There are probably many contributing causes to increasing fertility in
African populations, including a decrease in lactational amenorrhea. I
suggest the following list, kinda/sorta in order of the ones I think are
most responsible for decreasing lact. amen.:
1. Earlier introduction of solids. Traditionally, mothers in some
population did not begin any serious supplementing of the breast milk diet
until the children were 8-10 months of age. The great work that WHO has
done in educating women about adding solids at 6 months (and until recently,
the recommendation was 4-6 months) -- among other factors, such as infant
nutritional education programs run by Freedom from Hunger, CARE, the Peace
Corps, and other groups -- has probably led to a generally earlier
introduction of solids, and a generally more consistent introduction of
solids. In other words, not only to mothers start giving solids earlier,
but they give them more consistently, like every day once they've started.
In the 1980s, a common practice in Mali was for mothers to give a bite of
something one day to the 8 month old, and then nothing but breast milk for a
couple of weeks, then another bite of something, and then nothing for a
week, etc. One of the new messages has been "Once you start solids, at 6
months, give them every day."
2. Better nutrition of the mothers. Some of the duration of long-term
lactational amenorrhea among the mothers in Africa was because the mothers
themselves were malnourished. Not only did their bodies know to postpone a
return to full fecundity until their own nutritional status was better, but
you also release more prolactin in response to suckling stimuli when you are
malnourished. As the mothers themselves become better nourished, even the
same amount/pattern of suckling on the part of the baby will lead to shorter
durations of lactational amenorrhea.
3. Babies sleeping through the night earlier. This one is a stretch, but
it may be that as the older babies are getting more solid foods in their
diet (reason #1 above), and perhaps getting more milk from their better
nourished mothers (reason #2 above), that they are sleeping through the
night more often or at least for longer stretches of time, so that their
mothers aren't nursing so much at night. A particular amount of suckling,
distributed mostly during the day, leads to shorter durations of lactational
amenorrhea that the same amount of suckling distributed mostly during the
night.
4. I suspect that worry about exclusive breastfeeding due to AIDS, and the
use of occasional bottles, are last on the list of contributing causes.
In addition to shorter periods of lactational amenorrhea, some of the
increasing fertility is due to the dying out of cultural practices of long
post-partum sex taboos. This has been going on for a long time, with men
being unwilling to wait out the traditional taboos, which may have been
"until the baby walks" or "until the baby talks well" or "until the baby is
completely weaned from the breast, even if that means 2-3-4-5-6 years." One
of the contributing factors to this trend is the spread of Islam, which
mandates only 40 days of post-partum abstinence, in contrast to the
traditional religious beliefs that mandated a much longer period of
abstinence.
Kathy Dettwyler, anthropologist
www.kathydettwyler.org
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