Camber Cooper and Dr. Erin Maughan, College of Nursing
Introduction
Tucumán is the poorest province in the country of Argentina, made worse by recent economic turmoil. Maternal nutrition is not only important for her own health, but it is also crucial to her developing fetus, both before and during pregnancy, as all nutrients the infant receives during this time come solely from the mother (Lowdermilk & Perry, 2004). Considering the importance of maternal nutrition, reports of malnutrition in Argentina cause particular concern for pregnant and nursing women. According to Argentina’s National Institute of Censuses and Statistics (n.d.), infant mortality across the country in 2002 was 16.8 per 1,000 live births, while in Tucumán it was 24.3 per 1,000. In contrast, the United States’ 2002 total infant mortality rate was 7.0 per 1,000 (Mathews, Menacker, & MacDorman, 2004).
The objectives of this study are three-fold: (a) to evaluate the nutritional knowledge and cultural beliefs of new mothers in Tucumán before and after their delivery; (b) to examine the extent to which this knowledge is employed by these women; and (c) to identify any barriers that may impede proper nutritional care.
Methods
The sample for this study consisted of 9 mothers conveniently selected from the Hospital de Maternidad, Nuestra Senora de la Merced, in Tucumán, Argentina. These mothers had recently (within two weeks) given birth and were staying in the post-partum units of the hospital until they and their babies were stable enough to return home. The women ranged in age from 19 to 36 years old, and differing levels of parenting experience, from two mothers having their first baby up to two others having their fifth. They also had educational levels varying from no formal education at all to one year of college. Eight of the nine mothers were unmarried but living with a consistent partner in a form of social contract common in that area. This hospital is a public hospital, so only one out of the nine mothers had insurance.
Data were collected in face-to-face interviews by the interviewer and an accompanying Spanish-speaking student. Hand-written notes were taken during the interview, and interviews were also tape-recorded for later transcription and translation into English. Questions asked included demographic questions as well as questions concerning pre-natal care and nutritional practices, cultural beliefs, the mothers’ knowledge and perceptions of what are considered “healthful eating,” and any barriers to proper nutrition. IRB approval was obtained prior to conducting this study, and verbal consent obtained from each participant before the interview.
Results
All women but one managed to receive frequent prenatal visits, which they termed “going to Control.” The Argentine government has a healthcare system which provides community healthcare centers (CAPS for short) in the rural areas and outskirts of the city where women can get free pre-natal care. Although some women did get nutritional counseling during these visits, it was often incomplete. About four of the women reported the doctor told them to take vitamins and/or iron supplements during their pregnancy. The most frequent advice from doctors cited was to “rest and take care of yourself” during pregnancy. When questioned further about how they interpreted this, the women responded with varying answers, such as resting often, maintaining good hygiene, or avoiding trauma to the abdomen. Others reported that the doctor told them to increase their milk or fruit intake. Two women reported that the doctor told them to avoid “heavy” foods, which they described as foods that were fattening or too spicy.
The women also received advice from family members, frequently mothers, older sisters, or female friends. Their advice often paralleled the doctor’s advice to increase milk and fruit intake. In addition to family advice, some cultural ideas prevailed, particularly among women with incomplete education. One woman stated that she ate excessive amounts of oranges, to make the baby’s skin soft and smooth. Two others, when questioned what they regarded as healthy food, responded that fried steak and soup were healthy. Yerba mate, a traditional Argentine drink, often replaced breakfast or dinner.
Implications and Discussion
Several barriers exist that prevent Argentine mothers from receiving the nutrition they need during pregnancy. Although the mothers interviewed received some nutritional information from doctors and family members, this information was often vague and incomplete. Intake of nutrients such as folic acid, iron, calcium, and protein need to be stressed, as well as teaching about increased fluid intake and smoking cessation. Women can also be counseled about ways to increase their intake of these nutrients inexpensively, such as milk provided by the government, citrus, and legumes.
Even women receiving information had problems with compliance due to financial, cultural, or other factors. Women with milk allergies or distastes can be given supplements or counseled to increase their intake of other calcium-rich foods. In addition, women need to be counseled to eat smaller, more frequent meals. This will help them meet the energy demands of pregnancy. Pre-natal classes were either unheard-of or too difficult to attend due to transportation barriers.
Several limitations to this study existed. Interviewers were BYU students speaking Spanish as a second language and dressed in white lab coats or scrubs that may have appeared intimidating. Some women may have had difficulty understanding the questions posed or felt embarrassed admitting they did not comply with pre-natal care. Future studies could include a greater variety of women. The Hospital la Maternidad is a high-risk hospital, and a higher percentage of women have been to Control than may be found in other facilities. For this reason, more information is needed regarding nutritional knowledge of those women not seen or counseled by doctors.
Conclusion
Although the Argentine government has already instituted some healthcare programs with tremendous success, much work remains in the area of pre- and post-natal nutritional education. These interventions can be carried out through nutrition workshops offered to doctors and nurses interacting with pregnant women and through written materials and posters at CAPS centers and the hospital. With clear and complete education, and taking a few steps to overcome financial and cultural barriers, the women of Tucumán can learn to improve their nutrition as well as their chances for a successful pregnancy and birth.