The results from this study indicated that there are important differences between grandmothers’ and HCPs’ infant feeding recommendations. These differences are important to consider because they may instigate tension and conflict as mothers decide how to feed their infants.

The role and perspectives of grandmothers on infant feeding

Grandmothers can be either great allies or great adversaries to breastfeeding [16,17,18,19,20]. In our study, some grandmothers were open to learning from HCPs through workshops offered by government programs and they were likely to share the knowledge they gained with other women. It is important to note, however, that there were some key differences between the perspectives of grandmothers and HCPs. Specifically, some grandmothers expressed the importance of giving herbal teas to infants. Others favored the early introduction to solid foods, and some expressed the value of breastfeeding well beyond six months postpartum.

Previous studies have reported the circumstances in which mothers may be more likely to follow the advice of grandmothers regarding infant feeding practices. A meta-ethnographic study with migrant women´s experiences of breastfeeding, reported that mothers were more likely to take into consideration the opinion of grandmothers if they lived with them or maintained a close relationship with them [36]. Results from another study in a Triqui community in Mexico further suggested that when mothers were experiencing vulnerable moments, in which they felt insecure, they were more likely to follow recommendations from their mothers to avoid any risks or health complications for their infants [37].

Biomedicine and colonialism

Healthcare professionals tended to perceive their infant-feeding recommendations as superior to the recommendations of grandmothers and anyone outside the biomedical field. This reproduced a clear hierarchy in which any knowledge outside the biomedical model was disregarded. This hierarchy can be associated with the coloniality of biomedicine, in which the biomedical model superimposes its knowledge as the most valuable and discounts any other knowledge, including that of communities [24,25,26,27, 38]. Previous research has shown that HCPs believe they have the absolute truth, and as such, there is no need for them to consider the opinion of women regarding their infant feeding practices [22, 23]. These assumptions lead HCPs to consider themselves as breastfeeding experts and to have the power to decide what is “natural” for mothers and infants [39]. This, in turn, can make doctor-patient communication difficult for mothers, as HCPs try to impose their visions in an authoritarian, vertical, and hierarchical way.

Despite the assumption that the infant feeding knowledge of HCPs is the most accurate, numerous studies have shown that this is not always the case [11, 12, 14, 23, 35, 40]. This can be attributable to several reasons. First, there is a lack of training on how to support breastfeeding mothers [11, 12, 23, 40]. Second, the biomedical model tends to favor the use of breast milk substitutes to improve the "efficiency" of infant feeding and not "waste time" accompanying and helping mothers breastfeed their infants [11, 23]. Third, some HCPs only value the biological and nutritional aspects of breastfeeding and pay little attention to the sociocultural context that impacts infant feeding practices [12,13,14, 23]. This may make it difficult for HCPs to understand why mothers do not breastfeed even though they may be able to recite the list of nutritional and immunological properties of human milk.

Not understanding or valuing the sociocultural context of infant feeding may be difficult for HCPs as the vast majority that work in rural communities tend to be foreign to the communities they serve [38, 41, 42]. Previous research [42,43,44] has corroborated that HCPs who perform internships in smaller provinces tended to dismiss traditional concepts and beliefs during doctor-patient interactions. Furthermore, having received training based on a biomedical model makes it difficult for HCPs to understand and identify the complex realities of the communities they serve.

It is unclear why HCPs in our study made the assumption that mothers do not follow their advice, but utilizing a broader perspective that accounts for the ongoing colonial history of Mexico may provide important insights. The biomedical system is a direct result and perpetuator of colonial legacies, including classist, racist, and sexist attitudes [38]. This perspective informs HCPs’ assumption that rural and Indigenous mothers and people in general are too “ignorant” to follow advice from healthcare professionals. Previous research in Mexico has found that HCPs are likely to attribute the lack of adherence to medical recommendations of their Indigenous and poor patients to supposed ignorance and obstinacy [41]. Another study conducted in Mexico also reported that HCPs tended to perceive low-class, dark-skinned (sometimes Indigenous), women as problematic, hyper-fertile, ignorant, filthy, unable to care for children, and that their sole contribution to society was to birth so called “defective” citizens [45].

The influence of media on infant feeding

Findings from our study indicate that messages from the media may have an impact on infant feeding practices. Interviews from HCPs revealed that some of them perceived that the media was heavily influencing how mothers cared for their infants. For example, some HCPs reported that through media, infant formula was portrayed as a “modern” commodity that makes it easier for mothers to deal with crying infants.

These findings align with previous research conducted in Mexico that reported how human milk substitutes are advertised. Research from a rural Nahuatl community in Morelos reported frequent TV broadcasts of human milk substitutes paired with blond babies from apparently high socioeconomic status [42]. Another study on the marketing of breast milk substitutes further reported that 85% of mothers were exposed to this type of advertising on television. These advertisements were broadcasted mostly in the afternoon and evening, specifically during soap operas and family shows, thought to be the time most preferred by women [46]. An additional study identified breast milk substitute’s promotion in nearly all retail stores, pharmacies, and convenience and corners stores visited [47].

Maternal blame and suffering

Community support and care for mothers during the postpartum period has been gradually declining within the context of Mexico [48]. Traditionally, women in Mexico received emotional and physical support from the women in their families and communities [48, 49]. Examples of such support women received during the postpartum period included housework, care for other children, and maintaining social networks to promote a sense of belonging to the community. Today, mothers are expected to recover rapidly and return to their “productive” lives. This is further complicated for mothers who work outside the home, as they are expected to fulfill their domestic and parenting “obligations” as well, which imposes a double workload and a significant obstacle to breastfeeding.

In our study we found that grandmothers and HCPs perceive mothers as becoming increasingly irresponsible in their parenting. Mothers who do not breastfeed are seen as lazy, selfish, as not caring for their children, and as only concerned with their body image or social life. Previous research reported that HCPs frequently blamed mothers for neglect or carelessness towards their children when they did not carry out the biomedical recommendations or practices that they assumed they should know and carry out [39]. Another study conducted in Bolivia found that women who received the most criticism were often those with the least power to respond to negative judgments and discrimination, poor and Indigenous mothers [25].

While mothers are blamed and held as the only ones responsible for their infants, ironically, they often experience significant invisibility when communicating with HCPs [22]. It appears that the experiences of mothers are not taken seriously by healthcare professionals. Instead, mothers tend to receive homogeneous and standardized recommendations that ignore their particular contexts [13, 23]. Moreover, mothers often encounter disrespectful attitudes, such as a mother in Bangladesh reporting that a doctor compared her to a cow [39].

The present study found that some grandmothers and HCPs considered pain and suffering as an essential component of motherhood. Other studies in Latin America have also corroborated this finding [22, 25]. A study in Bolivia reported that suffering and sacrifice were perceived as central components of motherhood [25]. Maternal sacrifices start during the prenatal stage when mothers must comply with food cravings for the sake of their babies. The sacrifices continue with the pain of childbirth, which is essential to establish a lifelong bond between mother and child. Suffering is then reinforced through breastfeeding, which is believed to have the possibility of transmitting the emotional states of the mother to the child. Future research should further analyze the effects of these notions around pain with breastfeeding in different contexts in Latin America.

Considerations for public health policies and intervention programs

Findings from our study suggest that there are gaps and differences in infant feeding recommendations coming from grandmothers and healthcare professionals. It is important to address these findings by considering educational and counseling interventions that promote breastfeeding without causing maternal guilt and that consider the existing traditional knowledges within a community [50]. Moreover, our study highlights the importance of including grandmothers in interventions given that they demonstrate an interest in learning from HCPs and sharing the information they learn with other mothers. Our study also demonstrates the lack of skillsets for HCPs to communicate accurate information regarding optimal breastfeeding practices, therefore, it would be beneficial to develop educational programs to address this lack of training.

There are two pedagogical models that could provide insightful strategies to address the gaps identified in this study. First, the pedagogical model from Colombia’s Universidad de Antioquia, which is based on a reflective-experiential process that deconstructs established truths and constructs new ways of approaching breastfeeding based on the needs of mothers and their families [22]. The “Trato Digno” model [51] is another one to consider because it invites participants to reflect on structural factors of racism, classism, and sexism within biomedicine in the context of Mexico’s culture. Elements from both models may help address structural factors that perpetuate the gaps between traditional and biomedical infant feeding recommendations.

Limitations

This study should be interpreted taking into account the following limitations. First, the current study used secondary data of a previous study conducted by our team. As such, the primary objective of the original research was not to examine the differences in infant feeding recommendations between grandmother and healthcare professionals. Therefore, the interview questions were not specifically designed to address the question addressed in this article. Despite this limitation, as demonstrated in this article the secondary data analyses provided important insights into the different perspectives of grandmothers and HCPs. Secondly, there was limited information on how mothers negotiate receiving conflicting information from grandmothers and HCPs. Nevertheless, our study has now identified this knowledge gap as an important area for future research.

Reflexivity statement

The research team conducting this study represents a diverse group of individuals with expertise in the areas of anthropology, medicine, nutrition, psychology, and public health; all of which have a shared interests in the topics of reproductive and infant health, particularly in infant feeding practices in the context of social inequities. All researchers are Mexican or of Mexican descent and have been privileged to access higher education and work within institutions in either Mexico or the United States. It is also important to acknowledge that none of them are from the communities who participated in this study. As such, the research team is aware that there are important differences and inequities between them and the participants, which are driven by colonialism and subsequent neocolonial social structures. For this reason, even though the study was designed to strongly represent the voices from the communities, the team acknowledges that its interpretation of results for the present study have been influenced by the research team’s social privileges, experiences, assumptions, and beliefs.