Academic journal article Human Organization

Infant Agency and Its Implication for Breast-Feeding Promotion in Brazil

Academic journal article Human Organization

Infant Agency and Its Implication for Breast-Feeding Promotion in Brazil

Article excerpt

Studies indicate that early weaning and supplementation (before six months) are widespread problems in Brazil. To arrest and reverse this trend, national, local, and grassroots organizations have implemented a number of breast-feeding promotional campaigns. While these campaigns employ a number of different strategies, many incorporate education as a key component. Often these programs share a common assumption about infant feeding and decision making. Specifically, these campaigns frequently conceptualize the decision to breast-feed as a unilateral one, with mothers making feeding decisions and infants passively accepting and complying with these decisions. While health care professionals may assume that mothers share this model of breast-feeding decision making, this may not always be the case. This paper presents a case study from the urban Amazon where mothers attribute agency to their infants. As such, mothers state that successful breast-feeding is the result of bilateral decision making; both mothers and infants must decide to breast-feed. This bilateral model shapes observed patterns of early weaning in the community. When asked why they terminated breast-feeding, 42 percent of mothers stated it was their infants' decision. The implication of attributing agency to infants for breast-feeding promotion is discussed.

Key words: agency, breast-feeding promotion, infant feeding, Brazil

Infant Feeding and Health Promotion

Scholars and health officials agree that breast milk is an ideal infant food. It is nutritionally complete, contains maternal antibodies that boost an infant's developing immune system, and is sterile. These characteristics make breast milk an especially important food in poverty environments where households often contend with unhygienic water sources, expensive or scarce fuel, inadequate storage facilities, and competing demands on limited financial resources (Van Esterik 1989). Under these conditions, the early introduction of formula and weaning foods may compromise infant health by exposing infants to intestinal pathogens via contaminated food and water, while simultaneously depriving them of maternal antibodies (Arifeen et al. 2001; Cesar et al. 1999; De Zoysa, Rea, and Marlines 1991; Glass and Stoll 1989; Huttly, Morris, and Pisani 1997; Victora et al. 1987). Early weaning may also lead to malnutrition if caregivers overdilute expensive formula or use less expensive, but non-nutritious, foods to stretch the household budget (Egemen et al. 2002; Ojofeitimi, Elegbe, and Afolabi 1986; Potur and Kalmaz 1996; Scheper-Hughes 1992). As such, breast-feeding promotion is a key component of programs designed to improve infant health. At present, the standard recommendation is that infants exclusively breast-feed until four to six months of age and then supplement breastfeeding with formula and appropriate foods until two years (UNICEF 2002:49; WHO 2001:5).1

Infant feeding patterns, however, do not always conform to this ideal.2 This is true of metropolitan Brazil, which has the dubious distinction of having one of the highest rates of early weaning in the developing world (Lares et al. 1996). Between 1940 and 1975, the percentage of babies ever breast-fed fell from 96 percent to less than 40 percent (Scheper-Hughes 1992). Even after extensive promotional efforts in the 1980s and 1990s, breast-feeding practices in Brazil are still far from ideal. One study conducted in northeast Brazil found that while 99 percent of mothers initiated breast-feeding, 80 percent gave their newborns water or tea in the first week and 58 percent gave other milk in the first month. Additionally, only 0.6 percent of children were exclusively breast-fed at six months (Marques et al. 2001). Another study from the Northeast reports that only 3 percent of children between the ages of zero and four months are exclusively breastfed (Baumslag and Michels 1995). Reports from the more prosperous Southeast indicate that, while figures are slightly higher, they still do not approach the suggested guidelines. …

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