BackgroundThe problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers’ infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies.MethodsSemi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes.ResultsThe results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother’s accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers.ConclusionsIdentifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.Electronic supplementary materialThe online version of this article (10.1186/s13002-018-0271-2) contains supplementary material, which is available to authorized users.

Purpose Exposure to racial insults among youth in Jujuy, Argentina, was examined as a factor associated with smoking behavior. Methods Youth sampled from eighth-grade classes in 27 randomly selected middle schools completed annual surveys in the ninth and tenth grades. Demographics, race/ethnicity (Indigenous/Amazonian, Indigenous/Andean, Indigenous unspecified group, Mixed European-Indigenous, European), cigarette smoking, and other attitudinal and behavioral factors were measured. Exposure to racial insults, measured in the ninth grade, was modeled to predict cigarette smoking in the previous 30 days (defined as current) in the tenth grade conditional on ninth grade smoking. Results Of the 3,122 respondents, 35.5% reported exposure to racial insults and 33.8% were current smokers. Factors associated with racial insults were being male, indigenous language spoken at home, ever and current smoking, smoking in a ceremonial context, exposure to second-hand smoke at home, number of friends who smoke, having low expectations for the future, low identification with conforming role models, high identification with defiant role models, and depressive symptoms. Reported exposure to racial insults increased the risk of current smoking in the 10th grade among Indigenous Amazonian respondents (OR = 3.8; 95% CI 1.4–10.4) and among the Indigenous-unspecified group (OR = 1.8; 95% CI 1.1–2.8), but not among European or Indigenous Andean youth. Conclusions Exposure to racial insults is commonplace among youth in Jujuy. Evidence of a longitudinal effect of ninth-grade racial insults on tenth-grade smoking rates provides support for an association of racial insults with smoking behavior.

This study evaluated the effect of factors reflecting appreciation of Indigenous culture and racial insults on alcohol and drug use initiation among multi-ethnic youth in Jujuy, Argentina. Students were surveyed from 27 secondary schools that were randomly selected to represent the province. A total of 3,040 eligible students in 10th grade, age 14 to 18 years were surveyed in 2006 and 2,660 of these same students completed surveys in 11th grade in 2007. Multivariate logistic regression models assessed the effect of appreciation for Indigenous cultures and reported exposure to racial insults in 10th grade on incident current alcohol drinking in previous 30 days, binge drinking (≥5 drinks at one sitting), and lifetime drug use (marijuana, inhalants or cocaine) in 11th grade among students not reporting these behaviors in 2006. In 2006, 63% of respondents reported high appreciation for Indigenous cultures and 39% had ever experienced racial insults. In 2007, incident current drinking was 24.4%, binge drinking 14.8%, and any drug use initiation was 4.1%. Exposure to racial insults increased the likelihood of binge drinking (OR=1.6; 95% CI 1.2–2.1) but was not significant for any drug use. Appreciation for Indigenous cultures reduced the risk of any drug use initiation (OR=0.5, 95% CI 0.3–0.7) but had no effect for alcohol drinking outcomes. These effects were independent of Indigenous ethnicity. Enhancing appreciation for Indigenous cultures and decreasing racial insults are achievable goals that can be incorporated into programs to prevent youth substance use.

A commonly reported reason for early breastfeeding cessation is inadequate milk production. In response, women across the globe turn to galactagogues – substances used to increase the milk supply. Andean women have traditional knowledge about the medicinal and nutritional properties of plants and animals that are considered good to eat during breastfeeding. This research explores the maintenance and use of galactagogues, and specifically the use of the Andean flicker bird, within the wider framework of breastfeeding and nutrition policies in Peru. To elicit maternal knowledge and use of galactagogues, semi-structured and free-listing interviews were conducted with 33 mothers. Data analysis calculated the frequency and percentage of women reporting each type of galactagogue. In addition, thematic codes and relevant text passages were used in an iterative analytic process to document emerging themes. Identified galactagogues included five plants and six animals. Several galactagogues included protein-rich foods such as lamb meat and the Andean flicker bird. The use of protein-rich galactagogues as solid food is reinforced by public health messages. However, galactagogues in the research communities are usually consumed as soups or drinks, which are less rich in proteins than solid meals. The potential role of liquid galactagogues in the maintenance of appropriate hydration levels during breastfeeding in an environment where safe drinking water is scarce is a new contribution to the existing literature. The results are relevant to the design of maternal and child health policies that comply with intercultural health premises that value and respect the knowledge and practices of Andean Peoples.