When we are talking about mothers in "traditional breastfeeding cultures" we
must remember to be cautious about making sweeping generalizations.  What is
true for a rural woman in Mali may be very different from what is true for
an urban woman in Mali, likewise differences by socio-economic status,
educational level, ethnicity, and northern or southern part of the country.
In my 2.5 years of research on breastfeeding in Mali, almost exclusively
among the Bambara ethnic group, I saw ONE case of thrush, in a peri-urban
community, and ONE case of cracked and bleeding nipples, in a remote
northern village on the edge of the Sahara.  In both cases, the mothers came
to me as a last resort, hoping I would have some treatment or ideas because
NO ONE had ever seen, or even heard of, either condition.  In the thrush
case, this was a community of 20,000 people, with lots of nursing mothers
and grandmothers.  The bleeding nipples case was in a small village of maybe
200 people.

I never heard anyone complain about sore nipples, but then I didn't
specifically ask about that.  Newborns were held across the mother's lap,
stomach to chest.  I wonder how many of the problems seen in modern
hospitals are due to the adoption of western practices during labor,
delivery, and postpartum.

Finally, we need to recognize that breastfeeding does not protect children
against malnutrition and stunting when the first foods available for
children to begin eating at 4-6-8-10 months are composed of bulky
carbohydrates, with very low density of nutrients (calories, fat, protein),
and often contaminated with bacteria and parasites.   Add to that a high
disease load including malaria, upper respiratory and gastro-intestinal
infections, and it is no surprise that many children are malnourished and
stunted.  In some Bambara villages, you must add to these factors a lack of
understanding of the link between nutrition and health (only a recent idea
even in the West) and a cultural value on giving the best food to the elders
(also a belief in the West, but our "poor" children's alternatives, such as
hot dogs instead of filet mignon, chicken fingers instead of lobster, are
still high in nutritional value), and the stage is set for malnutrition even
where children are breastfed for 2 years and offered plenty of food to eat.



Kathy D.
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