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

Swigart, Tessa; Bonvecchio, Anabelle; Théodore, Florence; Zamudio-Haas, Sophia; Villanueva-Borbolla, María Ángeles; Thrasher, James F.

doi:10.1371/journal.pone.0180185

Cited by 55 publications

(76 citation statements)

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“…The primary obstacles reported for breastfeeding in this study aligns with results of previous research from the region (12,(18)(19) and other populations (20)(21). Even though they had the option of adding another obstacle that was not listed, all the participants who reported having some di culty with breastfeeding selected one of the 10 options presented.…”

Section: Discussionsupporting

confidence: 84%

Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.

Bueno-Gutierrez¹,

Castillo²,

Mondragón³

2020

Preprint

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Breastfeeding rates in Mexico are among the lowest in Latin America with 14.4% for Exclusive Breastfeeding (EBF) under six months of age. It has been reported that rates has been decreasing among low-income and vulnerable population, where there is lack of healthcare assistance. Culturally appropriate counseling based on formative research has shown to be effective in improving breastfeeding. Our objective was to evaluate the effect of interpersonal counseling on EBF in a primary healthcare center in Tijuana, México. MethodsThis was a randomized controlled trial pilot with a sample of mothers with infants under 4 months of age from a Primary Care Center. Participants were randomized to a 1) Control Group, receiving counseling about immunizations as well as routine infant feeding information, and 2) Intervention Group, receiving breastfeeding counseling based on previous formative research using a socio-ecological framework. Changes in breastfeeding attitudes, self-efficacy and EBF at 2 months post-intervention were evaluated.ResultsEighty mothers were included in the study (40 in each group). The mean age was 26.4 years for mothers and 1.4 months for infants. Breastfeeding obstacles reported were breastfeeding in public discomfort (23%), infant unsatisfied (23%), pain (19%), insufficient milk (15%) and returning to work (8%). We observed a significant improvement in breastfeeding attitudes (P=0.0001), self-efficacy (P=0.018) and EBF (P=0.001). There was a 30% increase in EBF in the intervention group and 15% decrease in the control group post-intervention.ConclusionsBreastfeeding counseling based on formative research improved breastfeeding attitudes, self-efficacy and practices in this population. Breastfeeding should be promoted by well-trained health professionals with knowledge and skills to clearly communicate breastfeeding messages, and sensitivity to address women’s needs according to their sociocultural context. Since breastfeeding responds to health systems and socio-economic and cultural environments in which the mother lives; development and evaluation of programs to increase breastfeeding rates in low- and middle-income countries are necessary. Trial Registration ANZCTR ID: 380462 (Under review). Retrospectively registered.

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Section: Discussionsupporting

confidence: 84%

Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.

Bueno-Gutierrez¹,

Castillo²,

Mondragón³

2020

Preprint

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“…In general, we could observe that the age and education years explained the myth scores, especially for certain myths. For example, younger participants in our study, women with the lowest levels of education and lower socioeconomic status, and fewer previous pregnancies were most likely to believe that "a frightened or angry mother should not nurse a baby" and "drinking atole or beer enhances maternal milk production", as showed by Swigart et al, in low-income communities in Mexico [36]. On the other hand, it has been reported that older mothers held fewer myths; the reason may be due to that they have more experience [10].…”

Section: Myths About Nutrition and Diet During Breastfeedingsupporting

confidence: 49%

Dietary Knowledge and Myths Vary by Age and Years of Schooling in Pregnant Mexico City Residents

et al. 2020

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Pregnancy is a stage in a woman’s life when she is more open to receiving health advice, especially related to diet. However, women are often caught between receiving scientifically unfounded myths and concrete empirical knowledge. Culturally perpetuated myths may be acted upon more than knowledge, but research on these concepts, especially in the Americas, is scarce. This cross-sectional study aimed to describe the frequency of diet and nutrition myths and knowledge and describe the associated factors in pregnant mothers receiving care in Mexico City. A total of 695 pregnant adults and 322 pregnant adolescents participated in this study, in which they responded to a questionnaire on nutrition and diet myths, knowledge, and practice during pregnancy and breastfeeding. The myths were examined individually, but for the purposes of statistical analysis, a score was obtained. We compared means of variables that could be associated to myth and knowledge scores, then calculated linear and logistical regressions. Forty-six percent of participants had below the mean myth scores. Ninety-two percent of participants had a knowledge score below the mean. Age (β = 0.025, SE 0.007, 95% CI 0.011–0.040, p = 0.001) and years of education (β = 0.166, SE 0.024, 95% CI 0.119–0.213, p = 0.001) explained the myth’s score, while age explained the knowledge score (β = 0.011, SE 0.020, 95% CI −0.032–−0.008, p = 0.002). We found that although most women reported not believing in the myths, they acted on them. The probability of practicing such myths as “You must eat for two during pregnancy” was associated with being an adolescent (OR 1.76, p = 0.001) and being married (OR 1.47, p = 0.007), “Not satisfying cravings leave a mark on the infant’s body” with being adolescent (OR 1.59, p = 0.003) and low socioeconomic level (OR 1.41, p = 0.038), “A frightened or angry mother should not nurse her baby” with being adult (OR 2.61, p = 0.004), and “Drinking atole or beer enhances breast milk production” with being single (OR 2.07, p = 0.001). The probability of not acting on some knowledge was associated with being an adolescent (p ≤ 0.003) and having a high school education or below (p ≤ 0.046). Almost all of our participants held at least one myth about nutrition and diet during pregnancy and breastfeeding; younger participants showed a higher frequency of holding myths. Years of schooling and age were associated with acting on myths and not acting on correct knowledge.

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“…Promotion of breastfeeding needs multilevel supportive measures with interventions being implemented through several channels [ 17 ]. Fathers have been named as one recommended target in promoting breastfeeding [ 22 , 23 ]. Qualitative research findings have revealed some domains of the father’s role in breastfeeding [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis

Mahesh¹,

Gunathunga

Arnold³

et al. 2018

BMC Public Health

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BackgroundFurther research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes.MethodsPubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done.ResultsSelected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58–2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52–0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10–0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22–1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was “low” (for one outcome), “moderate” (for four outcomes), and “high” (for two outcomes).ConclusionsTargeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence.This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.

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

Cited by 55 publications

References 50 publications

Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.

Breastfeeding Counseling Based on Formative Research at Primary Healthcare Services in Mexico.

Dietary Knowledge and Myths Vary by Age and Years of Schooling in Pregnant Mexico City Residents

Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis

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