Mixed-methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala.

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.

When a girl's decision involves the community: the realities of adolescent Maya girls' lives in rural indigenous Guatemala.

Adolescent Maya girls are among the most vulnerable, marginalized sub-populations in Guatemala, a country that is largely young, indigenous and poor. Adolescent Maya girls have limited access to secondary schooling, opportunities to work or earn an income, and sexual and reproductive health information and services. This article explores the extent to which adolescent Maya girls are able to adopt what they have learned in a community-based skills-building and sex education programme in isolated rural, indigenous Guatemalan communities. This is presented through an interview between the authors, who met and worked together in the Population Council's programme Abriendo Oportunidades (Opening Opportunities) for girls aged 8-19 years. The interview discusses what can be done so that indigenous adolescents not only obtain the sexual health information they need, but develop the skills to make decisions, communicate with their peers and parents, and exercise their rights. Much culturally and linguistically sensitive work must be done, using a community-based participatory approach, so that young people who do want to use condoms for protection or contraceptive methods not only have access to the methods, but the support of their families and communities, and government-sponsored sex education programmes, to use them.