Is Independently Associated With Infant-Feeding Practices in a Cohort of Rural Guatemalan Women

Maternal factors influencing the initiation of exclusive breastfeeding (EBF), the timely introduction of comple-mentary foods (CF), and their subsequent effects on maternal, neonatal, and child health are thus a focus of research and programming. Among these, the effects of maternal exposure to formal schooling are not well understood. In more affluent settings, greater maternal education correlates with greater initiation and duration of breastfeeding and increased exclusivity of breast-feeding to age 6 months.4-9 However, in developing countries where primary school for women may not be universal, the effects of schooling on the optimal initia-tion and duration of breastfeeding are equivocal.10-16 Multiple pathways have been hypothesized to explain the effects of maternal schooling on child health.17-21 In Figure 1, we extend these hypotheses to appropriate infant-feeding practices. It has been hypothesized that the acquisition of academic skills through formal school-ing (ie, literacy, problem solving) is one route by which schooling may influence mothers ’ child care and, by extension, infant-feeding practices. For example, literacy and basic knowledge of disease processes may enhance women’s ability to understand and assimilate breast-feeding promotion campaigns. Enhanced problem-solving skills could enable mothers to overcome barriers to optimal infant feeding. Specific health curricula may arm women with the knowledge necessary to implemen