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.
18th May 2006
Is it true that you are still …
March 2006 / Mumbai
A woman interrupted me last night as I was taking printouts of the petitions we were planning to send to the Prime Minster to stop the Sardar Sarovar project from going up to 121 m. Urging me aside, she told me, “As early as possible you should stop breastfeeding her.”
She was probably not the only one surprised when my daughter nursed during the meeting, but she was the only one to state her views so directly. Unprepared for such a confrontation, I simply said, “I am very busy, and I am not going to stop breastfeeding now.” Seconds later, more crisp responses filled my head … “Really, this is neither the time nor the place…” but alas, the moment was gone. Not that it is the first time. I was once stopped on the street by an elderly woman who looked uncomfortable as I said “hi” as I walked into a party that she was just leaving. As she walked slowly towards me I smiled and waited for her acknowledge my greeting before I continued walking towards the house. She finally said, “Is it true that you are still breastfeeding your daughter?”
Most of the conversations I’ve had about breastfeeding (and I do have a lot) are among friends who are also mothers and who don’t need to be reminded of the basic facts … that the World Health Organisation recommends breastfeeding at least for 2 years and beyond as long as mother and child wish. That breastfeeding offers nutrition superior to any other food or drink. That cow’s milk is for baby cows and human milk is for baby humans. That breastfeeding is so much more than nutrition – it is immunity not only to germs but also to excessive stimuli from the environment, it nurtures one’s sense of wholeness, it is comfort after a fall or stress, and of course, it is a warm cozy place to sleep, etc. The world offers alternatives for all of these functions, and the child who learns to avail these at her own pace will utilise them best. Children in adivasi societies, from whom we have much to learn, are allowed to wean naturally, meaning that no one really monitors their weaning. One fine day people may notice that the child hasn’t nursed in a while. Somewhat the same way children in urban societies may start eating meals on their own, or knowing the way home on their own.
A rural parent may be more than amused to see urban children being spoon-fed. I myself have seen urban parents spoon feeding their children even into adulthood. However the rural parent will refrain from judgement, at least aloud. If only we afforded them the same courtesy!
Breastfed children may have the freedom to discover the world of solid foods at their own pace, since they are not dependent on these for nutrition. They need not be fed at all – parents need only present fresh and healthy food and let the babies do the rest. Spend a day with an adivasi family and you will see that babies and young children are quite self sufficient when it comes to eating. No coaxing, cajoling. These parents read no research articles like (quote) which meticulously urge parents to allow self feeding from infancy, avoiding even suggesting that the child “finish the plate” or have an extra bite after the child stops on his own. In this way, they say, the child learns to guage his own hunger and satiety and not reply on external signals like parental approval, or amount on the plate as an indicator of how much he should eat.
While the adivasi diet is not as varied as the city diet, nearly all the food is not only grown locally but prepared fresh, to the point of freshly stone grinding their grains twice a day. Their chapatis perhaps offer more nutrition than our vegetables which we import from long distances and eat days or even weeks after they are harvested before the point of ripeness. And though their fruits and vegetables are far fewer, they are always fresh.
Often writings in the West take for granted that breastfeeding is better understood, supported and more widely practiced in “traditional societies.” While this may be true in the fourth world, i.e. tribal or indigenous communities, and those parts of the “third world” that have sustained their natural resource base and along with it, their parenting traditions, in the semi-urban, urban, and urbanizing parts of the third world, we see an abrupt departure from generations of family living wisdom. Nearly every component of the “attachment parenting” model that is gaining popularity as well as growing support from the medical establishment in Western countries – sleepsharing, breastfeeding, babywearing and natural infant hygiene (using cloth diapers or no diapers) is falling out of fashion among those who have been practicing these for generations without ever having to read a book, consult a doctor or chat in an online support forum.
What may be most telling of all, of course, is what my friends at the meeting last night may not have noticed. Without the benefit of breastfeeding, what 2 year old child is able to attend a meeting for 2 hours late in the evening? Sure, she brought along snacks, but breastmilk is much more than protein, vitamins, superior fats and highly absorbable minerals. In a crowded room, breastfeeding gives baby a safe haven where she can touch home base, settle and process her observations.
[to be continued …]
9th March 2006
Where there is no lactation consultant
District Gajapati (Orissa), January 2006
A year after our first visit to Rasuru village near JITM, we had a few programs going in this and a few more villages in Gajapati District. Desilting/soil support, electricity connections, childrens libraries, and a team of artisans designing products and training new people to earn livelihoods in cane, bamboo, tailoring, and pottery. With our new packets of sprouted ragi [millet] flour, we talked to the families about nutrition, with special attention to mothers and young children. Devi and Nirmala went house to house to call parents to the meeting, and several came with babies in arms. As they introduced themselves and their children, we found that most children between ages of 0-4 years were twice as old as we would have guessed by looking. We asked each of the mothers what the children were eating or drinking. A few mothers said that they did not have milk for their babies and therefore were using powdered milk or diluted cow’s milk. Having strongly imbibed the message that every mother has milk and that it is extremely rare for a mother not to have milk, though quite common for her not to get the support and confidence to breastfeed, I said, “I also was not able to feed for several days. Because there were people to help me, I kept expressing my milk and eventually I could breastfeed normally. If you want I can also help you so that you can breastfeed.”
To my immense relief, the women said yes. Why was I relieved? Because mother’s milk is so important for babies as well as mothers, because of all the nutrients in perfect balance that it provides, all the immunity and bonding and empowerment. And because it was more than obvious that these newborn infants taking bottles were the weakest among those present, while the babies who were exclusively breastfeeding were as curious and plump as any baby anywhere. Breastmilk does not discriminate.
Next morning we went house to house to meet the mothers and in many cases the fathers, who were home because they had no work or because of the Sankranti holidays spilling over into the week. We talked to the families, weighed the children and peddled the ragi. In many cases the grandparents came to see what we were talking about and piped in, “ragi tinTE cAlA balam” [If we eat ragi, we will be strong.] There were also people who derided the ragi – why are you talking about ragi, no one eats that any more. And in fact, when we asked people one by one if they were eating ragi, many of them giggled and only after we said that we ate ragi did they admit to eating the ragi. They had it in their homes – they would buy whole ragi and take it to the mill for grinding periodically.
Our ragi was sprouted, increasing its iron and calcium values, so we described how we made it and asked them if they would try it. We gave out samples and went back in two days to ask if they ate it. Whomever we asked, had opened the packet and at least one child in the family had eaten it. We encouraged the mothers also to eat it as it would give them good iron, calcium and other nutrients. One mother expressed doubt whether it would affect her milk. We said that it would improve her milk and the baby would only derive benefits from her eating healthy food. Moreover, she would have the strength she needed to keep on nursing.
Many people were eating two meals per day with a tea here and there. Candy and cigarettes were also in use. Some said the children fell asleep before dinner and therefore did not eat dinner. We asked if they got access to bananas, guava, or any other fruits to eat in the middle. They said that they did not eat bananas in the “winter” because it would give them a cold. We assured them that although a banana might not be a good thing to eat if you already have a cold, it would not lead to catching cold. If they had any doubt, they should go for bananas that were very ripe, with as many spots as possible.
Regarding the formula, they told us that they were putting 2 or 3 scoops in the bottle and using 2 – 3 bottles in a 24 hour period. Whereas according to the instructions on the box, they were to mix 4 scoops and give 6 bottles in 24 hours. Some showed us some vitamin drops that they had bought as well.
I spent extra time with the mothers who told me they had no milk. One child was already a month old and the other 6 weeks, so I was really unsure that I could help them establish lactation at such a late stage. But bravely I sat with them and asked them if they had tried putting the baby to the breast. They had. Did s/he drink? Yes, s/he had. Could they try again now? Yes. One of these babies was asleep so I asked her mother to call me when the baby woke up and I would come back and watch her feed, and proceeded to the next house. After some time the mother found me and we sat down together. She put the baby to the breast and she began sucking right away.
I visited another mother who said she had no milk. Her baby was also asleep in the sari-swing, but he woke up while we were there and she took him in her lap. He did not latch on. He had just had a few ounces by bottle. But she was able to express milk from both sides and I assured her that she had enough milk. The next day I visited her and watched as she breastfed her son.
Actually in both cases it was a case of the glass being half full or half empty. When the mother said, “pAlu lEvu” [no milk] it was similar to saying of a child, “burra lEdu” [no brains]. It is not something to be taken literally. She just did not consider the milk that she had as worthy of the name, “mother’s milk.” Each of these mothers had nursed their babies even before I visited them – they just were not confident that it was enough and therefore bought the formula and bottles.
Both the babies were extremely small and I encouraged them to use a sling so that the babies could feed more frequently. I explained how milk reached the breasts and that when the baby fed it was like turning the system “on” and when there were long gaps between feeds then less milk would be produced. So if they were concerned about their milk supply, the best way to increase the supply would be to feed more often. Demand would naturally increase the production. And they should eat more often as well. I told them that everything we eat will go into our milk, and asked them about their diet. They usually had rice and dal two or three times a day. Sometimes they also get fish and vegetables. No telling how often. They also made idlis and we saw many people preparing idli dough by hand as we toured the homes. I described the nutrients in all the things that they were eating and then asked them what the cows are eating. Grass. And junk by the side of the road. So which milk had better things to offer for their babies?
It has been a week of emotional highs and lows. I told the mothers whom I helped to nurse that I had been awake all the previous night worrying about them and that I was simply elated to see them nursing today. Part of me was worried that I was entering their lives out of the blue and I should fully understand what all they were doing, why, what all constraints they were facing, what might be the strengths of some of the things they were doing and only then offer any counseling from my side. But I drew confidence from my own experience with nursing, which did not come easily for me at first either, and also with slinging, another art which may soon be lost, at least among the poor. To guard against my own zeal, I always asked for their consent before I offered help either with nursing or with slinging, and asked them what they thought of what I said. I emphasised that I myself was doing each of the things that I was recommending to them. Devi and Nirmala, our village volunteers were somewhat in the middle, wanting to help ‘translate’ what I was saying – either literally into Oriya for those who did not know Telugu, or effectively into the local context which they knew first hand. However when the villagers would put the question back at them, “do you eat mandya [ragi]?” our volunteers would be giggling as well.
It is interesting to note the similarities across states – for example we hear that in other parts of India people have expressed the fear that eating bananas – a nutritious fruit that is readily available and affordable, would cause a cold. I was relieved that no one objected to having their baby weighed, as has happened in other places. In fact the anganwadi worker has records from the monthly weighings that she conducts in the months when she has food to offer and parents actually come. Her next weighing is scheduled for Jan 22 and if her grains come in time she will make the khichdi and offer it and then probably most of the children will come and be weighed. Mothers of newborns need support right away and at more frequent intervals than once a month. If we can start by complementing the efforts ofthe anganwadi probably more avenues can open up to raise awareness on nutrition.
2 Responses to “Where there is no lactation consultant”
- Radhika Says:
March 17th, 2006 at 4:00 pm eAravinda! Bless your heart for taking this up; something I too feel so deeply about. If people like me with post-graduate degrees, access to internet, libraries and La-leche-leagues can feel inadequate and uncertain about nursing, how isolating and unsupported it can feel for a young mother with none of these facilities Its a very sad thing that there seems to be less and less traditional knowledge and support for nursing, which is by far the best food for an infant. Helping mothers build their confidence is probably one of the most worthwhile and commendable efforts…Advocacy for breastfeeding – support for moms in different situations, whether working in offices or in the fields, its all so sadly lacking and I would love to come help in any way I can.
- Mansoor Khan Says:
April 17th, 2006 at 2:59 am eHi Aravinda,Excellent article. Got to read it because I just got an invite from aidindia that I confirmed with a reply. Thought of you and the Narmada days. I sent an email but maybe address is old. It has been a while. Sorry I am using this space to connect but had no other way to reach you. Do write and we can exchange notes.