Greetings from a Stockholm finally emerging from its dark winter (but where
winters are hardly colder than, say, New York and less so than St. Louis
where I was born). I have been on LACTNET for only a few days but look
forward to this means of contact with a growing group of experts on
breastfeeding.

For 10 years I have commuted 90 minutes each way to Uppsala University
(over 500 years old!) where I have a position somewhat equivalent to an
assistant professor in the US, doing a bit of teaching and research in
International (developing country) Nutrition, but mainly consultancy work
for the Swedish International Development Authority and various UN agencies
once in a while, travelling a lot to Tanzania and Zimbabwe and occasionally
to Bangladesh and elsewhere (recently to Sri Lanka and Brazil). I have been
on the ILCA Professional Advisory Board since its inception. My masters
degree at Cornell University was based on research in St. Vincent, West
Indies on the impact of infant food advertising on infant feeding patterns
and on infant health. My wife, Stina Almroth, and I then did research for
the UN Food and Agriculture Organization on the economics of breastfeeding
in West Africa and later I did my PhD on a breastfeeding promotion program
in Yemen.

At the Unit for International Child Health within the Pediatric Department
of the Uppsala University Medical School, we have recently formed a group
of Swedish and developing country graduate students interested in
breastfeeding research and are trying to simultaneously learn about key
issues, what is going on in the world in breastfeeding promotion, and
research methodology.

The Innocenti Declaration says women should be "enabled and empowered" to
breast feed. The International Code and Baby Friendly Hospital Initiative
as well as lactation management training centers and various health worker
training courses have made a lot of progress and will continue doing so in
the "enablement" department. But what has been achieved in empowerment? I
became convinced of the importance of this aspect when I read an article
and eventually the PhD dissertation by Datha Brack "Why women breast-feed:
the influence of cultural values and pernatal care on choice of infant
feeding methods and sucess and breast-feeding," City University of New
York, 1979. The recent WHO book "Breastfeeding: the Technical Basis"
identifies two areas of breastfeeding protection, support and promotion
that should be relevant: mother-to-mother suppport and support to working
women. Research is needed to develop "success stories" and eventually
models of how to work on these aspects in various cultural/economic
settings. This is part of what our group hopes to work on in coming years.

I see the type of work lactation consultants do as a sort of hybrid, with
each individual consultant having better possibilities of empowering
clients than, say, a physician has (who belongs to a professional tradntage),
but being more at risk of taking on a disempowering style than, say a LLL
advisor. (A "Brave New World" view of what can happen when male physicians
gain complete power over women's reproductive health can be seen in Brazil
where 65% of deliveries are now caesarian sections --the others take place
mainly in areas where the health care services do not reach. A modern,
educated Brazilian woman would be frightened and worried if informed that
she were to be delivered naturally.) But in all cases, personal awareness
of empowerment as an important issue and makiving within. After many years of
contact with the Swedish culture I have become convinced that human effort
can make conscious change in culture--albeit much easier in Sweden than in
a big heterogenous country like the USA. In a democracy where women haal party, the Social Democrats, ran out of excuses
and agreed to fill half of all political posts with women. What a shame
that the job as head of UNICEF just went to an American woman (good though
she may be) instead of her main competitor for the job,n a family bed
until they were 7 and 10. For a couple years after that we always laid with
them at night until they went to sleep. Now of course they do so on their
own and are delightful, independent young teenagers. For the past three
years we three trition, based on
research in Lesotho, partly dealing with exclusive breastfeeding. Some of
you may have seen her recent article in Lancet (March 18) on why home
management of diarrhea, including use of ORS to prevent dehydration, was
poorly thought through and perhaps has been harmful on the whole (my words)
compared to what could have been--encouragement of the use of home fluids
to prevent dehydration.

Our first child was born in a small hospital on the coast of Finland and we
spent his first weeks in a cabin on a nearby island. Lik output--but I realize this will achieve little more
than smiles for some years to come...

Ted Greiner, PhD
Senior Lecturer in International Nutrition
Unit for International Child Health, Entrance 11
Uppsala University
751 85 Uppsala
Sweden

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