Promotion of breastfeeding in Costa Rica: the Puriscal study

Abstract

The decline in rate and duration of breastfeeding in urban areas in developing countries seems to have resulted from the transition from extended to nuclear cofamilies and exposure of young mothers to influences affecting their breastfeeding attitude and working patterns.',2 Experimental studies have demonstrated that early mother-infant stimulation has a marked promoting effect on breast feeding and bonding, and that man behaves like many animal species regarding mechanisms governing nursing and rearing behaviour.'* Breastfeeding is also declining in rural areas in many countries, due to profuse advertising of infant formulas and to 'Westernization' of ways of life." It was not obiious, however, that many failures to breastfeed in urban and rural areas have an origin in practices adopted during pregnancy, childbirth, and its aftermath.' Such practices have proliferated as institutionalized delivery increased in the last decades, expanding to rural populations throughout developing countries. In Costa Rica, only 50 per cent of births occurred in maternity wards in 1960, but in 1970 the rate had risen to 70 per cent and to 91 per cent in 1980. The increase in hospital deliveries was not accompanied, until 1977, by promotion of early mother-infant stimulation, bonding, And nursing, since strict separation and formula feeding of infants unfortunately had been established for about 10 years. This chapter summarizes observations recorded during 1976-83 in all the 77 847 live borns delivered in the San Juan de Dios Hospital, one of the largest and more prestigious institutions of Costa Rica.7•9 Observations were also made on neonates from a mountainous rural region, Puriscal, who were born during the period September 1979 to September 1980 primarily in the hospita1.1°." Possible effects of hospital practice were expected to influence rates and duration of breast feeding, and health and growth of Puriscal neonates born after the interventions.