Although many attempts have been made to promote breastfeeding in a variety of contexts, few programs have explicitly incorporated cultural beliefs in these efforts. This article describes a breastfeeding promotion program conducted on the Navajo reservation. This program was designed to be culturally appropriate. Background information regarding beliefs and factors affecting infant feeding practices in this setting is provided, followed by a description of the intervention. The intervention, which incorporated both social marketing and community participation techniques, consisted of three components: an intervention in the health care system, a community intervention, and an individual intervention. Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful. This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.
Get full access to this article
View all access options for this article.
References
1.
1. Report of the Surgeon General's Workshop on Breastfeeding and Human Lactation (HRS-D-MC 84-2). Rockville, MD, U.S. Department of Health and Human Services, 1984.
2.
2. Ryan AS, Rush D, Krieger FW, Lewandowski GE: Recent declines in breast-feeding in the United States, 1984 through 1989. Pediatrics88(4):719-727, 1991.
3.
3. Abramson R: Cultural sensitivity in the promotion of breastfeeding. NAACOG Clinical Issues3(4):717-722, 1992.
4.
4. Wright AL, Holberg CJ, Martinez FD, et al: Breastfeeding and lower respiratory tract illnesses in the first year of life. Br Med J299:946-949, 1989.
5.
5. O'Gara C, Kendall C: Fluids and powders: Options for infant feeding. Med Anthropol9(2):107-122, 1987.
6.
6. Bledsoe CH: Side-stepping the post-partum sex taboo: Mende cultural perceptions of tinned milk in Sierra Leore, in van de Walle E (ed.): The Cultural Roots of African Fertility. Berkeley, University of California Press, in press.
7.
7. Raphael D (ed.): Breasifeeding and Food Policy in a Hungry World. New York, Academic Press, 1979.
8.
8. Feinberg R: Symbolic dimensions of breast-feeding in America. Case Analysis1 (4):329-335, 1981.
9.
9. Fishman C, Evans R, Jenks E: Warm bodies, cool milk: Conflicts in post partum food choice for Indochinese women in California. Social Sci Med26(11):1125-1132, 1988.
10.
10. Bryant C, Lazarov M, Light R, Bailey D, Coreil J, D'Angelo S: Best Start: Breastfeeding for healthy mothers, healthy babies—A new model for breastfeeding promotion. J Tenn Med Assoc (December), 1989.
11.
11. Wright AL, Holberg C, Taussig LM, et al: Infant feeding practices among middle class Anglos and Hispanics. Pediatrics82:496-503, 1988.
12.
12. Martinez GA, Dodd DA: 1981 milk feeding patterns in the United States during the first 12 months of life. Pediatrics71:166-170, 1983.
13.
13. Scrimshaw SC, Engle PL, Arnold L, Haynes K: Factors affecting breast-feeding among women of Mexican origin or descent in Los Angeles. Am J Public Health77:467-470, 1987.
14.
14. Mohrer J: Breast and bottle feeding in an inner-city community: An assessment of perceptions and practices. Med Anthropol3(Winter): 125-145, 1979.
16. Rassin DK, Richardson CJ, Baranowski T, et al: Incidence of breast-feeding in a low socioeconomic group of mothers in the US: Ethnic patterns. Pediatrics73(2):132-137, 1984.
17.
17. Hirschman C, Butler M: Trends and differentials in breast-feeding. Demography64(5):686-692, 1975.
18.
18. Brimblecombe FS, Cullen D: Influences on a mother's choice of method of infant feeding. Public Health91:117-126, 1977.
19.
19. Reiff MI, Essock-Vitale SM: Hospital influences on early infant-feeding practices. Pediatrics76(6):872-879, 1985.
20.
20. Frank DA, Wirtz SJ, Sorenson JR, Heeren T: Commercial discharge packs and breast-feeding counseling: Effects on infant-feeding practices in a randomized trial. Pediatrics80(6):845-854, 1987.
21.
21. Wright AL, Rice S, Wells S: Changing hospital practices is associated with increases in breastfeeding duration. Pediatrics, 97(5): 669-676, 1996.
22.
22. Wright AL, Bauer M, Clark C, Morgan F, Begishe K: Cultural interpretations and individual beliefs about breastfeeding among the Navajo. Am Ethnology20(4):781-796, 1993.
23.
23. Wright AL, Clark C, Bauer M: Maternal employment and infant feeding practices among the Navajo. Med Anthropol Q7(3):260-281, 1993.
24.
24. Bauer MC, Wright AL: Integrating qualitative and quantitative methods to model infant feeding behavior among Navajo mothers. Human Organization, 55(2):183-192, 1996.
25.
25. Brody DW, May PA: Demographic and epidemiologic transition among the Navajo Indians. Social Biology30:1-16, 1983.
26.
26. Lamphere L: To Run After Them. Tucson, University of Arizona Press, 1977.
27.
27. Winikoff B: Modification of hospital practices to remove obstacles to successful breastfeeding, in Jelliffee DB, Jelliffe EFP (eds.): Programmes to Promote Breastfeeding. New York, Oxford University Press, 1988, pp. 279-285.
28.
28. Perez-Escamilla R, Pollitt E, Lonnerday B, Dewey KG: Infant feeding policies in maternity wards and their effect on breast-feeding success: An analytical overview. Am J Public Health84(1):89-95,1994.
29.
29. Nadel EL: Breastfeeding promotion in an urban New Jersey WIC office. J Human Lact9(2):140-142, 1993.
30.
30. Myers D, Kent H, Baranov S: The joys and challenges of promoting breastfeeding in South Central Los Angeles. J Human Lact9(4):284-287, 1993.
31.
31. Bryant CA: Impact of kin, friend and neighbor networks on infant feeding practices. Social Sci Med16:1757,1982.
32.
32. Wallerstein N, Bernstein E: Empowerment education: Freire's ideas adapted to health education. Health Educ Q15:379-394,1988.
33.
33. Robertson A, Minkler M: New health promotion movement: A critical examination. Health Educ Q21(3):295-312,1994.
34.
34. Manoff R: Social Marketing. New York, Praeger, 1985.
35.
35. Green CP: Media Promotion of Breastfeeding: A Decade's Experience. Washington, DC, Academy for Educational Development, 1989.
36.
36. Cunningham AS: An historical overview of breastfeeding promotion in Western Europe and North America. Programmes to Promote Breastfeeding. ed DB Jelliffee and EFP Jelliffe. Oxford University Press. 15-21, 1988.
37.
37. Lawrence RA. Major difficulties in promoting breastfeeding: US perspectives. Programmes to Promote Breastfeeding. ed. DB Jelliffe and EFP Jelliffe. Oxford University Press. 267-270, 1988.
38.
38. Hill PD. Effects of education on breastfeeding success. Matern Child Nurs J16(2):145-156, 1987.
39.
39. Tognetti J. Evaluating breastfeeding promotion programmes, in Jelliffee DB, Jelliffe EFP (eds.): Programmes to Promote Breasifeeding. New York, Oxford University Press, 1988, pp.405-417.
40.
40. Palti H, Valderama C, Pogrund R, Jarkoni J, Kurtzman C: Evaluation of the effectiveness of a structured breast-feeding promotion program integrated into a maternal and child health service in Jerusalem. Israel J Med Sci24:342-348, 1988.
41.
41. Mata L, Allen MA, Jimenez P, et al: Promotion of breastfeeding, health, and growth among hospital born neonates, and among infants of a rural area of Costa Rica, in Chen LC, Scrimshaw NS (eds.): Diarrhea and Malnutrition. New York, Plenum, 1983, pp. 177-202.
42.
42. Jelliffe DB, Jelliffe EFP, Latham M, Greiner T: Devising breastfeeding programmes—Some practical realities and recent developments, in Jelliffee DB, Jelliffe EFP (eds.): Programmes to Promote Breasffeeding. New York, Oxford University Press, 1988, pp. 426-445.
43.
43. Valdes V, Perez A, Labbok M, Pugin E, Zambrano I, Catalan S: The impact of a hospital and clinic-based breastfeeding promotion programme in a middle class urban environment. J Tropical Pediatrics39:142-151, 1993.
44.
44. Scrimshaw SCM, Hurtado E: Rapid Assessment Procedures for Nutrition and Primany Health Care (UCLA Latin American Center Reference Series Vol. 11). Los Angeles, University of California, 1987.
