title: Cultural determinants of optimal breastfeeding practices among indigenous Mam-Mayan women in the Western Highlands of Guatemala.
abstract: BACKGROUND
  Among indigenous Mam-Mayan women, breastfeeding practices may be intertwined with cultural influences during the early postpartum period.
  
  
  OBJECTIVE
  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.
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, Canada.
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Wren
authors.affiliation: Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
authors.forename: Noel W
authors.initials: NW
authors.lastname: Solomons
authors.affiliation: Institute of Parasitology, McGill University, Montreal, Canada.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Chomat
authors.affiliation: Institute of Parasitology, McGill University, Montreal, Canada.
authors.forename: Marilyn E
authors.initials: ME
authors.lastname: Scott
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, Canada kristine.koski@mcgill.ca.
authors.forename: Kristine G
authors.initials: KG
authors.lastname: Koski
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005260:Female; D006166:Guatemala; D006303:Health Services, Indigenous; D006801:Humans; D007199:Indians, South American; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D044382:Population Groups; D055815:Young Adult
keywords: breastfeeding, early initiation; exclusive breastfeeding; infant growth; predominant breastfeeding; ritual fluids