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Acta Pædiatrica. Supplement. 1999 Aug; 88(430):1-6.The prevalence of breastfeeding varies very much throughout the world. In some countries, such as in Scandinavia, it is extremely high, whereas it is rather low in many industrialized countries such as northern Italy. In urban areas of many developing countries the prevalence is extremely low, although it may be high in rural areas. For instance, in rural Guinea-Bissau in West Africa it is reported to be 100% at 3 mo of age, and this high prevalence may be explained by the fact that infants who have not been breastfed die before this age. In Sweden the prevalence at 2 mo of age was around 95% in 1945 (including infants fed by milk-mothers) but then gradually dropped until 1972, when it was as low as 20%. However, during the following 10-y period the prevalence gradually increased to around 80%. The main reasons for the decline most probably were that infant formulae, then considered to be safe, became available, that an increasing number of women started to work outside their homes, making formula feeding part of the feminist movement, and finally that no real attempts were made to promote breastfeeding in the maternity wards and well-baby clinics. The reverse trend started in 1972, when the attitude towards breastfeeding changed completely. Well-educated mothers became aware of the new discoveries of the importance of breastfeeding from immunological and nutritional points of view, and organized campaigns. Within a few years, the Swedish parliament passed a law which guaranteed all mothers paid leave from their work (80% of their salary) for 9 mo after childbirth, which has now been increased to 12 mo. The WHO/UNICEF code from 1980, which regulates the marketing of infant formula, has also probably played an important role. After a plateau for the prevalence of breastfeeding between 1982 and 1990, a further increase has taken place, particularly between 6 and 9 mo of age. Whereas the first phase in the increase of the prevalence of breastfeeding was, to a certain extent, the result of the concern of well-educated mothers, the second phase (1990-1998) may, at least partly, be explained by the fact that Swedish maternity wards then implemented the suggestion, launched by WHO/UNICEF, to create "baby-friendly" maternity hospitals with the aim of enabling all women to practise exclusive breastfeeding immediately after birth. Methods to stimulate lactation and proper nutritional suckling behaviour of the newborn were then developed. (author's)
Human Rights Quarterly. 1999; 21:853-906.This article will trace the evolution of thought and activism over the centuries aimed at defining women's human rights and implementing the idea that women and men are equal members of society. Three caveats are necessary. First, because women's history has been deliberately ignored over the centuries as a means of keeping women subordinate, and is only now beginning to be recaptured, this is primarily a Northern story until the twentieth century. Second, because of this ignorance, any argument that the struggle to attain rights for women is only a Northern or Western effort is without foundation. Simply not enough available records exist detailing women's struggles or achievements in the Southern or Eastern sections of the world. The few records available to Northern writers attest that women in other parts of the world were not content with their status. Third, the oft-heard argument that feminism (read the struggle for women's equality) is a struggle pursued primarily by elite women is simply another example of the traditional demeaning of women. History is replete with examples of male leaders who are not branded with this same charge, even though much of history is about elite men. (excerpt)
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1999; 77(5):436-8.This is a retrospective report on the importance of Kark and Cassel's 1952 paper on community-oriented primary care (COPC). In 1978, WHO and UNICEF endorsed COPC. However, the ideas girding and framing this approach had first been given full expression in practice some four decades earlier. In Depression-Era South Africa, Sidney Kark, a leader of the National Department of Health, converted the emergent discipline of social medicine into a unique form of comprehensive practice and established the Pholela Health Center, which was the explicit model for COPC. COPC as founded and practiced by Kark was a community, family and personal practice; it also was a multidisciplinary and team practice. Furthermore, the innovations of COPC entailed monitoring, evaluation, and research. Evaluation is the essence of Kark and Kassel's paper, which offers a convincing demonstration of the effects of COPC. Its key findings include the following: 1) that there was a decline in the incidence of syphilis in the area served by the health center; 2) that diet and nutrition improved; and 3) that the crude mortality rate as well as the infant mortality rate--the standard marker--declined in Pholela. In the succeeding decades, OPC had an international legacy (through WHO and H. Jack Geiger's influence in the US Office of Economic Opportunity), which came full circle in the 1980s, when a young generation of South Africans began to search their history for models for their health care programs at the dawn of the post-Apartheid Era.
American Journal of Public Health. 1999 Mar; 89(3):399-407.Despite conceptual advances that incorporate broad structural approaches, international agencies embrace a persistent reliance on "reductionist reproductive terms" to define women's health. This article locates the origins of this phenomenon in the policies and activities of the Rockefeller Foundation's (RF) public health program in Mexico in the 1920s and 1930s. After an introduction, the article describes the Mexican work of the RF and how it "stumbled upon" gender health differentials during a hookworm eradication campaign and then furthered gender stereotypes in its health education materials. The article continues with a consideration of the RF's eventual dual targeting of women as patients and as public health workers (nurses) during the effort to create permanent health units and institute a system of nurses who visited homes as proponents of the supremacy of modern medicine. Next, the article describes how the RF further entered women's domain by identifying, monitoring, and training traditional midwives. This targeting of midwives coupled with a total disregard for every aspect of traditional midwifery reflected the RF's policy of blaming midwives for infant mortality while ignoring socioeconomic determinants. The policy also exacerbated the differentials of social class by elevated working- and middle-class nurses and denigrating peasant midwives. The article concludes that the RF's faulty and often ineffectual policies in Mexico created the women's health paradigm based on reproduction that was later intensified by population control efforts and that fails to advance health for all as a matter of equity.