Determinantes sociais de saúde e a qualidade de vida na intenção de amamentar

Abstract

Social Determinants of Health (SDH) indicate the living and health conditions of a community, promoting comprehensiveness, equity, and highlighting pathways to reduce social inequities. Related to SDH, Quality of Life (QoL) is considered a predictor of health and well-being. The relationship between SDH and QoL regarding breastfeeding intention has been explored separately in the literature, making it difficult to understand the interrelationship between these constructs. Furthermore, the originality of this study lies in its focus on investigating breastfeeding intention rather than breastfeeding management. This study aimed to investigate the relationship between SDH and QoL in the breastfeeding intention of adolescent and young puerperal women. This was a cross-sectional, analytical, and correlational study conducted at a high-complexity maternity hospital within the Brazilian Unified Health System in Fortaleza, Ceará, Brazil. A total of 323 adolescents and young women aged 10 to 24 years admitted to a rooming-in care unit were included. The following instruments were applied: 1) sociodemographic, clinical, and obstetric questionnaire; 2) Social Determinants of Health in Schoolchildren Questionnaire (Q-DSSE); 3) Health-Related Quality of Life Scale for Children and Adolescents (KIDSCREEN-52); and 4) Infant Feeding Intentions Scale (IFI). The Chisquare test was used to analyze associations between variables, and the strength of association was calculated using prevalence ratios (PR). Variables with p<0.20 in bivariate analyses were included in logistic regression. Simple linear regression was performed with transformed scale scores. A significance level of 5% was adopted for all analyses. The research project was approved by the Research Ethics Committee under opinion no. 6,800,591. The results showed a statistically significant reduction in the intention to exclusively breastfeed over time, with a progressive decline in mean scores between the 1st, 3rd, and 6th postpartum months (p<0.001). Correlation analysis revealed statistically significant positive associations, although of weak magnitude, between breastfeeding intention and maternal age (p=0.020), as well as neonatal clinical indicators. Higher Apgar scores at the 1st minute (p=0.002) and 5th minute of life (p<0.001) were associated with higher levels of maternal intention to exclusively breastfeed. Regarding QoL, puerperal women with more than one childbirth showed a higher proportion of low or regular QoL (39.3%) and (27.7%) (PR=1.69; p=0.031; 95%CI:1.05–2.74). Similarly, those with a previous childbirth presented worse scores (40.4%) (PR=0.55; p=0.017; 95%CI:0.34–0.90). Equivalent findings were observed among women with previous breastfeeding experience, who also showed a higher frequency of low or regular QoL (40.5%) (PR=0.55; p=0.017; 95%CI:0.34–0.90). It is concluded that, for adolescent and young puerperal women, breastfeeding intention appears to be less determined by structural social conditions and more sensitive to clinical and obstetric experiences, highlighting the importance of early interventions focused on perinatal care and individualized support in the immediate postpartum period. This study contributes to broadening the understanding of factors influencing breastfeeding and points to the need for comprehensive, longitudinal, and socially sensitive care strategies.