Gender Bias in Breastfeeding Behaviors in Developing Countries
In diving into breastfeeding behaviors in developing
countries, I have come across a few articles that have found that there are
certain gender biases that exist in regions with regards to exclusive breastfeeding
behaviors (Fledderjohann et al., 2014; Fujita et al., 2012;
Jain, Tyagi, Kaur, Puliyel, & Sreenivas, 2014). Can this be
attributed to particular cultural ideologies and if so, should public health interventions
approach the topic of breastfeeding with simply this in mind, or should there
be an intervention of its own on female equality?
Countries such as India have been investigated and researchers
have found that in some of these areas, there was over 10% difference in males
being breastfed more often in Delhi, and 21% lower breastfeeding rates among
females in other regions (Fledderjohann et al., 2014; Jain et al., 2014). In Sub-Saharan Africa,
males were breastfed for a longer duration in comparison to females (Fujita et al., 2012; Chakravaty, 2012). Jain et al,
(2014) linked this gender bias difference in breastfeeding behaviors to postpartum
depression and found that mothers of girls in Delhi had a higher rate of postpartum
depression and less likely to breastfeed. In searching as to possible reasons
as to why this can occur in communities, I came across the discussion of having
the preference for boys versus girls in families. Chakravaty (2014) discussed
the fact that this gender bias of breastfeeding is linked to the presence of a “son-biased
fertility choice” in both India and regions in Africa, and a possible
attributer to postpartum depression. These breastfeeding behaviors have of
course also been linked to an 11% greater chance of dying among females before
the age of five (Fledderjohann et al., 2014).
I became torn when trying to analyze how public health
professionals should approach a concept such as this. The preference for a son
has been evident in these cultures, and as it is part of a cultural construct,
should there be an attempt to ‘remove’ this ideology from these communities? I
am largely opposed to any intervention attempting to change ANY cultural
ideology; however, at the same rate, there is a large social justice issue with
regards to life and death situations of females being threatened. My question
to all is what is your opinion on this? How should we approach a change that
needs to be made in breastfeeding behaviors among developing communities? Also, of separate programs are needed, which should be tackled first?!
References
Fledderjohann, J., Agrawal, S., Vellakkal, S., Basu,
S., Campbell, O., Doyle, P., … Stuckler, D. (2014). Do Girls Have a Nutritional
Disadvantage Compared with Boys? Statistical Models of Breastfeeding and Food
Consumption Inequalities among Indian Siblings. PLOS ONE, 9(9),
e107172. https://doi.org/10.1371/journal.pone.0107172
Fujita, M., Roth, E., Lo,
Y.-J., Hurst, C., Vollner, J., & Kendell, A. (2012). In poor families,
mothers’ milk is richer for daughters than sons: A test of Trivers–Willard
hypothesis in agropastoral settlements in Northern Kenya. American Journal
of Physical Anthropology, 149(1), 52–59.
https://doi.org/10.1002/ajpa.22092
Jain, A., Tyagi, P.,
Kaur, P., Puliyel, J., & Sreenivas, V. (2014). Association of birth of
girls with postnatal depression and exclusive breastfeeding: an observational
study. BMJ Open, 4(6), e003545.
https://doi.org/10.1136/bmjopen-2013-003545
Chakravarty,
A. (2012). Gender
Bias in Breastfeeding and Missing Girls in Africa: The Role of
Fertility Choice. Mimeo.
Amy,
ReplyDeleteThanks for this information. I am a big proponent of breastfeeding and the question posed I believe is a structural one. For a long time some cultures value male children over female ones. I am not sure why, however I am of the belief that it is a social construct of reality. I believe that we have to look at the history of the people and social norms to see why this is so prevalent. Did something happen for people to believe that breastfeeding males longer was better or because of the believe in the inherent value of a male child. Also as a woman, I find it intriguing that women are treating their own daughters this way. It says a lot about how one values themselves by how they treat their progeny. Do women feel that they can change their situation or that of their daughters. Where is self efficacy? There is a demoralized populous that is subjected to carrying out the very destruction that decimate their numbers. Before we engage in epistemic violence I believe that we should understand the factors that have led up to this point and deal with the structural as well as social issues so that individuals and the population as a whole can make a effective long lasting change. As with the entertainment education that was introduced via the Novellas with Sabidao, I believe that those may work with this group to both education and entertain them and bring about change.
Thank you Amy for raising this point.
ReplyDeleteIn fact, I totally agree with Chris that it is a social construction of reality. I will talk from my experience in my home country. In rural areas in Egypt there is a strong preference for having males rather than females. Husbands blame their wives for giving birth to a girl. The wife become under excessive psychological stress that she may suffer depression and abandon breastfeeding her daughter. Community as a whole blames wives for not giving birth to a boy. Having a boy is a source of pride in these communities. Sadly, from my experience, it is a cuture of gender inequality but on a very heartbreaking level. In my opinion, achieving a high level of cultural competence by well understanding such norms is a must before going through any intervention.
Amy, Chris, and Salma, love this discussion! What a heartbreaking topic, and definitely something that will take quite a bit of time to change. Whenever a culturally-engrained social construct is the source of inequality in a community, I personally believe a well-intentioned and sensitively-planned intervention by an outside party to promote change is not only appropriate, but in some cases a moral obligation. As a woman, I believe gender inequality is intolerable. Let us not forget that not too long ago even in the United States women had a fraction of the civil rights we hold today, and even our battle for gender equality is not over. Our own culture has been going through this process of cultural change and I guarantee that no one views it as an imposition or disrespectful or forced culture change. Even arguing for women to be allowed to freely breastfeed in the U.S. -- that's a culture change! Just because something is cultural does not mean it is right or that it should be allowed to continue indefinitely. There are things in our own cultures that we would all like to change.
ReplyDeleteThat said, as we have discussed, cultural change must be inspired tactfully and effectively. For the breastfeeding case in particular, in the context of a larger gender equality issue, I believe the root of the problem is women's empowerment, and as Chris mentioned, their self-efficacy. Once all women can feel confident and satisfied with their place in society and with the support of their husbands, and know that their daughters will grow up more supported and loved by their community, a more equal breastfeeding rate between boy and girl babies is likely to follow. However, the biology nerd in me would also wonder if in addition to the social reasoning for increased PPD after giving birth to girls, there are any biological factors at play...