Maternal Knowledge and Use of Galactagogues in Andean Communities of Cusco, Peru

Abstract A commonly reported reason for early breastfeeding cessation is inadequate milk production. In response, women across the globe turn to galactagogues – substances used to increase the milk supply. Andean women have traditional knowledge about the medicinal and nutritional properties of plants and animals that are considered good to eat during breastfeeding. This research explores the maintenance and use of galactagogues, and specifically the use of the Andean flicker bird, within the wider framework of breastfeeding and nutrition policies in Peru. To elicit maternal knowledge and use of galactagogues, semi-structured and free-listing interviews were conducted with 33 mothers. Data analysis calculated the frequency and percentage of women reporting each type of galactagogue. In addition, thematic codes and relevant text passages were used in an iterative analytic process to document emerging themes. Identified galactagogues included five plants and six animals. Several galactagogues included protein-rich foods such as lamb meat and the Andean flicker bird. The use of protein-rich galactagogues as solid food is reinforced by public health messages. However, galactagogues in the research communities are usually consumed as soups or drinks, which are less rich in proteins than solid meals. The potential role of liquid galactagogues in the maintenance of appropriate hydration levels during breastfeeding in an environment where safe drinking water is scarce is a new contribution to the existing literature. The results are relevant to the design of maternal and child health policies that comply with intercultural health premises that value and respect the knowledge and practices of Andean Peoples. Keywords Traditional knowledge; Public health policy; Breastfeeding; Water intake; Maternal and child health; Nutrition Full Text: PDF HTML References American Academy of Pediatrics, Section on Breastfeeding. 2012. Breastfeeding and the Use of Human Milk. Pediatrics 129:e827–e841. DOI:10.1542/peds.2011-3552. Balogun, O., A. Dagvadorj, M. Anigo, E. Ota, and S. Sasaki. 2015. Factors Influencing Breastfeeding Exclusivity During the First 6 Months of Life in Developing Countries: A Quantitative and Qualitative Systematic Review. Maternal and Child Nutrition 11:433–451. DOI:10.1111/mcn.12180. Barbour, R. 2001. Checklists for Improving Rigour in Qualitative Research: A Case of the Tail Wagging the Dog? British Medical Journal 322:1115–1117. Available at: http://pubmedcentralcanada.ca/pmcc/articles/PMC1120242. Accessed on November 10, 2016. Bastien, J. W. 1985. Qollahuaya‐Andean Body Concepts: A Topographical‐Hydraulic Model of Physiology. American Anthropology 87:595–611. DOI:10.1525/aa.1985.87.3.02a00050. Bastien J. W. 1987. Cross-Cultural Communication Between Doctors and Peasants in Bolivia. Social Science and Medicine 24:1109–1118. DOI:10.1016/0277-9536(87)90025-6. Bentley, G. R. 1998. Hydration as a Limiting Factor in Lactation. American Journal of Human Biology 10:151–161. DOI:10.1002/(SICI)1520-6300(1998)10:2<151:AIDAJHB2>3.0.CO;2-O. Bernard, H. 2011. Research Methods in Anthropology: Qualitative and Quantitative Approaches. Altamira Press, Lanham, MD. Bnouham, M. 2010. Medicinal Plants with Potential Galactagogue Activity Used in the Moroccan Pharmacopoeia. Journal of Complementary and Integrative Medicine 7. DOI:10.2202/1553-3840.1268. Brückner, C. 1996. A Survey on Herbal Galactagogues Used in Europe. In Medicam. Aliment. L’approche Ethnopharmacol, edited by E. Schroder, G. Balasard, C. Pierre, J. Fleurentin, and G. Mazars. Colloque Européen d’Ethnopharmacologie et de la 11 Conférence internationale d’Ethnomédecine, Heidelberg, Paris, France. Available at: http://www.documentation.ird.fr/hor/fdi:010005528. Accessed on November 10, 2016. Bussman, R., and A. Glen. 2010. Medicinal Plants Used in Northern Peru for Reproductive Problems and Female Health. Journal of Ethnobiology and Ethnomedicine 6:30. DOI:10.1186/1746-4269-2-47. Chan, S. M., E. A. S. Nelson, S. S. F. Leung, and C. Y. Li. 2000. Breastfeeding Failure in a Longitudinal Post‐Partum Maternal Nutrition Study in Hong Kong. Journal of Pediatrics and Child Health 36:466–471. DOI:10.1046/j.1440-1754.2000.00544. Crandon-Malamud, L. 1991. From the Fat of Our Souls: Social Change, Political Process, and Medical Pluralism in Bolivia. University of California Press, Berkeley, CA. Dandotiya, H., G. Singh, and S. K. Kashaw. 2013. The Galactagogues Used by Indian Tribal Communities to Overcome Poor Lactation. International Journal of Biotechnology and Bioengeneering Research 4:2231–1238. Available at: https://www.ripublication.com/ijbbr_spl/ijbbrv4n3spl_12. Accessed on November 10, 2016. Dettwyler, K. A. 1987. Breastfeeding and Weaning in Mali: Cultural Context and Hard Data. Social Science and Medicine 24:633–644. DOI:10.1016/0277-9536(87)90306-6. Forinash, A. B., A. M. Yancey, K. N. Barnes, and T. D. Myles. 2012. The Use of Galactogogues in the Breastfeeding Mother. Annals of Pharmacotherapy 46:1392–1404. DOI:10.1345/aph.1R167. Frisancho Pineda, D. 2009. Las Enfermedades: Su Etiología Según la Mentalidad Indígena y Popular. In Medicina Tradicional Andina: Planteamientos y Aproximaciones, edited by R. Sánchez Garrafa and R. Sánchez Garrafa. Centro de Cuzco Medicina Andina, Centro de Estudios Regionales Andinos Bartolomé de las Casas. Cusco, Perú. Froemming, S. 2006. Traditional Use of the Andean Flicker (Colaptes rupicola) as a Galactagogue in the Peruvian Andes. Journal of Ethnobiology and Ethnomedicine 2:23. DOI:10.1186/1746-4269-2-23. Gatti, L. 2008. Maternal Perceptions of Insufficient Milk Supply in Breastfeeding. Journal of Nursing Scholarship 40:355–363. DOI:10.1111/j.1547-5069.2008.00234.x. Gbadamosi, I., and O. Okolosi. 2013. Botanical Galactogogues: Nutritional Values and Therapeutic Potentials. Journal of Applied Bioscience 61:4460. DOI:10.4314/jab.v61i0.85594. Graham, M. A. 1997. Food Allocation in Rural Peruvian Households: Concepts and Behavior Regarding Children. Social Science and Medicine 44:1697–1709. DOI:10.1016/S0277-9536(96)00372-3. Hammer, P. 2001. Blood makers made of blood: Quechua Ethnophysiology of Menstruation. In Regulating Menstruation: Beliefs, Practices, Interpretations, edited by E. Van de Walle and E. P. Renne, pp. 241–253. University of Chicago Press, Chicago, MI. Institute of Medicine, Food and Nutrition Board. 2004. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academies Press, Washington, DC. Instituto Nacional de la Salud. Centro Nacional de Alimentación y Nutrición. 2004. Lineamientos de Nutricion Materno Infantil del Perú. Centro Nacional de Alimentación y Nutrición. Ministerio de Salud, Instituto Nacional de Salud,Lima, Perú. Available at: http://repositorio.ins.gob.pe/bitstream/handle/INS/218/CENAN-0060.pdf?sequence=1&isAllowed=y. Accessed on November10, 2016. Jelliffe, D. B., and E. F. P. Jelliffe. 1978. Human Milk in the Modern World. Oxford University Press, Oxford, United Kingdom, and New York, NY. Larme, A. C. 1998. Environment, Vulnerability, and Gender in Andean Ethnomedicine. Social Science and Medicine 47:1005–1015. DOI:10.1016/S0277-9536(98)00162-2. Liu, H., Y. Hua, H. Luo, Z. Shen, X. Tao, and X. Zhu. 2015. An Herbal Galactagogue Mixture Increases Milk Production and Aquaporin Protein Expression in the Mammary Glands of Lactating Rats. Evidence-Based Complementary and Alternative Medicine 2015:1–6. DOI:10.1155/2015/760585. Lutter, C. K., C. M. Chaparro, and L. M. Grummer-Strawn. 2011. Increases in Breastfeeding in Latin America and the Caribbean: An Analysis of Equity. Health Policy Plan 26:257–265. DOI:10.1093/heapol/czq046. Mahmood, A., M. N. Omar, and N. Ngah. 2012. Galactagogue Effects of Musa x Paradisiac a Flower Extract on Lactating Rats. Asian Pacific Journal Tropical Medicine 5:882–886. DOI:10.1016/S1995-7645(12)60164-3. Makari, J., K. Cameron, and M. Battistella. 2014. Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review. Canadian Journal of Hospital Pharmacy 67:441–446. DOI:10.4212/cjhp.v67i6.1407. Mathez-Stiefel. S. L., I. Vandebroek, and S. Rist. 2012. Can Andean Medicine Coexist with Biomedical Healthcare? A Comparison of Two Rural Communities in Peru and Bolivia. Journal of Ethnobiology and Ethnomedicine 8:26. DOI:10.1186/1746-4269-8-26. Mazzes, R. B. 1968. Hot-Cold Food Beliefs Among Andean Peasants. Journal of the American Dietetic Association 53:109–113. Available at: https://www.cabdirect.org/cabdirect. Accessed on November 10, 2016. Miles, A., and T. Leatherman. 2003. Perspectives on Medical Anthropology in the Andes. In Medical Pluralism in the Andes, edited by J. D. Koss-Chioino, T. Leatherman, and C. Greenway, pp. 3–15. Routledge, London, United Kingdom, and New York, NY. Mortel, M., and S. D. Mehta. 2013. Systematic Review of the Efficacy of Herbal Galactogogues. Journal of Human Lactation 29:154–162. DOI:10.1177/0890334413477243. Othman, N., R. A. C. Lamin, and C. N. Othman. 2014. Exploring Behavior on the Herbal Galactagogue Usage among Malay Lactating Mothers in Malaysia. Procedia - Social and Behavioral Sciences 153:199–208. DOI:10.1016/j.sbspro.2014.10.054. Pan American Health Organization (PAHO). 2008. Una visión de salud intercultural para los pueblos indígenas de las Américas. Available at: http://new.paho.org/hq/dmdocuments/2009/54-VisionSaludInterculturalPI.pdf. Accessed on November 2016. Patton, M. Q. 2005. Qualitative Research. Sage Publications, Thousands Oaks, CA. Paul, C., M. Zenut, A. Dorut, M. A. Coudore, J. Vein, J. M. Cardot, and D. Balayssac. 2015. Use of Domperidone as a Galactagogue Drug: A Systematic Review of the Benefit-Risk Ratio. Journal of Human Lactation 31:57–63. DOI:10.1177/0890334414561265. Piperata, B. A. 2008. Forty Days and Forty Nights: A Biocultural Perspective on Postpartum Practices in the Amazon. Social Sciences and Medicine 67:1094–1103. DOI:10.1016/j.socscimed.2008.05.031. Riessman, C. 2008. Narrative Methods for the Human Sciences. Sage, Thousand Oaks, CA. DOI:10.1017/S1368980014003000. Rosinger, A. 2015. Dehydration Among Lactating Mothers in the Amazon: A Neglected Problem. American Journal of Human Biology 27:576–578. DOI:10.1002/ajhb.22672. Rossi, M., and G. Giorgi, G. 2010. Domperidone and Long QT Syndrome. Current Drug Safety 5:257–262. DOI:10.2174/157488610791698334. Sakka, A. E. L., M. Salama, and K. Salama. 2014. The Effect of Fenugreek Herbal Tea and Palm Dates on Breast Milk Production and Infant Weight. Journal of Pediatric Sciences 6. DOI:10.17334/jps.30658. Scott, J. A., and W. B. Colin. 2002. Breastfeeding: Reasons for Starting, Reasons for Stopping and Problems Along the Way. Breastfeeding Review 10:13. Available at: https://search.informit.com.au. Accessed on November 10 2016. Short, L. L. 1972. Systematics and Behavior of South American Flickers (Aves, Colaptes). Bulletin of the AMNH, Vol. 149. Available at: http://digitallibrary.amnh.org/handle/2246/1198. Accessed on November 10, 2016. Sim, T., H. Hattingh, J. Sheriff, and L. Tee. 2015. The Use, Perceived Effectiveness and Safety of Herbal Galactagogues During Breastfeeding: A Qualitative Study. International Journal of Environmental Research and Public Health 12:11050–11071. DOI:10.3390/ijerph120911050. Tawia, S. 2014. Breastfeeding and Herbal Galactagogues. Australian Breastfeeding Association eNewsletter. Available at: https://www.breastfeeding.asn.au/breastfeeding-and-herbal-galactagogues. Accessed on May 12, 2016. Tenfelde, S., R. Zielinski, and R. L. Heidarisafa. 2013. Why WIC Women Stop Breastfeeding?: Analysis of Maternal Characteristics and Time to Cessation. ICAN Infant, Child and Adolescent Nutrition 5:207–214. DOI:10.1177/1941406413492820. Torabi Gudarzi, M., L. U. F. Qarah Guz, A. A. F. Yusefi, and H. Akbari. 2008. Investigation on to the Effect of Fennel (Foeniculum vulgare) and Nigella (Nigella sativa) on Production in Milking Cow. Available at: http://agris.fao.org/agris-search/search.do?recordID=IR2010000035. Accessed on May 12, 2016. World Health Organization and UNICEF. 1990. On the Protection, Promotion and Support of Breastfeeding. WHO/UNICEF Policy Makers’ Meeting “Breastfeeding in the 1990s: A Global Initiative”, Spedale degli Innocenti, Florence, Italy. Available at: http://www.unicef.org/programme/breastfeeding/innocenti.htm. Accessed on May 12, 2016. Winterfeld, U., Y. Meyer, A. Panchaud, and A. Einarson. 2012. Management of Deficient Lactation in Switzerland and Canada: A Survey of Midwives’ Current Practices. Breastfeeding Medicine 7:317–318. DOI:10.1089/bfm.2011.0092. Zapantis, A., J. G. Steinberg, and L. Schilit. 2012. Use of Herbals as Galactagogues. Journal of Pharmacy Practice 25:222–231. DOI:10.1177/0897190011431636. DOI: http://dx.doi.org/10.14237/ebl.8.1.2017.935 Copyright (c) 2017 Madalena Monteban