Nutrition and Health, 1994 Vol. 9, pp.

255-263 255
0260-1060/94 $10
© 1994 A B Academic Publishers, Printed in Great Britain

BREASTFEEDING AND WEANING PRACTICES

IN RURAL MEXICO

SHERRY LIPSKY*•, PATRICIA A. STEPHENSON"·b,

THOMAS D. KOEPSELL", STEPHEN S. GLOYD", JOSE-LUIS LOPEZ',
CAROLYN E. BAI~
•School of Public Health and Community Medicine, University of Washington, USA
b Centre for Public Health Research, Karlstad, Sweden, c Laboratorio de Salud Publica,
Facultad de Medicina, Universidad de Guadalajara, Guadalajara, Mexico,
dHenry M. Jackson School of International Studies, University of Washington, USA

ABSTRACT

This report describes the breastfeeding and weaning practices of rural women in two Mexican
towns and the cultural beliefs upon which these practices are based. Interviews and focus
group discussions were used to collect information. Women thought breastfeeding preferable
to bottle-feeding. Eighty percent initiated breastfeeding and 69% gave colostrum.
Breastfeeding was discontinued early (mean age 4 months). The mean age at which children
were introduced to other liquids was 2 months (range 0-5 months) and to solids, 4 months
(range 1-8 months). Women's decisions regarding infant feeding were influenced most by
custom and advice from doctors and family members. In some instances medical advice
conflicted with traditional practices. These findings suggest important avenues for
intervention in hospital practices, education for health care workers, and in the development
of health promotion services.

INTRODUCTION

Breastfeeding is a primary means of preventing infant morbidity and

mortality in developing countries (Population Information Program 1981;
Millman and Cooksey 1987; Brown, et al. 1989). Infants breastfed
exclusively for 6 months or more receive optimal nutrition and
immunological protection (Population Information Program 1981). Bottle-
feeding can be hazardous, especially if formula is diluted improperly, if
water supplies are contaminated, or if sterilization and refrigeration are
inadequate. Weaning practices are equally important since malnutrition can

*Address for correspondence: Sherry Lipsky, P.A., M.P.H., 5706 43rd Avenue North East,
Seattle, Washington 98105, USA, Telephone: (206) 296-4774

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256

result when other foods are introduced too early or late, or are contaminated
(Mosley and Chen 1984; Seward and Serdula 1984; Underwood and
Hofvander 1982).
Infant feeding practices vary within and among countries. In general,
shorter durations of full or partial breastfeeding are associated with lower
maternal age and parity, higher socioeconomic status and maternal
education, urban residence, use of modern medical care, maternal
employment and availability of breast milk substitutes (Forman 1984;
Huffman 1984; Potter, et al. 1987; Magana Cardenas, et al. 1981). The most
common reasons for supplementation or discontinuation of breastfeeding
are perceived breast milk insufficiency, maternal or infant illness, and
maternal employment (Forman 1984).
Many of these factors cannot be readily modified. On the other hand, the
reasons women report for discontinuation of breastfeeding or early
supplementation suggest that factual misconceptions are common and have
a significant bearing on breastfeeding practices. Such factors are amenable
to intervention so long as providers of health services are aware of the
cultural assumptions and community norms on which these beliefs are
based.
Currently, little is known about the influence of community and cultural
factors on infant feeding decisions (Hull 1987; Pelto 1987; Desantis 1986).
This study was undertaken to examine breastfeeding and weaning practices
of women in two rural Mexican communities, the factors affecting these
practices, and the community and cultural context in which infant feeding
decisions were made.

MATERIALS AND METHODS

The study was carried out in two rural towns in Jalisco, Mexico during 1988,
as part of a larger survey conducted simultaneously in these and six other
towns. The towns had populations of 1200 and 2000 and were 70 and 225
kilometers, respectively, from the capital city of Guadalajara. Each town
had a government health clinic staffed by a sixth year medical student.
All households in each town were mapped, numbered and randomly
sampled. Women with one or more children under two years of age were
eligible. They were informed of the nature and purpose of the study and all
agreed to participate.
A structured interview was used to collect information on demographics
and factors influencing infant feeding decisions. A 24-hour recall method
was used to determine feeding practices. The questions referred to the
practices of the mother with respect to the youngest child. (hereafter referred
to as the index child).
Focus group discussions were also used to elicit information about
breastfeeding and weaning beliefs and practices, generational changes and

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cultural influences. Two discussion groups were held in one town and one in
the second town. Women were recruited by word-of-mouth and public
announcements. Any woman was welcome to attend, including those who
participated in the interview portion of the study.

INTERVIEW SAMPLE

Thirty-five women were interviewed. They were between 16 and 43 years old
(mean 26 years)and had zero to 13 years of formal education (mean 6years).
Ten percent worked outside the home. Prenatal care was obtained while
pregnant with the index child by 94% of the women. The 35 index children
ranged in age from 2 weeks to 17 months (mean 11 months).

RESULTS

Interviews

Infant Feeding Practices

Table 1 summarizes percentages of women interviewed who breastfed and
who offered colostrum. Note that the feeding of colostrum did not enable
one to predict whether a child would be breastfed subsequently. Some 11
mothers discarded colostrum before the initiation ofbreastfeeding while 24
mothers fed colostrum.
The index children were breastfed from 2 weeks to 17 months (mean 4
months). Exclusive breastfeeding was not practiced; all breastfed children
were given water from birth.
The index children were introduced to other liquids at birth to five months
of age (mean 2 months). Cow's milk (fresh or powdered) was given to all but
five infants who received commercial formula. Less than half of the women
boiled fresh unpasteurized milk. All used boiled water in the preparation of
reconstituted milk.

TABLE 1

Index children breastfed and given colostrum

Index child Index child

breastfed given colostrum % N
Yes Yes 60 21
Yes No 20 7
No Yes 9 3
No No 11 4
Totals 100 35

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258

Solid foods were introduced between 1 and 8 months of age (mean 4

months). If, at the time of interview, the index child was receiving solid
foods or breast milk substitutes, the mother was asked to report the types
and portions of food given. Those receiving solid foods were fed once or
twice daily with portions ranging from a spoonful of each of a few foods to a
small plate of food. Those receiving breast milk substitutes were given two
to four feedings a day by bottle or cup (portions unknown).
Children under six months of age were given fruit, vegetables, rice, cereal,
and liver. The six to nine month-olds had diets that included beans, tortillas,
bread, pasta, fruit, chicken soup, flavored gelatin and soft drinks. The 9 to
23 month-olds had similar diets, but had also been fed vegetables, beef, fish,
egg, cookies and cornflakes (pre-packaged cold cereal).

TABLE 2

Respondents' reasons for infant feeding decisions

Decision Reasons % N
To not breastfeed Woman ill, upset 58 4
(n = 7 of 35) Breast problem 14 1
Not enough milk 14 1
Child ill 14 1
To give colostrom Doctor's advice 29 7
(n = 24 of 35) Best for baby 21 5
Woman's preference 21 5
Custom; family advice 12 3
Don't know 17 4
To not give Child rejected breast 27 3
colostrum Doctor's advice 18 2
(n = 11 of 35) Woman ill; breast problem 18 2
Separated in hospital 9 1
Woman's preference 9 1
Don't know 18 2
To switch to Not enough milk 39 9
bottle Child rejected breast 17 4
(n = 23 of 28) Woman ill; breast problem 9 2
Woman's preference 9 2
Employment 9 2
Child ill 4 1
Don't know 13 3
To give solids Child needed it 48 15
(n=31of35) Accustom child to food 19 6
Doctor's advice 16 5
Own mother's advice 3 1
Don't know 13 4

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 259

Factors Affecting Infant Feeding Practices

Table 2 summarizes the reasons women gave for their infant feeding
decisions. Illness of the woman or baby in the postpartum period was the
primary reason for not initiating breastfeeding.
The women who gave colostrum and those who did not cited the doctor's
advice among the reasons for their decisions. The other commonly reported
reasons for not giving colostrum were illness (of the woman) and inability to
get the baby to nurse, (i.e., the women stated that the children "rejected the
breast").
The majority of breastfeeding women who added or switched to bottle-
feeding felt they had not enough breast milk. Women also switched because
of the "child's preference", their own preference, illness (of the woman or
child), or the need to work. Women who had started their children on solid
foods said this decision was based on the "child's needs", the desire to
"accustom the child to solid foods", or the "doctor's advice."
Several women reported that their decisions were influenced by doctors,
their own mothers or other family members. Most said that no one
influenced their decisions concerning infant feeding.

Focus Group Discussions

Seven to 12 women participated in each of the three groups (total 27).

Women in the focus groups felt that breastfeeding was preferable to bottle-
feeding because it protects the baby, is more convenient for the mother and
it increases communication with the baby. They added that it was more
healthful for the baby, cleaner than the bottle, and that breast milk was the
right temperature (hot). Mothers estimated three to nine months as good
lengths of time to breastfeed exclusively, with the exception of water and
herbal teas which they reported giving during this period.
Some of the women thought that colostrum provided "antibodies;' and
"protection of the stomach" for the baby. Several women reported that their
doctor had advised giving colostrum as it would "help the breast milk come
out." However, another woman discarded colostrum because the doctor
told her that the "first milk was bad." Colostrum was recommended by the
mothers' mothers and other relatives. A few women told of being separated
from their babies in the hospital because there was not enough personnel to
bring the babies to them. Thus, these women were unable to breast-feed for
the first few days following birth.
Breastfeeding was said to be harmful when the woman was ill, scared or
angry, if she had exercised, had a "hot back" or had been in the sun awhile.
Following a scare or upset, the usual practice was to express and discard the
milk, otherwise the tainted milk could give the baby diarrhea. They would
also withhold breast milk for 4 to 5 hours if a child were vomiting or had
diarrhea.

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260

Views regarding appropriate age for weaning from the breast ranged from
2 months to 1 year. The women felt weaning should take place when the
mother is unable to breastfeed, the child does not want to continue or if the
child "has teeth and bites." Some felt that weaning should be done little by
little so that it does not hurt the breasts, while others thought it should be
done quickly.
Women said they would begin to introduce solids when breastfeeding was
"not enough." This should occur at 2 to 6 months of age. Mashed foods,
cereals, juices, fruits, tortillas, chicken, vegetables, rice, eggs, beans, soup,
and oatmeal were considered good first foods.
Women stated that they would insist on feeding their sick children unless
they were unable to eat or were sick to their stomachs. Some would omit
cow's milk if the child had diarrhea and offer instead rice water, corn meal
mush, bean soup and some fruits.
Most of the women felt that infant feeding practices have changed across
generations. Bottle-feeding was said to be more common now than in their
mothers' day. Their mothers breast-fed for 8 to 12 months, they spaced their
children 2 years apart and had breast milk of "a different quality." All this
despite the fact that their mothers had less opportunity to see a doctor, less
information and food available, no television or radio, and less
transportation.
The women in one town also described a "hot" and "cold" food
classification system (Messer 1987; Kay and Yoder 1987). Fish, cactus, fresh
fruits and raw vegetables were considered cold foods while breast milk,
chocolate, meat, grains and chilies were considered hot. They felt children
should eat cold foods when sick and, in general, preferred them. The
women's mothers intervened at times, advising the children not to eat
certain foods; With regard to dietary restrictions during times of illness, the
women said that traditional customs sometimes prevailed and at other times
doctor-prescribed foods were given.

DISCUSSION

The women who participated in this study thought breastfeeding preferable

to bottle-feeding. Most breastfed but supplemented breastfeeding with
water and herb teas. Breastfeeding mothers introduced cow's milk or
commercial formula and solid food early. Young children were also exposed
to the risk of pathogens from unboiled fresh milk.
The reasons given for decisions about initiation, supplementation and
discontinuation of breastfeeding were similar to those reported in other
studies (Forman 1984; Desantis 1986; de Freitas, et al. 1986; Anderson, et al.
1983). Maternal illness hindered initiation while perceived breast milk
insufficiency was the primary reason for supplementation and dis-
continuation of breastfeeding.

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 261

The focus group discussions revealed reasons behind responses given in

the interviews. For example, women's decisions may have been influenced
by the extent of their knowledge about infant feeding. Women were
knowledgeable about the advantages of breastfeeding, but less so about the
value of colostrum, how long to breast-feed exclusively and appropriate
weaning practices.
Women believed breast milk could be tainted· by emotional states, heavy
exercise and exposure to sun. However, it is unlikely these beliefs would
have a negative effect on breastfeeding practices since the solution was
simply to express the tainted milk and then resume breastfeeding.
Illness of either the mother or child appeared to be a reason to avoid
breastfeeding altogether. Aside from self-reports of breast problems,
specific illnesses which affected breastfeeding were not determined in these
two communities.
While the majority of women interviewed stated that no one influenced
their decisions about infant feeding, many of the beliefs described above are
traditional notions passed down through generations of mothers.
Although cultural norms encouraged breastfeeding, the women believed
that practices were changing. The accuracy of these impressions could not
be determined because longitudinal data were not available. However,
women's impressions were consistent with data from other studies showing
a decline in rates of breastfeeding over time (Population Information
Program 1981; Forman 1984; Magana Cardenas, et al. 1981).
Doctor's advice also influenced women in their decision to supplement
breastfeeding with breast milk substitutes and solid food. When asked about
the advice given to women, one town's student doctor confirmed that
supplementation at two months of age was recommended routinely. She
believed that many women did not have enough milk and were themselves
poorly nourished. Thus women's concern about breast milk insufficiency
may have originated in the town clinic.
Other medical practices, as well, did not support or encourage
breastfeeding. Some women may have received confusing information
about colostrum from their doctors as noted in the focus group discussions.
In addition, one student doctor held the view that women do not have much
colostrum to give. Hospital routines kept a few women from initiating
breastfeeding soon after birth. Newborns were also given dextrose solution
while in the hospital. The negative effect of medical and nursing advice and
care on breastfeeding has also been documented in other studies (Forman
1984; Potter, et al 1987; Magana Cardenas, et al 1981; Simopoulos and
Grave 1984).

IMPLICATIONS

These findings suggest several avenues for intervention. An essential

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262

element is the provlSlon of accurate, up-to-date information about

breastfeeding and weaning in the training programs of health care
providers. For example, providers need to know that the volume of milk
produced by poorly nourished women is similar in quantity to that
produced by well-nourished women (Simopoulos and Grave 1984).
Insufficient lactation more often results from supplementation which
decreases the frequency of breastfeeding leading to diminished milk
production and early weaning. Similarly, providers should know that there
are few contraindications to breastfeeding, although it should not be
encouraged if a woman has a debilitating illness that makes her too weak to
nurse (Simopoulos and Grave 1984).
Hospital routines also need to be modified. Rooming-in helps to promote
breastfeeding and maternal-infant attachment and prevent nosocomial
epidemic infections (Bowes 1986). Breastfeeding initiation at birth should be
promoted and the continuing practice of giving dextrose solution should
generally be discouraged.
Programs need to be aimed not only at women, but at their families as
well. Taking into account custom, local beliefs, and family influence
increases their relevance and acceptability. For example, to attempt to
dissuade women from expressing and discarding milk after strenuous work
may be counterproductive so long as they continue to breastfeed. The use of
medicinal herbs and teas may be so integral to cultural beliefs about health
that to attempt to discourage this practice would only serve to discredit the
health care provider. Emphasizing the importance of boiling water for the
preparation of teas and of techniques for sterilizing bottles may be more
important, particularly in developing countries.
Lastly, the results of this study suggest that women have many
misconceptions about breastfeeding and weaning. Breastfeeding promotion
programs must attempt to dispel these and support women's positive
attitudes and practices with factual information on appropriate weaning
practices.

ACKNOWLEDGEMENTS

The authors wish to express their sincere appreciation to the Mexico Rural Health
Project, International Health Program, University of Washington School of Public
Health and Community Medicine. The University of Guadalajara faculty and
students are also gratefully acknowledged for their participation and support.

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 263

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(Received 12 August 1993)

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