Lactation Practices – Neuquén, Argentina

As a second year Master’s in Public Health student (Global Health track), I am completing my practicum in the province of Neuquén, Argentina. The road that has led me here was not a straight one, and I am thrilled at how it has turned out. When I started the MPH program in August, 2008 I knew two things – I wanted to complete my practicum abroad, and I wanted to combine my practicum with lactation and mother and infant health. So over the last year and a half, I have been making contacts and researching possible goals of what I could accomplish. With every new article I read, I redefined what I wanted my practicum to include. After a little soul searching, I also began to think of this practicum as an opportunity to get back to my roots and learn a little bit more about my birthplace. And in November 2009, with the help of key people in the MPH department and at the Institute for Global Health, I was put in contact with Dr. Alejandra Mercado with the expectation to work with the urban population and the indigenous population (the Mapuche people) in the southern province of Neuquén, Argentina to examine the lactation education and support practices of the region.

Although I wanted to be in Argentina for my practicum for personal reasons, I was careful to select a place that would truly be valuable to my interests in lactation. Breastfeeding rates in the United States are extremely low, and public health campaigns are sparse if not non-existent. Neuquén has the highest breastfeeding rates accompanied by the lowest infant mortality rate in the nation. With this as my foreground, I began to assemble my project, in which I plan to discover if and how policies, culture, and education affect breastfeeding rates in both urban and rural communities in order to provide recommendations of how public health campaigns can improve in the United States to influence breastfeeding practices. Throughout my five week practicum trip, I will be in various cities within the province of Neuquén, including the capital city of Neuquén, Aluminé, Junin de los Andes, and Cutral Có.

I spent February 1st through the 5th in the city of Neuquén completing interviews with medical personnel and patients in four medical centers and five hospitals. I also used the time to compare the public healthcare system and the private (insurance-based) healthcare system. I am thrilled with the results at this point. Patients and medical personnel were very accommodating in answering questions and more than happy to show me their clinics and hospitals. In the maternity ward, women with their one-day-old infants were willing to spend twenty minutes with me to explain their personal views on lactation and the promotion programs here. In many cases, I was also able to witness the beauty of this wonderful bond form between mother and child, and observe the mom nursing her infant to take note of her abilities to properly position and latch the child for the best possible establishment of lactation. Many of the hospitals and medical centers display promotional materials and beautiful art pieces to support lactation and family unity. The picture was taken at a hospital, where a mural was painted to show a Mapuche woman nursing her infant.

Breastfeeding is truly a large part of the culture in Neuquén, and it is evident with the advertisements seen in public health medical clinics and hospitals. The frankness and slight humor in some of the ads are enough to catch someone’s attention, but are also educational. The picture below was used as a public health campaign a few years ago during world breastfeeding week, with posters and promotional materials all over the city. The caption reads “Security, satisfaction, and smiles”, with a very obvious message that breastfeeding will lead to these. These types of blatant campaigns are often in the United States for STD prevention, breast cancer awareness, and tobacco use prevention, but never for lactation support. In fact, many times these types of images are considered pornographic and we learn to censor one of the most natural and fundamental elements that define us as mammals. Ironically, we are completely accepting of the exposure of the breast for sexual purposes. Perhaps this fundamental difference between how the breast is viewed in Argentina versus the United States is at the root of the declining breastfeeding rates in the United States. I feel that it is obvious that public health workers need to stimulate a culture change to create a mindset that is understanding of the true necessity of the breast and acceptance for lactation promotion campaigns. Surely, this type of paradigm shift will induce an increase in breastfeeding rates.

These are just two of the many images that I was able to take while in Neuquén, however the promotional posters can be found in almost every waiting room of medical centers in the public health system. However, in the private healthcare system, nothing is advertised and the walls are blank, not only in regards to lactation, but they lack all public health campaigns. This difference in lactation education and promotion is manifested in the new mothers having less knowledge about breastfeeding recommendations and ease with practice. The moms I observed in the private healthcare setting were unsure of how to place their infant for the best latch. Additionally, it is known that the majority (over 75%) of women that seek help from the lactation specialists at the public hospitals within the first month of life are patients that were seen in the private healthcare sector that did not receive assistance in proper breastfeeding practices. Many differences can be discussed between the public and private sectors in Neuquén, as well as the overall public health efforts that vary with those in the U.S. I hope you follow my updates and learn with me what we can do together to improve breastfeeding practices.