CHICHALUM, Guatemala — Painted on the side of a health post in this rural town in Guatemala’s western highlands is a simple message: Breast-feeding is a lifelong gift.

But around the world, breast milk is a gift that many children are given incorrectly or not given at all — and the results are devastating. Health scholars report that a child dies more than once a minute somewhere in the world for lack of proper breast-feeding.

This isn’t the case in the United States, where debates about breast-feeding don’t normally involve child mortality. In rich countries where water is clean, a bottle is not lethal the way it sometimes is in poor countries.

In countries like this one, however, breast-feeding can make a vast difference. Consider Eva, a wide-eyed 14-month-old baby being treated for malnutrition at the Casa Jackson Hospital in Antigua, Guatemala.

Eva and her mother were homeless for the first three months of her life, says Rina Lazo Rodriguez, the director of the hospital, during which time Eva was fed soda or juice, braved the elements and faced unhygienic conditions.

Before being sent to Casa Jackson, Eva was hospitalized for pneumonia and diarrhea. Lazo Rodriguez attributes non-exclusive breast-feeding as one of the many factors that led to Eva’s malnourishment.

The lives of 823,000 children younger than five could be saved annually if we scaled up breast-feeding to near universal levels, according to estimates published in The Lancet breast-feeding series from 2016. Specifically, breast-feeding is linked with decreases in diarrhea, middle ear infections, and respiratory infections and increases in IQ and nutrition.

Babies don’t hog all the benefits of breast-feeding, either. The same analysis estimated that increasing the amount of time mothers breast-feed could prevent more than 22,000 breast cancer deaths each year. For mothers, some evidence also links breast-feeding to protection against ovarian cancer and type 2 diabetes.

The good news is that these are lives we know how to save: Babies should start breast-feeding within an hour of birth, breast-feed exclusively for the first six months of life without any other food or liquid, and then continue breast-feeding with complementary food until they are at least two years old, according to the World Health Organization.

Guatemalan women are far ahead of U.S. women in optimal breast-feeding practices — Guatemala’s exclusive breast-feeding rate, 53 percent, is double the U.S. rate. In the U.S., Mississippi has the country’s worst exclusive breast-feeding rate, a mere 13 percent.

Similarly, in the United States, only 6 percent of infants continue breast-feeding until they are two years old, whereas in Guatemala, that number is 57 percent. In the United States there are also class, age and racial disparities among women who breast-feed, with affluent white women most likely to do so.

This comparison isn’t totally fair, because in Guatemala breast-feeding is more urgent, particularly in communities without clean water or much food. Some women and health workers I talked to said that mothers in rural areas continue breast-feeding because even if they don’t have food to give their child, at least they have milk.

None of this is to blame women, either in Guatemala or the United States, for not following breast-feeding recommendations to a T. As someone who has never had a baby and never breast-fed, that’s the last thing I would want to do. And I understand the argument that one should leave breast-feeding to be a purely personal decision for each mother to deal with.

But when we frame breast-feeding as solely a woman’s responsibility, as the 2016 Lancet series notes, we are also “ignoring the role of society in its support and protection.” Though the challenges look different depending on where you are, as a society we’ve erected barriers all around the world to make it harder for women to give their children the breast milk they need in the way they need it.

In the United States, these barriers may involve workplace rules hostile to breast-feeding or hospitals that unnecessarily separate infants from mothers, whereas in Guatemala, they may involve misinformation surrounding when to introduce water or lack of access to healthy complimentary food.

Americans often think the problems with breast-feeding in poor countries arise just from marketing by formula companies. That is indeed an issue. But often the biggest problem is that women do breast-feed but don’t start soon after birth, or on hot days they give the baby water, or they introduce other foods before six months.

“You have to give them a little bit of water with milk,” Marcela Morales Herrera, a traditional birth attendant in the hillside village of Chichalum, within the municipality of Chiantla, told me, speaking of babies younger than six months. Morales Herrera, 66, has 18 kids of her own and has been delivering babies in her community for about 20 years now.

In reality, breast milk is about 80 percent water, meaning breast milk alone can keep babies hydrated, said Ellen Piwoz of the Bill and Melinda Gates Foundation — whereas unclean water can cause the baby to get sick. And even clean water can be harmful because it may fill up the baby’s stomach, discourage further breast-feeding and therefore inhibit milk production, which is stimulated by suckling.

Irma Domingo, 29, a nurse at the health post in Canquintic, within the municipality of Nentón, told me that exclusive breast-feeding was the hardest element of optimal breast-feeding for most of her patients, and she estimated about 30 percent of mothers she works with give their babies water or coffee before six months, despite recommendations against it.

After the first six months, it’s important that babies be introduced to nutrient-dense food. When I asked a group of women in the village of Exchimal, near Aguacatán, what they fed children after six months, they mentioned tortilla and potato soup — though that, they explained, was out of necessity.

“Here there are no vegetables or fruit,” said María Mendoza Raymundo, 42, referring to the community’s failing crops and water shortages, which she attributed to climate change.

Some women I talked to cited their own malnutrition as another barrier to breast-feeding. But somewhat counterintuitively, research indicates that virtually all mothers, even malnourished ones, can produce sufficient breast milk, because breast milk is stimulated by suckling and good attachment, and does not much depend on the mother’s own nutrition. And while a malnourished woman may have less nutrient-dense milk, kids will compensate by consuming more of it.

So while meeting these women’s nutritional needs is urgent for a host of other reasons, to breast-feed they may just need more support.

“The overwhelming majority of women will be able to breast-feed and breast-feed successfully if they’re given support,” Piwoz said.

“From a public health perspective, it’s the adequate support for breast-feeding that is the biggest critical determining factor.”

I’ve seen on this trip how difficult it can be to get nutrition right, and how widespread malnutrition is. Some of the solutions are complex, expensive and high-tech. But one of the solutions requires no electricity or refrigeration, no out-of-pocket cost, and has been part of our tradition of raising our young since before we evolved into humans.

It’s a solution for Jeidy Funes, 20, who lives just up the hill from the health post with the Breast-feeding is a lifelong gift mural. When we met, she had just woken up from a nap — her three-week old, Tatiana Nicole, had been keeping her up at night. She smiled down at Tatiana Nicole with tired eyes, and told me she knew she was going to be able to give her daughter a better quality of life than her own. Breast-feeding, she said, was going to help her do it.

Mia Armstrong, a 2019 graduate of Arizona State University, is the winner of Nicholas Kristof’s 2019 “win-a-trip” contest, allowing a student to accompany him on a reporting trip and write about it for The Times. This is the first of several articles she will write from the trip.

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