Promotion of Breast Feeding, Health, and Survival of Infants Through Hospital and Field Interventions

Abstract

Most authorities agree that the decline in the rate and duration of breast feeding in urban areas in many developing countries has been the result of urbanization and influences of Western culture. Two sequalae have been the transition from extended to nuclear families and the exposure of young mothers to influences affecting their attitudes and working patterns [Jelliffe and Jelliffe, 1978; Elliott and Fitzsimons, 1976]. Experimental studies have demonstrated that early mother-infant stimulation has a marked promoting effect on breast-feeding and bonding. It has become quite obvious that man is not so different from certain animal species in the kind of Mechanisms leading to successful nursing and infant-rearing behavior [Bowlby, 1969; Klaus and Kennell, 1976]A similar decline in breast feeding is also becoming apparent in rural areas, partly owing to a profusion of advertisements of infant formulas and partly to "Westernization" of ways of life [Jelliffe and Jelliffe, 1978; Greiner et al, 1979]. It was not obvious to many, however, that many failures to breast-feed in urban and rural areas have an origin in the inadequacies of medical support during pregnancy and particularly during childbirth and its aftermath [Jelliffe and Jelliffe, 1978]. Such inadequacies have proliferated as institutionalized delivery increases and is expanded to rural populations throughout developing countries. To illustrate, only 50% of births were attended in maternity centers and clinics in Costa Rica in 1960, but in 1970 the rate rose to 71% and in 1980 to 91% [Mata, 1983]. The increment in hospital delivery has not necessarily been accompanied by practices to promote early mother-infant stimulation, bonding, and nursing. Strict separation of mothers and infants after delivery, and feeding neonates with artificial formulas are common practices in the developing world. This report summarizes observations recorded during 1976-1982 in the population of newborns delivered in the San Juan de Dios Hospital, one of the largest and most prestigious Costa Rican institutions [Mata et al, 1982a, 1983]. Observations were extended to neonates of one particular mountainous rural region, Puriscal, who were born during the period September 1979-September 1980 primarily in the San Juan de Dios Hospital [Mata et al, 1981; Mata, 1982]. The early neonatal morbidity and mortality were calculated across the 7-year period for the 61,478 live births during the observation period. Furthermore, possible effects of hospital practice were evaluated in terms of differentials in rate and duration of breast feeding, health, and growth among Puriscal neonates born from September 1979 to September 1980. Since this effort was part of a long-term prospective observation on nutrition, health, and growth of mothers and infants in a typical rural area, field interventions were also evaluated accordingly.