Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies
Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies
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DOI：
10.1186/s13002-018-0271-2
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发表时间：
2018-11-20
影响因子：
3.6
通讯作者：
Yucra Velasquez, Benedicta
中科院分区：
文献类型：
--
作者：
Monteban, Madalena;Yucra Velasquez, Valeria;Yucra Velasquez, Benedicta
背景：尽管当地政府和国际发展机构作出了长期努力，但低收入国家的儿童营养不良问题依然存在。为了解决这一问题，秘鲁卫生部侧重于改善获得初级保健的机会，并提供孕产妇和儿童健康监测和教育。秘鲁目前的妇幼保健政策提出的建议在某些方面有别于土著高原社区的建议。本文分析了公共卫生与母亲婴儿喂养建议的异同。方法：对秘鲁高原农村社区18名老年母亲、15名正在哺乳的母亲和15名公共卫生工作人员进行半结构式访谈。在数据分析过程中，主题代码和文本段落被用来记录新出现的主题。结果：结果突出了围绕婴儿喂养和护理的传统信念语料库的存在，这与安第斯民族医学信念是一致的。母亲的描述说明了这一点，她提到了保持液体和半液体的饮食平衡以及与自然环境中的元素保持和谐的重要性。母亲还纳入了她们认为有用的公共卫生建议的一些方面，包括在出生后立即开始母乳喂养，以及直到6个月的纯母乳喂养。这两个系统之间也存在矛盾，包括在母乳喂养和婴儿食品的概念上的差异，以强制手段强加公共卫生保健服务，以及对安第斯农村饮食和母亲的负面刻板印象。结论：识别不同系统之间的异同可能为有效的跨文化卫生政策提供有用的信息。应认真评估紧张的根源，以期改进公共卫生政策。这种努力应该采用一种文化谦逊的过程，让卫生保健专业人员参与与患者和社区的交流和对话，承认他们自己理解中所包含的假设和信念。这一进程还应承认和重视安第斯母亲的知识和做法及其作为主要照顾者的作用。
Background: The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers' infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies.Methods: Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes.Results: The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother's accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers.Conclusions: Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.