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 Mothering: Instinctual or learned...
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 Conclusion
 Tables
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Title: effects of indigenous versus modern techniques on lactation : the Luvale of Zambia
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Title: effects of indigenous versus modern techniques on lactation : the Luvale of Zambia
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Creator: Spring, Anita
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Publication Date: 1976
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Table of Contents
    Title Page
        Title Page
    Mothering: Instinctual or learned behavior
        Page 1
        Page 2
        Page 3
        Page 4
    Differences in lactation
        Page 5
    The doula in the non-ritual situation
        Page 6
    The doula in the ritual situation
        Page 7
        Page 8
    Conclusion
        Page 9
    Tables
        Page 10
        Page 11
    References cited
        Page 12
Full Text
















THE EFFECTS OF INDIGENOUS VERSUS MODERN TECHNIQUES
ON LACTATION: THE LUVALE OF ZAMBIA










Anita Spring
University of Florida






Prepared for "The Biosocial Aspects of Breastfeeding",
a symposium organized by Dana Rapheal and Solomon Katz
American Association for the Advancement of Science,
Boston, February 21, 1976









Mothering: Instinctual or Learned Behavior

A popular assumption is that nurturance--the quality of protecting and promot-

ing the growth of others-is a sex-linked trait. According to this assumption, women?

instinctively know "correct" mothering techniques because female nurturance is

associated with physiological apparatus and hormonal changes centering around birth.

Martin and Voorhies point out that "the etymology of the word suggests an unambig-

uous female orientation because it is derived from the Latin, nttrire, to suckle"

(1975:77). At present there are no unequivocal data which link nurturance with

female hormones. Studies such as Mead (1963) and Money and Ehrhardt (1972) show

that nurturance is learned along with the society's appropriate gender specifica-

tions.

A classic control study on the instinctual female nurturance trait is Harlow's

study on rhesus monkeys (Harlow, Harlow, and Suomi 1971). The control females were

raised normally with their parents and peers, mated normally, and acted out the

expected "good mothering" roles with their offspring. Another group of females was

reared in isolation and manifested "psychotic" symptoms. When they became adults,

they could not mate normally; however, some were impregnated by knowledgable males

or by artificial insemination. These individuals proved to be inadequate mothers

who neglected and "abused" their offspring. If there were genetic programming for

"good mothering" this behavior would not be so.

There are moral inhibitions against setting up studies such as these among

human females. Yet there are ethnographic examples of bad nurturing such as Yano-

mamo and Ik mothers who literally starve their children by negligent feeding (Harris

1974; Turnbull 1972). Sometimes there is differential sexual selection--usually

girls are relegated to "benign neglect." These bad mothers come from societies

where, the ethnographers argue, there are population pressures on resources, and/or

the society is very chauvinistic.








Rapheal (1975) describes a "new/old" rite of passage, matrescence, the period

of becoming a mother. This phenomena is the critical transition period when the

transformation from woman-wife-female to mother occurs. She writes that "giving

birth does not automatically make a mother out of a woman" (1975:66) and notes that

the assumption of maternal roles is another transition rite that can be profitably

studied. Concerning lactation in particular, optimal breast-feeding requires one

or more wcmen to act as doula (doulas), that is, as supportive-instructor(s).

According to Rapheal (1973;1975) the woman or women interact(s) with the mother in

the postpartum period and "mothers", i.e., nurtures, the new mother. This suppor-

tiveness is vital for the establishment of successful lactation patterns which are

vital to infant health. In fact Rapheal argues that if this supportive system

breaks down, the mother's capacity to succeed at breast-feeding is reduced and the

infant dies.

The case study I present today concerns an ethnic group, the Luvale, who reside

in Northwest Zambia, where I did field work 1970-1972. The Luvale material provide:

evidence that correct mothering and breast-feedingis learned and that instruction

commences after the results of bad mothering are.seen. Instruction in nurturance

is curative rather than preventative. Lactation training is considered here as

one indicator of nurturance.

The Luvale are matrilineal people and, like other matrilineal Central African

societies, have elaborate puberty rituals for girls.. The purpose of the girls rit-

ual is twofold; to ensure future fertility and to prepare a young woman for sexual

life. The ritual is long and multiphasic. Many proscriptions and interdictions

are related symbolically to her fertility. During the long seclusion phases, actue

instruction in traditional Luvale medicinal (intra-vaginal) therapies are given.

Further, elaborate instructions on being a good dancer and sexual partner are pro-

vided with much "mock"-practice with the instructress. No practical advice about









domestic matters, childbearing, or childrearing is transmitted even though the

period of instruction lasts from three months to two years and culminates frequently

in the marriage ceremony.

School girls do not participate in the standard puberty ritual but instead

frequently undergo a shortened version. Here they learn about a few medicinal

treatments. Sexual instruction, especially for Christian girls, is delayed until

directly prior to marriage. These girls are taught sewing, hygiene, preparation of

food--including babyfoods--as part of the school curriculum.

Young Luvale girls, unlike Harlow's isolated monkeys, do, of course, see adults

"mothering" children. They, along with their brothers, participate in child care.

But child-nurses are responsible for entertaining their young chargers, not "mother-

ing" them. Furthermore child-nurses only care for children who are older than one

and a half or two years.

The transition from potentially fertile young woman to mother occurs after the

puberty ritual. Most young women become pregnant about two years after the ritual.

However, not all pregnancies are successful; many women miscarry, have stillbirths

or lose their infant. Even though Luvale are a non-contracepting population, they

have small families and high childlessness, stemming from infertility. Traditional

Luvale women of completed family size average two live births while the average for

Zambian women is seven. I have discussed the factors accounting for Luvale low

natality elsewhere (Spring 1974, 1976). These include maternal infertility caused

by traditional therapies, loss of fetal viability due to indigenous midwifery, and

infant and child mortality due to exposure and improper feeding practices.

Some patterns are recurrent. A woman may have two live births and no more; or

she may miscarry the first pregnancy and follow it with a live birth. Her first or

second child may die. The difference between traditional Luvale women and many








other women is that Luvale may not continue becoming pregnant and having babies.

Women who rely on traditional therapies end their reproductive spans quite early--

usually by their early thirties. There are, however, another group of Luvale women

who do not rely on traditional therapies. They have longer reproductive spans, and

less fetal wastage and infant mortality. For the past twenty years, American miss-

ionary nurses and midwives have operated a maternity hospital in the area. The

results of these health care facilities are noticeable, and I have found it possible

to distinguish two populations in terms of their success with natality. I call them

Village Women and Hospital Women. These two groups also manifest differential be-

havior in terms of lactation and curative rituals.

Village Women undergo indigenous medicine and rituals (spirit possession)

treatments with regularity and rely on traditional midwifery. Hospital Women forego

traditional treatments for hospital ones and give birth at the hospital. Many Hos-

pital Women were school attenders and some are Christians. Hospital Women do not

share the low birth rate and women of completed family size average five live births.

Table 1 contrasts the rates of live births between the two groups. Older Village

Women do not show higher rates than younger Village Women, whereas the expected

relationship--higher rates with increasing age--appears in the hospital group. Fur-

ther, Village Women have twice as many miscarriages, stillbirths and neonatal deaths

as their hospital counterparts (Table 2). In terms of child mortality, Village

Women lose twice as many children within the first year of life as Hospital Women.

These women do not form two separated populations but co-exist in the area.

There is a tendency for Hospital Women to come from slightly wealthier families and

to marry wealthy and important men. Hospital women may utilize traditional support

systems if they desire, but receive extra training and care from hospital personnel,

other patients, and school teachers. Further, they articulate with a medical system








that aims at preventative as well as curative treatments. It is within the tradi-

tional context of low Luvale natality and within the modern context of differential

natality that mothering and lactation must be examined.


Differences in Lactation

In village deliveries, infants are repeatedly washed with medicines; they are

not covered or kept particularly warm. Village women wait until all the colustrum

has passed before allowing the infant at the breast. In the interim, infants are

fed water and chihuna (Combretum molle) roots--a decoction called lizumbo--the first

food given to a visitor. Hygiene in the preparation and storage of the solution is

often low. Traditional mothers carry around containers--such as used Coke bottles--

of lizumbo. Hospital infants, on the other hand, are wrapped immediately and kept

warm; hospital mothers are encouraged to give colustrum. Boiled water, glucose

solutions, and powdered milks are available. The use of lizumbo is less frequent

among them. Some do use standard feeding bottles--but at present their use is spo-

radic. Jelliffe (1968) has documented the negative effects of this procedure in

hot climates.

There are a variety of traditional techniques for medicating breast "illnesses"

such as engorgement and boils. If the breasts become swollen, the milk is thought

to be sour and unfit for baby; it is hand expressed and discarded--the infant is

meanwhile fed lizumbo. Similarly, the infant is not nursed when the mother has a

breast boil. When the milk flow appears low, cuts over the breasts are made and the

woman is told to drink soup. No efforts to increase the milk supply occurs after

the first three months of lactation. Hospital Women go to hospital for breast ail-

ments and generally return to suckling before their village counterparts. They may

purchase powdered milk or use hospital preparations in the interim.








During lactation women are subject to certain food restrictions (eggs, certain

fish, meat, and fowl are forbidden); but these will be stringently enforced only if

the woman participates in a child rearing ritual (see below). Although restrictions

do not usually confer much hardship, Hospital Women do not defer to them unless they

participate in rituals.

Interestingly, some Hospital Women breastfeed for fewer months than traditional

women--nine to ten months as compared with eighteen to twenty-four months. Inter-

course resumes when the child walks rather than when lactation ends. Women in both

populations introduce supplemental foods about the third month; I do not have infor-

mation on differential Hospital and Village Women's usage. Usually first foods are

cassava and maize gruels. Educated women learn about new foods and ways to prepare

them, e.g., mashed bananas, at well-baby clinics. Traditional women never utilize

these foods even though they are readily available.


The Doula in the Non-Ritual Situation

Rapheal notes a world-wide preference for the mother's mother or mother's

maternal kin to act as doula (1975:68). In the Luvale situation there is no parti-

cular kinswoman so designated. A midwife performs a variety of postpartum rituals

for mother and child and stays with the parturient for many days after birth. A

midwife's reputation is based on maternal welfare rather than the infant's; atten-

tion in village parturition is directed toward the mother. The midwife would be a

logical choice for a doula. Many famous midwives are childless, either because of

infertility or infant death. Although it is not impossible for them to act as

doula, i.e., to give support for lactation, they cannot do so from their own exper-

ience.

Instruction in mothering is not a matter of course but occurs only if there is

great trouble. In short, although the midwife is responsible for the new parturient








health and ritual status, neither she nor a specifically appointed female provide

supportive mothering at this time.

Hospital parturients, by contrast, are surrounded by other newly delivered

women in one large ward. There are helpful nurses around them. Further, these

women have generally attended pre-natal classes in the past and attend well baby

clinics postpartumly.


The Doula in the Ritual Situation

The Luvale have a large series of rituals of various complexities for children':

illnesses. They believe that the ancestors may send illness and death at any stage

from gestation through childhood. This retribution reflects upon the worldly conduct

and proper devotion of the child's parents. Children's treatments are interwoven

closely with their mother's natality and child mortality record. The woman's pre-

vious history of childbearing and rearing influences decisions concerning current

treatment of any given ill child.

Actual divinations and treatments operate as follows. If the baby of a woman

with a good natality record (i.e., she has borne children who have not died) sickens

only medicinal treatments or a minor ritual are necessary. However, if the woman

has a history of not bearing children or keeping themalive, then elaborate spirit

possession rituals are necessary also.

When the child or child and mother are in a ritual for child rearing, elaborate

directions are given on how to take care of the child. Attention is given to pro-

perly suckling, feeding, and clothing of the child. The woman's matrilineal and

affinal relatives, the curing doctors, and others minister to her and the child.

Extra efforts are expended for successful lactation and in obtaining all required

food stuffs. The mother carries around a "medicine horn" and must eat a bit of its

contents before each new food. With ritual there is great concern for mother's and

child's diet.








The community of women who have experienced these rituals--many of them

mothers--voluntarily participate. Real help is given because people believe

that rituals work and that their participation is needed. Further, participation

is reciprocal.

The herbal or spirit possession doctor is often the individual who acts as

doula giving instruction or suckling and caring for children, as well as overseeing

the ritual.* Unlike midwives who may be barren, to become a doctor one must exper-

ience the illness and treatment, and then recover. Ritual experts in children's

illnesses fulfill the prerequisites of being successfulmothers; they transmit their

expert knowledge to their clients.

A comparison of the types of rituals that Village and Hospital Women undergo

for their own and for their children's illnesses is shown in Tables 3 and 4. The

tables count whether a woman has ever had the ritual performed; multiple performance

are not counted. Participation in rituals for childbearing, menstruation, and ill-

ness is far greater among Village than Hospital Women (Table 3). At first glance

it appears from Table 4 that both groups take part equally in rituals for children.

However, Hospital Women have two to three times as many children as their village

counterparts. It is nevertheless interesting that Hospital Women who will not un-

dergo traditional treatments for themselves, often do so for their children. While

this is not an unfamiliar sentiment, there are a couple of cultural reasons to

account for this behavior. The child's father is responsible for treatment and he

or his relatives may favor the treatment. Traditional members of his wife's matri-

lineage would demand a divorce if the child were not treated. There is much rein-

forcement for these rituals from the community. Minor children's rituals consist


*Sometimes these doctors live far away. They appoint a woman who has undergone the
ritual to fill the non-ritual parts of this procedure.








of an herbal medication and a shrine. No spirit possession rituals, which modern

women abhor and Christian women forbid,are'required. In any case, Hospital Women

seem to benefit by both hospital and traditional treatments. They receive good

maternal and child care from the hospital. When they are worried about their

children, they can "plug" back into good traditional supportive care from

women ritual experts in the community.


Conclusion

It is possible to argue that the Luvale system fails to teach nurturance,

and correct lactation prophylactically, yet traditionally much support and

effort are expended in keeping alive the few children produced after the results

of "faulty mothering." Perhaps successful mothering is not as highly valued

by the Luvale as by other societies. A more likely assumption is that although

they may desire to succeed, the cultural support systems fail to teach "mothering"

and child care skills at the proper time. However, corrections are made and

women who undergo rituals for child rearing learn proper lactation, supportive

"mothering" and child care. At the present time the beneficial effects of

traditional ritual therapies aided by modern therapies are contributing to

increasing Luvale success with natality.

This paper lends support to the thesis that successful lactation requires more

than general approval from a society. All human societies--even the ones which

consider bottle feeding best--recognize the physiological ability of the female

to lactate. But cultures set up the conditions under which this practice will

be helped or hindered.










TABLE 1 AGE SPECIFIC RATE OF LIVE BIRTHS PER WOMEN
OF VILLAGE AND HOSPITAL WOMEN


VILLAGE WOMEN HOSPITAL WOMEN

Years 15-29 30-44 45+ 15-29 30-44 45+

N of Population 49 43 61 125 67 5

Rate of Live Births 2.02 2.28 2.22 2.22 5.25 5.6




TABLE 2 A. MISCARRIAGES, STILLBIRTHS, NEONATAL DEATHS,
AS A PERCENTAGE OF TOTAL PREGNANCIES OF
VILLAGE AND HOSPITAL WOMEN


Years

N of Total
Pregnancies

Miscarriages

Stillbirths

Neonatal Deaths

Total Reproductive
Wastage


VILLAGE WOMEN

15-29 30-44 45+


118


132 154


HOSPITAL WOMEN

15-29 30-44 45+


313


10.2 19.7 14.3


5.9

16.1


6.8 5.8

5.3 9.1


5.3


32.2 31.8 29.2


386 28*


6.2 3.6

4.7 3.6

2.6 7.1


17.1 13.5 14.3


B. INFANT AND CHILD MORTALITY AS A PERCENTAGE OF
TOTAL LIVE BIRTHS OF VILLAGE AND HOSPITAL WOMEN


N of Total
Live Births


99 98 125


Infant Mortality 33.3 23.5
to One Year

Child Mortality 34.3 36.5
to Five Years


20.0


24.0


8.5 17.9


9.4- 11.1 21.4


*Discrepancies due to twin births.









TABLE 3 WOMEN'S PARTICIPATION IN TRADITIONAL SPIRIT
POSSESSION RITUALS FOR CHILDBEARING AND GENERAL ILLNESS
(IN PERCENTAGES*)


Years


Childbearing
Rituals

General Illness
Rituals Type I

General Illness
Rituals Type II


VILLAGE WOMEN

15-29 30-44 45+

26.5 40.7 31.2


12.2 24.4 34.4


12.2 30.3 40.0


HOSPITAL WOMEN

15-29 30-44 45+

13.6 26.9 0


3.0 20.0


7.5 20.0


TABLE 4 WOMEN'S PARTICIPATION IN CHILD REARING RITUALS
(IN PERCENTAGES*)


VILLAGE WOMEN HOSPITAL WOMEN

Years 15-29 30-44 45+ 15-29 30-44 45+

Herbals and 35.0 35.3 22.4 12.8 38.8 40.0
Shrines

Child's Illness 20.0 33.3 33.8 17.6 27.3 60.0
Rituals-Type I

Child's Illness 30.0 41.2 42.3 15.2 44.8 80.0
Rituals-Type II


*A woman may participate in more than one type of ritual.





* -*


Harlow, H.F., M.K. Harlow, and S.J. Suomi
1971 "From Thought to Therapy: Lessons
American Scientist 59:538-49.


from a Primate Laboratory."


Harris, Marvin
1974 Cows, Pigs, Wars and Witches. New York: Vintage Books.


Jelliffe,
1968


Derrick B.
Infant Nutrition in the Subtropics and Tropics. Geneva:
World Health Organization.


Martin, McKay and Barbara Voorhies
1975 Female of the Species. New York: Columbia University Press.

Mead, Margaret
1963 Sex and Temperament in Three Primitive Societies. New York:
William Morrow.


Money, John
1972


Rapheal, Dar
1973


and Anke A. Ehrhardt
Man and Woman; Boy and Girl. Baltimore: Johns Hopkins
University Press.


la
The Tender Gift--Breastfeeding.


Englewood Cliffs: Prentice-Hall.


1975 "Matrescence, Becoming a Mother, A "New/Old" Rite de'Passage."
in Being Female: Reproduction, Power and Change, Chicago:
Aldine, pp. 65-71.

Spring, Anita
1974 "Epidemiology of Spirit Possession--Alternatives to Procreation."
Paper delivered at the American Anthropological Association,
Mexico City.

1976 "An Indigenous Therapeutic Style and Its Consequences for
Natality: The Luvale of Zambia." in J. Marshall and S. Polgar,
eds., Culture Natality and Family Planning. Chapel Hill:
University of North Carolina Press, pp. 99-125.

Turnbull, Colin
1972 The Mountain People. New York: Simon and Schuster.


12



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