1 Introduction

Breast milk generates benefits for the mother and the newborn, for instance, physical, cognitive, and motor development, and an increase in the infant's immune response (Becerra, Bonilla and Rodríguez, 2015). However, in practice, infant feeding is affected by the surrounding community and factors related to the mother's way of life, such as cultural, social, and educational phenomena. Therefore, it is essential to analyze education in the field of health promotion and disease prevention, from prenatal control and throughout early childhood, to provide relevant tools to assist with decision-making and contribute to improving living conditions, in particular, for the child population (Montaño and Kasprzyk, 2015; Lawrence and Lawrence, 2011).

The literature is emphatic in considering breastfeeding as the safest and healthiest infant feeding method directly linked to the creation of affective bonds (Chung, Raman, Trikalinos and Ip, 2008; Zhang, Zhu, Zhang and Wan, 2018; Mahesh et al., 2018). Regarding the cost-benefits of breastfeeding, in addition to being economical and sufficient, diarrhea episodes are reduced by 80% compared with infants receiving formula milk, and there is a 70% less risk of suffering from respiratory and ear infections (Mahesh et al. 2018; Khatun et al., 2018; Maharlouei and Pourhaghighi, 2018; Verduci, Banderali, Peroni, Lassandro and Radaelli, 2017; Jalal, Dolatian, Mahmoodi and Aliyari, 2017;Yourkavitch, Alvey, Prosnitz and Thomas, 2017; Coulthard, Harris and Emmett. 2009; Kandeel et al.. 2018). Based on the above, it can be deduced that the practice of breastfeeding is one of the most effective strategies to prevent common diseases of early childhood, as well as to mitigate and avoid child malnutrition (Mateus. 2019; Dwinanda, Syarif and Sjarif, 2018). For example, breastfed children excel in tests of intellectual and motor development and have a lower risk of breast and ovarian cancer, compared to those who are not breastfed (Ministry of Health and Social Protection, 2012).

In Colombia, according to the latest Nutritional Situation Survey (ENSIN), in 2015, 72.6% of children under three years of age were breastfed in their first hour of life; however, only 36.1% continued to six months (Ministry of Health and Social Protection, 2012), showing a significant decline in continuity. The findings show that 29.6% of boys and girls consumed fluids other than breast milk during the first three days after birth. The figures indicate the need to comprehensively address the breastfeeding process since it is necessary to consider environments that involve women, promote spaces and institutional support for the breastfeeding family, and enable society to serve as a support network for achieving exclusive breastfeeding until the minor reaches six months of age (Gómez, 2020).

In promoting breastfeeding, educational models have focused on the mother as the only means of guarantee. Nevertheless, research has shown the need to include other close and external actors, which requires the interpretation of human interactions to recognize the contribution of each one. In this regard, the Ecological Model considers cultural behavior as the daily actions that take place in the ways of living transmitted from generation to generation, while culture is learned, shared, symbolic, natural, integrated, and creative (Kottak, 1994). In this sense, this model stands out as a useful measure when considering social and cultural factors (Bronfenbrener, 1991).

Despite criticism of the practice of breastfeeding, it should promote inquiry and reflection that leads to the development of accompanying measures given that breast milk is considered the best and only food that a mother can offer her child from birth. In recent years, concerted efforts have been made to promote and guarantee breastfeeding in the country; however, the practice is still low and is permeated by the economic inequalities associated with social, human, and structural development (Daza, 2015; Becerra et al.. 2015). It is noteworthy that the prevalence of breastfeeding practices in populations is varied and is influenced by the conditions and characteristics of the people, their communities, and their social structures (Daza, 2015).

Achieving breastfeeding up to six months of age contributes to improving the health conditions of the child population and, as such, is an indicator of public health. However, it can only be achieved by investigating, analyzing, and following the process that involves the mother with her fears and knowledge, along with strengthening the environments whose role is fundamental to the support and protection of breastfeeding. In other words, guaranteeing synergies between families, health institutions, society, and immediate environments increases the possibility of achieving this practice in the best way (Gilardi, 2013; Ramón and Alvarracín, 2019). Thus, the objective of this study is to identify the contribution of the ecological approach to the educational processes related to the practice of breastfeeding through a thematic review of the scientific literature.

2. Methodology

Thematic review. This is a descriptive study, using an exploratory approach, following the PICO methodology, where P refers to the person or problem, I to intervention, C to comparison, and O to outcomes or results. These elements served to identify the findings required to answer the question (Santos, Pimenta and Nobre, 2007).

A search of the literature was carried out in the scientific databases Lens, Scopus, and ScienceDirect. Terms standardized by the Health Sciences Descriptors (DeCS) were used as descriptors. The use of the Spanish words, lactancia materna, enfoque ecológico, conducta, corresponded to the English equivalents described by the Medical Subject Headings (MeSH) thesaurus, breastfeeding, ecological approach, behavior. The search found 549 articles that mainly focus on humans, breastfeeding, and pregnancy. Furthermore, the most recent publications address the concepts of the ecological social model, mothers, young adults, and breastfeeding education (see Figure 1).

Figure 1
Matrix of conceptual relationships in the search equation
Source: Scopus, VOSviewer; own input data.

The VOSviewer tool was used to visualize and analyze the scientific activity developed around studies of the Ecological Model in the practice of breastfeeding. VOSviewer is a software program that allows the user to create maps based on network data related to researchers, scientific journals, organizations, countries, or keywords. It also makes it easy to export the data from Web of Science and Scopus, among other databases (Eck and Waltman, 2019).

Three inclusion criteria were used for the selection of articles. The first was the time: publications from the period between 2010 and 2020 were chosen, taking into account the research needs that have arisen around the practice or abandonment of breastfeeding in the last decade. The second was the type of document, and the third was the inclusion in the methodology of the ecological approach in the design of the study. Following the selection process, 57 articles were obtained as shown in Figure 2.

Figure 2
PICO process for distilling information from databases.
Source: Own preparation.

3. Development and discussion

Breastfeeding: a social and cultural process

Milk production in women after childbirth is a physiological function that is part of the reproductive process and, as in other mammals, its purpose is to provide adequate nutrition to the offspring. Unlike other animals, in humans, breastfeeding is also a social construct and, therefore, is determined by learning, beliefs, values, norms, and socio-cultural conditions that evolve or regress to the beat of the times and the individuals who live and shape them (Rodríguez, 2015; Rodríguez and Acosta, 2008).

Although all societies have considered breastfeeding as a natural and necessary event for the life of the newborn, the practices regarding it have been very different according to the socio-cultural and temporal contexts. Like any practice, it depends on the meaning and interpretation that the individual gives to said practice in a specific time and circumstance, or, in other words, it depends on the social representations that exist in each group, time, and place (Rodríguez, 2015).

There are different reasons why a woman may decide not to breastfeed her newborn child m. Therefore, to establish breastfeeding, the socio-cultural factors of the mothers must be taken into account (Schmied, Beake, Sheehan, McCourt and Dykes, 2011), as well as the emotional or partner aspect, the mother's attitude to maternity, and, of course, the mother's culture, which has a marked influence (Victora et al.. 2016). It is worth mentioning that the concept of culture refers to the ways of living that are passed from generation to generation. In this sense, culture is learned, shared, symbolic, natural, encompasses everything, and is integrated into the life of each individual (Kottak, 1994; Lee. 2019).

The analysis of the variables for the establishment of breastfeeding should include socioeconomic characteristics and circumstances (Ministry of Health and Welfare, 2016). meaning the economic conditions and capacities of the mother (Afulani, 2016). The variable is conceptualized in the assistance and emotional support of the mother; thus, a single woman, without help, who must meet the needs of her home, is not the same as a woman who has the help of her partner and family (Pérez-Bravo, 2015; Meedya, 2010; Mekhail, 2019).

To understand breastfeeding and everything that is directly and indirectly associated with it, it is relevant to go beyond the individual and include the social and cultural community contexts where the lack of training and specific skills of breastfeeding professionals are addressed and strengthened. Also, hospital practices that favor bottle feeding, health policies that limit resources for the promotion, protection, and support of programs, cultural loss, and the network monitoring of neighboring environments (Oliver, 2012).

The traditional model: the challenge of the ecological model

The predominant quantitative positivist paradigm in the health sciences has almost always studied breastfeeding from a physiological perspective. However, at the beginning of the 1980s, with the development and scientific acceptance of the Bronfenbrenner Ecological Model, a new approach emerged to address human interactions based on a set of structures to support the different concepts and factors that influence human behavior. The purpose: to achieve a greater understanding of reality.

The concept of ecology is based on the understanding that a formal test does not always reflect performance in real life since an adequate anamnesis is required to determine daily capacities, which is why it is necessary to use scales that quantify the activities of daily living (Smith and Kroeger, 2009). However, there are reports of various ecological orientation tests that try to infer the ability of subjects to carry out their activities of daily living (Bronfenbrenner, 1991). In research, the difference between the designs and approaches lies in the levels of organization, specifically, at one level where individual units are integrated into groups and these groups become the units of analysis at the next level. Each level acquires collective properties that are more than the sum of the properties of its individual members (Susser, 1994).

With this in mind, the process of breastfeeding is one of the most complex processes in the life cycle of women and cannot be understood from a single perspective. Therefore, to study its meaning, prevalence, establishment, and duration, it is essential to understand the attitudinal and experiential aspects of the mother as a woman and mother, the environment and family support, and the social, cultural, emotional, and economic expectations, addressing breastfeeding within an Ecological Model with multiple interactions (Aguayo, Arena and Blásquez, 2008).

It is not by chance that the main motivation for conducting research with an ecological approach is centered on the ability to study health in an environmental context and not in a group since this is more than the sum of the health of individuals. Moreover, the perspective provided by the reflections whose unit of analysis is the group rather than the individual should be understood as a way of approaching epidemiology and public health, whose object of interest is the groups (Alpizar, 2019; Borja, 2000; Brown. 2011;Victora et al.. 2016).

Finally, it is correct to affirm that using the Ecological Model, different dimensions can be approached comprehensively since, from the perspective of psychology, ecological validity is the functional and predictive relationship between the individual's performance in a set of neuropsychological tests, and individual behavior in a variety of real-world settings, including the vital concept of understanding and interpreting the subject's moods. For example, the observation of post-partum psychological alterations leads to tests that allow suggestions to be made to improve education, therapies, and/or treatments. With this approach, internal and external actions are considered within a system that includes the immediate environment, family, neighborhood, and community, as well as local and national governments (Ortíz, Lauro, Jiménez and Silva, 2000). Additionally, with this model, new fields of research can be conceived that provide answers and conclusions regarding the abilities of individuals, especially about the competent performance of the activities of daily living, independent living, and occupational tasks, and the relationship with environments (Sbordone, 1998).

Using the ecological model to address the practice of breastfeeding

There are barriers in the lactation process that occur at various levels, the microsystem, mesosystem, exosystem, and macrosystem. In the first level, a relevant role is played by the mother and the child and their interactions with the other levels. Idealized concepts of beliefs, attitudes, and knowledge about breastfeeding do not work with real-world experiences (McLachlan, 2010). The component of the mother's attitude to and experience with the breastfeeding process determines a very important factor for developing successful breastfeeding, which complies with the parameters for its prolongation, independent of the cultural or social environment in which the mother develops the process (Hall and Hauck, 2007; Grummer. 2017).

Studies have shown the relevance of prenatal education and an attitude towards exclusive breastfeeding at six months after delivery when mothers, fathers, or the immediate environment, health services, and modifying territorial regulations are engaged, involving in that sense the second and third levels of the ecological model. And indeed, the support of the actors in each of the settings, the education of caregivers and maternal companions, improves the physical and psychological state of the mother, which translates into greater willingness to breastfeed (Kaunonen, 2012).

Finally, encompassing the fourth level of the ecological model is the training of state entities, the application of legislation and the formulation of government policies within the institutions, and physical and information access within the entities that provide health services around the protection of breastfeeding (Che'Muda et al.. 2019; Zhao, Lin, Wang and Bao, 2020; Gleason et al.. 2018).

Studies with ecological approaches have the advantage of viewing comparisons between different areas, which allows an evaluation of multiple levels of exposure, something that is almost impossible in a single geographical area when there are perhaps homogeneous exposures (Borja, 2000; Mateus. 2012; Susser, 1994). With this new paradigm, human interactions are conceived in a multifactorial environment within a complex, changing society, and, therefore, breastfeeding education must be approached using the Ecological Model, where there are interactions at different levels that modify the attitude towards the act of breastfeeding, influencing the duration of breastfeeding and its exclusivity (Lutter and Morrow, 2013).

In recent years, a greater number of qualitative studies have been carried out on breastfeeding, understanding it as a human practice that is historically constructed, transmitted by culture, and related to specific contexts. Although it is supported by physiological processes, it is not an irrepressible impulse of human nature. In this sense, it has very ancient roots and is the product of certain ecological, economic, and demographic conditions that prioritize certain cultural contents that give meaning to what "must be done" or to the pattern of what "must be" (Echazú, 2004). Under this scenario, the Ecological Model allows a broader understanding and a comprehensive approach to the factors influencing the prevalence and establishment of breastfeeding in society (Muñoz, 2019; Valderrama, 2019).

It is necessary to emphasize that the initiation and duration of breastfeeding must involve the four levels of the ecological model where there are meeting points between the psychological and demographic attributes of the health care environment and its policies, both local and governmental (Ojeda, Ordoñez and Ochoa, 2010). Despite the growing number of studies on breastfeeding with an ecological approach, where psychological, social, and cultural aspects are analyzed, the inclusion or reference of this new proposal is not observed in the field of public policies.

In this context,from an ecological perspective of breastfeeding, it is necessary to clarify the influence of the variables that affect the practice in the different cultural regions within a territory, in order to develop prospective research and identify determining factors of the practice and duration of breastfeeding. Also, to design and implement policies and plans based on comprehensive planning methodologies for health interventions, develop appropriate and cost-effective extra-institutional interventions to prolong the duration of breastfeeding, and implement more reliable surveillance systems (Mateus. 2012).

The reason for this is that the Ecological Model allows a detailed and in-depth analysis of the object of study. However, in the field of breastfeeding, there are very few studies carried out with an ecological approach in the international sphere, hence the need to promote and awaken interest in the use of this proposal for the development of public health research.

4. Conclusion

To conclude, prenatal education for the practice of breastfeeding with an ecological approach provides the ability to positively influence the development of knowledge and the importance of breastfeeding the newborn, in addition to inferring the need to involve the environment in the process. In that sense, within the educational actions and dynamics for the establishment of breastfeeding, it is pertinent to use a methodological approach that includes teaching based on Bonfrenbrenner's structured concepts. Also, it is necessary to design tools and mechanisms for gathering information from the conceptualization of the ecological approach to characterize breastfeeding within society. Finally, in the development of new policies and strategies to promote breastfeeding, it is useful to include an ecological approach to the programs. The goal is to generate a greater impact on the prevalence of breastfeeding in the community.

References

ABUYA, Timothy; NDWIGA, Charity; RITTER, Julie; KANYA, Lucy; BELLOWS, Ben; BINKIN, Nanzy & WARREN, Charlotte. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. In: BMC pregnancy and childbirth. 2015. vol. 15. no. 1, p. 224. https://doi.org/10.1186/s12884-015-0645-6

AFULANI, Patiencie. A. Determinants of stillbirths in Ghana: Does quality of antenatal care matter? In: BMC pregnancy and childbirth. 2016. vol. 16, no. 1, p. 132. https://doi.org/10.1186/s12884-016-0925-9

AGUAYO, Josefa; ARENA, José & BLÁSQUEZ, Guillermo. Manual de Lactancia Materna. 2. ed. Bogotá: Panamericana, 2002. 458 p.

ALPÍZAR CAMPOS, María José; CANALES MADRIGAL, Jennifer; MOREIRA ÁLVAREZ, Rodolfo; CASTILLO RAMÍREZ, Marisol. Factores que influyen en la duración de la lactancia materna en las estudiantes universitarias. En: Enfermería Actual de Costa Rica. 2019. vol. 37, p. 110-126. https://doi.org/10.15517/REVENF.V0137.34905

BECERRA BULLA, Fabiola; BONILLA BOHÓRQUEZ, Laura y RODRÍGUEZ-BONILLA, Juliana. Leptina y lactancia materna: Beneficios fisiológicos. En: Revista de la Facultad de Medicina. 2015. vol. 63. no.1, p. 119-126. https://doi.org/10.15446/revfacmed. v63n1.43953

BORJA ABURTO, Víctor Hugo. Estudios ecológicos. En: Salud pública de México. 2000. vol. 42, no. 6, p. 23-56. https://doi.org/10.1590/S0036-36342000000600010

BRONFENBRENER, Urie. La Ecología del Desarrollo Humano. 4. ed. Bogotá: Paidos Iberica, Ediciones S. A, 1991. 456 p. http://psicopedagogosrioiv.com.ar/wordpress%20colegio/wp-content/uploads/2017/07/la-ecologia-del-desarrollo-humano-bronfenbrenner-copia.pdf

BROWN, Amy; RAYNOR, Peter & LEE, Michell. Young mothers who choose to breast feed: The importance of being part of a supportive breast-feeding. In: Community, Midwifery. 2011. vol. 27. no. 1, p. 53-59. https://doi.org/10.1016/j.midw.2009.09.004

CHE'MUDA, Che Muzaini; ISMAIL, Tengku Alina; AB JALIL, Rohana; HAIRON, Suhaily; SULAIMAN, Zahara & JOHAR, Nazirah. Postnatal breastfeeding education at one week after childbirth: What are the effects? In: Women and Birth. 2019. vol. 32. no. 2, p. e243-e251. https://doi.org/10.1016/j.wombi.2018.07.008

CHUNG, Mei; RAMAN, Gowri; TRIKALINOS, Thomas; LAU, Josep & IP, Stanley. Interventions in primary care to promote breastfeeding: An evidence review for the US Preventive Services Task Force. In: Annals of internal medicine. 2008. vol. 149. no. 8, p. 565-582. https://doi.org/10.7326/0003-4819-149-8-200810210-00009

COULTHARD, Helen; HARRIS, Gillian & EMMETT, Pauline. Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age. In: Maternal & child nutrition. 2009. vol. 5. no. 1, p. 75-85. https://doi.org/10.1111/j.1740-8709.2008.00153.x

DAZA CALERO, Marcela. Desigualdad económica y determinantes sociales en la duración de la práctica de lactancia materna en Colombia. Trabajo de grado PhD tesis. Bogotá D.C: Universidad Nacional de Colombia-Sede Bogotá. 2015. 234 p. https://repositorio.unal.edu.co/handle/unal/76187

DWINANDA, Novitria; SYARIF, Badriul & SJARIF, Damayanti Rusli. Factors affecting exclusive breastfeeding in term infants. In: Paediatr Indones. 2018. Vol. 58. no.1, p. 25-35. https://doi.org/10.14238/pil.1.2018.25-35

ECHAZÚ, Gretel. Ecología y Lactancia:Apuntes desde la Antropología. 3. ed. Bogotá: Universidad Nacional de Salta, 2004.123 p. https://www.academia.edu/17302780/Ecolog%C3%ADa_y_Lactancia_Apuntes_desde_la_Antropolog%C3%ADa

ECK, Ness Jan van; WALTMAN, Ludo. Manual for VOS viewer version 1.6.10. México D.F.: Torrer BIT, 2019. 234 p. https://www.vosviewer.com/documentation/Manual_VOSviewer_1.6.10.pdf

GILARDI, Pilar. El problema de la verdad histórica: Una lectura desde la fenomenología hermenéutica. En: Estudios de Historia Moderna y Contemporánea de México. 2012. no. 46, p. 121-140. https://doi.org/10.1016/S0185-2620(13)71417-8

GLEASON, Stacy; WILKIN, Margaret; SALLACK, Linnea; WHALEY, Shannon; MARTÍNEZ, Catherine; PAOLICELLI, Courtney. Breastfeeding Duration is Associated with WIC Site-Level Breastfeeding Support Practices. In: J Nutr Educ Behav. 2020. vol. 52. no. 7, p. 680-687. https://doi.org/10.1016/j.jneb.2020.01.014

GÓMEZ, A. M. Lactancia Materna. Educar Consumidores. 2. ed. Bogotá: Ministerio de Protección Social, 2020. 150 p.

GRUMMER STRAWN, Laurence; ZEHNER, Elizabeth; STAHLHOFER, Marcus; LUTTER, Chessa; CLARK, David; STERKEN, Elisabeth, HARUTYUNYAN, Sussana; RANSOM, Elizabeth & NETCODE, Who. New World Health Organization guidance helps protect breastfeeding as a human right. In: Maternal & child nutrition. 2017. vol. 13. no. 4, p. e12491. https://doi.org/10.1111/mcn.12491

HALL, Wendy; HAUCK, Yanny. Getting it right: Australian primiparas' views about breastfeeding: A quasi-experimental study. In: J Adv Nurs. 2007. vol. 44. no. 786, p. 795. https://doi.org/10.1016/j.ijnurstu.2006.02.006

JALAL, Mitra; DOLATIAN, Manhrokh; MAHMOODI, Zohreh & ALIYARI, Roqayeh. The relationship between psychological factors and maternal social support to breastfeeding process. In: Electronic physician. 2017. vol. 9. no. 1, p. 35-61. https://doi.org/10.19082/3561

KANDEEL, Wafaa A.; RABAH, Thanaa; ZEID, Dina; EL-DIN, Abu; METWALLY, Anny, M.; SHAALAN, Anny; EL ETREBY, Lib. A., & SHAABAN, Soulon. Determinants of Exclusive Breastfeeding in a Sample of Egyptian Infants. In: Open access Macedonian journal of medical sciences. 2018. vol. 6. no.10, p. 18-18. https://doi.org/10.3889/oamjms.2018.359

KAUNONEN, Marja; HANNULA, Leena & TARKKA, Marja. A systematic review of peer support interventions for breastfeeding. In: Journal of clinical nursing. 2012. vol. 21. no.13-14, p.1943-1954. https://doi.org/10.1111/j.1365-2702.2012.04071.x

KHATUN, Halima; COMINS, Carly; SHAH, Rajesh; ISLAM, Manuriel M.; CHOUDHURY, Nuzhat & AHMED, Tahmeed. Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka's slums: A mixed method study. In: International breastfeeding journal. 2018. vol. 13. no. 1, p. 44. https://doi.org/10.1186/s13006-018-0186-5

KOTTAK, Conrad. Antropología cultural. 4. ed. Bogotá: McGRAW-Hill. 1994. 357 p.

LAWRENCE, Robert & LAWRENCE, Ruth A. Breastfeeding: More than just good nutrition. In: Pediatrics in review. 2011. vol. 32. no. 7, p. 267. https://doi.org/10.1542/pir.32-7-267

LEE, Yi Hua; CHANG, Guey Lind & CHANG, Hau Y. Effects of education and support groups organized by IBCLCs in early postpartum on breastfeeding. in: Midwifery. 2019. vol. 75, p. 5-11. https://doi.org/10.1016/j.midw.2019.03.023

LUTTER, Chessa; MORROW, Ardythe. Protection, promotion, and support and global trends in breastfeeding. In: Adv Nutr. 2003. vol. 4. no.2, p. 213-219. https://doi.org/10.3945/an.112.003111

MAHARLOUEI, Najmeh & POURHAGHIGHI, Amirhosein. Factors affecting exclusive breastfeeding, using adaptive LASSO regression. In: International journal of community-based nursing and midwifery. 2018. vol. 6. no. 3, p. 260. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048001/

MAHESH, Pasyodun; GUNATHUNGA, Moraendage; ARNOLD, Suriyakumara; JAYASINGHE, Chintah; PATHIRANA, Sisira; MAKARIM, Mohameh; MANAWADU, Pradeed & SENANAYAKE, Sameera J. Effectiveness of targeting fathers for breastfeeding promotion: Systematic review and meta-analysis. In: BMC Public Health. 2018. vol. 18. no. 1, p. 1140. https://doi.org/10.1186/s12889-018-6037-x

MATEUS SOLARTE, Julio. Ecología y política de lactancia materna exclusiva en Colombia: una propuesta. En: Colombia Médica. 2012. vol. 43. no. 3, p. 206-211. http://www.scielo.org.co/scielo.php?script=sci_abstract&pid=S1657-95342012000300006&lng=en&nrm=iso&tlng=es

MATEUS, Julio. Factores asociados con la práctica de lactancia exclusiva en una cohorte de mujeres de Cali, Colombia. En: Colombia Médica. 2019. vol. 50. no.1, p. 22-29. https://doi.org/10.25100/cm.v50il.2961

MCLACHLAN, Helen. Women's views and experiences of breast feeding: positive, negative or just good for the baby? In: Midwifery. 2010. vol. 26, p.116-125. https://doi.org/10.1016/j.midw.2008.04.009

MEEDYA, Shahala; FAHY, Kathleen & KABLE, Ashely. Factors that positively influence breastfeeding duration to 6 months: A literature review. In: Women and birth. 2010. vol. 23. no. 4, p. 135-145. https://doi.org/10.1016/j.wombi.2010.02.002

MEKHAIL, Kirsi; LINDBERG, Lene; BURSTRÕM, Bo & MARTTILA, Anneli. Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: Fathers striving for stability. In: BMC public health. 2019. vol. 19. no. 1, p. 102. https://doi.org/10.1186/s12889-019-6440-y

MINISTRY OF HEALTH AND WELFARE. Exclusive Breastfeeding for Six Months: The Gold Standard for Infant Feeding. 4. ed. Taipéi: Zhonghua. J. Juzhen, 2016. 100 p. https://www.hpa.gov.tw/EngPages/Detail.aspx?nodeid=1052&pid=5962

MINISTERIO DE SALUD Y PROTECCIÓN SOCIAL COLOMBIA. Colombia necesita mejorar la lactancia materna. 3. ed. Bogotá: Ministerio de Salud y Protección Social, 2012.100. p. https://www.minsalud.gov.co/Paginas/lactancia-materna.aspx#:~:text=%2D%20 El%20Ministerio%20de%20Salud%20y,hasta%201os%20dos%20 a%C3%Blos%20o

MONTAÑO, Daniel & KASPRZYK, Danuta. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Health behavior:Theory, research and practice. 2015. vol.70. no.4, p. 231. https://psycnet.apa.org/record/2015-35837-006

MUÑOZ, Araceli; FONTALBA NAVAS, Andrés; ARREBOLA, Juan Pedro & LARREA KILLINGER, Cristina. Trust and distrust in relation to food risks in Spain: An approach to the socio-cultural representations of pregnant and breastfeeding women through the technique of free listing. In: Appetite. 2019, p. 142. https://doi.org/10.1016/j.appet.2019.104365

OJEDA, Gonzalo; ORDOÑEZ, Mario y OCHOA, Luisa. Duración de la Lactancia Materna, motivos de suspensión e intensidad diaria de amamantamiento. Encuesta Nacional de Demografía y Salud ENDS 10. 4. ed. Bogotá: Profamilia, 2010. p. 275-278. https://dhsprogram.com/pubs/pdf/fr246/fr246.pdf

OLIVER ROIG, Antonio. El abandono prematuro de la lactancia materna: incidencia, factores de riesgo y estrategias de protección, promoción y apoyo a la lactancia. Tesis doctoral. Alicante: Universidad de Alicante, 2012. 125 p.

PÉREZ-BRAVO, María Dolores. Maternidades y lactancias: La lactancia materna desde la perspectiva de género. Trabajo de grado. Universidad Autónoma de Madrid, Facultad de la Salud. 2015. 345 p. https://repositorio.uam.es/handle/10486/676057

RAMÓN, Armando & ALVARRACÍN. Mario. Conocimientos en lactancia. 1. ed. Buenos Aires: Siglo XX, 2019. 67 p. https://rua.ua.es/dspace/bitstream/10045/23524/l/Tesis_Oliver.pdf

ORTÍZ GÓMEZ, María; LAURO BERNAL, Isabel; JIMÉNEZ CANGAS, Leonor y SILVA AYZAGUER, Luis C. Proyectos de Intervención en Salud Familiar: Una propuesta método. En: Revista cubana de salud pública. 2000. vol. 26. no.1, p. 12-16. https://www.redalyc.org/pdf/214/21400102.pdf

RODRÍGUEZ-GARCÍA, Jesús; ACOSTA-RAMÍREZ, Naydu. Factores asociados a la lactancia materna exclusiva en población pobre de áreas urbanas de Colombia. En: Revista de Salud Pública. 2008. vol. 10, p. 71-84. https://scielosp.org/article/rsap/2008.v10n1/71-84/

RODRÍGUEZ, Rita. Aproximación antropológica a la lactancia materna. En: Revista de Antropología Experimental. 2015. no.15, p. 407-429. https://doi.org/10.17561/rae.v0i15.2620

SANTOS, Cristina Mamiedo; PIMENTA, Cibele & NOBRE, Moacryd Roberto Cuce. Estrategia PICO para la construcción de la pregunta de investigación y la búsqueda de evidencias. En: Revista Latino-Americana de Enfermagem. 2007. vol. 15. no. 3, p. 508-511. https://www.researchgate.net/publication/283522391_Estrategia_pico_para_la_construccion_de_la_pregunta_de_investigacion_y_la_bsqueda_de_evidencias

SBORDONE, Robbert. J. Ecological Validity: Some critical issues for the neuropsychologist. 4.ed. New York: St. Lucie Press, 2008. 456 p. https://psycnet.apa.org/record/1996-98718-002

SCHMIED, Virginia; BEAKE, Sarah; SHEEHAN, Athena; MCCOURT, Christine & DYKES, Fiona. Women's perceptions and experiences of breastfeeding support: A metasynthesis. In: Birth.2011. vol. 38. no. 1, p. 49-60. https://doi.org/10.1111/j.1523-536X.2010.00446.x

SMITH, Linda & KROEGER, Mary. Impact of birthing practices on breastfeeding. 5.ed. NewYork: Jones & Bartlett Publishers, 2009. 248 p. https://www.jblearning.com/catalog/productdetails/9780763763749

SUSSER, Mary. The logic in ecological: I. The logic of analysis. In: Am J Public Health. 1994. vol. 84. no. 5, p.825-829. https://doi.org/10.2105/AJPH.84.5.825

VALDERRAMA, Sandra Marcela; DUQUE, Paula. Lactancia materna: Factores que propician su abandono. En: Archivos de Medicina (Manizales). 2019. vol.19. no.2, p.12-20. https://doi.org/10.30554/archmed.19.2.3379.2019

VERDUCI, Elvira; BANDERALI, Giuseppe; PERONI, Diego; LASSANDRO, Carlotta; RADAELLI, Giovanni. Duration of exclusive breastfeeding and wheezing in the first year of life: A longitudinal study. In: Allergologia et Immunopathologia. 2017, vol.45. no.4, p. 316-324. https://doi.org/10.1016/j.aller.2016.08.013

VICTORA, César; BAHL, Ravij; BARROS, Aulisio; FRANÇA, Gioanny; HORTON, Sussan; KRASEVEC, Julia; MURCH, Sali; SANKAR, María; WALKER, Ninna & ROLLINS, Carlotta. Breastfeeding in the 21^st century: Epidemiology, mechanisms, and lifelong effect. In: The Lancet. 2016. vol. 387. no.10017, p. 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7

YOURKAVITCH, Jennifer; ALVEY, Jeniece; PROSNITZ, Debra & THOMAS, James. Engaging men to promote and support exclusive breastfeeding: A descriptive review of 28 projects in 201ow-and middle-income countries from 2003 to 2013. En: Journal of Health, Population and Nutrition. 2017. vol. 36. no. 1, p. 43. https://doi.org/10.1186/s41043-017-0127-8

ZHANG, Zhihong; ZHU, Yu; ZHANG, Land & WAN, Hongwei. What factors influence exclusive breastfeeding based on the theory of planned behaviour. In: Midwifery. 2018. vol. 62, p. 177-182. https://doi.org/10.1016/j.midw.2018.04.006

ZHAO, Ying; LIN, Qiping; WANG, Jing & BAO, Jiangbo. Effects of prenatal individualized mixed management on breastfeeding and maternal health at three days postpartum: A randomized controlled trial. In: Early Human Development.2020. vol. 141, p. 104/944. https://doi.org/10.1016/j.earlhumdev.2019.104944

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