The Mexican Case: Socioeconomic Foundations

Abstract

Mexico is a particular example of how socioeconomic inequalities, a fragmented institutional health system, and the need for individual health choices are interrelated. The aim of this chapter is thus to describe the socioeconomic context of Mexico and to show that it represents an ideal-typical case of Latin American economic development associated with outdated and patchy institutional welfare state systems. This chapter sets the scene for the development of health inequalities in breastfeeding.

Mexico is a particular example of how socioeconomic inequalities, a fragmented institutional health system, and the need for individual health choices are interrelated. The aim of this chapter is thus to describe the socioeconomic context of Mexico and to show that it represents an ideal-typical case of Latin American economic development associated with outdated and patchy institutional welfare state systems. This chapter sets the scene for the development of health inequalities in breastfeeding. Thus, it revises the country’s socioeconomic situation within Latin America. It provides facts and data, adds knowledge for understanding the institutional context, and particularly about the health systems and health inequality in Latin America and Mexico.

3.1 Latin America

The term ‘Latin America’ is defined using a diversity of approaches such as a historical, cultural, colonial, economic, and geographical approach (Lockhart & Schwartz, 1983). It refers to all countries of the American continent south of the U.S.-American border (Ferranti, 2004). Hence, Latin America and South America are not the same geographically. Latin America includes Mexico as the northernmost country, the whole South American continent, and even the Caribbean islands. The division between the Caribbean islands is a cultural one, historically determined by colonialism—by Spain and Portugal and not by the British Crown. Countries with a Faroese influence (e.g., Haiti) are also placed in the understanding of Latin America. So, the commonly called ‘Latin America’ should rather be called ‘Iberoamerica’ but this is rather unknown outside the technical experts (Wallenfeldt, 2022). However, if we take political-geographical and political-economic criteria into comparison, various international and regional trade organizations and treaties can roughly distinguish North America (incl. Mexico), Central America, the Caribbean, and South America. This is also reflected in the introduction of various regional organizations and regional trade agreements (Nolte, 2017). For this work, the term ‘Latin America’ is used as a comprehensive term for all countries south of the U.S. border to Argentina including the Caribbean.

Focusing first on demographics in Latin America, the countries from this region experienced an exceptional population growth in the 1960 s due to internationally high natality rates. In some Latin American countries, this population growth was directly related to the highest rates of malnutrition, poor housing, poor clothing, illiteracy, and disease and health problems globally (Obaid & Prebisch, 1964).

Latin American countries share similarities in their colonial history and the recent past with high population growth and at the same time high rates of poverty. However, the demographic, political, economic, and cultural development in the past four decades have led to economic growth, although differently and with diverse socio-economic outlooks from country to country. Economically, Brazil and Mexico in particular are emerging economies in the region that have become important global actors since the early 2000 s. Countries like Peru and Colombia, too, show favorable economic developments. However, small countries such as Honduras, Guatemala and Nicaragua lag behind these positive examples and still display high rates of absolute poverty (KfW, 2022). Nevertheless, in the range of the SDGs 1 (“no poverty”), 2 (“zero hunger”), 3 (“good health and well-being”), 4 (“quality education”), 6 (“clean water and sanitation), and 10 (“reduce inequalities”) the Latin American countries as a whole are making noticeable progress in all indicators and across country borders (CEPAL, 2018).

The number of people living in absolute poverty in Latin America has fallen from one-third in 2006 to one-fifth in 2019. Income inequality over the same period has decreased significantly overall. Average life expectancy at birth generally increased from 73 years in 2000 to nearly 77 years in 2018, with mortality rates nearly halving for children under 5 years of age and decreasing by 30% for mothers during pregnancy or childbirth. The proportion of the population with an upper secondary education increased from 34% to 46%, while the proportion of people with tertiary education increased from 12% to 19% (OECD, 2021). However, the pace of positive developments has faltered significantly since the mid-2010 s. Some countries even entered a negative trend after the end of the commodity price boom. The reduction of income inequality and poverty slowed down. The OECD concludes that the will to tackle income inequality has diminished significantly since the mid-2010 s (OECD, 2021).

In particular, the share of workers in the informal sector remained particularly high across countries (57%) and declined only slightly (Link, 2008; Moreno-Brid et al., 2009). The OECD notes that while there has been some progress in reducing differences in well-being by gender, age, place of residence, ethnic or racial status, and educational attainment, inequalities overall remain very large (OECD, 2021). Income and assets are very unequally distributed in practically all Latin American countries (KfW, 2022). Weak social capital in the region (manifested by low and declining trust in others, weak tax morale, and higher perceptions of corruption) underscores the need to strengthen relationships between people and public institutions. Human capital has increased due to higher levels of education among new cohorts but is challenged by the persistently high proportion of young people in informal employment and (youth) unemployment (KfW, 2022; Link, 2008). As noted above, these institutional factors have an enormous impact on health. Health inequalities are increasingly manifesting themselves. Institutional conditions influence individual factors of health, standard of living and individual life satisfaction.

The level of economic capital in the region has been low compared to other OECD countries, and despite some increases since 2000 in gross fixed capital formation and government tax revenues, other aspects (such as investment in research and development) have stagnated (Link, 2008; OECD, 2021). Looking beyond these averages for Latin America, for almost all indicators, the averages conceal significant differences in levels between countries. In addition to these cross-country differences, there are equally significant differences in the distribution of well-being within countries. Certain groups, including women, children, older people, youth, rural residents, indigenous populations, and those with lower education levels, tend to experience inferior outcomes and limited opportunities, especially concerning material conditions. Moreover, women in the region are more likely to live in poverty than men, and the gap has widened rather than narrowed over the past two decades (Link, 2008; Sánchez & Luna, 2014). Women also perform more than twice as much unpaid work and domestic care as men. Additionally, they often do not feel safe in their daily lives in terms of, for example, leaving their own homes. Nonetheless, the overall education rate among women is increasing, and women can draw on higher levels of social capital (OECD, 2021). Women are participating more and more in the labor market. Their role is increasingly important, not only in social capital. However, on a leadership level, jobs in policy-making tend to be male-dominated (Link & García, 2021; Low et al., 2021; Sánchez & Luna, 2014).

3.2 Institutional Framework: Welfare and Healthcare in Latin America

As it was previously shown, Latin America is a transforming region. While some countries are already far within the transformation process to developed countries, others are taking first steps in this direction (Riesco, 2009). One aspect that has not been previously discussed is the population’s health, the quality of healthcare services, and access to healthcare services in the regions, which are inextricably linked to the economic situation of both a country and a household or individual person and will be further discuss in this section.

In the 1980 s, Latin American countries were hit by a severe economic crisis, which resulted—among others—in high inflation and accelerating absolute and relative poverty rates. This economic crisis led to measures aimed to decrease poverty levels, which countries developed and executed with the help of international organizations. The recommendations of international organizations, such as the WHO, were directed to alternative solutions paired with the opening of the market, so that social protection systems were accompanied by economic stabilization projects. In the 1990 s, after the implementation of these projects, some countries showed remarkable success in decreasing poverty rates, such as Brazil or Costa Rica, while others failed to do so, like Nicaragua or Venezuela. As a consequence, the socio-economic gap in the Latin American region increased—it was even larger than today (Barba Solano & Valencia Lomeli, 2016; Brearley, 2016; Fleury, 2017).

‘Welfare state’ as such is a European definition, but similar social security systems with conditional cash transfers started early to fight poverty, even if the concept did not fully cover all areas of life and especially work (Fleury, 2017). Nevertheless, the countries stuck to the welfare state idea, which has been put forward by the economic recovery plans of the 1980’s. In general, the target group for this type of welfare state intervention were those living in extreme poverty—those considered most vulnerable to economic shocks, natural or family disasters, and at risk of falling below established poverty thresholds (Barba Solano, 2007). This welfare state idea led to a paradigm shift in understanding poverty, but not really to an improvement in welfare. As a result, countries tried or implemented different approaches to fight poverty developing resilient welfare schemes. In this context, Barba Solano (2004) found that welfare state regimes in Latin America can be divided into three types, depending on their ability to organize their social security independently of a private entity.

Based on this classification, Barba Solano (2004) divides the countries of Latin America, with the exception of the Caribbean countries, into three different types of welfare state systems (Table 3.1).

Table 3.1 Types of welfare state systems in Latin America

Countries that still most closely resemble the European conservative regime are counted as universalist like Chile, Argentina, and Costa Rica. Social security is linked to the formal labor market and working-class organizations. Dual systems include a gradation of the previously mentioned aspects and an accompanying softening of universalistic provision in the area of social security. At the same time, labor in the informal sector has been increasing, for instance in Brazil, Colombia, and Mexico (Barba Solano, 2004; Barba Solano & Valencia Lomeli, 2016). In the category of exclusionary systems, the exclusion criteria become more stringent, and an imbalance arises between access to state social security benefits, for example, in the comparison between urban and rural populations. If target group selection is addressed by universal access, it can ensure a minimum level of access to benefits for those who have not been included so far and contribute to strengthening socially secured citizenship. However, there is a risk that this strategy will be used to suppress the expansion of this type of citizenship, especially in countries where universal rights are not yet as developed, with a rhetorical emphasis on overcoming poverty. This risk increases in exclusionary regimes like in Panama, Ecuador, or Bolivia. In these cases, the risk of social stigma and exclusion of society is rising. The clear differences between countries in the region remains remarkable, even though it has been recognized throughout the region that the creation of safety nets is essential to combat social vulnerability to economic cycles, natural disasters, and personal misfortunes, and to prevent families from slipping below the poverty line (Barba Solano & Valencia Lomeli, 2016; Macinko et al., 2016).

Priorities in different welfare regimes are uneven. In universalist regimes, where the problem of unemployment is greatest, workfare policies, i.e., reintegration into the labor market, have the largest share. In dualistic regimes, characterized by heightened poverty levels, cash transfers and investment in human capital development rank highest in welfare benefits. Within exclusionary regimes with substantial poverty rates, investment funds are the prominent feature (Barba Solano, 2004). The dual and exclusive systems in the region are characterized by increasing ethno-cultural heterogeneity, regressive nature of social protection systems (especially in the latter), and high degree of informality of labor markets (Keith & Prior, 2014). According to Barba Solano’s definition, Mexico is one of the dual welfare states. As a reminder, dual systems involve a graduation of the aforementioned aspects and a concomitant softening of universalistic provisions in the area of social security (Barba Solano, 2004).

3.3 Socioeconomic Situation of Mexico

Mexico’s role in Latin America is complex and multifaceted, encompassing economic, political, cultural, and social factors. Its sheer geographical size and economic power make it a key player in the region. In addition, Mexico’s historical and cultural significance shapes Latin American history and identity.

Mexico is the second largest economy (after Brazil). Its economy is diversified and includes a mix of agriculture, manufacturing, and services (Worldbank, 2022b). Mexico is the largest Spanish-speaking country in the world, and its political influence extends throughout Latin America. It is a member of many regional organizations, including the Organization of American States, the Community of Latin American and Caribbean States, and the Pacific Alliance (Worldbank, 2022b). In addition, Mexico has a rich cultural heritage, with a unique blend of indigenous, European, and African influences. Due to its geographic location, it is a major transit country for Central American migrants trying to reach the United States (OECD, 2021; Schröter, 2015). At the same time, there are researchers, especially economists, who cite the negative influence of neoliberal fiscal and monetary policy on Mexican economic policy. In the academic debate, poverty and income concentration are the main direct or indirect problems. Social inequalities as well as income inequalities are influencing day to day life (Cruz-Martínez, 2019; Garcimartín et al., 2021).

Since the early 1960 s, Mexico has, on the one hand, repeatedly tried to establish economic relations with other Latin American countries, but also intensified trade and economic exchange with the USA and Canada. The former relations are supposedly shaped by history and geography. On the other hand, Mexican politicians emphasize that the common language, similar histories and a similar colonial heritage and culture make Mexico part of Latin America (OECD, 2016). Economic indicators like exports or imports as well as strong trade agreements like the North American Free Trade Agreement emphasize the more direct economic affiliation and cooperation with the northern neighbors, especially the USA (Rico F., 1987). There are statements by leading (Mexican) politicians, who cite above all the unfinished implementation of structural reforms, such as liberalization of the labor market and foreign investment, and full privatization of the oil sector (Adick & Giesemann, 2014).

3.4 Mexican Health Policy, Health Indicators, and Health Expenditure

The increasing demand for health services has led Mexico to take steps to improve their performance. Over recent decades, the country has experienced remarkable improvements in life expectancy and a steady decline in infant mortality rates from 5% (per 100 live births) in 1980 to 1.1% in 2021 (Keith & Prior, 2014; Obaid & Prebisch, 1964; Worldbank, 2021). Even though life expectancy at birth is 72.2 years—the lowest across all OECD countries as the OECD average is 79 years—it has been continuously increasing during the last decades (OECD, 2010).

The OECD indicator “health spending” measures the consumption of healthcare goods and services, such as actual health expenditure as well as personal healthcare (including rehabilitation, medical goods etc.), prevention and public health services, and administration (OECD, 2017c). Within Latin America and the Caribbean, health spending averages 7.95% of gross domestic product (GDP) (Worldbank, 2020a). Mexico spends around 5.4% of GDP in healthcare (Worldbank, 2020a). Only 50% of total health spending is publicly funded, which translates to $606.5 per capita. The share of out-of-pocket spending on health in Mexico is 41.3% in 2017 which is 7.9 percentage points above the Latin American average and more than double of OECD average (20.6% in 2017, see Figure 3.1). The Latin American average for out-of-pocket health spending is 28.35% in 2019, according to the Worldbank data (2020b), indicating a further decline in average out-of-pocket spending in Latin America.

Figure 3.1

(Note. Adapted from WHO Global Health Expenditure Database 2020; OECD Health Statistics 2019)

Change in out-of-pocket spending as a share of current expenditure on health (in %), 2010–2017.

On average, Mexico has one hospital bed per 1000 inhabitants, although this varies greatly between urban and rural areas. The country is leading in obesity rates as the OECD defines 75.2% of the population aged 15 and older as overweight or obese, which puts even more pressure on the healthcare system (OECD, 2017d). The child immunization rate is 88% (OECD, 2017a). The OECD-estimated rate of Caesarean sections is 550 per 1000 live births, the highest among OECD member countries (OECD, 2017b). These indicators show important institutional factors influencing health, as already stated in the theory above. The focus here is particularly on mother-child health. Numbers of Cesarean sections are strikingly high in Mexican cities (Marian & Pérez, 2023) compared to numbers that studies of different Latin American cities have shown. This may indicate that both the level of education (high education, more Cesarean sections) and local conditions and care policies in the individual city are crucial (Blofield et al., 2020; Perner et al., 2022). For classification: The WHO recommends a Cesarean section rate ranging of 5% to a maximum of 15%. High-risk pregnancies and births are always excluded, it is primarily about elective Cesarean deliveries. In Latin America, rates increased from 22.8% to 42.2%, making Latin America the region with the highest rates and the largest absolute increase (19.4 percentage points) among all world regions in 2014 (Betrán et al., 2016).

3.5 Mexico’s Divided Public Healthcare System

The Mexican healthcare system considers or describes itself as a pioneering system in Latin American comparison notwithstanding its large weaknesses particularly due to the massive segmentation. Public and private hospitals, as well as the healthcare industry, face great pressure to control the continuously growing costs, even more so when governments have a major stake in this sector, driven primarily by maintaining the population health welfare and the correct allocation of scarce resources (Keith & Prior, 2014).

The Mexican healthcare system is divided into three main pillars. In these pillars there is further interweaving that is quite complex (see Figure 3.2).

Figure 3.2

(Source: Gómez Dantés et al., 2011, p. 2)

Mexican healthcare system.

The first pillar, which I examine in detail, is the Instituto Mexicano del Seguro Social (IMSS). It is the main public social security institute. IMSS is formed by the social security institutions, which are led by the federal government and mostly financed by mandatory employer, employee, and government contributions. The services within this pillar are free of additional charges for members in the clinics and health centers run by IMSS. A smaller part of this publicly financed pillar is designed for civil servants and called Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), as well as a special insurance scheme for the armed forces and workers at Petróleos Mexicanos, the biggest public petrol factory in Mexico (OECD, 2017). The financing is equal to IMSS, however ISSSTE does count with own doctors and clinics.

The second pillar is primarily organized by the Ministry of Health (MoH) which is responsible through the Sistema de Protección Social en Salud for the population who is not formally employed. The social health insurance program in place during the survey period was called Seguro Popular, which was first implemented in 2004. The ongoing reform since 2021 renamed it INSABI (Mexican Government, 2022). It is mainly financed by public funds and added up with modest user fees for affluent users. The insurance program Seguro Popular, which was still in place at the beginning of this research, was created as a public policy that sought to provide financial protection to the population that lacked social security through public health insurance, thus ensuring their access to health services. This program was intended, among other things, to strengthen the actions involved with mother and child health and to implement a system to prevent complications before, during and after pregnancy (Mexican Government, 2015).

The third pillar represents the private health sector which is highly unregulated but plays a significant role in the Mexican healthcare system. The respective quality, prices and accessibility vary. However, these services are often used to avoid waiting periods, receive test results quicker and enjoy direct contact to a doctor. Most private services are financed directly out-of-pocket. Each health insurance covers different health services and guarantees access to distinguished health centers, diagnostical tools, included and accessible medicine, and the type of hospital (Puig et al., 2009). In Mexico, a 3.6% equivalent to 2.1 million people do not count with formal employment and regular salaries according to a report by the National Institute of Statistics and Geography (Instituto Nacional de Estadística y Geografía) (Mexican Government, 2022).

The implementation of Seguro Popular has strongly minimized the out-of- pocket payments (OECD, 2017b) but there is still work to be done. 41% of overall health spending per household is private healthcare spending which is the second highest (following USA) in the OECD comparison (OECD, 2017a). Less than 75% of the population is covered by institutional health insurance; the uninsured generally do have access to Seguro Popular if they subscribe. The access to Seguro popular (and equally now to INSABI) is neither mandatory nor automatically provided. This deficiency in the insurance structure inevitably leads to the country having very high out-of-pocket payment figures. These health expenses, which must be covered by the citizens themselves, have a direct impact on the economic situation of the individuals (Weid, 2012). However, the overall consequences for society are often overlooked. The payment capacity of individual households to participate in economic life inevitably decreases. Spending on healthcare services is thus often described as catastrophic, posing an existential threat to families (Weid, 2012).

Jalisco

Jalisco is one of the 32 states in Mexico. Guadalajara, its capital, is the largest and most populous city in Jalisco. The average age of the population within the state is 29 years. At the national level, the population aged 15 and over has 9.7 years of schooling on average, which means a little more than high school completion. Out of every 100 people aged 15 and over, three did not attend any school at all, 50 have completed primary education, 24 have completed secondary education (high school) and 22 have completed a higher education. Illiteracy is high among people over 75 years of age, but among young people the rate is only 3% (OECD, 2022). In 2020, about half of all citizens of Jalisco are beneficiaries of health insurance, the other half do not count with any registered insurance scheme. Of these beneficiaries, 71.1% have access to IMSS, 20.8% to the Seguro Popular and 4% to ISSSTE, and 4.2% use private services. In 2020, the average number of births was 2.4 per women being 12 years old or older, while 13.6% of mothers are under the age of 20.

3.6 Women and the Issue of Breastfeeding in Mexico

Mexico has made considerable progress in the achievement of women’s rights and gender equality, especially in key areas at federal level: strengthening of national laws to ensure women and men equality; strong gender institutionalism and increased public resources earmarked for gender equality (UN Women, 2014). There are national policy plans for gender equality. Latin America in general, and Mexico in particular, is dominated by a patriarchal system of gender relations. This influences women’s role on the labor market. Further it affects their role as care-givers in the family and social participation (PAHO, 2011). An important and not to be neglected effect for the region is women’s poorer opportunities for migration (Massey et al., 2006; Worldbank, 2022a).

38% of women surveyed by UNICEF in 2015 said they read a newspaper or magazine, 58% listen to the radio, and 90% watch television at least once a week. 83% of women aged 15–24 have used a computer at some time, 81% have used the internet at some time, including 77% in the last year and 69% at least once a week in the last month. So, these women have access to the diverse information on the internet. The vast majority of young women in Mexico can read and write, and literacy levels exceed 90% in all regions. Within the data of UNICEF and the National Institute of Public Health (Instituto Nacional de Salud Pública, INSP), only 75% of women who reported primary school as their highest level of education could read a simple sentence. The patriarchal system is dominant underlined by the data stating that 8% of all women aged 15–19 and 9% aged 20–24 had a partner ten years older than them and 5% of women interviewed said they could understand being beaten by their husband/partner in one of the sample situations in the survey (e.g., dinner is not ready, it is not tidy, etc.). 63% of children and adolescents aging one to 14 reported (or mothers reported) having experienced psychological or physical punishment in the month prior to the UNICEF survey. In addition, 6% of children had been subjected to severe punishment. One in eight children and adolescents are involved in child labor (12%), of which 8% work in hazardous conditions (Instituto Nacional de Salud Pública y UNICEF México, 2016).

Half (48%) of all women between the ages of 20–24 with primary education in rural areas have already become pregnant under the age of 18. Compared to women with secondary education (14%) and women with high education (5%), this shows a large disparity. Almost all women from the survey (99%) with a child born in the two years preceding the survey received prenatal care, mainly from medical personnel (98%). 82% of women had been in contact with a physician for the first time during the first trimester. Almost all births were attended by specialists (98%). 82% of births were performed in the public sector, 15% in the private sector. This fact will become particularly important in the following empirical analysis. 94% of children have a birth certificate, and 95% are registered which emphasizes that a large majority of births now take place in regulated institutions and the births or children are registered accordingly (Figure 3.3).

Figure 3.3

Examples of influencing factors on the decision to breastfeed, own illustration.

In the area of infant feeding, which is particularly relevant here, the PAHO reports that an average of 32% of children are exclusively breastfed during the first 6 months of their life. 72% of Latin American countries guarantee less than 14 weeks of maternal leave from work. In Mexico, mothers are entitled to 12 weeks (PAHO, 2022). Only half of the Latin American countries take actions following the International Code of Marketing Breast-Milk Substitutes which is an international framework presented by WHO to regulate the marketing of breast milk substitutes in order to protect and favor breastfeeding (WHO, 2017).

For my case, I make particular use of data from UNICEF. The following chapter presents the dataset in detail, which forms the basis of the empirical analysis of this thesis. UNICEF’s report provides the basic details to outline the situation in Mexico. There, although almost all infants were breastfed at some point (95%), only half (51%) were breastfed for the first time within the first hour after birth. Breastfeeding initiation in the first hour was particularly low among children born in the private sector (32%). Approximately 31% of infants younger than six months were exclusively breastfed and 39% of infants younger than six months were mostly breastfed (Instituto Nacional de Salud Pública y UNICEF México, 2016). Further research shows that the general breastfeeding rates and even more those for exclusive breastfeeding are lower than within the UNICEF data and range around 15–20% (Castillo Magariños & Grados Torrez, 2018; Deming et al., 2015; Perez-Escamilla, 1994). The low figures are a constant source of concern for politicians. There is (actually) a law regarding breastfeeding, which ensures, for example, one hour of breastfeeding during working days. This legislation is widely known, but surveys show that underlying mechanisms and contextual factors, as well as previous experience and the environment, are more decisive than knowledge and implementation of the law (Hernández-Cordero et al., 2022). In addition, there are always campaigns that favor breastfeeding, inform about it and educate—often in cooperation between the Secretaria de Salud (Secretary of Health) and UNICEF or large non-governmental organizations (NGOs) (Mexican Government, 2015; Boletín UNAM-DGCS-297, 2022; WHO, 2011; WHO & UNICEF, 2019). For example, there is an official ban that prohibits pharmaceutical companies and pre-milk manufacturers from giving their formulas to hospitals for direct distribution which is discussed and present in international and national media (González de Cosío et al., 2018; The Guardian, 2015). In 2022, Mexico took part within the yearly international week of breastfeeding, an initiative of the PAHO in Latin America. In August 2022, the focus was on breastfeeding support and education. The state of Mexico supported the national agenda and stated that “the protection of breastfeeding is a shared responsibility” (Gobierno del Estado de Mexico, 2022).

In summary, Mexico has become an important key player in the Latin American region in recent decades. Nevertheless, the (public) healthcare system has serious deficiencies. There is a risk of underuse in some parts of the country. Maternal and reproductive health is underrepresented. Pregnancies are increasingly attended to professionally, although babies are often delivered by Cesarean sections. Breastfeeding experiences vary widely, but the rate of breastfeeding is extremely low in relation to international standards. Compared to the Latin American region, Mexico repeatedly shows efforts to install a solid welfare state, but there is little to hardly any public investment in the most important institutions. The connection between health and poverty is clear.

This chapter has provided a framework for understanding the context of the case study discussed here by providing an overview of the situation of women in Latin America, and Mexico in particular, and the breastfeeding situation. In the following chapter, these are presented for the data analyzed in this thesis and the strategies used.