Bøhler E, Ingstad B
Department of International Health, Oslo, Norway.
Soc Sci Med. 1996 Dec;43(12):1805-15. doi: 10.1016/s0277-9536(96)00086-x.
This paper presents the qualitative part of a project in a traditional community in East Bhutan, which, among other items, investigates the effects on child health of breastfeeding, weaning and subsequent pregnancy of the mother. Quantitative data from the project have shown that children who are weaned during a subsequent pregnancy of the mother have a reduced weight gain and an increased incidence of infectious diseases during weaning, while this is not so for children weaned from non-pregnant mothers. In-depth interviews with 35 women with experience from breastfeeding were carried out in the local language in order to obtain qualitative data regarding the processes underlying the motherś decisions during weaning. Breastfeeding was found to fulfil a valuable social function in addition to its biological and emotional properties. The breastfed child had an undebatable "right of access" to the mother's care, not only her breast, whenever it wanted. This child also assumed a status in the family in which both its vulnerability, its special needs and its value were clearly recognized. The mothers expressed a basic motivation to breastfeed "as long as possible". There were, however, important limitations as to how this was manifested in the practical weaning process. If the mother was pregnant at the time of weaning, these limitations tended to be mother-centred. Most of the women had experienced tenderness of the breasts and a reduced milk production from the start of the next pregnancy. It was believed that the breast milk of a pregnant woman could "rot" and cause disease in the child. In spite of this belief, concurrent breastfeeding and pregnancy were common, but a pregnant mother whose breastfed child got ill, e.g. with diarrhoea, would immediately stop breastfeeding. The child would thereby abruptly loose the most important protection against the negative effects of the disease, when this protection was most needed. Concurrent pregnancy and lactation are common in many areas of the poor world. This has important consequences for the health of mothers and children, and has only recently been given the attention it derserves.
本文介绍了不丹东部一个传统社区项目的定性部分，该项目除其他事项外，还研究了母乳喂养、断奶以及母亲随后怀孕对儿童健康的影响。该项目的定量数据表明，在母亲随后怀孕期间断奶的孩子体重增加减少，断奶期间传染病发病率增加，而从未怀孕母亲处断奶的孩子则并非如此。为了获取关于母亲断奶决策背后过程的定性数据，我们用当地语言对35名有母乳喂养经验的女性进行了深入访谈。研究发现，母乳喂养除了具有生物学和情感属性外，还履行着重要的社会功能。母乳喂养的孩子无论何时需要，都拥有无可争议的“获得”母亲照顾的“权利”，不仅是获得母乳。这个孩子在家庭中的地位也得到明确认可，其脆弱性、特殊需求和价值都得到重视。母亲们表达了“尽可能长时间”母乳喂养的基本动机。然而，在实际断奶过程中，这种动机的表现存在重要限制。如果母亲在断奶时怀孕，这些限制往往以母亲为中心。大多数女性从下一胎怀孕开始就经历了乳房胀痛和乳汁分泌减少。人们认为孕妇的母乳会“变质”并导致孩子生病。尽管有这种观念，但母乳喂养与怀孕同时发生的情况很常见，但如果母乳喂养的孩子生病，比如腹泻，怀孕的母亲会立即停止母乳喂养。这样一来，孩子在最需要这种保护的时候，会突然失去抵御疾病负面影响的最重要保护。在贫穷地区的许多地方，怀孕和哺乳同时发生的情况很常见。这对母亲和孩子的健康有重要影响，而直到最近才得到应有的关注。
