title: Early Initiation of Breastfeeding Among Maya Mothers in the Western Highlands of Guatemala: Practices and Beliefs.
abstract: BACKGROUND
  Guatemala exhibits the sixth highest rate of child stunting worldwide, and stunting disproportionately affects Guatemala indigenous communities. In a country struggling to combat this result of malnutrition, early child nutrition is especially critical. Specifically, early initiation of breastfeeding is important for the development of newborn infants. Understanding beliefs and practices related to early initiation of breastfeeding in Maya Guatemala may provide an avenue to guide nutrition interventions in indigenous communities. Research aim: This study aimed to determine major beliefs and practices associated with early initiation of breastfeeding among Maya mothers in Lake Atitlán, Guatemala.
  
  
  METHODS
  As part of a larger study to assess child nutrition in the Lake Atitlán region, we created a series of semistructured interview questions to document breastfeeding practices and beliefs among mothers. We conducted and audio-recorded in-person interviews that were translated from Kaqchikel, the local language, to Spanish by a community assistant.
  
  
  RESULTS
  We conducted 178 interviews with mothers; 76% practiced early initiation. Early initiation was associated with the village and complementary feeding practices. Mothers held a variety of beliefs about the value of colostrum, and these beliefs were associated with the village. Mothers who held negative beliefs toward colostrum were more likely to delay breastfeeding initiation.
  
  
  CONCLUSIONS
  Although most Maya mothers practice early initiation, the intervillage disparity in breastfeeding practices demonstrates a need to geographically focus breastfeeding interventions. Our novel insights into the breastfeeding beliefs among Maya mothers will serve as a guide to structure culturally competent breastfeeding education interventions in indigenous communities.
authors.affiliation: 1 Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Natalie N
authors.initials: NN
authors.lastname: Atyeo
authors.affiliation: 1 Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Tahvi D
authors.initials: TD
authors.lastname: Frank
authors.affiliation: 1 Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Emma F
authors.initials: EF
authors.lastname: Vail
authors.affiliation: 1 Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: William A L
authors.initials: WAL
authors.lastname: Sperduto
authors.affiliation: 1 Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Boyd
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology*; D003126:Colostrum; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D006166:Guatemala / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology*; D036301:Qualitative Research; D013997:Time Factors
keywords: breastfeeding; breastfeeding initiation; breastfeeding practices; colostrum; infant development; infant nutrition