For my second summer of fieldwork in Guatemala, I initiated a collaboration between the NGO Project Concern International and Dr. Holly Shakya from the Division of Global Public Health at UCSD.

Infant care in rural Guatemala is characterized by high levels of physical contact, on demand breastfeeding, and prompt responsiveness to infants’ cues. These three infant care behaviors –characteristic of “proximal care cultures” (Keller, 2002) – are highly correlated, culturally-mediated, and are associated with distinct parenting goals (Menzel, 2006; Richman, Miller, & Levine, 1992). They are also associated with positive implications for the developing infant.  For example, on demand breastfeeding is associated with decreased crying, increased milk production, and higher quality of milk production (Menzel, 2006; Keller, 2002; Keller & Otto, 2009; Richman, Miller, & Levine, 1992) and also promotes healthy eating behaviors and prevents malnutrition (Engle, Bently, & Pelto, 2000; Wright, Fawcet, & Crow, 1980). Mother-infant physical contact is associated with improved stabilization of physiological processes (Bergman et al., 2004; Charpak et al., 2001; Ramanathan et al., 2001), including better temperature regulation (Anderson et al., 2003; Chwo et al., 2002), analgesic effects during heel lance procedures (Gray et al., 2000), improved weight gain (Ferber et al., 2002), longer periods of quiet sleep (Chwo et al., 2002), and more organized sleep-wake cycles (Feldman et al., 2002).  Physical contact is also associated with decreased crying (Barr et al., 1991; Hewlett et al., 1998; Hunziker et al., 1986; James-Roberts et al., 2006; Whitelaw, Heiserkamp, Sleath, Acolet, & Richards, 1988), improved shared attention (Feldman et al., 2002), more time in quiet-alert state (Gale & Vandenberg, 1998), and increased multimodal exploration (Feldman et al., 2002). Responsiveness is associated with social learning (Calvert, Strong & Gallagher, 2005; Troseth, 2003; Troseth, Saylor, & Archer, 2006; Bigelow & Birch, 1999; Johnson, Slaughter, & Carey, 1998) and language development (Goldstein & Schwade, 2008; Nicely, Tamis-LeMonda, & Bornstein, 1999; Tamis-LeMonda, Kuchirko, & Song, 2014). Responsive caregiving is also a consistent predictor of secure attachment (De Wolff & van Ijzendoorn, 1997; Dunst & Kassow, 2008).

These positive infant care behaviors are fairly universal among indigenous mothers in Guatemala. However, there are still high levels of malnutrition, premature births, low birthweight, and neonatal mortality. These risks for Guatemalan infants and infants in other developing countries have been attributed to the variation among mothers in other maternal-infant health behaviors, including adolescent fertility, birth spacing interval (Rutstein, 2005), immediate breastfeeding initiation (Lie et al., 2014), postnatal skin-to-skin contact (Boundy et al., 2016), prenatal care (Mcdonagh, 1996), and family planning. This disconnect between such positive primary components of Guatemalan infant care (breastfeeding, physical contact, responsiveness) and the high variability in other maternal-infant health behaviors – that have potentially risk-inducing effects on infants –is unclear and understudied.

Past research analyzing psychosocial predictors of maternal-infant health behaviors have focused primarily on the influence of attitudes, intentions, and social norms (Gwo et al., 2016). There is limited research on the role of motivational factors on breastfeeding and other maternal-infant health behaviors (Peleg, Shamir-Dardikman, Hermoni, & Ginzburg, 2015). A handful of studies have looked at the role of different types of motivation on breastfeeding success, finding that an overwhelming majority of mothers in many places of the world are most likely to be motivated to breastfeed because of their interest in the baby’s health and well-being, (e.g., Takushi et al,. 2008). However, there is still a lack of understanding of how different forms of motivation relate to different maternal-infant health behaviors in specific communities, especially those most vulnerable to malnutrition and infant mortality. This is surprising, given that broader research in health behavior motivation has documented that variation in types of motivation can play a central role in the initiation and maintenance of health behaviors (e.g., Self-Determination Theory, Deci & Ryan, 1985; 2008). Understanding the more nuanced roles of certain types of motivation on infant care and health practices is essential to addressing maternal-infant health concerns among Guatemalan mothers.

The aims of this study were to: 1) document the motivational factors underlying the practices of breastfeeding, physical contact, and responsiveness, and 2) assess the connection between motivations for these widely practiced behaviors and variability in other maternal-infant health behaviors and outcomes (e.g., prenatal care visits, birthweight).