Anne - The Pakistani twins picture definitely originates with UNICEF.  I
have a set of UNICEF slides which we use for the BFHI l8-hour training
course.  The first slide in the Breastfeeding Management set, labelled
C-107, slide 1, is this very picture.  It is disturbing, I agree.  It is
shown to illustrate the possible difference in health outcome between
breastfed and non-breastfed babies, especially in under-privileged
environments.

I also have the picture I posted about on 17th January, as follows:

>I have a picture of the Pakistani twins published on the front page of the
>United Nations Administrative Committee on Coordination - Subcommittee on
>Nutrition, May 1991 issue of SCN News, reprinted with support from UNICEF.
The >paragraph beside the picture reads,

>"This picture tells two stories:  most obviously, about the often fatal
>consequences of bottle-feeding:  more profoundly, about the age-old bias in
>favour of the male.  The child with the bottle is a girl - she died the
next >day.  Her twin brother was breastfed.  This woman was told by her
mother-in-law >that she didn't have enough milk for both her children, and
so should >breastfeed the boy........"

>The photo is published courtesy of Children's Hospital, Islamabad, Pakistan.

To complete the paragraph, this follows

"...But almost certainly she could have fed both children herself, because
the process of suckling induces the production of milk.  However, even if
she found that she could not produce sufficient milk - unlikely as that
would be - a much better alternative to bottle-feeding would have been to
find a wet-nurse.  Ironically, this role has sometimes been taken by the
grandmother.  In most cultures, before the advent of bottle-feeding,
wet-nursing was a common practice.

"Use my picture if it will help", said the mother.  "I don't want other
people to make the same mistake."

"Source:  UNICEF."

I think this picture is so very shocking that we probably look at it very
closely, hoping it isn't true.  Quite apart from the tragedy of the dying
baby there are one or two things that have always bothered me about it.  The
mom is not looking at either of the babies - she is looking at a point on
the bed in front of her (pillows just discernible in the background). The
breast which is being nursed from is about 4" lower than the other one,
which is small-ish, so it wouldn't "droop" that far.  She has her hand
supporting the back of the breastfed baby's head, but she is not touching
the dying baby at all, in fact her hand is turned away from her - this
strikes me as very posed and unnatural in the circumstances - the baby is
mortally ill, and she would feel protective - and I have always wondered if
the bottle-fed baby is already dead.

Pamela Morrison IBCLC, Zimbabwe