Fellow Since 1999
This description of Nair Carrasco's work was prepared when Nair Carrasco was elected to the Ashoka Fellowship in 1999.
Nair Carrasco is creating a national network in Peru to promote breastfeeding in a culture where it is underused despite widespread infant malnutrition.
The New Idea
Nair believes that the importance of breastfeeding and proper nutrition for children is a concern for all of society, not just mothers, and requires widespread attitudinal changes. She has established the Maternal Breastfeeding Network, which coordinates and encourages the efforts of women from all social strata, as well as doctors, nurses, community workers, businesses, government agencies, and the press. Her distinctive approach connects sectors that have previously worked separately, brings together women from different socioeconomic levels to work on a common problem, and is ongoing rather than tied to specific events or crises. Nair uses communication tools to make Peruvian families aware of the advantages of breastfeeding. She is encouraging the national government to implement pro-breastfeeding policies, to make health services meet international quality standards, and to provide access to breastfeeding facilities. Nair's network is also fostering national alliances in civil society, which will strengthen and ensure implementation of state policies on breastfeeding.
Malnutrition affects a staggering proportion of Peru's infants and childrenan estimated 26 percent of children below the age of five, and in rural areas nearly 40 percent. It is the fourth largest cause of death among children under one year of age. Malnutrition, especially the under-consumption of protein calories, causes obvious physical effects, such as low body weight, and also makes children more vulnerable to sickness and reduces their ability to learn and develop. Despite the fact that maternal milk is well documented as an excellent source of nutrition for infants, Peruvian mothers practice exclusive breastfeeding for an average of only two and a half months, far below the minimum international recommendation of six months. Various factors contribute to this situation. Few women know the benefits of breastfeeding, because there is insufficient information about it, and health centers do not emphasize its importance. The workplace does not provide time for employed nursing mothers to take breaks at appropriate intervals nor does it offer readily accessible daycare. A social stigma accompanies breastfeeding. Middle-class mothers, who serve as role models for the lower classes, rarely breast feed in public since it is considered to be something done only by people of limited means. Milk formula is a lucrative business, and companies frequently market their products through hospitals and target their advertising at mothers of newborns, particularly middle- and upper-class women who can afford to buy the formula. Their promotions often mislead mothers into thinking that powdered milk is the best option for their babies. Child nutrition experts and advocates have attempted to address the attitudes and ignorance that keep breastfeeding from becoming more common. However, there has been no coordinated effort beyond Global Breastfeeding Week. Despite the efforts of people like Nair, the participants have been unable to maintain their work past that one week per year.
Nair helped found the Center of Promotion and Studies of Nutrition as a platform for launching the Maternal Breastfeeding Network. She has identified three main strategies for action. The first is to unify and strengthen the lobbying power of the groups promoting breastfeeding, to enable them to address public policy in such areas as workplace laws and protection against misleading advertising by powdered milk companies. Nair is incorporating government bodies into the network and has worked closely with the Ministry of Health. Second, the network provides institutional support for breastfeeding, ensuring that healthcare providers give proper attention to new mothers and supports them in their decision to breast feed. The network educates and encourages pediatricians and health practitioners to promote breastfeeding, and the pediatricians in turn recruit women from the middle and upper classes who would normally not be targeted for promoting breastfeeding. The network is unique in the Andean region in offering accredited training about proper breastfeeding technique. The third element is the promotion of information campaigns and community support that affirms breastfeeding mothers as role models and enables them to breast feed comfortably in public without social reproach. The network provides the media with the latest information on health and nutrition, and, in return, reporters inform the public about the importance of breastfeeding and upcoming promotional events. Nair has defined five key phases in the process of institutionalizing her work. The first, already accomplished, is a census of potential participantsorganizations that promote, protect, and support breastfeeding at the national and regional levels. This phase also included producing a plan for the management, organization, and regulation of the network. Nair has moved to the second phase, execution, which concentrates on strengthening the abilities of the promoters of the network. In addition to producing guides about nutrition, breastfeeding, and advocacy, she is documenting the management plan, constructing a web page, and creating a discussion list about breastfeeding. The second phase coincided with Global Breastfeeding Week. In 1999 and 2000, at the request of the World Alliance for Breastfeeding Action (WABA), Nair coordinated the activities in Latin America and the Caribbean for Global Breastfeeding Week. In the third and fourth phases, evaluation and revision, Nair will focus on achieving long-term sustainability, which is the fifth phase. She has begun creating businesses for products related to motherhood and breastfeeding that can become a source of income for the network. She plans to make agreements with large supermarket chains like WONG or product groups like Procter & Gamble, to sell and promote the network's products. Current products are educational and promotion tools such as children's books and the Mommy Doll, the network's symbol throughout Peru, which demonstrates birth, breastfeeding, and maternal care and comes complete with an educational guide. Disadvantaged women in poor communities make the dolls and receive a percentage of the earnings. Nair's network recently sold fifteen hundred dolls to citizens' organizations and private buyers in Argentina, Chile, and Peru. Nair regards the development of the Maternal Breastfeeding Network as her most important goal in life. Support from USAID, UNICEF, World Alliance for Breastfeeding Action, OPS, and other organizations has enabled the network to touch the lives of approximately ninety-five hundred people. Nair expects to reach an additional one hundred thousand during the next few years.
One of eleven children, Nair was brought up with a strong sense of social commitment. Her father encouraged his children, particularly his daughters, to study. Nair began studying nutrition at the age of eighteen and worked in communities to build better nutrition plans. She gained firsthand knowledge about how mothers fed their children and was therefore able to identify the causes of malnutrition. At the university, Nair majored in nutrition, yet the curriculum included only two hours about breastfeeding. Not until 1992 did Nair grasp the importance of lactation and become an inspired advocate of breastfeeding. The decisive event occurred while working with the Preventative Center of Infant Malnutrition. She was invited to attend an international conference in Guatemala held by the leaders of the Milk League, an international volunteer organization that promotes breastfeeding through mother-to-mother support. Nair was impressed by the extent of the movement and the variety of women of different classes who supported it. She was especially impressed by the professional and organized manner in which the women, of the middle and upper classes, were transmitting their experiences to other mothers. That experience refocused her vision and showed her that breastfeeding was the critical component to improving health among the communities in which she was working. She began organizing breastfeeding services, designing a national project with hospitals, writing guides for breastfeeding, training health workers, and conducting evaluations and monitoring of hospitals.