First, your letter was beautiful, as is the work you are doing. People who
selflessly serve others (such as caring enough to realize that lending a
shoulder to cry on is part of what is neede, and not getting into charging
for every follow up) are what keep us all going. Even if they do not
realize it themselves, they are little saints.

Regarding the points I was making, I feel that some refinement is
necessary. I am of course only going on what I understand from the very
experienced female colleagues I work with. (And I should tell you that,
although I have lived here in Sweden for a long time I am originally
American, so I am not really an expert on Swedish--or modern-day
American--culture.) Anyway, the idea of Sweden being an open society or a
sexual playhouse is a myth, though most Swedish women are certainly less
uptight than most American and certainly than most British women about
showing breasts in public. Even old and fat women swim topless in the
lovely clean lakes and sea water that abound in the middle of Stockholm if
they want to.

But I've understood that the reason health professional do not want to
intervene is not because Swedish women are so knowledgeable about
breastfeeding (rates were down to about 15% here too in the early 70s). It
is rather to allow the woman to experience her own competence and to help
as little as possible, often to give just that little hint that they need.
The really big difference I experience in the Swedish culture is that it
is, for better or worse, considered inappropriate to try to stick out and
show how clever one is (in this context by showing a mother more than the
minimum neede, which may really be a hidden way to say, "see how clever and
knowledgeable I am and how valuable I am likely to be to you in the
future").

I can fully appreciate that someone working as a breastfeeding counselor
meets mainly women who do need help. They should get help and of course it
should be hands on. My point was that, no matter how many these women are,
they are not necessarily a reflection of society  reason
that public health messages so often "get it wrong" (as in the case of ORS
that I cited) is that physicians who deal mainly with pathology do not
understand that they unconsciously generalize from patients to all of
society.

Here is an example to show that the people who show up for care can never
be studied to see what society as a whole is like. In Yemen where my wife
and I worked on and off from 1978-1985, one research team studied the
relationship between breastfeeding and infant health among clinic
attenders. There was not much diffe
beginning to loosen up in the general public. But many health professionals
are still convinced that breastfeeding too long is deadly for the child's
teeth and causes all sorts of physical problems. (Strange that Africans
have any teeth left!) But the ll breastfeeding if they do so beyond about 8-10 months. But then when a
baby has a serious problem and the health worker asks detailed questions
about diet, she is worried and tells it all. "Just like I thought," thinks
the health worker without knowing that many healthy babies have passed
through the clinic that day and, unbeknowst to the staff, were "closet
breastfeeders."

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

phone +46 - 18 515198
faxhone +46 - 8 191397 (can be used as fax also)