary
education or more, and in those who not living with a
partner or other family members. Premature cessation
was also more frequent among women who worked
during pregnancy, in those who had been breastfed less
than 6 mo, in those who had breastfed their previous
child for less than 6 mo and in those who had their Ž rst
contact with their child or gave them their Ž rst feeding
at more than 90 min after birth (Table 2). The
proportion of premature cessation was also greater,
although not statistically signiŽ cant, in those children
who received artiŽ cial milk or glucose syrup as their
Ž rst nourishment and in those who did not remain with
their mothers after birth.
The predictive factors of cessation of breastfeeding
before 6 mo (Table 3) which were statistically
signiŽ cant in the Ž nal model were: mother having been
ACTA PÆDIATR 90 (2001) Predictive model of premature cessation of breastfeedin g 547

Table 1. Characteristic s of CLACYD I and CLACYD II samples

CLACYD I (%) CLACYD II (%)

Characteristic (n = 632) (n = 291)
Sociodemographic
Sex of child: female 51.1 46.7
Maternal age: <18 y 6.6 7.2
Maternal education: primary education incomplete or less 11.1 7.2
Family composition: nuclear family 58.5 61.9
Birth order: Ž rst child 37.0 41.2
Socioeconomi c stratum: lower–very low 49.8 50.2
Pregnancy planning: unplanned 61.9 62.2
Mother working during pregnancy 37.3 40.0
Institution where birth occurred: public 47.0 47.8
Perinatal
Type of birth: caesarean sectiona 31.7 35.7
Time between birth and Ž rst mother–child contact: >90 mina 81.2 57.0
First feeding: maternal milka 45.0 52.9
Rooming in maternity ward: rooming-ina 63.8 74.9
Breastfeeding antecedents
Mother having been breastfed: <6 mo 32.8 31.3
Breastfeeding of previous child: <6 mo 33.7 32.1
Duration of lactation: <6 moa 59.8 46.7
a
w2 -test, p < 0.05.

breastfed for less than 6 mo [odds ratio (OR) = 1.84], (OR = 2.75), the Ž rst mother–child contact occurring
previous child being breastfed for less than 6 mo after 90 min of life (OR = 1.88) and having an un-
(OR = 4.01), the condition of the Ž rstborn child planned pregnancy (OR = 1.50).

Table 2. Variables associate d with end of breastfeedin g before 6 mo of life (CLACYD I)

Cessation of breastfeeding (%)

Variable n Before 6 mo 6 mo or more pa
Maternal education
Primary education incomplete or less 70 47.1 52.9 0.02
Primary education or more completed 562 61.4 38.6
Family composition
Nuclear 370 55.7 44.3 0.01
Single mother or extended family 262 65.6 34.4
Mother worked during pregnancy
No 388 56.4 43.6 0.04
Yes 233 68.4 56.4
Type of birth
Vaginal 194 57.2 42.8 0.05
Caesarean section 437 65.5 34.5
Rooming in maternity ward
Rooming-in 400 57.5 42.5 0.09
Nursery or other 227 64.3 35.7
First mother–child contact
<90 min 119 49.6 50.4 0.01
¶90 min 513 62.2 37.8
First breastfeeding
<90 min 78 48.7 51.3 0.03
¶90 min 535 61.9 48.7
First feeding
Maternal milk 262 56.5 43.5 0.07
Other (artiŽ cial milk or syrup) 320 63.8 36.3
Mother having been breastfed
¶6 mo/does not know 416 55.3 44.7 <0.01
<6 mo 203 70.0 30.0
Breastfeeding of previous child
¶6 mo 181 41.4 58.6 <0.01
No previous children 235 63.0 37.0
<6 mo 211 72.0 28.0
a
w2 -test.
548 S Berra et al. ACTA PÆDIATR 90 (2001)

Table 3. Multiple logistic regression model for predictio n of had a greater probability of cessation of breastfeeding
premature end of breastfeedin g (CLACYD I) than those who did.
Variables OR 95% CI
When the model was applied to the CLACYD II
sample, the area under the ROC curve was 0.68 and the
Breastfeeding of previous child
¶6 mo 1a calibration showed an overestimation of weaning above
No previous child 2.75 1.79–4.21 values of 0.567 (C = 31.9; p = 0.0005) (Table 4B). After
<6 mo 4.01 2.58–6.20 the model was adapted using the logit transformation
Mother having been breastfed (Table 4C), the calibration improved, so that the
¶6 mo/does not remember 1a
<6 mo 1.84 1.26–2.70
difference between expected and observed cessation
First mother–child contact of breastfeeding was not signiŽ cant (C = 11.4; p =
<90 min 1a 0.18).
¶90 min 1.88 1.22–2.91
Pregnancy planning
Planned 1a
Unplanned 1.50 1.05–2.15 Discussion
a Reference category. This is the Ž rst study to examine the possibility of
OR: odds ratio; CI: conŽ dence interval. predicting premature cessation of breastfeeding in
newborns, in which both the initial model development
and the evaluation of the model were performed in
prospective cohorts of newborns. Although this type of
Figure 1 shows the probabilities of premature evaluation is recommended (17) few studies actually
cessation of breastfeeding for each combination of have used it. In addition to conforming with a necessary
factors analysed, calculated with the coefŽ cients ob- methodological exercise, the results may be of practical
tained with the logistic regression model. For example, use. The study design thereby avoided some of the risks
a Ž rst child born to a mother who had been breastfed for associated with cross-sectional and retrospective stu-
less than 6 mo, with a Ž rst contact with his or her mother dies, such as directionality of association (19).
after 90 min of life and the product of an unplanned The study identiŽ ed 4 factors associated with early
pregnancy, has a 0.787 probability of cessation of weaning: mother having been breastfed for only a short
breastfeeding before 6 mo. period, reduced breastfeeding of the previous child,
The model’s calibration was acceptable (C = 6.94; excessive time between birth and Ž rst mother–child
p = 0.54). Some differences were seen between ex- contact, and absence of pregnancy planning. The
pected and observed premature cessation of breastfeed- presence of these 4 factors in a single case implies a
ing for probabilities greater than 0.51 and less than 0.74 probability of cessation of breastfeeding before 6 mo
(Table 4A). The ROC curve showed that in 72% of the which is 4 times higher than in those mothers with
pairs, mothers who did not breastfeed for at least 6 mo previous experience of breastfeeding 6 mo or longer,

Fig. 1. Predictive model of premature cessation of breastfeeding .

ACTA PÆDIATR 90 (2001) Predictive model of premature cessation of breastfeedin g 549

Table 4. Breastfeeding and cessation of lactation observed and expected by the model, at 6 mo of age

Stop breastfeeding <6 mo Stop breastfeeding ¶6 mo

Probability of premature cessation of breastfeeding Observed Expected Observed Expected
(A) In CLACYD I sample
µ0.415 21 20.4 43 43.6
>0.415–0.421 38 37.5 51 51.5
>0.421–0.515 21 20.4 20 20.6
>0.515–0.572 37 34.3 23 25.7
>0.572–0.660 47 52.6 37 31.4
>0.660–0.667 32 38.0 25 19.0
>0.667–0.711 30 27.0 8 11.0
>0.711–0.745 66 62.5 18 21.5
>0.745–0.787 45 44.8 12 12.2
>0.787–1.000 30 29.5 5 5.5
C = 6.94 (p = 0.54) a
(B) In CLACYD II sample (without adjustment )
µ0.327 5 8.0 25 22.0
>0.327–0.416 14 11.6 14 16.4
>0.416–0.473 8 10.7 17 14.3
>0.473–0.567 17 15.8 13 14.2
>0.567–0.574 9 16.0 19 12.0
>0.574–0.656 12 14.9 12 9.1
>0.656–0.667 17 26.6 23 13.4
>0.667–0.745 21 25.8 14 9.2
>0.745–0.787 11 14.9 8 4.1
>0.787–1.000 12 12.7 3 2.3
C = 31.922 (p = 0.0005)
(C) In CLACYD II sample (adjusted)
µ0.280 5 7.2 25 22.8
>0.280–0.340 14 9.5 14 18.5
>0.340–0.379 8 8.7 17 16.3
>0.379–0.446 17 12.5 13 17.5
>0.446–0.451 9 12.6 19 15.4
>0.451–0.515 12 11.7 12 12.3
>0.515–0.524 17 20.9 23 19.1
>0.524–0.592 21 20.5 14 14.5
>0.592–0.633 11 12.0 8 7.0
>0.633–1.000 12 10.4 3 4.6
C = 11.41 (p = 0.18)
a
Hosmer–Lemeshow C statistic.

whose pregnancy was planned and who had contact
with their children within 90 min after birth. Those
women who breastfed their previous child for 6 mo or
more never had a greater than 60% probability of
premature cessation of breastfeeding.
Few studies have addressed the association between
the duration of breastfeeding of the mother or of a
previous child with the duration of breastfeeding of a
new child (20). The in uence of the experience of
breastfeeding with a previous child is consistent in the
literature on this subject (7, 21), and may be representa-
tive of a difŽ culty in the previous breastfeeding that was
not resolved positively or of a negative predisposition
that in uenced the conduct of the mother. These factors
can be investigated beginning with the Ž rst obstetric visit
and can be addressed by the professional as well as by
birth and breastfeeding assistance and preparation
groups. Although breastfeeding of the previous child is
usually considered to be a “non-modiŽ able” factor, it is
also important to keep in mind that breastfeeding lasting
for longer than 6 mo has beneŽ cial effects on the
probability of breastfeeding the later siblings.
Birth and puerperium assistance practices have been
shown to in uence the duration of breastfeeding (22).
Nevertheless, the independent effect of a delay in Ž rst
contact has not been well deŽ ned (8). The strong
association found in this study deserves consideration.
This is the only variable included in the model
concerning the practices of healthcare services, with a
high prevalence in the present context and unjustiŽ ed
from the point of view of clinical practice (22).
The lower educational level of the mother, which
appears to be a protective factor against the premature
end of breastfeeding in developing countries (2, 23), did
not present an independent contribution to early
weaning in the present study. This may be associated
with a change in lactation patterns in the urban areas of
Argentina or, in other words, an intermediate result or
evidence of a transition towards the lactation standards
of developed countries.
550 S Berra et al.
Some limitations of the study deserve comment.
Some factors, related to the family and cultural
context, such as the opinion of the father and the
grandmothers regarding the feeding of the child and
the use of a paciŽ er, could not be used. They were
collected in the CLACYD I sample during the
interview conducted at the age of 1 mo, when the
maternal lactation pattern was already established, and
therefore the directionality of the association could
not be established. In the same way, the work of the
mother in the Ž rst months of life (24) and the
incorporation of artiŽ cial milks (25), which have been
shown to be associated with the duration of breast-
feeding, were not taken into account because they
occurred in phases after the birth. The association
between premature abandonment of complete breast-
feeding due to the incorporation of artiŽ cial food and
the shortening of the total period of breastfeeding are
well documented factors (26, 27). This should be the
subject of a speciŽ c study aimed at analysing the
factors associated with the introduction of non-
maternal milks.
The discrimination power of the model, evaluated
with the area under the ROC curve, would improve with
the inclusion of other potential indicator variables of
cessation at birth. In addition, the overestimation of
premature ending of breastfeeding that the model makes
with the CLACYD II sample can be partly explained by
the reduction in the prevalence of premature cessation
in relation to the earlier sample.
One variable that was not studied, although asso-
ciated in other studies with the duration of breastfeed-
ing, was the intention to breastfeed (7, 28). This might
be a useful factor in predicting cessation during the Ž rst
moments of lactation. It is possible that the history of
breastfeeding of both the mother and the previous child,
as well as the planning of the pregnancy, could be an
expression of the mother’s attitude and disposition
towards the future child as these relate to the decision to
breastfeed.
The rural population was not represented in this
study. Nevertheless, the model was constructed in a
representative sample of a city in South America, where
the population concentration in cities could be more
than 70%.
The presentation of a predictive model of premature
cessation of breastfeeding is a Ž rst step in the construc-
tion of new instruments which may allow action to be
taken against the risk of premature ending of breast-
feeding.
The construction of new models based on data
collected in different contexts and which cover the
wide spectrum of determinant factors of cessation of
breastfeeding will open the way to improved strategies
for the promotion of breastfeeding at birth. The
development of models that could be used during
pregnancy is also an interesting subject for future
studies.
ACTA PÆDIATR 90 (2001)
Acknowledgements.—The authors thank the families whose participation
made this project possible; institutions with obstetrics services for
allowing us access to mothers; professionals and students from Nutrition
and Medicine for their co-operation ; Montse Rue (Hospital de Sant Pau,
Barcelona) and Marõ´a del Pilar Dõ´az (Escuela de Nutrición, Universidad
Nacional de Córdoba) for their assistance with statistical methods; Michel
Herdman and Michelle Pollit for their help in preparing the manuscript;
Fabiana Pirán and the staff of the CLACYD study for their support of the
project. This study was supported by research grants from the Consejo de
Investigacione s Cientõ ´Ž cas y Tecnológicas de la Provincia de Córdoba
(CONICOR), Argentina, and Alberto J. Roemmers Foundation, Argen-
tina.
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Received Sep. 6, 2000; revision received Dec. 29, 2000; accepted
Jan. 23, 2001