title: Using the socio-ecological framework to determine breastfeeding obstacles in a low-income population in Tijuana, Mexico: healthcare services.
abstract: BACKGROUND
  In Mexico, breastfeeding rates are one of the lowest of Latin America, with 14.4% of infants under 6 months being exclusively breastfed. Previous studies indicate that lack of support from healthcare services is a serious obstacle to breastfeeding mothers in Mexico. Our objective was to identify the main obstacles to breastfeeding presented by the healthcare services in a low-income population in Tijuana, Mexico.
  
  
  METHODS
  We used a socio-ecological framework to determine factors affecting breastfeeding practices. In four low-income communities in Tijuana we conducted focus groups and interviews with mothers, fathers, grandparents, and key informants. Interview notes and focus group transcripts were then studied in-depth independently by three researchers. The primary analytic technique was constant comparison.
  
  
  RESULTS
  One hundred twenty-nine subjects participated in this study: six focus groups (n=53) and 51 interviews among mothers, fathers, and grandparents, as well as 25 interviews among key informants. Main healthcare service obstacles to breastfeeding were erroneous information, lack of training and supervision, negative attitudes, miscommunication between healthcare providers (HCPs) and patients, detrimental medical practices such as giving free formula at hospitals, and the conflict of interest between the infant food industry and the HCPs.
  
  
  CONCLUSIONS
  This study showed that women in low-income communities in Tijuana face multiple obstacles to breastfeeding presented by healthcare services. In order to increase breastfeeding rates, institutional and structural changes are required.
authors.affiliation: 1 Department of Medicine, Autonomous University of Baja California , Tijuana, Mexico .
authors.forename: Diana
authors.initials: D
authors.lastname: Bueno-Gutierrez
authors.forename: Caroline
authors.initials: C
authors.lastname: Chantry
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008430:Maternal-Child Health Centers / Q000592:standards*; D008800:Mexico / Q000453:epidemiology; D009035:Mothers / Q000193:education / Q000523:psychology; D009042:Motivation; D011247:Pregnancy