E. F. Patrice Jelliffe

Lactation, conception, and the nutrition of the nursing mother and child

Summary Successful unsupplemented lactation has a definite contraceptive effect lasting for months, which is less effective if early supplementary feeds are given. This contraceptive effect declines with time, and ultimately menstruation, ovulation, and conception are resumed during prolonged breast-feeding. 71 The decline in breast-feeding in newly urbanized families in the shanty towns and slum areas 64 does not only have direct nutritional ill consequences for young children, with an increase in the “diarrhea-marasmus syndrome,” but also has an anticontraceptive potential of public health proportions. The importance of breast-feeding needs consideration as one mode of child spacing, especially by religious groups concerned with natural methods. With regard to hormonal contraceptives, the low-dose progestagen drugs, both those given by mouth and by intramuscular injection, do not appear to have major ill effects as far as lactation is concerned, and may even increase the yield. However, further investigation is needed into the effect of various types and doses of contraceptives on the composition and yield of milk in various nutritional circumstances, into possible effects on the nursing baby, and into nutritional consequences in the women concerned, especially folic acid deficiency. What seems to be needed in less developed regions is initial unsupplemented breast-feeding of the infant for six to eight weeks after birth, followed by a mutual reinforcement of the proved contraceptive effects of lactation and mechanical (intrauterine contraceptive devices * ) or hormonal contraceptives—preferably long-lasting, “one-attendance” methods, such as intramuscular Depo-Provera, given initially at the postnatal clinic. Optimally, a hormonal compound is needed which is not only a contraceptive but also has no nutritional ill consequences for the mother and enhances lactation. Research into these important interactions and interdependences between mother and infant should be a priority in world nutrition; there are indications that the efforts needed are being given increased emphasis. 10,11

Doulas confidence and the science of lactation.

The psychophysiology and practice of breast-feeding is discussed. Successful lactation involves stimulation of the nipple and areola by the nursing baby which causes the secretion of prolactin. This is followed by the milk-ejection reflex. This reflex is psychosomatic in nature and leads to contraction of the myoepithelial cells which results in expulsion of the milk. These reflexes can be inhibited by anxiety doubt and other forms of emotional tension. Prolactin secretion is proportional to the stimulation of the nipple and areola. Western practices such as oversedation of the newborn the use of prelacteal bottle feeds and the separation of mother and the newborn seriously limit the amount of suckling time. In rural India it is customary for another woman to remain with the mother during childbirth and the neonatal period while the mother is secluded for several weeks. The routines practiced in Western societies do not enhance the prolactin and milk-ejection reflexes. No-cost modifications of procedures during pregnancy childbirth and the newborn period would substantially improve upon the success of breast-feeding.

Infant Feeding Practices: Associated Iatrogenic and Commerciogenic Diseases

The widespread acceptance of both formula feeding and the early introduction of semisolids as a convenient and desirable method of choice for all infants is being more critically reviewed by pediatricians and nutritionists.

Education of the public for successful lactation† : Psycho‐social considerations

Success or failure in human lactation mainly depends on two psycho‐physiological reflexes, the prolactin reflex and the let‐down reflex. In actual communities, frequent suckling and confidence are major factors, and the latter is related in large measure to knowledge and social support. Success in social mammals, including traditional human societies, is made more likely by the presence of what Raphael has termed a doula or culturally defined assistant, usually female. Consideration is given to the anti‐doula function of most modern midwifery units, and to the need to consider the need for the doula role in programmes designed to promote lactation in the community.

Nutrition and human milk

The nutritional composition of human milk is specifically suited to the needs of the human infant. In addition to eliminating the chance for contamination, human milk provides active protection against infection, and breast-fed babies have fewer metabolic anomalies and are less subject to allergy than formula-fed babies.

Early Infant Nutrition: Breast Feeding

Functional and practical understanding of infant feeding can best be achieved by appreciating its dyadic nature—that is, as a nutritional, psychological, and biological interaction between mother and offspring, both in pregnancy and lactation, with each affecting the other, and, at the same time, by considering the early stages of the young human organism according to the biological classification of Bostock (1962)—that is, the fetus, the exterogestate fetus (up to 6–9 months postnatally), and the transitional (9 months to 2–3 years) (Jelliffe, 1967) rather than by the statistical calendar catagories of “infant” and “preschool child.”

The cultural cul-de-sac of Western medicine (towards a curvilinear compromise?)

Abstract Modern Western culture has its roots in the Industrial Revolution. It may be categorised as “linear” and has a self-image as being direct, efficient-seeming, dramatic, numerically-provable and speedy. In medicine the tremendous scientific advances of the second half of the last century in bacteriology, radiology etc. lead to modern medicine being hospital-laboratory-curative in dominance and with training of health staff being hospital-based and with exaggerated prestige and emphasis on the laboratory. What is now termed “medicine” is, in fact, “allopathic” (or reacfive) medicine, with little emphasis on prevention. This type of Western medicine was so successful with a segment of diseases (especially infections) that it had been incorrectly assumed that its approaches were universally appropriate. All cultures in the world, including those of the West until the Industrial Revolution, are “bio-traditional”—that is based on biological adaptations and on customs evolved by the community over generations. Biotraditional cultures may be categorised as “curved”—with almost the opposite characteristics to those of linear Westernism, with approaches that are more biologically based, slower, and not so concerned with precise numerical proof. Some methods of healing and techniques of social support in bio-traditional cultures are often more effective in some conditions in which linear Westernism has been shown to have only partial value. Neither linear Westernism nor curved bio-traditional cultures have a monopoly of answers for health. The real need is to develop syntheses between Western medicine (“allopathy”) and other healing systems, and between the direct linear and the improved curved bio-traditional.

The At-Risk Concept as Related to Young Child Nutrition Programs A Discussion of Principles and Practice

as potential subjects of a particular illness have formed a subconscious part of medicine and public health since man became capable of reason and logic. In clinical practice, for example, prior to the development of statistical epidemiology, &dquo;at risk&dquo; factors in relation to rheumatic fever in the United Kingdom were considered to be the female sex, blonde complexion, poverty, and the cold, damp season of the year.9 Similarly, red-haired wo-

Adaptive MCH Services: A Key Strategy in Overcoming Malnutrition in Young Children

MALNUTRITION due to a lack of protein is usually associated with some degree of shortage of calories.3 It is mainly seen in early childhood, when it can be rampant.x In some areas of the world, adults are also affected, usually to a lesser extent, except for pregnant and lactating women for whom early mating, ceaseless and dose cycles of reproduction and lactation, restrictive food customs, and continuous hard physical work lead to progressive maternal nutritional depletion. The well-known syndromes of severe malnutrition in young children-kwashiorkor and marasmus 3-have high mortality rates and these, humanitarian considerations aside, are expensive of time, money and hospital space. They are also preventable. Less appreciated until recent years is the fact that there are many more young children in affected communities who suffer less dramatically,

Nutritional Assessment at Village-Level

The general activities that can be undertaken by Primary Health Care Workers (PHCW) in the field of nutrition will plainly vary with need and the presence of other resources, including, for example, the existence of other extension agents in the village (e.g., from agriculture, community development, etc.). Moreover, in all cases, PHCW need to be part of an existing health system, with opportunities for referral, for supervision and for continuing education. In all programmes, some form of nutritional assessment will be necessarily part of their work.