Growth monitoring and the promotion of breastfeeding

Recent studies evaluating the efficacy of growth monitoring programs have scrutinized their educational and preventive capabilities. Advocates claim that growth monitoring can be effective if communities and mothers are more actively involved in the process of weighing and measuring, and if the technology is understood by all as an aid for disease prevention and health promotion rather than as a 'curative' procedure. Others have argued that this theory is rarely possible to implement. The ways in which preventive growth monitoring can be made possible are still under exploration, given that the reasons for such deeply imbedded 'curative' expectations of growth monitoring are not fully understood. Any such understanding requires an analysis of growth monitoring within the context of the GOBI (growth monitoring, oral rehydration therapy, breastfeeding and immunization) child survival framework. To attain this type of understanding, a series of qualitative methodological techniques were used in a population of 50 mothers and several health care facilities in Pelotas, RS, Brazil, as a complement to pre-existing epidemiological data from the Center for Epidemiology at the Federal University of Pelotas. With a subsample of 15 mothers, intensive interviews and observations were specifically focused on: (1) mothers' understanding of growth monitoring, (2) breastfeeding practices and beliefs, (3) doctor-patient communication. Findings from this study suggest that, even in a program with widespread attendance and a relatively 'interactive' growth monitoring approach, the use of growth charts do little to promote duration or frequency of breastfeeding, and may even pay a role in the factors which deter women from choosing to breastfeed for longer durations or with greater frequency. We found that mothers' personal interpretations of the charts were representative of the larger socio-cultural and economic issues that affected their lives on a daily basis. Growth charts thus served as one of the many tangible domains onto which mothers could project their worries and measure their personal 'successes' and 'failures'.