Field notes on breastfeeding and diarrhea
— Blog Post — 4 min read
Children get diarrhea from many things; one is, as Dean has pointed out, contact with human feces. Part of the focus on weaning in the analysis of child growth has to do with the possibility of children contracting bacteria by eating food prepared in unhygienic conditions, and drinking contaminated water. Some people ask: How can little babies who are only breastfed, come in contact with feces and be affected by diarrhea? An encounter I had recently with a little baby boy, only 12 hours old when I first him, illustrates how.
Here is an excerpt from my field notes—I’m currently working on a small qualitative project about late pregnancy and very early childhood in villages near our house in Sitapur, Uttar Pradesh. The names changed to protect the privacy of the participants:
When my “interpreter” (to whom I will henceforth refer as PB) and I arrived at the house with the crumbling brick wall, a man was standing outside, looking dazed. I told him about my project, and asked whether there were any pregnant women or little babies in his household. He told me that his wife had given birth at home the night before.
We received permission to enter and found Lila Kumar sitting up in bed with the baby on her lap. The naked baby was wrapped in some light cloths and there was a light blanket around Lila. Her hair was falling down around her and she looked exhausted, and in pain. She had given birth to her second son at 11pm the night before. She said that she had carried the baby to term and that she'd planned to go to the government hospital for the delivery, but her husband was out at the time, and the baby came fast.
As we chatted, my feet sank a bit into the damp dirt floor, and I looked around the room. There wasn't much there besides the cot that Lila was sleeping on, with straw strewn on top of, and under it, and some clothes hanging on a line at the other side of the room. A log was smoldering near the doorway; presumably, it had burned all night to keep Lila and the baby warm. The smell of smoke was strong, and I had to struggle to keep from coughing. When the short interview ended, I asked Lila and the baby’s grandmother, who was listening in on the conversation, if they would like me to come back later to take the baby's birth weight. They said they would.
Around 1pm, PB and I went to my house and had lunch, then strapped the scale and the infant-o-meter (a plastic board to measure a baby’s length) to the back of the bicycles and headed back to the village. When we got to the house I asked the grandmother, who was cleaning dishes outside, whether they would still like to have the baby weighed. She said yes but told us to wait before going in the room. We set up the scale and the infant-o-meter outside, and squatted on the ground. She sprinkled some water on our shoes; I assume she intended to purify them. I suggested that we could take them off, but she said not to.
We went into the room, and Lila was lying down on the same cot with a thicker blanket over her this time. The log was still smoldering. A pile of feces (I assume they were human because I can't imagine anyone would have allowed a dog to enter the room with the newborn) had appeared on the floor between the door and the bed in the time that we had been gone. There were also some rags on the floor. PB did not want to walk over them, and she asked the grandmother to pick them up. (I later learned that PB believes that if a woman walks over rags which have been used to absorb menstrual blood or blood from birth, that woman will become infertile.)
After safely crossing the place where the rags had been, we squatted down and placed the scale on the dirt floor between the bed and the hole in the wall that served as a window. The grandmother went to retrieve the baby from Lila. She noticed that the baby had defecated on itself and became angry with Lila for not cleaning the baby. According to PB, she said that Lila “had already had one baby, so she should know how to take care of this one.” She went to fetch some water and used her hand to clean off the baby's bottom. She did this in the foot of space between the bed and wall; the feces fell onto the floor.
Then the grandmother brought the baby over and asked me if she should take off its clothes. The only thing he wore was a large polar fleece sweater and a charm around his neck. I explained that taking the clothes off would indeed help me take the weight better. She removed the polar fleece, but left the charm. She put the baby on the scale. He weighed only 2.5 kilograms, or 5.5 pounds, which is considered the cutoff for low birth weight.
The combination of the baby boy’s low birth weight and the presence of feces on the floor were reminders how vulnerable this little boy is. Even though he will probably be breastfed without much supplementary food and water for the first few months, it is likely that both Lila and the grandmother will put their fingers in his mouth, an easy way to stop him from crying until he can be fed. With so much poop around and so little soap in the house, diarrhea, slow growth, and the cognitive stunting that is associated with it, seem likely to start early.