Conference

Towards a Breastfeeding Model that Works

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

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Conference

Gender Work and Health – Part 1: Birth

Gender, Work, and Health

Women’s Health from a Women’s Rights Perspective

Following are notes from a presentation I gave at the National Institute of Labour as part of a training program on Gender, Work, and Health.  I presented on Women’s Health from a Women’s Rights Perspective, focussing on three themes, Birth, Breastfeeding and Food. 

Before I continue to the three themes I presented, let me share some of my own apprehensions about speaking to both of these audiences.

My brief was to talk to the Ph D students about research methods and to the health officials about policy. Continue reading

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Conference

Women’s Rights Perspective in Health – dangerous?

At a training program in Delhi, organized by the VV Giri National Labour Institute, I spoke on birth, breastfeeding and health from a women’s rights perspective.  I gave the presentation to two groups – one comprised 36 PhD students from universities and institutes in various parts of India and the other comprised a similar number of health officials and physicians from developing countries outside India.

We sometimes talk about the inadequacies of the biomedical model of health and birth, insofar as it excludes social, psychological, environmental and spiritual factors.   What we notice less often is the possibility that the biomedical model may itself depend on metaphors that are influenced by cultural stereotypes.

In the first part of my talk, I discussed gender stereotypes in the medical descriptions of women’s bodies and of reproduction.  For this I relied on Emily Martin’s work The Woman in the Body and in particular “The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles.”  (Signs, Vol. 16, No. 3 (Spring, 1991), pp. 485-501.

Drawing from several standard medical textbooks, Emily Martin shows that descriptions of women’s bodies reflect the values of industrial capitalism as well as gender bias and stereotype.  Take away these values and substitute gender equality and women’s rights, and you would describe these processes quite differently.

I presented some of her examples  and quoted from her article to explain each one. In summary these are:

Biological process

Standard Medical Textbooks

Why not

conception

journey of the sperm

interaction of egg and sperm

ovum

passive, fragile, dependent, waiting

connecting with sperm

sperm

active, strong, heroic, autonomous

connecting with egg

ovulation

overstock inventory

just-in-time maturation

spermatogenesis

amazing feat

excess

menstruation

failed production

indicator of fertility

menopause

factory shutdown

golden years

I continued to talk about how we had the choice to look at these processes in a way that grants women autonomy over their bodies and reproductive health, and this could help us to take a rights-based approach to women’s health.  Just as I was about to move along to a discussion of women’s rights in birth, several hands flew up.

“The processes are described this way because that is the function of the reproductive organs,” one doctor said.  I replied that we could look at the process differently if we did not assume that the objective of every woman and every menstrual cycle was to have children.

Why are you calling menopause “Golden years?”  several men asked.

I answered that it signals a transition in life and that each phase of life could be appreciated on its own terms rather than regarding the woman’s body only through its child-bearing function.  It is not to imply that earlier phases of life are less “golden” but simply to use a positive and respectful term.

“These ideas would be all right coming from a Western Perspective,” commented a physician from Sri Lanka.  “But you being from our culture, should not be spreading these ideas.  This kind of thought, if it spreads would be very dangerous,” he said.  “It would cause a disruption in our society.”   A physician from Afghanistan agreed with him and added,  “In our culture motherhood is not a burden, it is a privilege.”    One more health official from an African country added that menopause should not be called golden years and went on to explain that men could continue to reproduce for the whole of their lives.

I asked, “Can we hear from any of the women in the room?”

No one spoke up.  The physician from Sri Lanka said, “I am speaking on behalf of the women.”

I was stunned that no one objected to such a statement.   Nevertheless, I stayed on message and reiterated that a woman has the right to decide whether to have children and that having children was not the only, primary, or necessary purpose of a woman’s life and by extension, women’s health.  To address women’s health from a women’s rights perspective, one must recognize the value of the body without limiting it to its capacity for childbearing.   One must also respect women’s rights when addressing women’s reproductive and maternal health needs, including during pregnancy, labour, birth and beyond.

During the break several women approached me and said, “Your lecture is very interesting.  Some of our colleagues are from very patriarchal backgrounds.”  I said that they should speak up during the discussion.   Later in the evening, I thought of I should have replied to those who cautioned against the social disruption that feminist ideas may cause.  In order to make progress on women’s health issues, we must change our ideas and practices, and be prepared for the disruption that such change would cause.

In the remainder of the seminar, I presented on three themes:

Birth Models that Work.

Breastfeeding Models that Work.

Food Models that Work.

(to be continued …)

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Conference

Women’s Rights Perspective in Birth, Breastfeeding and Food

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

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Report

2012

Below is an overview of my work in 2012 in the following areas:  Jivika, Women’s Health, learning, support to AID chapters, projects and publications.

Jivika

Jivika started as an effort to encourage consumer producer links, based on the faith that people were looking for ways to buy products that used fewer resources and supported more livelihoods in the rural areas at living wages.   We also sought to develop products that helped people live more sustainably, reducing dependence on disposables, and encouraging lifestyle choices compatible with a greener and more peaceful world.    We also wanted to see that half the revenues from sales went to the producers and not more than half went into marketing and shipping the products, so as to reign in the ecological footprint and the income-gap reflected in the overall enterprise.

Though it was difficult to meet all the criteria in any given product we kept these guidelines in mind while developing and marketing products.  This has limited the range of products that we make, the kinds of materials we use and the ways that we can sell and accept payment.  Because we want consumers to be linked with the people involved in bringing the product into their hands, we have not pursued online sales, which would in effect remove the person closest to the point of sale.   Typically people see products on the AID website or at a table at an event and volunteers talk to the customer, either via email or in person, before closing the sale.   Even in cases where customers contact us by email, volunteers may meet the customer in person.  These conversations form part of the outreach of jivika, to increase the amount of time that people spend thinking about where their goods come from and their role in building a sustainable world and examining the power of their purse to impact social and environmental justice.

Working with the Srikakulam team we are training tailors and young women learning to sew in making some of the unique products in our line that are also simple for novice tailors to produce.  These include baby slings, menstrual pads and cloth bags, where size specifications are not as exacting as they are for ready-to-wear garments.   Those who do well will be assigned loose-fitting clothes such as the khadi hoodie or pyzama.

At an AID wide level, more of our partner organizations are supplying fair trade goods.  We need to develop some criteria for adoption of products.  While not all products will meet all criteria, we can expect every product to meet at least, say, three criteria of social and environmental responsibility in order to be marketed via AID.

Fair trade:  We have been producing and marketing products that help support sustainable living and livelihoods.  These include khadi kurtas and other popular garments, nursing kurtas,  baby slings, and cloth menstrual pads.

Products for sustainable living

  • -energy-saving “EZ Cooker,”
  • “anytime-anywhere” nursing kurta,
  • “no need to whisper” menstrual pads
  • “say no to plastic” cloth bags.

I have taken these products to the weekly organic farmers’ market in Mumbai.   Three large EZ Cookers are in use every week at the organic cafe which is part of the farmers’ market.

AID Publications

Maharashtra Nature Park

AID 2013 Calendars at Maharashtra Nature Park

I continued uploading AID resources on the AID website as well as Twiki and AID Gallery and helped volunteers and chapters access these for various publications.

Our 2013 Calendar highlighted the role of bicycles in diverse aspects of sustainable development, including health, environment, transportation, education and livelihoods. I worked with publications team and fundraising team, including Vinod, Rishi,  Sai, Shilpa, Naga, Dushyant, Mona and others.

We printed 5000 copies of the calendar in the United States and 1000 copies in India.  Some of these were used for a physics conference in Pune and others were sent to AID India Chapters for local awareness.

AID Cares

As part of the campaign to bring sustainable agriculture into our every practice, also known as AID Cares, I table at the organic farmers’ market in Mumbai, and raise awareness of the same in local and like-minded circles.

Women’s Issues

Gender Footprint:  Following the AID Conference of 2008, I sought a way to connect the micro and macro components of gender bias and violence.  This connection becomes all the more urgent when gender issues come to public attention, as they did at the end of 2012.  It was vital to ensure that outrage did not reinforce people took the opportunity to introspect and begin changing from within, as well as recognizing violence inherent in social and political structures.   The Campaigns team issued a statement and sent the same to the Justice Verma Commission, appointed to issue recommendations to address violence against women and gender justice.

Srinadh reminded the group that this could be “a moment to ask questions of ourselves and each other not just authorities.”  Reviving the ongoing gender discussions that have ebbed and flowed within AID, the publications team started planning to raise the issue in the newsletter and at an AID wide level.

Piya Chatterji reflected the hopes of many volunteers who took part in the discussion in the conclusion of one of her messages:  “And I hope that AID might be able to open up forums of discussion around these issues in a more systematic way.”  I plan to work on this in the coming years.

Context

The work closest to my heart is currently on the periphery of mainstream and even of prominent alternative development programs.    My approach has been slow and steady, seeking partners who are involved at the ground level and also sounding out communities that have the potential to be involved and benefit from the kinds of interventions.

These involve health and education through what can be termed a natural, community based and continuum approach that connects how we are born to how we nourish the body and mind.

Women’s Rights in Birth

In January when I presented birth stories of a few rural women at the Bangalore Birth conference I noted that much of the knowledge that they had gained through non-textual sources was being rediscovered and made available to those who rely on textual sources for learning.  In the transfer from the non-literate to the literate, the knowledge had become expensive, affordable to the few and leaving the majority who had sustained that knowledge over generations, now deprived and dependent on inferior systems and services.

Slow Learning

In February I presented my newfound concept of slow learning at the Learning Societies Conference which took place in the village of Jhadpoli, in Vikramgadh Tehsil in Maharashtra.  The session was well received and led to further exploration of this approach to learning.

Slow learning recognizes the learning that takes place because something else was not learned.  The “something else” typically belongs to a standard roster of learning outcomes, already known and classified according to the knowledge system in the community prevailing around the learner.  While not learning this prevailing knowledge, the learner explores other knowledge, with a freedom that depends precisely on the inability of the prevailing community to recognize and classify that knowledge.  The learner pursues knowledge as if doing it for the first time in history, regardless of its value or correctness in the prevailing knowledge system.

Therefore while typical education programs may have a checklist of learning outcomes that will be used to evaluate the learners, with more checked items indicating more learning and in turn greater success of the program, slow learning looks between and beneath the checked items to the inner curriculum driving the learning of the child.  In this sense, the fewer checked items, the more space for this inner curriculum to grow.

Slow learning empowers the learner over the learned and honours what is not learned and what is not readily recognized as learning by prevailing knowledge systems.

Examples are given in Slow Learning, published on the pages of Swashikshan: Indian Association of Homeschoolers.

Conferences

January 2012  Birth India Conference.  I presented on Birth Stories and the advocacy, training and empowerment required to ensure that women have the right to informed and healthy birth experiences.

May 2012 AID Conference.  Took part in sessions on Projects, Publications, Campaigns and Internships.

August 2012 Northeast Unschooling Conference.  I presented on Multigenerational Living and Learning, a practice that has until recently been the norm around the world but is threatened by current trends in education and labour.

December 2012 – World Breastfeeding Conference.  I presented on the topic of Forgotten Foods:  Tradition, Nutrition and the Price of Memory.  The video is here: “Forgotten Foods” presentation at World Breastfeeding Conference Delhi.

Visiting AID Chapters

Along with Ravi I visited San Francisco Bay Area, Baltimore, Maryland, Boston, Albany, Amherst and other chapters.  We worked with volunteers and spoke with community supporters to help explain the way AID works, what makes the work effective, and how they could participate in supporting the work.  In Boston, Seattle and Maryland the chapter also hosted a fundraising dinner where we spoke with community supporters.

In Seattle along with Sunitha and Murthy and Madhavi we met with some local members of the community to seek donations.  We got some thoughtful suggestions and feedback on our awareness materials.

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Comment

Maternal mortality in the first world

Re: maternal mortality in the first world

New postby LS Aravinda on Sat Nov 08, 2008 7:59 am

As with so many issues, we cannot do justice to the problem as it affects people in the third or fourth worlds, if we examine the problem only there. We must also recognize how this persists in the first world, affecting the affluent as well as those less so, and particularly prevalent among the third / fourth world pockets within the first world. In part this helps us understand reasons for maternal mortality that may not have to do with money or state-of-the art facilities. What are the factors related to attitudes, inequality, that contributed to this? How can cultures moving towards affluence and superior technology take care along the way to overcome or avoid the factors that allow maternal mortality to persist in the first world?

Maternal Morality rates in the US – ranked 20th according to CDC and 41st according to UN & WHO – are believed to be under-reported (only 21 US states record on the death certificates if the deceased was recently pregnant). Currently CDC reports maternal mortality rate to be 13 / 100,000 live births, up from 12 in 2003. It is also up from 8 in 1982, and once again higher than 10 , which was the rate in 1977. [A UN / WHO report (2007) places the US maternal mortality rate at 1 / 4800 or 21 / 100,000]. Maternal mortality in the African American community in the US is double, or more – one source reported 34 / 100,000 live births. Poor pre- and post-natal care, in-hospital neglect, denied right to information for patients, and low status of women, vulnerability of pregnancy / motherhood all play a role in this.

Midwife Ina May Gaskin has studied maternal mortality and complications in pregnancy and birth in the US and the social and political factors that cause these to persist and, in recent years, increase. She has raised awareness through the Safe Motherhood Quilt Project.

In “Masking Maternal Mortality, “(Mothering, March-April 2008, pp64-71), Ina May Gaskin asks the crucial question – WHY are we not talking about this serious issue in the United States? Why are we not alarmed that it persists? To her questions, I would add, what can developing countries like India learn from the persistence of maternal mortality in the US, as birth practices are rapidly changing – reducing risks in some spheres, while perhaps unkowingly increasing risks in others?

She writes about shocking cases of maternal death in the US. One case is that of Army soldier Tameka McFarquar who was transferred to New York from her tour of duty in South Korea after becoming pregnant. However, 10 days after being discharged from Samaritan Hospital in New York, she was found dead in her apartment, her newborn also dead from dehydration as there was no one else to notice that the mother was unable to care for her.

Just one follow-up visit would have detected the problem that cost her her life. Tragically, her chances of survival might have been higher had she not transferred to the US. South Korea has a lower maternal mortality rate than the US.

– Aravinda

references:
In May Gaskin, “Masking Maternal Mortality,” Mothering, March-April 2008, pp 64-71.
U.S. ranks 41st in maternal mortality
Maternal Mortality Shames Superpower US
Racial And Ethnic Disparities In Maternal Mortality – American Medical Association
Pregnancy-Related Mortality Surveillance — United States, 1991-1999
http://www.medicalnewstoday.com/articles/80743.php
Pioneering midwife crusades for natural birth


[OP]

Jay Jayakumar

When the heavily pregnant woman had complications during labour, the villagers of Shattak faced a problem. The nearest hospital was 60km (37miles) away and they had no car.

“We got a ladder,” says Abdul-Majid, the head of the village’s health shura (council) recalling the incident over four years ago.

The villagers then laid the woman on the ladder and 20 men took turns to carry the make-shift stretcher along a rutted, windy track that rarely sees vehicles. The pace was agonisingly slow.

“We didn’t make it to the hospital,” says Mr Abdul-Majid. “The mother died on the way.”

……….
For almost 16 babies born, one woman will die in labour. As a country, Afghanistan is ranked second in the world for maternal mortality rates after Sierra Leone.

But health professionals in the province are optimistic that a new project is reducing the numbers of deaths.

Run by the Aga Khan Health Services, a midwife trainee programme selects bright young women from districts across the province.

The students take an 18 month course in the provincial capital, Fayzabad, before returning to their villages as trained midwives.

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Conversations

Conversations on Birth and Women’s Health

Conversations on Birth and Women’s Health

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.

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