In the mountains of Guatemala, graduate student Christine Bixiones watched mothers feed coffee and soda to their newborns. She saw some of the poorest women in the world — who could barely afford to eat — buy baby formula instead of simply breastfeeding their babies. And she saw way too many malnourished children — 78 percent in the highland indigenous communities, where pneumonia and diarrhea are the two main causes of childhood death.

“One way to prevent these deaths,” she says, “is through exclusive breastfeeding for the first six months of a baby’s life.”

Breast milk contains antimicrobial and anti-inflammatory agents that strengthen a baby’s immune system. Breastfeeding provides essential bacteria — the good bacteria — that in turn fight intestinal pathogens.

Many Guatemalan women, though, don’t exclusively breastfeed young babies, and this puts children at greater risk of getting sick later on.

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Bixiones linked up with Curamericas-Guatemala, a nonprofit group that sends local maternal-health professionals to isolated regions to educate women about the benefits of breastfeeding. In the northwest highlands of Guatemala, Curamericas convinced women to breastfeed newborns from day one, and more babies stayed healthy as a result. But the nonprofit wasn’t as successful near San Miguel, so they asked Bixiones to help find out why.

“One reason is that women there were throwing out their colostrum,” she says. Colostrum is the thick, yellowish milk that women produce within a day of giving birth. Pediatricians and midwives call colostrum the baby’s first vaccine because it’s so nutritious and full of immunizing nutrients — nature’s gift to a fragile newborn.

Bixiones interviewed more than one hundred mothers with babies under six months old, and one thing kept coming up: colostrum was considered dirty, cold, and too yellow and thick. Mothers thought it would make their babies sick. Some said that colostrum is the old leftover milk from when the mother was nursing a previous child. When Bixiones questioned mothers further, they said that they discard colostrum because that’s the way it’s been done for years.

Many indigenous Guatemalan women wait three to five days before breastfeeding, Bixiones says, giving their infants coffee, soda, sugar water, and corn flour in water instead. About 65 percent of women she interviewed said they fed children these other liquids because they weren’t producing any milk. Near San Miguel, where children had more health problems, 90 percent of mothers fed children liquids other than breast milk.

Bixiones suspected that the women were producing colostrum, and most of them eventually admitted that they did produce a very little bit of milk during the first few days after birth. But they assumed it wasn’t enough, even though babies need only a few drops the first day or two. What they really need, Bixiones says, is to be skin-to-skin with their mothers and to suckle, which actually stimulates milk production. But most mothers she interviewed thought heat from a traditional sauna called a chuj helped generate milk.

A lot of women told Bixiones that formula is superior to breast milk. “Many people said to me, ‘In America, they give their babies formula, and look how big and healthy they are.’ One woman pulled out a package from her son in Texas who told his mother, ‘American women use formula and breast milk. That’s what you have to do.’ She was nursing her tenth baby, and her son was telling her how to feed her child.”

Other women said that they weren’t healthy enough to breastfeed. “But we know that’s not the case,” Bixiones says. “Poor nutrition does not have a substantial effect on breast milk production or quality unless the woman is severely malnourished.”

Miriam Labbok, one of Bixiones’ professors at UNC, says that breast milk is so specific to human babies — much more so than formula — that it reduces the risk of cancers, chronic gut disease, obesity, and high blood pressure. “It also helps the mother recover after delivery, and reduces the mother’s risk of bone thinning, diabetes, and certain cancers later in life,” Labbok says.

And bottle-feeding in Guatemala — whether formula or other liquids — begins a dangerous practice, Bixiones says. “A lot of bacteria stay on the nipple, and bottles are rarely washed. When they are, it’s usually in contaminated water.”

When Bixiones reported her findings to Curamericas-Guatemala, she found that some of the health advocates hadn’t been discussing colostrum’s benefits with indigenous women. So Bixiones and Curamericas came up with a nickname for colostrum — leche de oro, or golden milk, because gold has an especially positive connotation in Guatemalan culture. They also put information about colostrum as the baby’s first vaccine on the vaccination cards that Curamericas hands out.

“The mothers there know how important vaccination is,” Bixiones says.

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Curamericas added two other components to their advocacy work: testimony and more detailed education. At one meeting, a woman stood up and proudly told other mothers about her healthy breastfed baby, and Bixiones says that the mothers were hanging on this woman’s every word. It’s an effective way to communicate a meaningful message, she says.

As for education, new mothers everywhere benefit from learning proper breastfeeding techniques because such methods are not intuitive. Curamericas teaches them, and also trains mothers in the benefits of breastfeeding early — the more a baby nurses, the more milk the mother will produce.

Bixiones recommended teaching women exactly how much milk a newborn needs. Because children there play with marbles, Bixiones told the mothers that a newborn’s stomach is about the size of a marble, so the babies only need a tiny bit of milk — a marble’s worth.

“Breastfeeding is so natural that we expect that optimal breastfeeding practices are common in traditional societies,” Bixiones says. “But this is not always the case.”

Christine Bixiones is a second-year graduate student in the Department of Maternal and Child Health in UNC’s School of Public Health. She received an International Internship Award from UNC’s Center for Global Initiatives to help finance her trip. Miriam Labbok is a professor of the practice of public health in the School of Public Health, and director of the Center for Infant and Young Child Feeding Care at UNC.For more information on Curamericas, go to