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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
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la
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REFERENCES CITED
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