What follows is the third part of a talk called “Women’s Rights Perspective in Birth, Breastfeeding and Food” that I presented at a Training Program on Gender, Work and Health held at the National Labour Institute, Delhi in March 2014. The earlier two parts concern Birth and Breastfeeding. Continue reading
In Part II of my talk on Gender, Work, and Health, presented at the National Labour Institute in Delhi, first to a group of research scholars from various parts of India and second to a group of policy makers from different countries, I talked about how a rights-based approach would improve implementation of policies that would bring about a Breastfeeding Model that Works.
A breastfeeding model that works:
Recognizes the importance of breastfeeding
Accords with World Health Organization Guidelines and the Indian Constitution and Maternity Benefits Act
Recognizes the importance of food.
Breastfeeding is the normal way humans feed their young, and also introduce their young to the diverse flavours of foods. Currently in India, however, only 1 in 3 babies is exclusively breastfeeding for the first six months, and even fewer continue breastfeeding for at least two years, as the WHO Guidelines recommend. Continue reading
On 10 March 2014, I spoke about Women’s Rights Perspective in Birth, Breastfeeding and Food at a Training Program on Gender, Work and Health held at the National Labour Institute, Delhi. In one session, graduate students from institutes in various parts of India attended. In another session, Health Officials from various countries attended. Continue reading
What’s behind that glass of milk?
6th May 2013
ANUSHA NARAIN, What’s behind that glass of milk?
The Hindu, May 4, 2013
Nutritionally, we only need to look at what the cows eat, or at least are supposed to eat – greens! We can get our calcium, iron and other nutrients directly from leafy greens rather than making the cows chew them for us. This will be better for our health and the cows can be free. As the author points out, it will be economically and ecologically better for the country as well and help ensure that everyone gets better food. Especially nursing mothers, who need to eat well and stay strong so that they can give children the milk they really need – mother’s milk, and thereby introduce their kids to a wide variety of foods rather than using milk from another animal.
Even those who aren’t vegan can benefit from reducing dairy (especially unfermented dairy) in the diet.
Abstract Submitted to World Breastfeeding Conference | http://www.worldbreastfeedingconference.org/
to be presented in the session : Forgotten Foods – Use of local foods for complementary feeding
I would like to discuss two cases, from Srikakulam and Khammam Districts respectively, of people’s experience with traditional foods, the obstacles people face in “remembering” them, and the impact this has on people’s breastfeeding, health and the social fabric of life.
Nutritional supplementation with local millets.
In rural Srikakulam District, a program of nutritional supplementation with local millets has been in place for 5 years. Run by an NGO, AID-India, the program targets malnourished children below the age of 5, and has successfully brought the children to normal weight as per ICDS weight charts. However obstacles remain in restoring millets as a normal part of the local diet – it is fast becoming or has already become a “forgotten food.” It is not procured by PDS, not served in ICDS, and not supported in agricultural policy in spite of its demonstrated value for individual health, farmer’s livelihood, and land.
At the same time, we observe that communities still practicing traditional diet with not just one but several varieties of local millets as part of their diet, are facing threat of extinction. One example is the Koya adivasis, forced to flee their homes and lands, and now living as Internally Displaced Persons without land.
Update – To Be presented on Dec 8, 2012: http://www.worldbreastfeedingconference.org/abstract
Note from JP Dadhich <email@example.com>:
Greetings from Organising Committee of World Breastfeeding Conference 2012!
We are pleased to inform you that the abstract for the presentation submitted by you for World Breastfeeding Conference to be held on 6th-9th December, 2012 in New Delhi has been accepted for oral presentation in conference programme on 08/12/2012 at 16.30-18.00 hrs.
Your presentation has been scheduled for the session TS-14 (Research papers on various aspects of infant feeding) as indicated below in session summary.
Technical Session – 14 Research papers on various aspects of infant feeding
Title of paper
Foods: nutrition, tradition and the price of memory
Desogestrel mini pill: Is this safe in lactating mother-A prospective Study
Dr Dilip Kumar Dutta
Breastfeeding and equality
Impact of the promotion of breastfeeding support for women in four hospitals in the Pacific island country of Solomon Islands.
James Auto, Divi Ogaoga, Shakila Naidu
Microbiological assessment of expressed and stored breast milk of lactating mothers in Abia state, Nigeria
Ukegbu PO Uwaegbute AC, Ijeh, II, Ukegbu AU
FoneAstra: Improving safety and monitoring systems for low-tech human milk banks
Rohit Chaudhri, Lysander Menezes, Anna Coutsoudis, Penny Reimers, Darivanh Vlachos, Maya Newman, Kimberly Amundson, Noah Perin, Kiersten Israel-Ballard
Each speaker will be allotted 8-10 minutes for completing the presentation. We’re looking forward to your participation at the conference.
If you have any queries, please do not hesitate to contact us. Please Note: If you are not the author presenting your paper, please forward this message to your co-author who is doing the presentation.
Dr. JP Dadhich MD,FNNF
Organising Secretary, World Breastfeeding Conference (WBC-2012)
National Coordinator, Breastfeeding Promotion Network of India (BPNI),
Consultant, Breastfeeding and HIV – IBFAN Asia,
Co-coordinator, WABA Taskforce on Global Advocacy,
South Asia Regional Focal Point Coordinator for WABA
3rd July 2009
Proposal for discussion to present at PERINATAL: Symposium on Birth Practices and Reproductive Rights
George Mason University, Fairfax, Virginia
Title: Changing choices in childbirth in rural India – stories from Srikakulam District, Andhra Pradesh, India
Women’s options in childbirth are circumscribed by broader factors that determine their opportunities in life, whether and when to marry, to study, or work outside the home. The limiting factors include ideas about women’s bodies, of menstruation, fertility and reproductive cycles. Colluding with women’s sense of inferiority and powerlessness are government policies pushing women towards institutional childbirth and requiring women to report to the hospital at 9 months 3 days gestation. For women who do not go into labor at 9 months 3 days, this policy increases the likelihood of hospital birth and related interventions, including Cesarean birth. A generation is growing up that considers hospital birth and Cesarean birth to be “normal” and home birth or vaginal birth to be exceptional. In the process the tradition of midwifery is disappearing. This pattern reflects a broader global pattern in which traditional living practices such as natural birth, breastfeeding, sleepsharing, babywearing, and natural hygiene (also called elimination communication) are being disparaged and discontinued in societies where they have been in continuous practice up to the present generation, while being revived among the elite in the first world. These trends in turn impact attitudes towards learning, health, hygiene and natural resources in a way that creates a gap in the tradition so that the practices can no longer be handed down from elders but must be learned from books, classes or other media. Meanwhile government policies and profit-driven advertising promote institutional birth, bottle feeding, diapers, cribs and timetables of vaccination, discipline and education that are not oriented to optimal health, growth and learning of the child. Ironically, people believe that following these trends will help them climb the social and economic ladder, but in the larger picture we see that this helps to transfer from the poor to the rich, practices respecting health of mind, body and environment.
19th December 2007
Talking about birth …
“ippuDu evvariki normal avaTamu lEdu.”
[No one has normal anymore.]
“noppulu rAkunDAnE tIsupOtunnAru.”
[they are taking them in even before contractions begin.]
“tommidi nellalu mUDu rOzulu avagAnE rammanTunnAru asupatriki”
[they are asking us to come in to the hospital by 9 months, 3 days]
Stirred by these anecdotes of rapid mass conversion from home birth to hospital birth in rural parts of Srikakulam district, I sought to talk in more detail with women about their birth experiences.
I met women in Tolapi and Appalagraharam villages, some of whom were receiving sOLLu pindi (ragi flour) in the AID India nutrition program. I said that child nutrition began before birth, even before pregnancy. A healthy woman would become a healthy mother and a healthy mother would be more likely to have a problem-free birth and be able to breastfeed easily. And so I asked them to share their usual dietary patterns, how these changed in pregancy and postpartum, and in this context asked them to share their birth experiences as well.
Those who had C sections, also known as “pedda operation [big operation]” said that they went to the hospital at the appointed time, often without any contractions at all. Generally people believed that once a Cesarean, subsequent births must be Cesarean and therefore the woman should not be kept at home waiting for contractions to begin but should just go to the hospital on the scheduled date. Other indicators for Cesarean, according to them were malpositioned baby or water breaking prior to onset of contractions. Apart from this since women were asked to come in at 9 months 3 days many went in prior to contractions anyway and for one reason or another had Cesareans. Many who went in after onset of contractions also reported that contractions slowed or stopped at the hospital and therefore they did have Cesareans.
In each village there were also home births and they described their birth experiences as well. I was mesmerised by the detail in which they could recall the progress of labor, indicating at what time contractions began, what they were doing at the time, whom they told (for some time they kept it to themselves so as not to interrupt what they were doing), right up to what time the baby was born.
One of the women who had a home birth reported that she did go into the hospital at 9 months 3 days as requested, and was asked to stay and wait for the baby to be born. However, her mother who went with her said that she was just fine and did not need to wait in the hospital and took her home. A few days later she delivered at home with only her mother to help her. Her mother was experienced in childbirth and was called by others as well. In another case the government nurse actually came home to deliver the baby for a woman.
There was also a case of a woman who delivered at home with a “mantrasani,” or traditional birth assistant, who lost the baby due to incompetent handling by the mantrasani. She reported that the mantrasani tried to pull the baby out by reaching in. The baby died. Another woman reported that because she had high BP the doctors told her that she could not deliver a breech baby and gave her injections to kill the baby. I asked why they did not do a Caserean delivery and she said that because of her high BP they could not do it. This happened in 1994. Since then she reports that she has fits and very poor memory.
After hearing all the stories I shared my birth experience as well. I also described what was happening during the “pains” which is the word used for contractions, and how this indicated that the body and baby were ready for the birth. 3 days past my due date my contractions began but occurred at 1 hour intervals. This continued for 7 days. I did not go to my midwife until the contractions came every 5 minutes. I told them that I was advised not to come in until contractions were 3-5 minutes apart, lasting 1 minute each and continuing at this rate for at least 1 hour. By waiting until this stage one could be relatively sure that the baby was ready to come and avoid unnecessary interventions. I emphasized that even if one had a Cesarean before one could possibly have a normal delivery next time. I asked them how long it took to reach the hospital and they said 30 minutes. This meant that they could definitely wait for labour to begin rather than going in advance “just to be safe.”
Some people asked how long you can wait – can you even wait till the 11th month?
Varalakshmi explained that we don’t always know the month that accurately, sometimes we may miss a period even before the pregnancy and think that we are farther along than we are. Also in case they are going by the lunar calendar, these months are 28 day months, which means that normal term is 10 full months. So entering the 11th month would be fairly common. Some people are counting in solar calendar months but then they should make sure they are not confusing the two.
We also talked about nutrition during pregnancy and postpartum. They reported that they were not getting the supplementary nutrition from the anganwadi as promised and for which their names were registered. We spoke with the anganwadi workers who reported that they were each responsible for 20-25 pregnant women but as their target was 8 women, they received supplies only for 8. Therefore they gave only to 8, sometimes by rotation so that they prengnant women would “adjust among themselves.”
Before coming to breastfeeding I also asked them about postpartum nutrition. I knew this would be an explosive topic. Postpartum dietary restrictions are quite tough on women. Many reported that they ate only one meal / day comprising dilute pappu (dal) or only charu with rice or chapati. Even those who raised a fuss (”goDava”) and ate 2 meals a day were very restricted in terms of what vegetables were allowed, and generally everyone reported feeling very weak and hungry during that time. Some took tonics from the doctor to help overcome this weakness and to produce milk. Some reported that they did not have milk and had to use cow’s milk or dabba (formula) milk. I emphasized that women should eat heartily during post partum without restricting any vegetable unless they personally had a problem with it, not because someone somewhere had a problem.
Some are even limited from eating their fill during pregnancy because they are afraid a big baby will be hard to deliver.
[I was in doubt about the whole peanut issue so I steered clear of it. Peanut was the only food I restricted during the first 2 years of breastfeeding, due to prevalence of peanut allergy in US. But the theory that allergies are likely to affect people in highly sanitary living conditions much more than those living with plenty of germs in the environment made me pause before casting aspersions on the peanut, which is a local crop, cheap and nutritious. ]
It seems that villagers think that rich people are healthier because they eat more expensive, i.e. packaged foods. So when they have a little spare money they try to buy packaged foods.
After learning more about their diets and diets of infants and children, we wanted to make a pamphlet on nutrition that would be locally relevant, written in colloquial language, focussing on the nutritional value of locally harvested food and how to incorporate more into the daily diet. We have made a rough draft and would appreicate help from anyone interested in nutrition and fluent in Telugu.