>Date:    Wed, 7 Feb 1996 11:58:04 -0500
>From:    Anne Andrianos <[log in to unmask]>
>Subject: twin picture
>
>I an seeking more facts surrounding the picture of twins (one
>breastfeeding and one bottlefeeding and dying) which is shown on page 14
>of BF and Biocultural Perspectives.  Was the girl smaller at birth? did
>she have a congential problem which caused her condition and death, was
>medical help,sought a any time? Did she have some other problem which
>greatlt influenced the outcome.  I am asking because medical  people have
>rejected the notion the the method of feeding could have such different
>outcomes. Would aPPRECIATE SONE DATA. TIA. Anne Andrianos, MSN, IBCLC

Regarding the photo in Breastfeeding: Biocultural Perspectives:  This is a
famous picture; it is from the Children's Hopital of Islamabad, Pakistan,
and has been used in many venues, including UNICEF publications, and Naomi
Baumslag and Dia Michel's new book Milk, Money, and Madness.  Probably the
girl was smaller at birth, the girl in boy/girl twins often is.  No, she did
not have a congenital problem, yes medical help was sought, but too late.
In Pakistan, as in many societies, boys are given higher priority than girls
for food, medical care, education, attention, etc.  That is the case in
Pakistan as well.  The woman's DOCTOR told her she would not have enough
milk for twins, and had to feed one with formula.  So of course the girl got
the formula.  Undoubtedly the water used to mix it was not boiled, and was
contaminated, as were the bottles and nipples.  Undoubtedly the parents
stretched the formula or used plain cows' milk or even coffee whitener or
coconut milk or other "white liquids" when they couldn't afford formula.
Undoubtedly the daughter suffered many gastrointestinal illnesses as a
result of living in a contaminated environment without access to clean
water, and with lots of water-borne diseases like cholera and dysentery,
that contributed to her malnutrition and death.

Any doctor who doesn't realize how much malnutrition can stunt a child's
growth just doesn't have the requisite training or experience in a Third
World country.  I have seen 6 year olds who look like 3 year olds, and 12
year olds who look like 6 year olds, and 2.5 year olds who weigh as much as
their 6 month old siblings.  The girl in the picture is a typical example of
what a bottle-fed baby in the Third World looks like before it dies.  There
is nothing unusual about her or the picture at all.  What is so striking
about the image is the adjacent juxtaposition of her big healthy twin brother.

Another striking picture of malnutrition/disease effects on growth (not of
breast vs. bottle differences) is from my book on my research in Mali,
Dancing Skeletons, where my daughter Miranda is shown standing next to twin
girls.  Miranda is 3 years 2 months old in the picture, the twins are 3
years 4 months, and their heads don't even come up to her shoulder, and
their legs look like little sticks, with their knee joints the largest part
of their legs (i.e. no muscle tissue in calves or thighs, just skin over bone).

Another fact to point out to "medical people" who can't believe that
nutrition has such a major impact on growth is that populations once thought
to be "genetically short" such as the Vietnamese and the Maya Indians of
Central America and the tribal peoples of New Guinea -- many of whom have
average adult heights of under 5'0" for men -- turn out to be as short as
they are because of malnutrition and disease in childhood.  If you take a
Mayan or Vietnamese child out of their war-torn, poverty-stricken homeland
and bring them to the U.S., they grow almost as fast or as fast as American
kids.  The earlier they come to the U.S., or if they are born here, the
closer their growth matches American standards.  They may still end up 1-2"
shorter than U.S. as adults, because the effects of malnutrition and disease
can take several generations to overcome, but they are NOT genetically short.

Here are some relevant quotes from Pettigrew, Joyce J.M.  1982  Weaning
Practices and Childhood Illness in the Southern Punjab, Development Research
Digest (Special Issue on Women and Development), No. 7.  Pages 15-21.

My comments are in brackets [].
[In this part of the Punjab, India, children are often exclusively breastfed
(no supplements) until 14-16 months, and then are weaned from the breast at
18-24 months, and given little food after weaning.]

"The pressure to save [buffalo] milk meant, as mentioned above, that it was
not uncommon for a mother to be breastfeeding two children.  If they were a
boy and a girl, it was likely the boy would be fed first.  In one Jat
family, a mother was feeding a boy of 1.5 and a girl of 2.  The family was
so pleased with the birth of a boy that the mother was being given extra
[buffalo] milk to feed him, but the girl was expected to thrive on whatever
she got from the breast afterwards [after the boy had nursed].  She had had
first degree malnutrition [mild] for six months and her weight was on the
point of becoming static.  Other crises in the family might exacerbate the
situation.  For example, one poor artisan family had been badly affected by
illness and the marriage of five daughters [for whom dowries had to be
supplied].  When their 2 year old boy would not take much chapati [bread],
he was put back to the breast rather than have [buffalo] milk bought for
him.  His 2 month old sister then became deprived and developed first degree
malnutrition."

"The distribution of the [buffalo] milk was totally at the discretion of the
mother-in-law, though it was often the daughter-in-law who gathered the
fodder (even when she was heavily pregnant) which enabled the buffalo to
produce milk.  One daughter-in-law who had three children inlcuding a baby
girl, commented 'I'm not belonging to them' (not of the husband's kin group)
'so they won't give me any milk.'  Except in Jat families, it emerged
clearly that milk would not be kept or bought for female children.  Selling
milk was the mother-in-law's way of acquiring money for her own purposes
(which included giving it to her sons, often to be spent on drinking), and
the needs of a female child were not of sufficient importance to overrule
this.  Mothers themselves were pushed into excercising cruel preferences.
One little boy who was heard telling his mother that his sister wanted milk
-- a child suffering from third degree malnutrition [severe] -- was told
'you need it; let her die.'"

Sorry to be so depressing, but the images of the twins in the pictures has a
whole lot to do with preferences for male children, at least as much as it
does with the health consequences of bottle-feeding.


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Katherine A. Dettwyler, Ph.D.                         email: [log in to unmask]
Anthropology Department                               phone: (409) 845-5256
Texas A&M University                                    fax: (409) 845-4070
College Station, TX  77843-4352