I’ve borrowed the title of this post from the Gates Foundation’s infant and child feeding programs in Bangladesh, Ethiopia and Vietnam. I think it is an apt title for thinking about kids growing up in resource poor settings. Two babies born a little more than a month apart in one of the villages that I’ve been visiting in Sitapur illustrate the difference between “alive” and “thrive.”
If you’ve been a long time reader of our blog, then you already know the two moms I’m going to tell you about. I was there the day that Lila’s son was born (see here) in early February, 2012, and met Amrita’s daughter when she was just three days old (see here). When I went to visit them in late July, Amrita’s daughter was almost 17 months old and Lila’s son was almost 18 months old.
The differences between the two children are stark. If you ask each of them how old their children are, Amrita will tell you her daughter’s age down to the day, Lila guessed that her son was about 14 months old. Amrita’s daughter walks, runs and plays, Lila’s son can crawl but not stand or walk. Amrita’s daughter chattered away in baby talk and pulled on her mother’s clothes while we were visiting, Lila’s son sat very still in his mother’s lap and did not say a word. Amrita’s daughter had her hair pulled into two adorable black pigtails, Lila’s son’s dry and brittle hair stuck out in all directions, the tips a lighter brown than the roots (a sign of malnourishment). Lila’s son has sore all over the inside of his mouth, Amrita’s daughter has not been sick since our last visit. In short, Amrita’s daughter is thriving, and Lila’s son is just barely alive.
It was a little bit surprising that these babies are developing so differently, considering that they share the same environment. In fact, they are neighbors; they live just a few houses down from one another. They use the same handpump and take the children to the same unqualified “doctor.” But, while some things, like open defecation, or a bad harvest, do hurt everyone in a particular location, there are lots of factors that go into making a baby healthy.
I’ve been thinking a lot about the differences between Amrita and Lila that might be important for why their babies are growing up so differently. First of all, Amrita herself is a lot healthier and happier than Lila. Amrita lives with her mother, not her mother-in-law, which cuts down a lot on her stress (for more on the position of daughters-in-law in joint households, see here). Amrita’s mother, who is also the cook for the village school’s mid-day meals, helps her take care of her grand-daughter. Amrita is also quite a bit heavier than Lila, who is stick-thin. This difference in maternal health may have translated into a difference in success breastfeeding. Amrita’s daughter was breastfed with no supplements for the first several months, while Lila claimed she did not have enough milk for her son and supplemented from an early age with cow’s milk.
Amrita is also a lot more educated than Lila. Lila quit school when she was in primary school, Amrita is still studying now—she is in 12th grade. Amrita also knows quite a bit about child care, which she has learned from her mom, the cook. Amrita’s mom was once a village organizer for a CARE project on maternal and child health. She knows about the need to give babies complementary foods. Amrita’s daughter now eats everything that the family eats. Lila’s son on the other hand, almost exclusively drinks cow’s milk, and only occasionally takes some daal and rice from her plate. Amrita and her mother, and her younger sister all chip in to keep Amrita’s daughter clean and out of dirty places. I have often walked by Lila’s house to find her two sons sitting and playing in the mud.
Unfortunately, most the little kids in this village look more like Lila’s son than like Amrita’s daughter. So, while antibiotics and oral rehydration may be keeping most babies in rural UP alive, it is really important to start thinking seriously about how they can thrive in those extraordinarily important first two years of life.