Gotas de Leche: Their Influence on Infant Mortality Rates

''Those assisted by Drops of Milk usually arrive without shelter of any kind: it is the most indigent group of society, which the laws of foresight do not manage to protect; but who find in the Board what life has denied them; selfless attention, careful technique and, what is more important, an environment of cordiality and self-denial to mitigate or solve their problems" (Henríquez 1940).

During the nineteenth and beginning of the twentieth century, Chile had extremely high levels of poverty, illiteracy, and birth rates (Schonhaut, 2010). Mothers who survived giving birth were overwhelmed by their living conditions and numerous responsibilities. As a result of this, many women were unable to take care of their children and would either place them in orphanages, abandon them, or commit infanticide (Schonhaut, 2010). During this period, Chile had one of the highest infant mortality rates in the world, with some of its cities reaching up to 50 percent (Schonhaut, 2010). This was not the case for Uruguay, however, which had one one of the lowest infant mortality rates, 93 per 1000, in the world. This was believed to be due to a generally low population density, clean environment, and high rates of breastfeeding (Birn, 2008). However, the many attempts by the government of Uruguay to further decrease this rate yielded very little to no results (Birn et al, 2014). The creation of Gotas de Leche was able to impact both countries, both positively and negatively.

In order to combat the infant mortality rate, doctors and elites from Chile and Uruguay drew inspiration from France, where the private organization Gouttes de Lait had existed since the early 1890s (Markel, 2014). Known in English as “milk stations”, these depots were spaces that provided children, especially newborns, with clean, pasteurized milk. This concept quickly spread through Great Britain, the United States, and eventually Latin America (Markel, 2014). The private organization was first introduced in 1901 and 1908 in Chile and Uruguay respectively, where Gotas began to distribute milk and educate mothers on how to stimulate breastfeeding (Toro & Barros, 1980; Birn, 2008). Around this time, Gotas began experimenting with new ways to combat the high infant mortality rate and decided to hold a nationwide competition. Along with the Center for Propaganda of Tuberculosis, Gotas sites in Chile and Uruguay held year-long contests where the mothers of the children who gained the most weight would win cash prizes (Lavrin, 1998; Birn, 2008). This would in turn incentivize regular checkups at clinics and more consistent breastfeeding, all while attempting to reduce the infant mortality rate (Lavrin, 1998). Mothers who participated became more familiarized with checking their children in with the doctor, and with nurturing a long-lasting routine until their children were no longer at risk. Because of this, Gotas was readily accepted in its early years into marginalized communities as they assisted more around one fourth of households in need (Birn, 2008).

However, this was just the beginning for Gotas de Leche. A decade or so later, World War I broke out along with its crippling effects. In many Latin American countries, much of the government's money and resources were funneled into the war, leading to inflation and mass unemployment (Rinke & Kriegesmann, 2015). A new wave of impoverished Chilean mothers emerged and with it, the social pressure to breastfeed their children (Lavrin, 1998). However, either due to the stressful economic conditions or biological inability, the majority of working class mothers were unable to breastfeed their often already starving babies (Schonhaut, 2010). Moreover, the children of these mothers beyond infancy also had a need for milk. The Gotas de Leche were able to step in and provide cost-effective artificial milk formula to mothers and children in need.

However, Gotas were not always seen in the best light. A couple years after its implementation, the child mortality rate in Uruguay began to oscillate “around 1900 levels of 100 deaths per 1000 live births” (Birn, 2008). Julio Bauzá, director of the first Gotas site, was aware of this trend and insisted that it was simply the lack of visibility of rural women, and the incorrect implementation of artificial feeding. This was until there was another notable trend of gastroenteritis in cities where Gotas was operational (Birn et al., 2014). It was later found that the milk that was being distributed was of poor quality, with some going as far to say that is was dirtier than sewage water (Bauzá, 1920). Moreover, in 1916 Dr. Luis Morquio attacked the Gotas and Bauzá by claiming that handing out subsidized or free yet contaminated milk discouraged breastfeeding. His evidence was the increase in woman who stopped breastfeeding as soon as they enrolled in Gotas (Birn, 2008). Years of debate and reflection later, Bauzá was able to successfully reform Gotas by implementing aspects to the organization that more effectively targeted societal inequalities such as illegitimacy, poverty, and ignorance. After his retirement in 1949, Bauzá was able to leave Gotas and say he had a positive impact on the country as the infant mortality rate once again began to slowly decline (Birn et al., 2014).

Despite these setbacks, the private organization morphed into something that not only provided milk and respective alternatives, but also helped to build a community. They provided a comforting, warm space for mothers to relax and spend quality bonding time with their children (Schonhaut, 2010). As time progressed, the organization would evolve into a place where nurses and pediatricians could examine at-risk babies, ensuring that it was done in the presence of the mother (Schonhaut, 2010). After one year of these operations in Chile, the infant mortality rate of a city with an operational Gotas de Leche site dropped to an outstanding 7 percent out of the country average of 25 percent (Severino & Riaño, 2006). It’s clear that Gotas de Leche played different roles in Chile and Uruguay, however -- after much improvement, the organization was still able to help marginalized mothers and children. There is always more work that can be done in the efforts to decrease child mortality, but it is safe to say that Gotas de Leche has been instrumental for the lowered infant mortality rate that Chile and Uruguay have today.

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References

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