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The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.
[Unpublished] . vii, 44 p. (HON-05)In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.
American Journal of Clinical Nutrition. 1979 Feb; 32(2):368-417.Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate, and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, with folate deficiency also playing a role in some population groups, especially in pregnant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritonal anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action are outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance to member countries. (author's)
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 51-9.While many working women all over the world have abandoned breastfeeding because of social pressures and conflicts between work responsibilities and demands of breastfeeding, an elite group of women who firmly believe in the benefits of breastfeeding are struggling to overcome the stress of working outside the home and breastfeeding. There is a real need for the government to help the mothers of young children. A more practical and humanistic legislation will encompass the rights of the child as well as the welfare of the mother. Attention should be focused on the benefits accruing to the family and society in general, if the mother is paid to stay home to discharge her maternal responsibilities at this crucial stage in her child's life, and after the crisis period has ended, resumes working. Certain countries in Eastern Europe have developed favorable patterns of leave extension for working women. Some even provide nursing premises or nurseries at work or near the place of work. Mothers who are provided remunerated lactation leaves obviously have a great advantage over those who must cope with breastfeeding under stressful situations. In many affluent countries, employers do not regard nursing breaks as necessary and are thus not remunerated. In the US, there is currently no federal program for maternity benefits, and the concept of remuneration for lactation is an unusual and strange concept. Mothers who wish to work have to plan their breastfeeding strategy carefully. The full-time working mother's desire to provide her infant with the ultimate in good nutrition cannot be underestimated at the emotional, physical and economic levels. Employers should meet their responsibilities toward nursing mothers and suitable alternatives for infant care should be considered.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 39-44.The International Labor Organization's (ILO) conventions and recommendations that apply exclusively to women are of 2 main types: promotional and protective. The protective standards are concerned with providing them with the special protection they need because of their sociological and social function of maternity. Maternity protection is most important for both working mothers and society as a whole. This is becoming a more significant problem because of the increase in the number and proportion of women. The protection of working women in connection with their role as mothers was dealt with in 2 ILO conventions, the Maternity Protection Conventnion and the Maternity Protection Convention (Revised), and 2 recommendations. The 1919 instrument was ratified by 28 States and the 1952 instrument by 17 States (on January 1, 1977). The ILO policy on maternity protection is that maternity must be recognized as a social function and the protection of this function must be recognized as a basic human right. In relation with maternity, women and men require full and free access to information and facilities concerning family planning and the right to decide on family size and the spacing of births. The 1919 Convention provides that the working woman be allowed time to nurse her child. In a large majority of countries, rules provide for rest periods to allow a mother to feed her child during working hours. A number of legislations stipulate explicitly that the pauses for feeding must be allowed in addition to the normal rest periods. The 1952 Recommendation refers to the establishment of facilities for nursing or day care.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 47.Generally, the maternity protection legislation in different countries, as indicated by the International Labor Organization (ILO) conventions, has little appreciation of the problems concerned with working women and breastfeeding. Legislation which attempts to promote breastfeeding opportunities for working women may militate against the employment of women, and hence be discriminatory, unless it is carefully organized and socially relevant. Less protection is available for breastfeeding mothers when industry is not state controlled, but some countries with free enterprise are beginning to show sensitivity to the need and are making good provisions. Both financial and human costs need to be considered. ILO needs to investigate the problems of working women with regard to clarifying the position and stimulating countries to ratify the conventions in general and with a special relevance to opportunities for working women to breastfeed. Advocacy and consciousness-raising need to be depooyed in efforts to make the issue more prominent and to assist the ILO, the World Health Organization and other United Nations agencies to modify or stimulate necessary legislation.
London, International Planned Parenthood Federation, 1979. 163 p.Focus in the proceedings of the joint International Planned Parenthood Federation and the International Union of Nutritional Sciences Conference on lactation, fertility, and the working woman is on the following: 1) perspectives of the International Planned Parenthood Federation (IPPF) and the International Union of Nutritional Sciences (IUNS); 2) lactation and infertility interaction; 3) United Nations appraoches; 4) the social context (breastfeeding and the working woman, breast feeding in decline, and women's liberation and breastfeeding); and 5) case studies for the countries of France, Egypt, Ghana, Scandinavia, Chile, Indonesia, Lebanon, Yugoslavia, Singapore, and Sri Lanka. Breastfeeding supplies nutrition specifically adapted to the human infant's needs, mother/child interaction important to emotional development, and biological birth spacing resulting from maternal hormonal changes brought about by sucking. Over the last 50 years, there has been a marked decline in breastfeeding, originally in industrialized countries. Since the end of World War 2, there has been a decline in breastfeeding in developing nations. Recent scientific research has shown increasing evidence of the unique value of human milk and breastfeeding for infants in industrilized countries and developing areas. As women have become more emancipated, conflicts have arisen between their biological family reproductive role and their role as salaried workers outside the home.
WHO CHRONICLE. 1979 Dec; 33(12):435-43.At the WHO/UNICEF meeting on infant and young child feeding which was held in Geneva during October 1979, urgent action was called for to promote the health and nutrition of infants and young children by governments, international agencies, nongovernmental organizations and the infant-food industry. The primary concern of the meeting was with the development of practical measures to improve infant and young child feeding practices. The themes for discussion at the meeting included the following: 1) how to encourage and support breastfeeding; 2) promotion and support of appropriate weaning practices; 3) promotion of information, education and training of health workers concerning breastfeeding; 4) the health and social status of women in relation to infant and young child feeding; 5) appropriate marketing and distribution of breastmilk substitutes; and 6) suggested actions for governments and other groups. A statement which was adopted by consensus is included. It highlights poor infant feeding practices and their consequences as a major problem in the world and as a serious obstacles to development. The full text of the recommendations made is also provided.
International Family Planning Perspectives. 1979 Sep; 5(3):127-9.The International Fertility Research Program (IFRP) is sponsoring research in 30 developing countries and 13 developed nations in an effort to develop more effective contraceptive methods. Particular emphasis is being placed on developing contraceptives for women in developing countries where nutritional, health, and sanitation conditions make current methods either difficult or less effective to use. Trials of a pill regimen including vitamin supplementation are underway in Sri Lanka, and a progestogen-only pill for use by lactating women is being tested in Egypt and India. Progestogens apparently do not modify the content of maternal milk. Another study involves the testing of a Lippes loop which releases Trasylol, a bleeding suppressant, in an effort to overcome bleeding problems associated with IUD use. The IFRP has developed and is testing biodegradable appendages which can be attached to IUDs to help retain the device in postpartum women during the period when the uterus is enlarged. Other efforts are being directed toward improving and simplifying sterilization procedures. In Chile, pellets of quinacrine have been inserted into the upper area of the uterus. As the pellets dissolve the quinacrine enters the tubes and produces scar tissue which eventually closes the tube. This research may pave the way toward the development of a non-surgical sterilization method. Animal studies of a reversible sterilization procedure in which a condom-like device is fitted over the ends of the tubes are in progress. In another project a modified laparoscope, called the Laprocator, is being evaluated. The device does not use electricity and is particularly suitable for use in areas in which electricity is lacking or the source is unstable. The device is used in a procedure called suprapubic endoscopy in which only a small incision is needed. Insufflation of the abdomen is unnecessary, and elastic rings are used to close the tubes. IFRP will undertake an innovative motivational project in the Middle East during the coming religious holidays.