‘Life does not make it easy to breast-feed’: using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

Abstract

Objective: Breast-feeding rates reflect sociodemographic discrepancies. In Mexico, exclusive breast-feeding under 6 months of age has deteriorated among the poor, rural and indigenous populations from 1999 to 2012. Our objective of the present study was to identify the main social obstacles to breast-feeding in a low-income population in Tijuana, Mexico. Design: Qualitative study using a socio-ecological framework for data collection. Setting: Low-income communities in Tijuana, Mexico. Subjects: Mothers (n 66), fathers (n 11), grandparents (n 27) and key informants (n 25). Results: One hundred and twenty-nine individuals participated in the study: six focus groups (n 53) and fifty-one interviews among mothers, fathers and grandparents; and twenty-five interviews among key informants. Seven social themes were identified: (i) embarrassment to breast-feed in public; (ii) migrant experience; (iii) women's role in society; (iv) association of formula with higher social status; (v) marketing by the infant food industry; (vi) perception of a nonbreast-feeding culture; and (vii) lack of breast-feeding social programmes. Conclusions: Socio-structural factors influence infant feeding practices in lowincome communities in Tijuana. We hypothesize that messages emphasizing Mexican traditions along with modern healthy practices could help to re-establish and normalize a breast-feeding culture in this population. The target audience for these messages should not be limited to mothers but also include family, healthcare providers, the work environment and society as a whole. Keywords Breast-feedingObstacles Low income Socio-ecological framework Breast-feeding practices have improved in the last decades in most of Latin America (1)(2)(3) . Exclusive breast-feeding (EBF) under 6 months of age has increased greatly in Brazil, Colombia and Peru. However in other countries, such as Mexico and the Dominican Republic, prevalence of EBF under 6 months of age has decreased (3,4) . Despite improvements, only in five of nineteen Latin American countries with nationally representative data on trends in EBF over a 10-20 year period do >50 % of mothers exclusively breast-fed babies under 6 months of age (1) . Table 1 depicts rates of EBF under 6 months from Latin America including Tijuana.In the last decades, changes in breast-feeding prevalence in Latin America have shown less improvement in population subgroups whose children are most at risk for mortality and increased morbidity from not being breast-fed, such as poorly educated women with little access to health care (5,6) . In Mexico, EBF under 6 months deteriorated among the poor (33·5 % to 16·6 %), rural (32·7 % to 18·5 %) and indigenous (46 % to 27·5 %) populations from 1999 to 2012 (7,8) . Breast-feeding rates in Mexico are one of the lowest of Latin America with 14·4 % of EBF under 6 months of age (1) . Particularly in North Mexico, there is a lower prevalence of EBF under 6 months of age (10·6 %) than the national average in 2012 (4,9) . There are no data with EBF rates in...

Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies

“…This means having resources available when women face difficulty BF, and strong social support to help them problem-solve. Additionally, Guerrero et al and Bueno-Gutierrez et al, both mention the importance of emphasizing cultural traditional values as an important part of BF promotion, as modern life can be seen as a cause for obstructing recommended practices [45,46]. Our research also supports highlighting the traditional perception that BF is normal and natural, and changing social norms to circle back to these beliefs.…”

“…The fathers mentioned that they were not often given information or included at the health centers. Yet given the literature that demonstrates the importance of the father’s influence [46,50] as well as the sentiment among participants that father’s involvement may be changing, future efforts in Mexico need to be more inclusive of fathers.…”

Early feeding patterns among Mexican babies: findings from the 2012 National Health and Nutrition Survey and implications for health and obesity prevention

“…The feeding practices and food consumption patterns of the infants and young children observed in our study are probably influenced by a range of environmental and behavioral factors that are likely shared by both conditions of undernutrition and obesity. These factors may include, but are not limited to, the mother's cultural beliefs, perceptions, knowledge, social support networks, and educational level, as well as household income, and socioeconomic resources [30,[44][45][46][47][48][49], which we describe in more detail in the context of our findings.…”

“…The overall decline in exclusive breastfeeding could, in part, be related to the early introduction of other beverages such as water (prevalence of 20 % and 45 % of infants ages 0-3.9 months and 4-5.9 months, respectively; data not shown), and sugar-sweetened tea/coffee as well as complementary foods among some infants. Additional factors affecting breastfeeding practices could be related to changes in perceptions due to the migration from rural areas where breastfeeding is considered to be more 'natural' to urban cities where life is faster and there is a perception of a non-breastfeeding culture, i.e., breastfeeding is getting lost as fewer women see other women breastfeeding, which may explain their embarrassment to breastfeed in public [46]. Moreover, the findings on breastfeeding could be a response to the Mexican Ministry of Health's recommendation for breastfeeding initiated prior to the NHNS 2012 data collection period, which was to exclusively breastfeed from birth until age 4 to 6 months [58], and was subsequently changed to age 0 to 6 months in 2012 [17].…”

“…While infant formula use was high in early infancy, consumption also decreased over the first year of life as cow's milk, considered an inappropriate milk for children under age 1 year [16,17,19], was fed to increasing percentages of infants. Communication of the guideline to delay feeding cow's milk to infants is important, since some Mexican mothers think that if whole cow's milks are fortified, they can be given to babies under 1 year [46]. Early feeding of cow's milk is associated with an increased risk of developing iron-deficiency anemia (IDA) [59], a concern especially in Mexico, where IDA is a prevalent (23 %) public health problem in young children ages 1 to 4 years [60] at all socioeconomic levels [61] and given the potential serious and irreversible consequences of IDA on physical and cognitive development and long term health of children [62].…”