The New Nation - Internet Edition

Md. Sazedul Islam

Breastfeeding, an essential component of good health care contributing to healthy growth, better IQ and psychological development, is part of fundamental human right which is as important as other rights to food, clothing, shelter, and health.

Actually it is the only optimum food in proper proportion for the infants.

If mothers breastfeed her baby upto six months of birth, then there is no need of other foods even water for the children during that period.

In infancy, no gift is more precious than breastfeeding, yet globally barely one in three infants is exclusively breastfed during the first six months.

Allah has ordained us to continue breastfeeding for at least two years after the birth of a baby in Sura Bakara.

If a baby is unrestrictedly breastfeed for 6 months and breastfeeding continues into the second year, the average mother will not have a period until her baby is at least 14 months old.

About 52.7% of Bangladeshi children aged between 6-5 months are suffering from anaemia and it is more marked among the younger age group with 78% among the age group of 6-11 months. The situation did not turn so worse if the child was on exclusive breastfeeding for first six months of life and continue the same upto two years with slowly introducing complementary foods.

Most infants require complementary foods when they are about six months of age, since breast milk alone is usually no longer sufficient to ensure proper growth and development.

Breastfeeding's psychological advantages are close loving relationship between mother and baby, mothers are more emotionally satisfied, baby cries less, mother behave more affectionately and less likely to abuse or abandon baby.

Survey report says the children who were deprived of breast-feeding face more death-risk than those who succeeded in getting breast-fed.

Non-infectious diseases, such as eczema, dental disease, lymphomas (cancer) and diabetes seem to occur less often in children who are breastfed. The mother-infant body contact and the body temperature of the milk also help prevent hypothermia or low body temperature, in the infant.

Milk direct from mother's breast cannot be diluted or spoiled. It is easy to digest and contains none of the harmful of difficult-to-digest components found in substitutes.

The activity of breastfeeding promotes proper development of facial bones and muscles because of the feeding actions required. Breastfeeding lowers the risk of at least two kinds of cancer. The risk of ovarian is significantly lower among women who have breastfed. Studies also have shown that breastfeeding helps prevent breast cancer, primarily among pre-menopausal women.

Previous studies show that breastfeeding decreases the incidence of gastrointestinal infections arid diarrhea, urinary tract infections, lower respiratory tract illness, otitis media and bacteriaemia and meningitis.

Breastfeeding prevent malnutrition for children. Breastfeeding help them prevent various diseases such as diarrhea, pneumonia, meningitis, exzema, allergy, and asthma and tooth disease. Breastfeed children are less attacked by cancer, diabetes, high blood pressure and chronic digestive illness later in life. Even if they are attacked by those diseases, they can recover from illness due to their strong preventive capacity.

The children who take substitute milk frequently suffer from various diseases such as loose motion, pneumonia, allergy and asthma while the breastfeed children can recover quickly if they are attacked by diseases.

Breast milk is the least expensive food for infants and the best. Breastfeeding mothers have no need to purchase breast milk substitutes. Breastfeeding's positive effect on maternal and child health can also reduce the burden on public health budgets.

The government as well as a society can save a lot of money, which is used in health and family planning with the help of breastfeeding.

Breastfeeding requires very little investment and has a tremendous payback for all. It can bring economic benefits to much level of society-savings on the unnecessary purchase of breaslmilk substitutes and feeding equipment, savings on medical care through fewer trips to a physician or hospital for a sick child, medications and time caring for a sick child.

To promote breastfeeding by regulating the marketing of breast-milk substitute (BMS), Bangladesh has passed the Breast Milk Substitute Ordinance-1984. According to the law, advertisement promoting the BMS has been prohibited.

The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution Act, 1992 (The IMS Act), ratified by many countries, strongly discourages promotion of BMS and bottle feeding.

A development country like Bangladesh should adopt the right to every child to a standard of living and for this, breastfeeding is the answer.

(PID-UNICEF Feature)

Dr. F.I. Biswas

Mental, Emotional, and Behavioral Disorders Are Real. Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. These problems, often called "disorders," are sources of stress for children and their families, schools, and communities. The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in five children and adolescents may have a mental health disorder that can be identified and require treatment. Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury.

Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person. Families and communities, working together, can help children and adolescents with mental disorders. A broad range of services is often necessary to meet the needs of these young people and their families. The Disorders Below are descriptions of particular mental, emotional, and behavioral disorders that may occur during childhood and adolescence. All can have a serious impact on a child's overall health. Some disorders are more common than others, and conditions range from mild to severe. Often, a child has more than one disorder. Anxiety Disorders Young people who experience excessive fear, worry, or uneasiness may have an anxiety disorder. Anxiety disorders are among the most common of childhood disorders.

According to one study of 9- to 17-year-olds, as many as 13 of every 100 young people have an anxiety disorder. Anxiety disorders includen Phobias, which are unrealistic and overwhelming fears of objects or situations. n Generalized anxiety disorder, which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience. n Panic disorder, which causes terrifying "panic attacks" that include physical symptoms, such as a rapid heartbeat and dizziness.

Obsessive-compulsive disorder, which causes children to become "trapped" in a pattern of repeated thoughts and behaviors, such as counting or hand washing. n Post-traumatic stress disorder, which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness of violence, or exposure to other types of trauma such as wars or natural disasters. Severe Depression Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Studies show that two of every 100 children may have major depression, and as many as eight of every 100 adolescents may be affected.

The disorder is marked by changes in Emotions- Children often feel sad, cry, or feel worthless. n Motivation- Children lose interest in play activities, or schoolwork declines. n Physical well-being-Children may experience changes in appetite or sleeping patterns and may have vague physical complaints. n Thoughts- Children believe they are ugly, unable to do anything right, or that the world or life is hopeless. It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide.

Bipolar Disorder Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (sometimes called manic depression). Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder (about one in 100) often experienced their first symptoms during their teenage years. Attention-deficit/Hyperactivity Disorder Young people with attention-deficit/hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Attention-deficit/hyperactivity disorder occurs in up to five of every 100 children. Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet.

Symptoms must be evident in at least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed. Learning Disorders Difficulties that make it harder for children and adolescents to receive or express information could be a sign of learning disorders. Learning disorders can show up as problems with spoken and written language, coordination, attention, or self-control. Conduct Disorder Young people with conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism. Current research has yielded varying estimates of the number of young people with this disorder, ranging from one to four of every 100 children 9 to 17 years of age. Eating Disorders Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Eating disorders can be life threatening.

Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys. Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food in one sitting). After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates of bulimia vary from one to three of every 100 young people. Autism Children with autism, also called autistic disorder, have problems interacting and communicating with others. Autism appears before the third birthday, causing children to act inappropriately, often repeating behaviors over long periods of time. For example, some children bang their heads, rock, or spin objects. Symptoms of autism range from mild to severe.

Children with autism may have a very limited awareness of others and are at increased risk for other mental disorders. Studies suggest that autism affects 10 to 12 of every 10,000 children. Schizophrenia Young people with schizophrenia have psychotic periods that may involve hallucinations, withdrawal from others, and loss of contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia occurs in about five of every 1,000 children. Treatment, Support Services, and Research: Sources of Hope Now, more than ever before, there is hope for young people with mental, emotional, and behavioral disorders.

Most of the symptoms and distress associated with childhood and adolescent mental, emotional, and behavioral disorders can be alleviated with timely and appropriate treatment and supports. In addition, researchers are working to gain new scientific insights that will lead to better treatments and cures for mental, emotional, and behavioral disorders. Innovative studies also are exploring new ways of delivering services to prevent and treat these disorders. Research efforts are expected to lead to more effective use of existing treatments, so children and their families can live happier, healthier, and more fulfilling lives.

(From previous issue))

Powerful families are generally immune from such abusive practices. Poor women are more vulnerable as they often lack a familial supportive umbrella to protect them. The poorer the woman, the greater is the likelihood of abandonment, divorce, and oppression. A large number of women are divorced and murdered for dowry. Within the family men have the monopoly over means of coercion and direct violence. The failure to fetch a large dowry on the part of the wife according to the demands of her husband can make her vulnerable to divorce, torture, acid throwing, and even murder. As Table 3 shows clearly, the incidence of domestic violence has increased very rapidly. A large majority of victims are from the lower socioeconomic strata who lack protective shelter and the resources for retaliation or redress.

Poorer women who often work in the fields, in construction, in factories, as domestic helpers and in the market are also vulnerable to sexual abuse, assault, and rape. There is an alarming rise in the incidence of rape (Table 3). Violence against women remains largely unreported mainly due to prevailing norms and values regarding women's honor, the insecurity of victims, and due to lengthy legal procedures that discourage people from seeking legal support.

Moreover, the legal process is complicated and the police are often influenced by political pressure and by bribes offered by mastaans (muscle-men or thugs) and violators, with the result that they either do not take adequate action or remain inactive.

During the period of legal litigation women neither get legal protection of their choice,7 nor financial support to save them and her family members from starvation and onslaught of violence from her ex-husband or mastaans. Poverty Impacts of Safety Net Programs A Public Food Distribution System exists in Bangladesh but its benefits are generally accrued by civil servants and the armed forces. The most effective channels of delivery of food to the poor have been the Rural Development (previously known as Food-for-Work) and Vulnerable Groups Development (VGD) projects. Both use wheat provided by World Food Program (WFP), bilateral donors, and the Government. The Rural Development project supports rural construction and maintenance activities while generating temporary employment. During 1996-1997, the project distributed over 195,000 tons of wheat and Suppression of violence against Women and Children Act, 2000 has made a provision of safe custody during the trial period but it vested absolute authority on the Tribunal to decide whether the victim needs protection of safe custody or not. Moreover, the Act is silent about the mechanism for safe custody before the case is sent to the Tribunal for trial.

Generated 30 million workdays for an estimated 450,000 participants. Women constituted a quarter of its participants; it increased to one half in 2000.

The VGD program, however, is solely directed towards the most disadvantaged rural women. It provides them with wheat and trains them on issues such as health nutrition, family planning, market-based income-generating activities, and literacy with the help of NGOs to make them more self-reliant.

These programs not only protect the target groups during lean periods but they also help the poor to generate savings for future investment. It has been found that the incidence and intensity of poverty is considerably lower among the target groups than in the nontarget groups. Sixty-three percent of Food-for-Work beneficiaries are deemed to belong to the category of the extreme poor compared with 72 percent of the control group. Women's Access to Social Services Implication of Water Sanitation Services for Women Increasing investment in the social sector is a prerequisite for creating an enabling environment for human development. Social sector investment broadly includes housing, compulsory primary and nonformal education, public health, and water and sanitation.

Analyses of women's access to social services primarily cover poor women's access to water and sanitation, health, and education. Access to basic amenities such as water and sanitation, housing, and electricity not only varies by class but also has implications for gender.

Whereas more than four fifths of the richer households have their water piped to and from a tubewell inside their homes, in both rural and urban areas poorer households collect water from a neighbor's house or from a communal standpipe or tap or tubewell. This affects women's time use pattern and energy levels since they are mostly responsible for water collection and management. The median time needed to collect drinking water is around 30 minutes per trip in urban slums and, generally, at least two trips a day are necessary to meet a family's drinking water needs. The situation is comparable for rural women from poorer households and even worse in coastal and hilly regions, where obtaining safe drinking water is a big problem (Afsar 1999).

Moreover, the growing threat of arsenic poisoning has made the lives of thousands of women, men, and children miserable. Existing evidence suggests that the incidence of sickness is almost 20 percent higher for households that lack piped water and sanitary toilet facilities. Poorer women get up earlier than men to queue up for water and take advantage of the dark while using communal or hanging and other types of toilets that hardly have any arrangement for privacy. As a result they become more vulnerable to health hazards than men do. Existing estimates on morbidity (Rahman 1999, Afsar 1999a) suggest that urban poor women in their youth (15-24) and at the middle of their reproductive age cycle (30-44) suffer from greater morbidity than their male counterparts in the same age group. Rural women aged between 30 and 44 years were also found to be more vulnerable in terms of morbidity than their male counterparts.

Country Briefing Paper-Women in Bangladesh Existing taboos and prejudices regarding disease and food, which in turn affect health, are prevalent. In general, rural people of all ages and sex suffer from harmful taboos and prejudices but women suffer more, because these taboos are mostly related with reproductive diseases and women have lesser information exposure and education than men.

Health Infrastructure and Bias in Health Program Physical infrastructure for public and reproductive health exists only in rural areas but services are extremely inadequate. Occupancy rates at 31-bed thana health centers are below 50 percent and only 15 percent of the sick seek treatment from government hospitals for current sickness. Government-run hospitals and health centers often lack drugs, nursing care, and equipment. Pharmacies are the major place where female readymade garment workers seek treatment. In villages and towns people also seek treatment from private doctors (Afsar and Baker 1999). Family planning programs mainly target women. Though family planning programs have enjoyed remarkable success in increasing the contraception prevalence rate, concerns exist in relation to the quality of services, the scope of exercising women's reproductive rights and choices, and male participation in family planning programs. Reproductive health services are mainly concentrated towards fertility control programs, ignoring women's overall reproductive health concerns.

Facilities related to education such as the "Food for Education" stipend scheme for girls up to Class 8, which exist in rural areas, do not exist in urban areas. The girl child's access to primary education and nonformal education are generally constrained by a number of factors that include:

(i) The domestic demand for girls' labor is more regular and generally higher than that for boys of the same age group. While boys become economically active at the age of seven and eight, it has also been observed that parents make special efforts to keep sons in school.

(ii) Despite the Government's efforts to encourage girls in education by providing free schooling at the primary level, and scholarships and food at the secondary level, it is found that some private costs associated with travel, stationery, examination fees, and clothing (particularly for girls) are beyond the means of poor households.

(To be continued)