Among indigenous Mam-Mayan women, breastfeeding practices may be intertwined with cultural influences during the early postpartum period.
Objectives:
Our study explored whether beliefs regarding transmission of emotions through breast milk, the feeding of agüitas or temascal (traditional sauna) use were associated with achievement of the World Health Organization infant feeding recommendations and if these cultural practices served as moderators of the relationship between optimal breastfeeding practices and infant anthropometry.
Methods:
We recruited 190 mother-infant dyads at infant age < 46 days. Data on breastfeeding and cultural practices were collected via questionnaire. Infant length, weight, and head circumference were measured and z scores were calculated. Multiple linear and logistic regression analyses were used to examine determinants of initiation of breastfeeding within 1 hour, breastfeeding frequency, breastfeeding exclusivity, and infant weight-for-age z score (WAZ).
Results:
Mothers who delivered at the traditional midwife’s house (odds ratio [OR] = 2.5) and those who did not believe in the transmission of susto (fright) through breast milk (OR = 2.4) were more likely to initiate breastfeeding within 1 hour postpartum. Higher breastfeeding frequency was observed among mothers who spent more time in the temascal. Initiating early breastfeeding within 1 hour postpartum was the sole infant feeding practice positively associated with exclusive breastfeeding and WAZ.
Conclusions:
Our investigation in the Western Highlands of Guatemala has highlighted the link between cultural practices and beliefs during lactation, breastfeeding practices and infant growth. Public health practitioners need to understand how local cultural practices influence early initiation of breastfeeding to promote adequate infant weight.
Department of State United States of America, Global Alliance for Improved Nutrition (GAIN), Interaction. 1,000 days: Change a life, change a future. 2011. Available at: http://www.thousanddays.org/about/. Accessed June 1, 2014.
2.
BlackREAllenLHBhuttaZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243-260.
3.
BhuttaZAAhmedTBlackRE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417-440.
4.
VictoriaCGde OnisMHallalPCBlössnerMShrimptonR. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):473-480.
5.
World Health Organization. The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation. Geneva, Switzerland: World Health Organization; 2001.
6.
World Health Organization and UNICEF. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2003.
7.
VictoriaCG. Effect of breastfeeding on infant and childhood mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000;355(9202):451-455.
8.
EdmondKMZandohCQuigleyMAAmenga-EtegoSOwusu-AgyeiSKirkwoodBR. Delayed breastfeeding initiation increases the risk of neonatal mortality. Pediatrics. 2006;117(3):380-386.
9.
LauerJABetranAPBarrosAJde OnisM. Deaths and years of life lost due to suboptimal breastfeeding among children in the developing world: a global ecological risk assessment. Public Health Nutr. 2006;9(6):673-685.
10.
EdmondKMKirkwoodBRAmenga-EtegoSOwusu-AgyeiSHurtLS. Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of causal links with observational data from Ghana. Am J Clin Nutr. 2007;86(4):1126-1131.
11.
de CarvalhoMRobertsonSMerkatzRKlausM. Milk intake and frequency of feeding in breast-fed infants. Early Hum Dev. 1982;7(2):155-163.
12.
American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 1997;100(6):1035-1039.
13.
World Health Organization. Postpartum care of the mother and newborn: a practical guide. Technical Working Group, World Health Organization. Birth. 1999;26(4):255-258.
14.
MatiasSINommensen-RiversLACreed-KanashiroHDeweyKG. Risk factors for early lactation problems among Peruvian primiparous mothers. Matern Child Nutr. 2010;6(2):120-133.
15.
EckhardtCLRiveraJAdairLSMartorellR. Full breast-feeding for at least four months has differential effects on growth before and after six months of age among children in a Mexican community. J Nutr. 2001;131(9):2304-2309.
16.
KramerMSGuoTPlattRW, et al. Feeding effects on growth during infancy. J Pediatr. 2004;145(5):600-605.
17.
MarriottBPWhiteALHaddenLDavisJCWallingfordJC. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr. 2012;8(3):354-370.
18.
JonesADIckesSBSmithLE, et al. World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings. Matern Child Nutr. 2014;10(1):1-17.
19.
Pérez-EscamillaRMejiaLADeweyKG. Neonatal feeding patterns and reports of insufficient milk among low-income urban Mexican mothers. Ecol Food Nutr. 1992;27(2):91-102.
20.
DodgsonJEDuckettLGarwickAGrahamBL. An ecological perspective of breastfeeding in an Indigenous community. J Nurs Scholarsh. 2002;34(2):235-241.
21.
Pak-GorsetinSHaqAGrahamEA. Cultural influences on infant feeding practices. Pediatr Rev. 2009;30(3):e11-e21.
22.
RogersNAbdiJMooreD, et al. Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia. Public Health Nutr. 2011;14(11): 2029-2036.
23.
DuongDVBinnsCWLeeAH. Breast-feeding initiation and exclusive breast-feeding in rural Vietnam. Public Health Nutr. 2004;7(6):795-799.
24.
NathanKJ. New life begins with 40. Puerperium. 2011;13(2):15-16.
25.
DoakCMvan der StarreREvan BeusekomIPonceMCVossenaarMSolomonsNW. Earlier introduction of agüitas is associated with higher risk of stunting in infants and toddlers in the Western Highlands of Guatemala. Am J Clin Nutr. 2013;97(3):631-636.
26.
CamposRHernandezLSoto-MendezMVossenaarMSolomonsNW. Contribution of complementary food nutrients to estimated total nutrient intakes of rural Guatemalan infants in the second semester of life. Asia Pac J Clin Nutr. 2010;19(4):481-490.
27.
Van BeusekomIVossenaarMMontenegro-BethancourtGDoakCMSolomonsNW. Estimates of exclusive breastfeeding rates among mother-infant dyads in Quetzaltenango, Guatemala, vary according to interview method and time frame. Food Nutr Bull. 2013;34(2):160-168.
28.
CominskyS. Changing food and medical beliefs and practices in a Guatemalan community. Ecol Food Nutr. 1975;4(3):183-191.
29.
CominskySScrimshawM. Medical pluralism on a Guatemalan plantation. Soc Sci Med. 1980;14(4):267-278.
30.
AdamsWRHawkinsJP. Health Care in Maya Guatemala: Confronting Medical Pluralism in a Developing Country. Norman: University of Oklahoma Press; 2007.
31.
GroarkKP. To warm the blood, to warm the flesh: the role of steambath in Highland Maya (Tzeltal-Tzotzil) Ethnomedicine. J Lat Am Lore. 1997;20(1):3-96.
32.
ThompsonLSmithKRKhalakdinaA, et al. Acute, severe carbon monoxide and particulate matter exposures among sauna bath (temascal) users in the Western Highlands of Guatemala. Epidemiology. 2004;15(4):173-174.
33.
SmithKRMcCrackenJPWeberMW, et al. Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomized controlled trial. Lancet. 2011;378(9804):1717-1726.
34.
HarrisonGGZaghloulSSGalalOMGabrA. Breastfeeding and weaning in a poor urban neighborhood in Cairo, Egypt: maternal beliefs and perceptions. Soc Sci Med. 1993;36(8):1063-1069.
35.
GuerreroMLMorrowRCCalvaJJ, et al. Rapid ethnographic assessment of breastfeeding practices in periurban Mexico City. Bull World Health Organ. 1999;7(4):323-330.
36.
LosaC. The Milk of Sorrow: A Journey from Fear to Freedom [DVD]. Lima, Peru: Generalitat de Catalunya-Institut Català de les Indústries Culturals (ICIC); 2009.
37.
World Health Organization. Indicators for Assessing Infant and Young Child Feeding Practices: Part 1 Definitions. Geneva, Switzerland: World Health Organization; 2008.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass index-for-age: Methods and Development. Geneva, Switzerland: World Health Organization; 2006.
40.
Pérez-EscamillaRLutterCSegallMRiveraATrevion-SillerSSanghviT. Exclusive breast-feeding duration is associated with attitudinal, socioeconomic and biocultural determinants in three Latin American countries. J Nutr. 1995;125(12):2972-2984.
41.
Pérez-EscamillaRSegura-MillanSCanahuatiJAllenH. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr. 1996;126(11):2765-2773.
42.
MatiasSNommsen-RiversLDeweyK. Determinants of exclusive breastfeeding in a cohort of primiparous periurban Peruvian mothers. J Hum Lact. 2012;28(1):45-54.
43.
DeardenKAltayeMde MazaI, et al. Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala. Rev Panam Salud Publica. 2002;12(3):185-192.
44.
WebbALSellenDWRamakrishnanUMartorellR. Maternal years of schooling but not academic skills is independently associated with infant-feeding practices in a cohort or rural Guatemalan women. J Hum Lact. 2009;23(3):297-306.
45.
BandyopadhyayM. Impact of ritual pollution on lactation and breastfeeding practices in rural West Bengal, India. Int Breastfeed J. 2009;4:2.
46.
DashtiMScottJAEdwardsCAAl-SughayerM. Determinants of breastfeeding initiation among mothers in Kuwait. Int Breastfeed J. 2010;5:7.
47.
GreinerTVan EsterikPLathamMC. Commentary: The insufficient milk syndrome: an alternative explanation. Med Anthropol. 1981;5(2):233-247.
48.
TullyJDeweyKG. Private fears, global loss: a cross-cultural study of the insufficient milk syndrome. Med Anthropol. 1985;9(3):225-243.
49.
GattiL. Maternal perceptions of insufficient milk supply in breastfeeding. J Nurs Scholarsh. 2008;40(4):355-363.
50.
Pérez-EscamillaRPollittELonnerdalBDeweyKG. Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytical overview. Am J Public Health. 1994;84(1):89-97.
51.
HruschkaDJSellenDSteinADMartorellR. Delayed onset of lactation and risk of ending breast-feeding early in rural Guatemala. J Nutr. 2003;133(8):2592-2599.
52.
MooreERAndersonGCBergmanNHepworthJ. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. April22, 2003. doi:10.1002/14651858.cd003519.
53.
WalkerM. Conquering common breast-feeding problems. J Perinat Neonatal Nurs. 2008;22(4):267-274.
54.
LamNNicasMRuiz-MercadoIThompsonLMRomeroCSmithKR. Non-invasive measurement of carbon monoxide burden in Guatemalan children and adults following wood-fired temazcal (sauna-bath) use. J Environ Monit. 2011;13(8):2172-2181.
55.
ThompsonLMClarkMCadmanBCanuzESmithKR. Exposures to high levels of carbon monoxide from wood fired temazcal (steam bath) use in highland Guatemala. Int J Occup Environ Health. 2011;17(2):103-112.
56.
BoyEBruceNDelgadoH. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ Health Perspect. 2002;110(1):109-114.
57.
ThompsonLMBruceNEskenaziBDiazAPopeDSmithKR. Impact of reduced maternal exposures to wood smoke from an introduced chimney stove on newborn birth weight in Rural Guatemala. Environ Health Perspect. 2011;119(10):1489-1494.
HeidkampRAyoyaMATetaINStoltzfusRJMarhoneJP. Breastfeeding practices and child growth outcomes in Haiti: an analysis of data from demographic and health surveys [published online August18, 2013]. Matern Child Nutr. doi:10.1111/mcn.12069.
60.
NickelNCLabbokMHHudgensMGDanielsJL. The extent that noncompliance with the ten steps to successful breastfeeding influences breastfeeding duration. J Hum Lact. 2013;29(1):59-70.
