research institute for compassionate economics

What women “know” about infant feeding

Written by Diane Coffey on August 7th, 2013

In the end of July, I spent some time in Sitapur following up with the moms and babies who I started visiting in winter, 2011. One of the most interesting visits was to Ria, a woman whose baby from the original cohort died in April, 2012. Ria got pregnant again soon after the baby’s death, and when I visited her just now her new baby, a boy, was two and a half months old.

Ria has lost three children, and has one surviving son who is about 10 years old. She and her family desperately want the new little boy to survive. Ria doesn’t speak much, so when I go to her house, I often hear as much from her older sister-in-law Archana as from Ria. Archana plays the dominant role between the two. She is the one who takes family members, including Ria’s kids, to the doctor—she knows how to talk to people and navigate the city. When the Auxiliary Nurse Midwife (also known as ANM) comes to the village, she sits in front of the house and she and Archana often exchange a bit of chit-chat. Ria stays inside with her sari pulled over her head.

I sat with Archana while she prepared puris stuffed with potato and cabbage for the large household. I realized that in all of the times I’d visited, I’d never counted exactly how many kids Archana had—I just knew that there were a lot, many more than Ria had, which I had not previously wanted to stress for fear of hurting Ria’s feelings. But Ria was distracted with the new baby, and so I asked. Archana sheepishly admitted to me that she has six girls and a boy. Why sheepishly? Because Archana, more than most village women, had been exposed to the ANM, who like many government workers, thinks that village women have too many kids, and often lets them know so. Archana expected that I might disapprove as well. I hoped that I did not show my sadness upon learning that Archana had just had a party to celebrate her son’s third birthday; she had never held a party for any of the girls.

I turned to Ria, who was sitting a little distance from me. I started to ask her about what she was feeding the new baby. (An important cause of the previous child’s death was that she was fed only cow’s milk; the family claimed she would vomit breastmilk.) At the same time that Ria was explaining that she was giving the baby cow’s milk three times a day and breastmilk when he cried, Archana quietly recited the fact that babies under six months should be fed nothing but breastmilk. I asked whether the baby was getting any water, and as Ria explained that she fed him water after she gave him his “medicine,” Archana murmured that babies of that age needed only breastmilk, not water. I did not want to cause any tension in the household, and I certainly did not want to encourage anyone to stop telling me the truth, so at the time I ignored Archana’s words.

But later on, as I bicycled home, I thought about the conversation. Archana had clearly wanted me to know that she “knew” the “right answers.” She knew what an ANM or government health worker might say about how to feed a baby, if that ANM bothered to stop what she was doing and explain it to someone. But she did not tell Ria to feed her son in the recommended way. I have no reason to believe that Archana feels ill will toward Ria; indeed, I have seen the two women support one another on a number of occasions. I also believe that if Archana told Ria to feed her son in a particular way, Ria would have done so. She considers Archana to be higher ranking and better informed than she is. My best guess is that although Archana “knew the right answer,” she did not really buy it. She was not convinced that breast is best, and so she let Ria continue to spend money and effort feeding cow’s milk and medicine (which of course, in Ria’s mind, was something “hot” and so needed to be followed by water).

It is daunting to think of what it takes for a message on infant feeding to reach a woman in a village—Archana has more exposure to government health workers than any other mother in that village—and even more daunting to think that many of the messages which reach village women will be doubted and ignored. After all, it is difficult for all of us to change our minds — to admit and believe that we were wrong, and have truly learned something new.