Breastfeeding knowledge and health behavior among Mayan women in rural Guatemala.

Guatemala has the fourth highest infant mortality rate in Latin America, which makes the support and protection of breastfeeding especially critical. Traditional health-promoting practices like breastfeeding may be protected by increasing knowledge of its benefits. Yet there is a dearth of research documenting breastfeeding knowledge (i.e., knowledge of its benefits for infant health and development) in communities where breastfeeding is already practiced. OBJECTIVE: Our aim was to assess degree of breastfeeding knowledge among Mayan mothers in the rural highlands of North-Western Guatemala and compare knowledge of breastfeeding - a practice promoted by local health centers - and other traditional yet non-promoted infant care practices. METHOD: We conducted a survey of maternal-infant health knowledge and behavior among mothers in rural Guatemala (N = 300) from six communities with a non-governmental organization (NGO) health program and one comparison community. RESULTS: Overall, mothers displayed more knowledge of the benefits of breastfeeding in comparison with other traditional infant care practices not promoted by a community health program. Mothers in communities with a health program demonstrated increased knowledge of breastfeeding, regardless of whether they personally participated in the program. This health knowledge predicted participation in novel health-promoting behaviors (family planning, prenatal care, exclusive breastfeeding). CONCLUSIONS: Understanding breastfeeding knowledge as a proxy for community health exposure may increase the efficacy and diffusion of community health messaging.

Factors influencing health care-seeking behaviours among Mayan women in Guatemala.

OBJECTIVE: to identify and better understand factors that influence care-seeking behaviour for women's health among indigenous Mayan populations in the highlands of Guatemala. DESIGN: adaptation of qualitative anthropological methods involving observations, key informant interviews and focus group discussions (FGDs). SETTING: Project Concern International's Casa Materna, Huehuetenango, Guatemala. PARTICIPANTS: Interviews and FGDs were conducted among 21 clients (current or past) of the Casa Materna and traditional birth attendants; 17 female advocates/promoters of the Casa Materna and related services; and 12 male advocates, including spouses, non-government organisation staff and community health workers. FINDINGS: the following findings emerged from focus group data: Women's support groups (WSGs) provided an enabling environment in which women could form friendships, bond, discuss concerns about their reproductive health, and identify concrete ways of addressing them; Supportive friends, family members and advocates influenced women's decisions to seek health care at the Casa Materna; Women's decisions to seek care were often associated with their sense of self-worth and self-esteem, and women's self-esteem was enhanced by their participation in the WSGs; Women's decisions to seek care were influenced by the perception that women would be able to access culturally appropriate, safe and secure health care services at the Casa Materna; The learned behaviour of negotiation with key decision-makers and/or opinion leaders was an effective tool for convincing such individuals of the value of accessing facility-based care; The proven track record, high quality of services and cultural competence offered at the Casa Materna increased the confidence and level of trust of clients and their family members about the care that would be received; Couple-based education and health promotion were effective techniques for achieving behaviour and attitude change among both men and women. KEY CONCLUSIONS: the Casa Materna and its community outreach strategy serve an essential purpose in the provision of maternity care for the isolated and vulnerable families of the Guatemalan highlands, by bridging traditional and Western approaches to health care services. The Casa Materna service model plays a critical role in improving women's self-efficacy and ultimately strengthening the social fabric that characterises this high risk and vulnerable population. IMPLICATIONS FOR PRACTICE: the Casa Materna model provides a foundation upon which to bridge and strengthen the relationship between community advocates, traditional community-based health care providers, and the government-funded system of health care. The findings of this study should be incorporated into future research to determine the potential for bringing the model to scale.