GLOBALIZATION AND THE DISRUPTION OF MOTHERCARE1

Research Review NS 17.1 (2001) 25-47

Christine Oppong

INTRODUCTION

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The Scale of the Tragedy

The  1998  UN1CEF top r! on the Stale  of the  World's Children detailed  the global scale of
the  loss of infant  well  b.-iig and lives  from  malnutrition  and  the steps  being  taken. It stated
that  malnutrition  is  larily a  silent  and  invisible  emergency,  exacting a  terrible  toll on
children and their  fami)';. It noted  that  malnutrition  plays  a role  in more than  half  of  the
nearly  12 million  de;.ss  each  year  of  children  under  5 in.  developing  countries—a
proportion  unmatched  '•>' any  infectious  disease)  since the Black  Death  ravaged  Europe in
the  fourteenth  century, i underscored the  fact  that  survivors  are left  crippled—chronically

vulnerable  to  illness and  mentally  disabled. Moreover  malnutrition  blunts  the  intellect  and
saps  the productivity  and  potential  of  entire  societies5.  The causes  blamed  were  multiple,
including " a  lack  of  food  , common  and  preventable  infections,  inadequate  care and  unsafe
water."  The  1998  report  did  not  however  focus  on  the 
time  lack  and  energy  deficits  and
conflicting 
tasks  of  mothers,  a  topic  which  had  in  fad  already  been  taken  up  earlier  in  a
number of studies on female time use and a problem of women which had begun to be referred  to
as the zero sum. game  (McGuirc and Popkin  1990).

The  problem  of  hungry  babies  is  not  only  present  in  rural  or  illiterate  or  poverty  stricken
areas.  It is also  found  in urban,  educated  homes and  in  non-poor  areas. In many  countries  in the
region the number of malnourished children in urban areas is also increasing, not only in absolute
numbers  but  also  as  a  proportion  of  all  malnourished  children  (Haddad  el,  al.  1999).  In  the
nineties  strategies  to reach  such children  were  influenced  by assumptions  that  malnutrition  was
located,  together  with  urban  poverty,  mainly  in  squatter  settlements  and  slums,  in  which
insanitary  conditions,  lack of wafer  and high  incidence of child  mortality  and  infectious  diseases
were  common.  Urban  areas were  expected  to be highly  differentiated,  with  spatial  clustering  of
such attributes assumed  to be linked. However  recent analysis of findings  from  African  cities has
shown  that  this  is  not  necessarily  the  case  and  that  nutritional  status  of  infants  is  highly
heterogeneous  within  neighbourhoods,1 a factor  which  itself  makes  location  of the problem  and
targeting of appropriate responses problematic.

Explanations

Many  different  explanations  have  been  put  forward  and  continue  to  influence  the  minds  of
policy  makers  and  planners  in  the  nutrition  field.  These  explanations  are  clearly  of  great
importance  and  need  to  be  carefully  examined,  as  they  affect  the  design  and  development  of
policies,  programs  and  perspectives,  But  first  it  should  be  rioted  at  the  outset  that  infant
malnutrition  has  not 
always  been  endemic  in  the  region.  For  historical  texts  have  been
assembled  to demonstrate the apparent absence of the problem of infant  and toddler  malnutrition
in  the  distant,  pre-coloiiial  past  (Rijpma  1996).  Secondly  the  FAO  (1.996)  Sixth  World Food
Survey  concluded  that,  although  it  is  essential  to  reduce  national  food  inadequacy  in order
to  combat  the  problem  oi*  child  under  nutrition, 
factors  besides
inadequate access  to  food,  since  infant  hunger  is  found  in  nations and  households  which are
not  the  most  food 
insecure  or  deprived.  Moreover  while  measures  to  eliminate  general
deprivation  (as  indicated  by  a  low  per  caput,  GDP  or  HDI)  may  go  a  long way  towards
improving 
it  will  necessarily  do  so.  Infant
malnutrition  is  found  in  countries  wilh  various  levels  of  food  security  and  GDP  and  Human
Development  indicators.  Thirdly  the broad  evidence  assembled  indicates  that poverty  is not  the
only  correlate  or  cause. For  while  income  growth  may  be a key  factor  in  reducing  malnutrition,
recent  studies have confirmed  that  malnutrition  of infants  may persist, even  where rapid  income
growth  occurs (World  Bank  20013 ), just  as it may  escalate when  health  indicators appear to be
improving  (Johnson  and  Stout 1999;  48  on  Mali).  Moreover  infant  malnutrition  is  found  in
households  in the  region  at  all  levels  of  wealth  or asset  holding, not  only  among  the poorest  of
the  poor.  Indeed  in  the  African"  region  there  is  a  markedly  weak  level  of  concentration  of  the
underweight children  under five among the poor or assetlcss households (Wagstaff 2000).7

is  no  guarantee  that 

there  are  other 

risk 

food  access, 

there 

Actually  there  are  several  dimensions  of  the  Sub  Saharan  African  case  under  discussion
which  make  it  unique.  These  include  the  fact  that  proportions  of  infants  malnourished  (aged  6
months to 2 years) have been  rising and continue to rise even  in countries where food, production
is also  reported  lo be  rising,  and  it. is found  in  countries  and  households  documented  as having
relative  sufficiency  of  food,  so it cannot  be  simply  attributed  to rising  food  scarcity  (ACC/SCN
1989;  Smith  1999)/  9  Furthermore  it  is  widespread  and  rising  even  in  countries  with  the
appropriate  political  will, which  have signed  international  declarations  on the  rights of the child.
in  countries  at  peace  nol  war,  so  it  cannot  only  be  blamed
It  is  found  to  be  widespread  even 

26

Research Review "US  17.1  (2001)25-4?

entirely  on  civil  strife  or  population  dislocation.  It  is  documented  in  both  countries  and
households  which  are  non-poor,  so  it. cannot  be  attributed  to  poverty  alone.  Unlike  medical
treatments  (vaccinations  etc.)  and  health  seeking  behaviour,  it  is  not  precisely  correlated  with
quintiles  of  assets  and material  wellbeing  (World  Bank  2001a).  It is fount!  in houses with  water
and  sanitation,  so it cannot  only be attributed  to lack  of such  facilities  (Sommerfelt  and  Stewart
1994),  If is found  among babies who have been given medical care and vaccinated  etc, (ibid). As
it is not precisely  correlated  with health  status and  health  care, one can  improve while the other
docs  not."'  Since  affluence  more  readily  impacts  health  care  than  nutritional  status,, attempts  to
devise  single  indices  of  maternal  cart:  which  combine  elements  of  both  are  doomed  to  weak
heuristic  value  (Maxwell  et  al,  2000  on  Accra).  It  is  found  among  mothers  with  some years of
schooling,  (even  secondary  level), so girls'  education  is not the overall  panacea  some may think
(ibid). 
It  is  found  among  babies  who  have  not  been  suffering  from  measles  or  diarrhea,
frequently  cited  as  a major  causal  factor.  Moreover  marked  lowering  of diarrhea  incidence  in a
whole  population  is  not  necessarily  correlated  with  a  lowering  of  malnutrition  incidence  (eg.
Poskitt  et  al.  1999  on  the  Gambia). 
It  is  not  only  located  in  slums  and  unsanitary
neighbourhoods,  it  is  also  found  in well  off  suburbs  (Haddad  et  a!.  1999).  It is not  found  only
among babies  in  large  families  with  many  siblings  (Dcsai  1992). It is found among babies  who
are well  spaced, born  two or more  years apart.  It is found  among babies of mothers of all  ages,
not only teenage mothers or older  mothers.  It is found  among children  of mothers recorded  to be
both employed  and not employed.

All  this  evidence,  coming  from  recent  Demographic  and  Health  Survey  (DHS)  data  and
Household  Measurement  and  Living  Standards  Surveys  and  medical  and  food  and  nutrition
studies, shows clearly  that  popular  stereotypes, implicating food insecurity,  lack  of political  will
or  legislative  framework,  war,  poverty,  sickness,  access  to  medical  care,  large  family  size,
inadequate  birth  spacing,  lack  of  knowledge  etc.  are  insufficient  as  single  causal  factors.  All
these  political,  economic,  demographic  and  environmental  and  medical  factors  are  obviously
related  somewhat  to  the  incidence,  But  they  do  not  explain  all  the  variation.  We  have  to  look
elsewhere to be able to explain  more of the variance, or in fact  what rather appears sometimes to
be an odd  lack of variance.

A  recent  muHivariate  analysis  of  available  statistical  evidence  by 

IFPRI,  attempting  to
explain  variance  in  child  malnutrition 
in  developing  countries,  has  found  underlying  a
number of determinants  which  appear to  be among the key  factors  (Smith  and  Haddad  1999).
These include: health  environments; women's  education; women's  relative status (as indicated
by  female 
life  expectancy  relative  to  men)  and  per  capita  food  availability,  as well  as  the
underlying  factors, per  capita  national  income and  democracy,  (The authors note that poverty
per  se  was  not  assessed  due  to  data  scarcity.)  They  perceive  the  important  underlying
determinants,  democracy  and  national  incomes,  as working  through  health 
improvements
and  national  food  availability.

As Table  1 demonstrates,  most of  the explanatory  variables  were  improving  globally  during
the  quarter  century  prior  to  1995,  while  the  percent  of  underweight  under  fives  decreased
worldwide.  Access to water,  female  secondary  school  enrolments,  female/male  life  expectancy,
per  capita  dietary  energy  supply  (DBS), and  per  capita  incomes  all  improved.  (Democratization
appeared  to  be.  occurring  until  setbacks  in  the  nineties).  The  quite  different  profile  of  Sub-
Saharan  Africa  however, provides a particular  conundrum.  Table 2 demonstrates the  differences.
While  child  malnutrition  was  going  up,  access  to  safe  water  improved;  female  secondary
schooling  rose;  per  capita  DMS  rose  and  democracy  appeared  to  become  more  widespread.
Negative  trends  were  falling  incomes,  slightly  rising  poverty  and  a  remarkable  fall  of  the
female/male  life  expectancy  ratio,  taken  as  indicating  a  lowering  of  female  status  relative  to
is
males.  Accordingly  in  the  case  of  Africa,  Smith  and  Haddad  (1999)  surmise  that  it 

27

deterioration  in women's  relative status  (life  expectancy  which  declined  since the  seventies
and  especially  after  1985)  and  per  capita  national 
incomes,  that
partly  explain  the marked deterioration  in child  nutiition  in the  region during the period.

incomes  and  household 

Table  1:  Global Trends  in < 5 Malnutrition (underweight) and  explanatory Variables

1970-1995.

1970

1975

1980

1985

1990

1995

Absolute
Change
1970-95

% Population with  safe access

to water

30.2

45.4

52.4

60.7

69.9

70.3

40.1

% Female secondary enrolment

15.6

25.4

28.4

30.6

36.4

46.6

Female  to  male  life

expectancy  ratio

Per  capita  dietary energy

supply (kilo calories)

1.022

1.026

1.033

1.040

1.045

1.048

2092

2089

2226

2380

2472

2559

31.0

.024

467

Per  capita  national  income  $

1011

1163

1361

1378

1673

2121

1111

Democracy (1  = least

2.85

2.99

3.75

3.31

3.24

2.71

-0.14

democratic)

% underweight <5

46.5

41.6

37.8

34,3

32.3

31.0

-15.5

Source: Smith and Haddad  (1999) tables  1 and 16.

They  speculate  that  other  related  factors  might  be  deterioration 

the  capacity  and
outreach  of  government services,  under the  impact  of  debt and structural  adjustment  and the
rising  incidence  of  HIV/AIDS  and  conflict.  They  find  puzzling  the  decline  in  women's
status (life  expectancy)  relative  to men, hypothesizing that declines  in  women's relative status
in the region  have  muted  the positive  impacts  of  the  other  determinants  which have been
improving (such as access to potable water).

in 

Female Roles and Relative Statuses

Accordingly  the conclusion  of Smith and Haddad  (1999) on the basis of their  comprehensive
statistical analysis was that, their  research confirmed  the  now  overwhelming  evidence  of the
impact  of  women's  education  on  children's  nutrition,  but  in  addition  it  also
strong 
established 
that women's  relative  status  is  an  important  determinant  of child  malnutrition
in  all  developing  country  regions. They  noted  that  their  findings  confirmed  women's  key
role in the  etiology  of  child  malnutrition;  whether  through  the  pathway  of  maternal and
security.  Significantly  they  emphasized  that  combined,
child  care  or  household 
improvements 
in  women's  education  and  status  alone,  contributed  to  over  50%  of  the
reduction  in child  malnutrition  that  took  place  in developing countries  from  1970 to  1995.
They accordingly  underlined  the fact  that more  emphasis  should  be  placed  on  these  factors
in  the  future  than  has  been  in the  past.11  They  finally  concluded  that  a  more  in  depth

food 

28

Research Review NS  17.1 (2001) 25-47

understanding  of  the  little  studied  roles  of  democracy and  women *s status  are  needed and
that the roles  of  debt and  structural  adjustment,  conflict  and HIV AIDS need  to  be  looked at
more (ibid p. 63).

Table 2 :1985 -  95 Trends in the Determinants  of  Child Malnutrition  in Sub Saharan

Africa

Child Malnutrition  (%)

Access  to  safe  water  (%)
Female secondary enrolment  (%)
Per  capita  dietary energy supply*
Democracy
Poverty  (%)
Per  capita  national  income

1985

25.8

33.5
16.4
2035
2.01
38.5  (1983)
$830

Female  to  male  life  expectancy  ratio

1.066

1995

31.1

48.8
19.0
2136
2.44
39.1  (1993)
$778

1.054

* DES kilocalories
Source Smith and Haddad (1999)
Data are  population weighted  means over all countries  in the  data  set  in the  region.

The  task  here  is to  look  further  at  the  issue  of  women's  declining  relative  status  vis  a  vis
males  in  the  region,  as  indicated  by  the  lowering  of  relative  life  expectancy,  and  to  examine
likely  causes  and  correlates  and  potential  impacts  on  maternal  care  and  infant  feeding,  which
have  led  to  the  escalation  of  infant  hunger  and  malnutrition.  The  underlying  conceptual
framework and dynamic model of family  and gender relations and an array of hypotheses needed
to facilitate such an analysis have been initially provided by anthropological work, carried out on
gender  roles  and  population  issues  in  the  nineteen  sixties  and  seventies  in  Ghana.12  This  was
anthropological work which spelled out a systemic framework  for examining change and lack of
change  in  gender  roles  and  relationships  in  the  processes  of  production  and  reproduction  in
altering familial  contexts.13 This work was followed by analyses of  dynamics of gender roles in
the  context  of economic  and demographic  transformation,  leading to excess  strain, conflict  and
vulnerability  for  working  mothers  and  linked  to  changes  in  demographic  outcomes  and
reproductive  health.14  This  earlier  work  now  provides  the  basis  and  the  models  needed  for
examining  changing  gender roles in production  and reproduction  and infant  nutrition  outcomes
and  in  particular  how  changes  in  occupational,  conjugal,  domestic  and  kin  roles  have  been
increasing womens' conflicts, stress and resource strain as nursing mothers of babies, resulting in
both negative impacts for mothers'  own wellbeing and their care of their babies. Sources of role
strain  include the diminishing help from  scattered kin, including school-going children, and role
conflicts  engendered  by  simultaneous  conflicting  tasks  in  contexts  of  diminished  opportunities
for delegation or support. Accordingly the ultimate focus is on Mother care of infants under two,
and  how  it  appears  to  have  been  changing  over  time,  partly  as  a  result  of  other  role  changes
ongoing.

INFANT  CARE AND FEEDING

Fortunately  the need  to include  mother care in  causal models of infant  nutritional  status, is
increasingly  acknowledged  in  the  pronouncements  and  writings  of  international  and  national
organizations focusing on the problem of infant hunger and malnutrition. It has in fact recurred in

29

a number of major  models  of  UN1CEF  and  other  organizations. Thus  in  1987 UNICEF  clearly
presented  a model  of the factors  at the household  level  impacting the state of children's  nutrition.
It  stressed  the  crucial  nature  of  the  child's  first  two  years,  the  months  when  growth  should  be
rapid,  energy  needs  are  great  and  the  period  when  the  task  of  feeding  the  child  is  at  its  most
difficult;  as the  child  needs  to  be  fed  with  loving  care  very  often  during  the  day  and  night  and
with  nutrients  suited  to  its  digestive  capabilities,  in particular  breast  milk  for  the  first  months,
even years. It is also the  period  when  guarding against  diarrhea! disease is most  important. In the
illustrative  figure  in  that  document  demands  on  mother's  time  were  seen  as  affected  by  the
family's  productive  labour  needs;  domestic  work  and  responsibility;  time  spent  collecting  fuel
and  water  etc.,  her  time  available  affecting  the  crucial  frequency  and  duration  of  baby's  feeds
and  food  intake.

Indeed  health  experts  of  the  WHO  are  fully  aware  that  devotion  of  more  maternal  time and
energy to breast feeding  more intensively and  for  longer durations could  prevent  the deaths of  1
million  or  more  children  world-wide  each  year.  However  the  problem  is  not  only  inadequate
access to food  and clean, water  but  inadequate  child-care; not  enough  time and  attention  of over
worked,  tired  mothers  available  for  allocation  to  the  crucial  processes  of  baby  nursing  and
weaning.  And  there  are  signs  that  mothers  themselves  feel  too pained  and  guilt-ridden  to speak
out  about  the problem.  Yet mother care does  not appear  to feature  prominently  enough  in many
current  explanatory  frameworks  or  to  be  well  indexed  or  measured  and  there  appear  to  be  a
number of problems involved  in indexing and  measuring of relevant variables,15

Taking  up  the  issue  of  the  adequacy  of  infant  care  and  some  possible  factors  linked  to  its
variation  and  change,  involves  considering:  la.cta.ting  mothers'  ability  to  respond  effectively  to
the  demands  of  motherhood,  in  the  context  of  other  demands  made  upon  them  as  housewives,
workers  and  so on  (role conflict); the effectiveness  of maternal  responses  to  infants'  nutritional
needs  and  possible  constraints  inhibiting  the  required  care  responses  (role strain  and coping—
availability  of  required  resources):  as  well  as  the  effectiveness  of  social  support  provided  by
spouses, kin  and  community  (see  Oppong  1980;  Oppong  and  Abu  1985;  1987). The  need  for
such a  framework  taking  into account  social  support  and  role  conflicts  has  been  demonstrated
by the  recent  findings  from  studies  of  infant  feeding  in Mali, which  have  shown the crucial
nature  of  assistance  from  grandmothers  and  daughters  and  the  potential  negative  effects  of
too  heavy  work,  demands  on  nursing  mothers (Casile  el ak 2001).

Breast  is Best

It is a sad  irony that scientific  evidence on the importance of breast feeding  to babies and their
mothers  has  been  rapidly  accumulating, just  at  a point  in  history  when  lactation  has  endured a
period  of  serious  decline.  Current  and  recent  medical  scholarship  provides  a  mass  of  weighty
evidence  of diverse kinds on trie need  for  exclusive and  extended  breast  feeding,  if infants  are to
thrive  and  reach  their  full  human  potential.  The  benefits  both  psychic  and  somatic  have  been
summarised  recently  on the basis of analyses  from  the  Demographic  and  Health  Surveys (DHS)
(Haggerty  and  Rutslein  1999:  xiii.).16  The  evidence  amassed  clearly  underlines  the  fact  that
breast  feeding  needs  to  be  revalued  and  ways  found  to  facilitate  its prioritization  globally in
mothers'  time  schedules. One  thing  which, appears  clear and well documented  from  around  the
globe,  is  that breast feeding  requires  solidarity  and  cooperation  at  the  household  level, from
spouses,  kin  and  older  children  (Raphael  and  Davis  1984). New  mothers  need  financial  and
social support, advice and  help  with  household  tasks, as well as infant  care. Critically they also
need  flexibility  and  lightening  of  their  own  occupational  and  domestic  schedules  in the  crucial
pre  and  post  birth  periods,  if  low  birth  weight  is  to  be  avoided  and  suckling  established  and
supported.  Data on  such potentially  critical  processes  and  resources is sadly  lacking in the  major
sources of evidence on breast  fcedinc

30

Adequacy  of Maternal  Care: Inadequacy  of the  Evidence

Research  Review  NS  17.1  (2001)25-47

in spite of the eloquence of global  and regional  overviews and policy  statements and  national
assessments,  maternal  nursing  and  infant  nutrition,  and  in  particular  failure  to  care  adequately
and  failure  to  thrive  on  the  part  of  infants,  is  relatively  understudied,  in  this  region  and
elsewhere;  in  view  of  its  tremendous  importance  to  human  and  economic  development  and
considering  the  vast  outpouring  of literature  on  women  and  gender  roles  in recent  years.  The
lack  of comparative  studies  is not only  a consequence  of the absence of will or interest,  it is also
partly  a result  of the  lack  of  appropriate  measuring  devices  and  conceptual  frameworks,  needed
to capture  the dimensions  of the mother  infant  interactions  and the socio-cultural,  economic  and
demographic  contexts within  which they occur. More specifically  the development  ofschemas  to
categorize  and  compare  both  breast  feeding  and  women's  work  have  only  recently  been
developed,18  Meanwhile  there  has  often  been  a  marked  reluctance  to  adopt  frameworks  which
specifically  include  and  deconstruct  the  several  different  roles  which  women  may  from  time  to
time  play  and  which  as  we  have  noted,  potentially  facilitate  the  assessment  of  role  conflict,
strain, harmony  and tension.14 Furthermore there has been a marked gender  of the data, whereby
information  in lar«c <-ralc «n»1ics on  labour  for men  and more on

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Tlie  Demographic  and  Health  Survey  (DHS)  findings  show  that  African  mothers  generally
undertake  extended  periods  of  breast  feeding,  bin  that  exclusive  breast  feeding  is  typically  of
very  short  duration  indeed  contrary  to the advice on best practice. However  these  survey  data
are  unfortunately  basically  unable  to  tell  us  much  about  women's  other  role  resources  and
demands  (occupational,  conjugal,  domestic,  kin  etc.)  and  how  they  appear  to  affect  breast
feeding,  due  to  the  nature  of  their  design.'1'  If  we  want  to  look  at  changes  which  have  been
occurring  over lime, we may have to look  more closely  at case studies as well  as statistics,

Child  Care as Labour  Process

Infant  and toddler care and  feeding  is clearly  required  on. a continuous basis,  because  infants
to obtain  the  nutrients  they  need,2'  Such  care  is of necessity  very
cannot  fend  for  themselves 
intensive  and  requires  considerable  time  and  attention,  throughout  the  day  and  night,  for  babies
need  feeding  every  two  or  three  hours  or  so,"  It  is thus  not  entirely  surprising  to  discover  that
levels of malnutrition  of babies are most serious  from  6-24  months; the period  when  they  are no
longer  new  borns  and  not yet  able  to obiain  food  for  themselves,  from  whatever  is available in
their  environment.  Meanwhile  at that tune their potential  growth  rate, especially  of vital  organs
such  as the  brain,  is high.  In  addition  there  is  the  absolute  requirement  that  somebody  must  be
there to  attend  to their needs  as  they  occur.  Furthermore  such  needs change  rapidly  as the baby

grows  into  a toddler,  and  have  ideally  to be continually  reassessed,  so  that  the response  can  be
optimal  and  appropriate  to  the  need/3 
It  is  not  surprising  that  skills  required  to  do  this  arc
resource  management,  interpersonal  skills,
accounted  to  be  of  a  high  level,  involving 
communication  and  intellectual  and  supervisory  skills 
(Gardiner  1997).  Last  but  not  least,
positive affect/love  is needed, as well  as maternal  confidence.  Without  love, effective  emotional
attachment  and  psycho-social  stimulation, babies become anorexic, wither, suffer  damage and in
the most extreme cases may die.

Systemic  Perspectives

In the  seventies  infant  feeding  and  care began  to  be  perceived  and discussed  in an  inter-
disciplinary  way  and  as  a  socio-biologica!  and  ecological  system,  involving  not  only the.
mother  infant  dyad,  but also  including  the  rest  of the  family  members (in the domestic group
and descent group)  and  the  community.  Indeed  it began  to  be  viewed  as  a  universal  issue,
with  a  number  of  dimensions,  including  social, psychological  and  cultural, linked  to global,
economic  and  demographic  transformations  and  as  a  process  in  the  context  of  human
development.24

The  perspective  adopted  here,  following  Brofenbrenner  (1979)  and  others,  is  that  infant
feeding  patterns  are  affected  by  the  state  of  their  ecological  niche,  which  is  in  turn  partly a
product of transformations  occurring in the macro  poliiical and  economic  context  of  the world
system,  both  historical  and  contemporary,  including  colonialism  and  structural  adjustment,
neocolonialism  and  globalization  processes,  as  well  as  the  micro  context  of  the  residential
group. The economic  and  demographic  transformations  engendered  involve  massive  dislocation
of people, through  labour migration  for elusive paid jobs and rapid urbanization, dispersal  of kin,
distortion  of  sex  ratios,  and  destabilizalion  of  traditional,  family  based  enterprises,  as  well  as
erosion  of  customary,  familial  solidarity  and  security  and  increasing  divergence  in  wealth  and
opportunities.

The household  level  processes include changes in the composition  of co-residential  domestic
groups, 
including  more  homes  bereft  of  fathers  and  husbands;  alterations  in  the  household
allocation  of  labour-  -often  more  work  for  women  alone;  changes  in  access  to  resources  and
power  bases  which  may  involve  less  for  women  and  children  in  the  midst  of  equality  rhetoric;
and  most  crucially,  the  break  down  of  the  moral  orders  underpinning  systems  of  kinship  and
marriage,  which  had  for  so  long  constrained  sexual  relations  and  ordered  the  sequence  of
pregnancies,  protecting  and  supporting  the  parturient  and  lactating  mother.  The  crux  of  the
matter is rapidly  and  profoundly  altering  gender roles and  relations, affecting  the demands upon
mothers  and  the  supports  and  protection  available  to  them  for  reproduction  and  infant  nursing
from  adults  and  children,  male  and  female  (husbands, molhers,  aunts, cousins,  daughters,  sons,
nephews and nieces).

Altering Patterns  of infant  Care

Historical  and  comparative  analysis  has  underlined  the  fact  that  it  has  been  usual  for  infant
care to be shared  and delegated  among close, supportive, female kin and affines,  and this is what
the  ethnographic  accounts  have  reported  from  many  traditional  African  societies  in  both  the
colonial  and post colonial  periods; while husbands and  male kin  should play a crucial  protective
and  supportive part. For example Levine et al. (1994) note that it used  to be customary for  Gusii
mothers  in  Kenya  to  return  to  work  in  the  second  year  of  the  baby's  life—women  worked  in
fields and  men  with  cattle  and  after  this transition  of the mother to the farm,  responsibilities  for
care  of  the  baby  were  shared  in  substantial  degree  with  older  siblings,  a  very  typical  African
pattern  of sibling  caref.ak.ing  (Weisner  and  Gallimore  j 977). New  mothers  were given  time and
secluded  space  to  concentrate  on  the  needs  of  the  newborn.  In  some  societies,  such  as  the
traditional  kingdom  of  Dagbon,  Northern  Ghana,  new  mothers  have  in  the  past  customarily
returned  to their natal  home for  a  time, to concentrate on  infant  care, while they themselves are

32

Research Review NS  17.1 (2001) 25-47

also  mothered,  until  the  infant  is grown  and  waking  (Oppong  1973). Such  practices,  combined
with  overseeing  of the new  mother's  activities  and  relations  with  the  husband,  clearly  prevents
the already born infant,  who is suckling at the breast,  from being superseded  and dethroned  from
its place of attention  by  another closely  spaced  birth. It gives the infant's  needs precedence  over
Ihc  father's  sexual  desires  and  enjoyment  of  the  mother's  more  or  less  undivided  attention.''
Now  school  attendance  for  most  boys  and  girls  from  6  or  7  years  means  that  there  are  only
preschoolers  or no one at all  left  to carry  and  look  after  the baby when the mother is working in
farm,  market  or  elsewhere.'6  The  babies  as  a  consequence  may  suffer  death,  anorexia  and
wasting away.

Comparative  Historical  Evidence of Failure to Care

Actually  taking  a broad  comparative  and  historical  view,  it  is  in  fact  culturally  rare, both  for
people  to  specialize  in domestic  childcare  and  for  domestic  chikicare  to be  the responsibility  of
isolated  individuals/mothers  (Gardiner  1997), Studies carried  out in many  different  locations and
decades have  discovered  levels of conflict,  stress  and depression,  when mothers  are expected  to
cope  alone with  several  different  sets of  demands, as well  as child  care (conjugal,  occupational,
domestic).  Significantly  female  depression  in the child  bearing years  is globally  on the  increase
and  is the  first  and  most  seriou,  cause  of  disease  burden,  for  women  aged  15-44  (1990)  in  the
developing  (and  developed)  world  (Murray  and  Lopez  eds,  1996).27  One  could  surmise  that
maternal  role  conflict,  a  result  of too  many  demands  on  energy  and  time  and  stress  and  strain,
exacerbated  by  lack  of  material  resources  and  social  support,  are  deeply  implicated  in  an
important proportion  of cases.

In  Sub  Saharan  Africa  and  elsewhere  economic  and  demographic  change processes  have  for
some time been perceived  as potentially jeopardising infant  care and feeding  practices,  through
altering  gender  roles and  relations—of  husbands  and  wives, siblings, parents and  children  and
wider  kin.  This  is  not  a  new  perspective.  It  is  evident  from  a  number  of  sources  that  macro
economic  and  demographic  processes, involving  migrant wage  labour have  for  some time been
bringing  about  irrevocable  changes  in  parenthood  and  family 
life  in  the  region.  The  early
writings  of  Audrey  Richards  (1.939)  among  others,  on  the  Bemba,  copiously  documented  such
processes  more  than  half  a  century  ago,  linking  hunger  with  labour  migration,  altering  work
locations  and  domestic  constraints.  And  for  several  decades  anthropologists  have  been  noting
that changes  in sexual divisions of labour have been  leading to diversion, of time and energy from
children  to productive  labour  and  the  consequent  deprivation  of  infants  and  changes  in  mother
care (eg. Levine  1966). In addition  there have been changes associated  with commoditizing  food
and rnedicalizing  infant  births,  and  health.

toddlers'  malnutrition,  the  outcomes  of 

In  the  seventies  escalating  infant  nutrition  problems,  even  child  survival,  began 

to  be
widely  associated  by health  experts with  altering  patterns  of  infant  feeding.28  Babies'  hunger
and 
inadequate  nursing  and  weaning,  were
recognized  to  be  issues  of gigantic  and  growing  proportions, with  a  historical  record  to  be
explored and  regional  differences  to  be  understood (Jelliffe  and Jelliffe  1978). Bottles of cows'
milk  of  various  kinds,  often  shipped  from  the  North  to  the  South,  were  viewed  as  part  of  the
problem.

Meanwhile  various  writers  have  documented  the  dislocations  of  parenthood  occurring  in.
contexts  of  exploitation,  pauperization  ami urbanization.29  In the  eighties  Van  Esterik  (1,989:
55-58) described  how  the  globalizing,  capitalist  economy  was using women's  cheap  labour
in  developing  countries  of  Africa  and  elsewhere  at  the  expense  of 
their  reproductive
functions;  sacking  them  on  pregnancy,  with  no  possibility  of  maternity  leave  benefits  or
lactation  breaks.  A four  country  study  of  infant  feeding  by  Winnikoff  et al. (1988)  had
shown that  there are  multiple  determinants of  duration  of  breast feeding,  and  that  conditions

strongly  associated  with  the 

of  mothers'  work  and  distance from  work are  very  important. Indeed  mother's work  load has
been  statistically  demonstrated  to  be 
of
complementary  feeding;  a point which  Neriove (1974) made earlier, with evidence on maternal
contribution  to subsistence  from  numerous pre-industrial  societies. This work  called  attention  to
the need  to  rethink  work  from  a  feminist  perspective,  since it has different  dimensions and  is
so difficult  to evaluate and  measure  (Van  Esterik  1990);'° In fact  a number of detailed  historical
studies 
from  various  countries  have  demonstrated  the  immediate  effects  of  mothers'  work
demands  os; failure to breast  feed  and  or wean  adequately, and  consequently  on infant  mortality
and  fertility  (eg.  Lithell  1981).  Surprisingly  however  by  the  end  of  the  eighties  Leslie  and
Paolisso  (eds.1989)  indicated  that  while  some  interesting  studies  had  been  undertaken  in  the
South the subject was surprisingly  comparatively  under studied.

early 

initiation 

Maternal  Coping  and  Infant  Outcomes: Colonial  Examples

In the  African  region  there  were  a number  of  small  scale, clinical  studies,  carried  out  in  the
colonial  era,  which  have  examined  the  well  being  and  nutritional  status  or  patfern  of growth  of
infants  and  toddlers  in  the  light  of  their  maternal  care  or  family  situation,  highlighting  factors
which  appear  to  be  linked  to  excess  infant  vulnerability.  Williams,  a  lady  physician  working
in  Accra,  was  a  significant  pioneer  in  treating  and  documenting  infant
among  the  Ga 
the  Ga  term  kwashiorkor,  meaning  sickness 
malnutrition.  She  used 
the  older  child  gets
when 
the  next  baby 
is  born  too  soon.  (See  Williams  1933:  1935;  1938;  1962).  The  term
became  part  of  the  nutritional  and  medical  lexicon.  Now  kwashiorkor  and  marasmus  arc
viewed  as  different  syndromes  of  protein  calorie  malnutrition.

Observations  from  a number of  Medical  Officers  from  the colonial  era. provide  examples of
differential  maternal  care  and  ils  immediate  outcomes  and  the  importance  of  effective  maternal
attachment  and  breast  feeding  (eg.  Welbourn  1955; Morely  et  al.  1968),  Evidence  comes  from
The Gambia  where there has been  a medical  research  project  in existence with external  financial
support for half a century. (See McGregor et al.  1961,)

Major  causes  of  high  mortality  and  faltering  growth  in  young  children  were  thought  to  be
infection  and  poor  care  by  overworked,  farming  mothers.  Examples  like  these  give  crucial
evidence from  the colonial  and  post colonial  eras, indicating linkages between  changing maternal
roles  and  infant  outcomes,  in  the  context  of  labour  migration,  changing  divisions  of  labour
between  mothers  and  others,  affecting  intensity  of  effort  required  and  demands  upon  mothers*
energy  and  time  and  the  supports  available  to  her  in  her  tasks  of  reproduction  and  production.
What  we  now  briefly  consider  is  why  the  situation  for  mothers  and  their  babies  seems  to  have
deteriorated  so rapidly  in  recent  years, to such  an extent that relative  female  life  expectancy  has
gone  down  and  infant  malnutrition  has  gone  up  (even  in  countries  not  so  far  devastated  by  the
ravages o f HIV/AIDS),

GLOBALIZATION,  STRUCTURAL  ADJUSTMENT  AND THE SPEED OF  CHANGE
There  arc  those  who  are  for,  and  those who  are  against,  globalization.  Some  view  it  as the
march  of  international  capitalism,  a force  for  oppression, exploitation  and  injustice.  Others view
it  as  economic  integration  and  a  force  for  good  and  the  only  feasible  cure  for  poverty  (Crook
2001)..  What  is  certain  is  that  there  are  painful  social  and  economic  dislocations  involved,  and
these  have  been  likened  to  those  involved  in  the  Industrial  Revolution  in  Europe-—probably  an
apt comparison  in this context,  as that  revolution  certainly took  its toll  of malnutrition  and  death
on  the  babies  of  working  women.31  In  the  same  way  there  have  been  proponents  of  the  good
(World  Bank  1994) and the bad  effects  of the Structural  Adjustment  Programs, which have been
put in place in a number of African  countries. Exponents of the latter have been many. They have
highlighted  harsh  realities  (Blandford  et  al.  1994);  the  deleterious  impact  on  women's  food
farming;32  the associated  impoverishment  (Berry  et al.  1997); the human  suffering  (Cornia  et al.

34

Research Review NS  17.1  (2001)25-47

eds.  1987);  the  policy  failures  (Sahn  cd.  1994);  and  the  severe  consequences  for  women  in
particular  (eg. Ashlar  and  Dennis eds.  1992; Baden  1993; Bakker ed.  1993). At the same time, if
we are considering the deteriorating economic conditions experienced  by the mass of the people
in  many  African  countries,  we  have  to  take  into  account:  the  effects  of  the  less  than  good
governance  in many  cases,, political  instabilities  of various kinds and  the widespread  opening up
of  avenues  for  exploitation  and  corruption  by  both  local  and  external  bodies  in  the  name  of
development.

Major  consequences  for populations at the local level  of the market forces  and global  changes
and  national  policies  and  practices  have  included  massive  dislocation  of  people  and  in  depth
inroads  of  the  cash  economy.  People  feel  increasingly  cornpclled  to  niigrale  to cam,  to  support,
themselves  and  any  dependents  they  are  willing  or  able  to  maintain.  Massive  waves  of  labour
migration  have  been  occurring  region  wide,  changing  direction  from  one  period  to  the  next  as
opportunities  for  wage  work  alter,  in the  wake  of  economic  progress  or  stagnation.  Populations
have  moved  from  rural  to  rural,  rural  to  urban  areas  and  an  increasing  number  of job  seekers
have  been  leaving  the  region  altogether,  to  pursue  their greener  pasture  survival  strategies  in
different  parts  of  the  globe,  with  a  range  of  implications,  positive  and  negative  for  family
members  left  behind.  Men,  women  and  children  have  been  moving  to  urban  areas  with
unprecedented  rapidity, making  Sub Saharan  African  cities some of the most rapidly growing in
the world.

Systems  of  agricultural  subsistence  production  and  labour  markets  have  also  been  changing
quickly.  Many  more  people  are  landless,  in  insecure,  daily  rated  jobs,  paid  below  the  poverty
line,  labouring  longer  and  harder  often  ai  more  than  one job,  to  earn  less.  The  position  of  the
labouring  poor  lias  radically  worsened.  The  power  of  workers'  organizations  has  been,
weakened,  as  has  the  capacity  of  states 
to  promote  or  enforce  labour  standards  or  to  collect
taxes to fund  welfare  programs.  Meanwhile  health, social  services  and  education  programs have
been  cut back, just  as populations are reaping the results of high  fertility,  lowering mortality and
the consequent  doubling of populations in two decades.

In  the  context  of  these  profoundly  disturbing  and  dislocating  economic  and  demographic
change processes, traditional  sources of familial  and  individual  sustenance are rapidly  dwindling.
Modern,  as well  as  customary,  social  supports  and  safety  nets  are  being  put  at risk,  as  descent
group/extended  family  solidarity  declines  through  dispersal  of  kin  and  growing  inequalities.
.Meanwhile  fragile  national  social  security  systems  falter  and collapse. Numbers of homeless and
destitute  are  rising.  Disputed  gender  roles  in  marriage  and 
the  family  are  common,  often
involving  conflict  (Narayan  and  Petesch  2002).  Hopes 
thai  market  forces  would  deal  with
social  problems  and  promote  human  development  have  not  materialized,  The gaps between  the
haves and have nots  at the national and community  levels are escalating  fast.

Gendered  Impacts

A  growing  proportion  of  wage  workers  have  for  some  time  been  women  (Standing  1989).
There  has  been  both  a  feminizution  of  labour  and  a feminization  of poverty  (United  Nations
1995).  By and  large  it  is  the  impoverished,  including  more  females  than  males,  who  maintain
and  care for  the  majority  of the  babies  and  young  children  as well  as the sick. This  pattern  is
found  at the global, regional, naiional  and household  levels, as is the trend  of increasing disparity
between  males  and  females,  in  both  resources  and  reproductive  effort  and  responsibilities.  In
addition  a  negative  fact  for  mothers  is  that  there  has  been  a  marked  downturn  of  state
employment  arid  welfare  policies  and  programs  ensuring  minimal  standards  of  human
development  and  social  protection,  as countries  have been  compelled  under  the duress of World
Bank  and  IMF  policy  pressures,  to  adjust  economies;  to  export  surpluses  and  pay  debts
accumulated  under  earlier  regimes; to  get  rid  of regulations  protecting  labour;  to  sell  off  public

35

enterprises  and assets and  to cut back  state expenditures on health, education  and public  welfare.
Such  policies  have  aggravated  hardships  for  the  poor.  The  bulk  of  the  latter  are  children  and
those seeking to care for and maintain  them, mainly  women.

In  the nineties  a number  of  feminists  noted  there  had  been  widespread  failure  to  recognise
that economic  restructuring  at all  levels was occurring  on a gendered  terrain  (Bakker  1993), Yet
gender—culturally  prescribed  sexual  divisions  of  labour,  resources  and  responsibilities  is  a
highly  significant  factor  in the economic  adjustment  of African  economies,  both  in terms of  the
impacts  of  gender  factors  on  Ihe  effectiveness  of  market  reform  policies  and 
in  terms  of
differential  impacts  of  reforms  on  women  and  men 
the  demands  made  upon  them  and  the
rewards  for  labour  which  accrue  to  them  (Palmer  1991).  The  point  here  is  that  social
reproduction  is also heavily gendered and  is currently  facing  increasing jeopardy.

The  migration  process  itself  is  shaped 

in  multiple  ways  by  the  dynamics  of  gender
relations.  Flowing  streams  of  labour  migration  by  females  and  males  remain  a  key  factor
dispersing  kin,  splitting  spouses  and  separating  parents  and  children. 
The  resulting
individualism,  dwindling  of  kin  controls,  community  constraints  and  sanctions  on  sexual
behaviour,  conjugal  contracts  and  parental  responsibilities,  have  resulted  in  more  frequent
marital  splits and divorces, greater  domestic instability, more births occurring outside caring kin
contexts, more conceptions to unaided, partnerless girls and women, and consequently  escalating
cases  of  maternal  inability  to  cope  with  infant  needs.  Not  only  are  more  and  more  girls  and
women  migrating  for  work  wiihin  their  own  countries  and  internationally,  they  are  also
increasingly  moving  either  into  paid  employment  or  various  types  of  economic  survival
strategies,  trading, home production  etc, through  part or all  of their  life  cycles. Their mobility  is
partly  a response to the inadequacy  or breakdown  of sources of  kin and conjugal  sustenance and
security  and opportunities  for  livelihoods in their home communities. Where male out migration
is the pattern  there  is  evidence  of sex  ratio  imbalances  among teenagers  and  young adults  in
many rural areas, with  serious implications  for marriage choices and opportunities  and parenting,
as  well  as  intensity  of  labour  effort  required.  The  numbers  and  proportions  of  households
maintained  by  mothers  alone,  without  the  husbands/fathers  of  their  children,  has  increased
throughout  the  region  and  has  readied  substantial  levels  in  a  number  of  countries.  The
widespread  feminisaiion  of  poverty  is  linked  to  these  increases.  Profound  changes  are  taking
place  in male  roles vis a vis partners  and  offspring,  gender  roles  and relations  are  being deeply
disrupted  and  linked to the  escalating  levels of potential child  deprivation.3

Escalating  Female Work  Burdens

Meanwhile  according  to  UN  Statistics  (United  Nations  1995) women  generally  work  longer
hours 
than  men  in  all  regions  and  the  number  of  hours  they  work  outside  the  home  is
increasing."  The  female  share  of the  documented  wage  labour  force  has been  rising,  in. contrast
to that of men, which has been  falling.  Sub Saharan Africa  is no exception to this trend. However
measurement  and recording difficulties  hamper a (rue assessment of the extent of the rise and  the
excess in this  region  (eg. Anker  1994).  rj  A  stumbling  block  is the widespread  under  recording
of women's  work. Often  women's  work  in agriculture is perceived  as part of her role  as  dutiful
wife  and  mother,  providing  food  for  her  family 
(e.g.  Whitehead  1994  on  Ghana).  The  hours
females  as well  as males work  and  the intensity  of  labour  is often  a function  of their position  in
the class and  family  structure, long hours and  hard  labour  reflecting  lack of assets, poor  conjugal
and  kin  support  and  consequent  insecurity.  But 
in  addition  their  subsistence  and  domestic
work  burdens  are  among  the  heaviest,  because  of  the  lack  of  basic  domestic  amenities
(such  as  electricity  or other  household  fuel).  Meanwhile  as household  wood  fuel  use  is even
increasing, access  is  constrained  by  drought  and  environmental  degradation  (United  Nations
1995). Household  subsistence  work  also goes mainly  unaccounted  and unvalued.  Yet it absorbs
a  large  proportion  of  women's  time  and  energy,  and plays  a significant  part  in  ensuring  family
survival  and subsistence (Gokisehrnidt Clcrmont  1987; 1994).36  There are signs that the burdens

36

Research Review NS  17.1 (2001) 25-47

of  such  work  have  been  aggravated  by  environmental  degradation,  worsening  access  to  fuel,
farming  land  and  water  (eg.  Ceceiski  1987;  Ardeyfio  Schaandorf  1993).  At  the  same  time
fertility  rates  remain  among the  highest in the  world; the  need  for  child assistance  providing
a  continuing 
fertility  aspirations;  the  lack  of  real  access  to  modem
contraceptives  and  break  down  of  traditional  abstinence  mechanisms,  effectively  constraining
attempts at family  planning, leaving abortion  sometimes as a method of last resort.

for  high 

support 

in  greater  numbers  away 

Whether  on  or  off  farms,  the  majority  are  self  employed  or 

in  family  enterprises  as
unpaid  labour, although  increasing  numbers are  insecure daily  rated  labourers.  Work  is  more
and  more  situated  far  away  from  home,  from  spouses,  from  children, and  kin.  This  is
having  profound  repercussions  on  conjugal  and  parental  relations  and  deeply  affecting  the
kinds  of  cooperation  usual  between  wives  and  husbands  on  farms.  In cases  where  males
have  migrated 
rural
households with  no  male  labour are  escalating,  with  consequent  impacts  on  women's  work
loads and  an  observed  ferninisaiion of agriculture.  The  loss of  soil  fertility,  the  introduction  of
cash  crops,  the  dispersal  of  kin  groups  and  wide  spread  ecological  changes  have  also  made
women's  agricultural  tasks  harder,  increasing  the  intensity  of  effort  required.  Improvements  in
data  collection  methods  are  providing  new 
insights  into  the  allocations  of  female  and  male
labour  on  farms.  Cultivators  and  agricultural  labourers  often  comprise  the  bulk  of  women
workers.  Many  work  on  plantations,  where  they  are  likely  to  perform  the  most  arduous  and
menial jobs in difficult  conditions,

from  rural  areas,  the  proportions  of 

Disadvantages  and  discrimination  faced  by  women  in  wage  labour  markets,  as  well  as  the
weight  of  their  family  responsibilities.,  force  them  to  accept 
less  secure,  less  well  paid  jobs,
involving  more  intense  labour,  longer  hours  and  inadequate  rest.  Women  and  girls  are  more
often  in  temporary,  casual,  pail-time  jobs,  home-working  and  subcontracting,  in  putting  out
systems  and  self  employment  in  petty  enterprises  in  the  informal  sector,  unprotected  by  labour
laws  and  regulations,  which  would  limit  their  hours  of  work,  weights  lifted,  unhealthy
conditions  and  provide  maternity  protection  etc.  What  is more,  many  are doing  several jobs  to
ensure  survival  of themselves, their  children  and  other  family  members.  ''  In  some eases  in. the
retrenchment  programs  affecting  government  employees,  part  of  Structural  Adjustment
packages,  have often  meant  that  hundreds of women,  including teachers  and nurses, part of the
small  formal  sector,  have  had  to  move  into  the  informal  sector.  The  result  for  women  is
generally longer hours of harder and more precarious work to maintain their  families.

The  Productive/Reproductive  Squeeze

While there have been  widespread  pressures to increase the numbers of hours  worked  outside
the home  for  wages  or  subsistence,  there  has been  no diminution  of  women's  responsibility  for
child  care  and  domestic  work.  Rather  their  responsibilities  have  tended  to  grow  as  their
customary  sources  of  support,  help  and  cooperation  are  no  longer  available 
(children  are  in.
school,  female  kin  are employed  or scattered  far  away men  are more  often  working  far  away or
absent). The result is that  women's choices regarding allocation of their time and energy to child-
care  or  paid  or  unpaid  work  of  various  kinds  are  in  many  cases  becoming 
even  more
constrained,  stressful,  and  conflict  prone,  leading  to  concern  for  a  productive  reproductive
squeeze  (eg.  Whitchead  1996).  For  rales  of 
conception  and  pregnancy  continue  high,  in
comparison  with  most other  parts  of the world, though  there is some evidence of  a downturn  in
the very  high fertility  rates. It is often  highest of all for those who lack  both traditional  as well as
modern  means to space births,3"

Not only  is women's work to maintain households increasing but  there is a  comparative and
growing lack  of inputs of men  into child rearing activities. Furthermore  in increasing numbers of
cases  men's 
into  financial  maintenance  of  children  are  dwindling,  because  of

inputs 

37

unemployment,  ridiculously  low minimum  wages (such  as $1 or $2)  or  lack of minimum  wages
and  also  because  of  males  reneging  on  paternal  responsibilities  and  the  increasing  spread  of
"free-riding"  in terms of child  maintenance  and care. There  is global evidence that, family  care is
increasingly  inadequate  and  that  less  time  is  being  devoted  to  infants  (WHO  1995: 41).  The
problems  associated  with  inadequacy  of  maternal  care  and  infant  feeding  arc  partly  due to a
serious question  of time poverty  (McGuire and  Popkin  1990), A parenting  deficit  is becoming a
world-wide  subject  of urgent  policy  concern  and  sociological  attention  and  leading  to calls  for
comprehensive  policy  formulation  on. gender  roles  and  the  family  (Etzions  1993).  We  would
argue  thai  a  major  manifestation  of  the  parenting  deficit  in  the  Sub  Saharan  African  region
appears to be the pervasive infant  nutrition  levels indicated, when  they occur  in  households and
communities which  are at  peace and among  the  rton  poor,'"1

Gender  Roles: Stress, Strain  and  Conflict

As  is becoming  increasingly  dear,  the mother's  role  and  her responsibilities,  resources  and
relationships  (conjugal,  domestic,  occupational,  kin  et  al.)  need  to  be  viewed  in  the context  of
local  and  global  escalating  demands  and  pressures,  which  reduce  and  put  in  jeopardy  her
maternal  caring  capacity.  Her  levels  of  resource  strain  and  stress  need  to be taken  into  account.
Women  in Africa  and  elsewhere  have  for sonic; time  been  viewed  as  being  involved  in a zero
sum game-—a closed  system  in which  time  or energy devoted  to any new effort  must be diverted
from  their  other  activities  or roles (McGuire  and  Popkin  1990). Women's  time is  finite  and  its
scarcity 
in  particular  activities.  Studies  of  energy
expenditure  and  body  mass  indices have shown  how  women  often  tend  to  spend  a  relatively
higher  proportion  of  their 
tasks  with
relatively  less  leisure  time,  due  mainly  to their  central  role  in  agricultural  production  and
distribution  and  a  lack  of  labor  saving devices  (eg. Higgins  and  Alderman  1993 on Ghana).
Moreover  marked  seasonal  swings  in  energy  expenditure,  as  well  as 
in.  body  weight  and
composition  and  food  availability,  have  also  been  documented  especially  in  rural  areas
among female  farmers.

than  men  performing  physically  demanding 

impacts  on  their  ability  to  engage 

time 

At  the  same  time  there  is  need  for  acute  awareness  of  the  potentially  deleterious  effects  of
female  role conflicts,  stresses and  strains on mothers'  own menial  and physical health  status; the
impacts of (he contradictions  in. the responsibilities  and expectations which  they  face; the  effects
of  the  discriminations  they  encounter  in  workplaces,  public  spaces  and  living  areas  and  the
burden  of fatigue., which overwhelms  them, from  frying  to do too many things  at the same time.
In  the wake of global  assessments,  highlighting  the  burden  of psychiatric  disease  on  females  in
their  reproductive  years  psychiatry  and  medicine  arc  beginning  to  take  seriously  the  socio-
economic  and  cultural  dimensions  of  their  sicknesses,  realizing  they  may  be  the  result  of  role
conflicts, resource strains and  stresses engendered  by  feelings  of guilt etc.40  Child  rearing itself
when  unsupported  is realized  to  be a source  of  serious  strain.  However  there  is still  a dearth  of
studies  which  combine  economic,  demographic  and  psycho-social  characteristics  of  women's
roles, in particular  stress and  strain, to identify  those most at risk of physical  or mental  relapse or
breakdown  (Russo  1990) and  in  particular  inability  to cope  successfully  with  infant  care needs.
Maternal  confidence  and  coping behaviour  on the one hand  and  depression  and  inability  to cope
on the other  feature  in medical  models of care and provide  a key link between  socio-cuitural  and
demographic  studies  and psycho-medical  research.

Women's  Voices

fanners, 

revealed 

A number  of  recent  writings  on  women  have  tried  to  give a  louder  voice  to  women
themselves, 
the  kinds  of
bitterness,  frustration,  guilt  and  anger seething in  women, as  they  try,  with  varying  degrees
of  success,  to  cope  with  their  multiple and escalating burdens. A study  in the Volta  region
in Southern  Ghana  for example, designed  to  document women's  health  problems,  discovered

traders.  These  accounts  have 

teachers, 

38

Rnnirch  Review NS  17,1 (2001) 25-47

incidentally  that  women's  greatest  concern  was  the  ways  in  which  their  workloads  were
detrimental  to 
their  health,  both  psychic  and  somatic  (Avoirs  and  Waiters  1999).  Load
carrying,  as  well  as  draining  energy,  could  prevent  a  mother  from  carrying  her  baby.  And  as
Mbilinyi  (1990)  records  on the  bitterness  of  Tan/anian  women,  "Cultivating  by  hand  with  a
baby  on  your  back 

thai  is a  problem."

Family  Conflicts

Not only are resources squeezed  and time and money  scarce, but there is evidence from  many
sources  that  family  conflicts,  even  violence,  are  rife;  between  husbands  and  wives  and  parents
and children.41  It. has long been  known  from  diverse settings that economic  hard times, including
unemployment  and  social  dislocation,  can  have  adverse  consequences  for  families:  increasing
risks of divorce  and  separation; domestic  disorganisation;  violence  and  discord.4'  There  has  no
doubt,  been,  an  enormous  upheaval  in  domestic  and  other  kinship-based  relations  between.
the  sexes.  These  changes  arc  producing  considerable  conflict  and 
it  h
hardly  an  exaggeration  to  say  that  this amounts  to  a sex  war, which  is often  exacerbated  by
development  planning  ami  projects  (Whitehead  1990:  58).  Moreover  there  is  rising  male
anxiety  regarding  the  dislocation  of  gender  relations  and  changes  taking place  in  women's
and  men's 
(ibid,  and  see  also  Silberschmidl  1999  on  Kenya).  An  account  of  how
women's  groups  in  Carneroun  reacted  to  Structural  Adjustment  Programs  (SAPs)  illustrates  the
multiplicity  and  nature* of the impacts born, the escalating work burdens, the trekking with heavy
weights  over  longer  distances;  the  dependence  on  daughters;  the  lack  of  rest  or  leisure
(Fonchingong  1999).  We  dearly  have  evidence  here  of  changes  which  are  likely  to  be
contributing  both  to  the  shortening  of  women's  lives  and  the  escalation  of  infant  hunger  and
malnutrition.

in  some  cases 

roles 

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''  t

.

'

l

f de 

I 'I  i 

(.  '

' 9' 

. 

, e , i o 'i 

» \ " i ii 

t ii  h<  n o t.  i ii it  m\ t ut •>  i<  1  •>

a l iu 

i l h l i . Sh 

C i C p e l lu 

i l i a h ' . u l i l t i u il 

Oi 
long and at what age  it  is  given  complementary  foods and  whether  it  receives  immunization
on  schedule.  In  addition 
that  malnourished
children  grow  faster  when  they  receive  verbal,  and  cognitive  stimulation 
special  attention
can. encourage a child in pain  to  eat  (UNDP  1999: 77-78),

that  many  studies  show 

the  report  recalled 

s l f e l d i i w r t l t l ly 

u IS v V h c t H ei 

Is  b t O t t ol 

t t ,d 

d l ld 

d 

C i l l ki 

l i OW

labour 

Caring 

is  recognized  as  being  mainly  performed  by  women,  unpaid  and.
undocumented.  The I him an  Development Report  of  1995  had  estimated 
that women  spend
two  thirds  of  their  working  hours  on  such  unpaid  work  (men  one  quarter)  and  most  of

39

the  HDR  offers 

is  social
the  I1DR  now  describes  as  caring  work,  that 
for  what 
those  hours  arc 
love, altruism  and social  obligation, mainly  in family  settings.
reproduction. Caring  involves 
Economic  analysis  of  care 
in 
impact  of
globalization  on  human  development.  They  are firs! that  women's  increased  participation  in
the  labour  force  and  changes  in  economic  structures  mean  that  needs  once  provided  for
through  unpaid  family  labour are increasingly  purchased  from  the  market  or  provided  by  the
state  (eg.  creches  for  infants  and  toddlers); second  that  as  the  size  and  scope  of  market
transactions  increases  and  families  become  less  stable  (economically  and  demographically)
reliance  on 
thai  people  and
institulions  have  been  free  riding  on  care  provided  by  women,  but  whether  they  will
continue  to  provide  it  is  in  doubt.

families  for  emotional  support 

increasing,  and 

insights 

three 

third 

into 

the 

is 

reproduction, 

furthermore  state  and  private  employers  are  not  paying  fathers  enough  to  cover  the
costs  of  social 
social
reproduction.  The  price  is  being  paid  by  infants  and  toddlers,  whose  mothers  have  to
work  so  hard  they  cannoi  respond  to their  infants'  needs  for  frequent  feeding  and  loving
care. Women's work  in the  paid  sector  is  increasing, but  their work  in  the  unpaid  sector  is
also  not  decreasing. Malnutrition  gives  us  serious  evidence  of  reproductive  work  not  done.
Many mothers are painfully  and guiltily  aware of  this,'"

that  women  can  afford 

to  chose  unpaid 

so 

Responses:  Programs,  Policies and the Gendering of Development  Economics

The  manifest 

shortcomings  of  "structural  adjustment  programs"  and  the  criticisms  of  the
World  Bank  advisers  and  IMF  have  resulted  in  some  apparent  concern  at  the  global  level,
following  the  lead  of  several  United  Nations  agencies,  and  international  non-governmenial
organisations,  to  take  more  seriously  into  account  human  development  objectives  and 
the
relevance of "gender issues". However  if the dimensions of the gender issues are not  sufficiently
spelled  out we may  find  that the pleas  to increase  women's  work  loads only  multiply yet  further
and  reproduction  continues  to  be  sidelined  and  to  be  viewed  as  a  barrier  to  women's  greater
economic  efficiency!-a  pervasive  perspective  of  many  gender  and  development  writings  of  the
past decade.

H UI

An  appr<"-«~h  wl-'c'i  irm>-pcratr; tlr* cn'rnlitv  nrr--,rr> will  contribute*  to the emerging  field
li  u
h.l
i',i
* 

< i'.Hi  '  m ») 
!  '!);_  r un  u i otml 
i.it 

niop'u.  j ul  a  dccridi  a  >uy s mb  a  discipline

tiadilKsnallv  iiiipT).  c<3 goods  vital 

i.iii  .md  happiness  ol  clnl  in  n" 

I  .
tt
ii'i

1  )!  -

•  11 'v

*  11

I I O J M1

.*<  O l'

ib

i 

,1

'  ll 

I ' l. 

J

1 

to
It  also  involves
,1.  she  stressed,  if
gender

ol
iri'
su
at  k
in*/
ro'i
w  t)

«1 
11'
I •»

'iin
o]\(

__,.,„  «

1 

1'

H1

«'  p.)'i  I ' . ' K cl  pi'jduetion  M o i r o \ ii 
.1  inu  iiiri  p i! 

H V1

l '| 

*

•• 

(

('

•i  >  "1  )

i 

I1;

Ittli

( . I 'M
.'l.'t'i
to  ,,•,.,>!!, L.'.i,,.,..  ,.i,.I  IK..dt.i.  to'.i«..uiv.  *I.JM  ...1  ^r  ......UB I

• \\'], 

1>  1.  1  »

(  I
11.eh  Au.l  __ lob.  !  i  siuj.,1  > i  r,s  <ifo  ieK\,iii!  h ue  m  a  globalizing
, i.  m  >i.v  .md  mi  K  oppressed  b\  mails,!  forces,  being

iti.  k  oinph  xii\  ,-ind  d i i k u n c e s in 

i< 

Conclusion

The  focus  of  this  essay  lias  been,  the  issue  of  adequacy  of  maternal  care  during  the  breast
feeding  and  weaning  phases  of  0  24  months.  Factors  affecting  mafemal  coping  skills  and
resources and social  support  have been  examined.  Historical  and contemporary case studies have
been  cited. A major  aim of the paper is to motivate new scholars to direct their efforts  to relevant
mulfidiscipJinary  research,  which  sets  mothers  and  infants  in.  the  centre  and  examines  their
developing  relationship  and  infant  feeding  and  growth  in  the  context  of  mothers'  (and  other
carers)  changing  roles  and  resources;  which  in  turn  are  affected  by  domestic  arrangements;
available  support  from  spouses  and  kin;  labour  demands  etc.  Underlying  these  discussions  is
the  evidence that  African  mothers'work  burdens  and  constraints  are  increasing more rapidly
now, just at a time when  many  of their  traditional  kin and  conjugal  supports  are  dwindling.'".

40

Research  Review  NS 17.)  (2001)  25-47

It  is  accordingly  the  thesis  of  this  essay  that  widespread  disruptions  in  mothers'  care of  infants
have  occurred  and  are  seriously  implicated  in  the plight  of the hungry  infants.  Such  disruptions
arc viewed as part of the wider disruption  of gender roles and relations occurring in the processes
of  reproduction  and  production.46  These  have  been  occurring  as  the  result  of  economic  and
demographic  transformations  since  colonial  times  and  have  been  variously  documented  and
discussed  both 
in  the  region  and  globally  (eg.  Hodgson  and  McCurdy  eds,  2001;  Fukuyama
1999),  Whereas  Boserup  (1970)  drew  attention  to  the  ways  in  which  such  alterations  were
putting  women's  productive  role  in  jeopardy, the  focus  in  this  essay  lias been  the risks  involved
for motherinu  and for babies.

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in

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Notes

1  The  research  on  which  this  paper  is  based  was  carried  out  while  the  author  was  a  Fellow  at  the
Netherlands Institute for Advanced Study (NIAS) 2000-2001. She is deeply grateful  to the Institute for the
opportunity  for  a year  of  dedicated  library  research and  writing  in such  a salubrious  environment,  and to
the University of Ghana for letting her take leave of absence at that time. Special thanks are due to the staff
of NIAS for their meticulous support, especially the librarian and her assistants.

This  is  an  abbreviated  version  of  a  longer  work.  The  expanded  version  will  appear  in  the  Occasional
Research Papers 2000 series of the Institute of African  Studies.

2 It has been taken up in earlier papers and is the subject  of a larger ongoing work  (Oppong  1991; 1999;
2000 and in progress (a)).
3  Researchers  at  IFPRI  Washington  used  a  computer  model  to make projections  based  on  a  scenario  in
which  governments  make no major  policy  changes  and populations  grow  at rates  forecast  by the  United
Nations.
4 Grantham McGregor S.M., W. Schofield  and C. Powell (1987) and other studies have indicated the kinds
of remedial work which have to be done to counteract even the psychological impacts.
5  Severe protein  energy  malnutrition  in children  affects  their  intellectual  as well as physical  development
for  many  years  and  requires  psychosocial  stimulation,  as  well  as  adequate  nutrients  to  prevent  serious
decline (Grantham McGregor et al. 1987).
6 Eg. Morris et al. (1999) on Abidjan  and Accra.
7  See Figure 4 p.  12 in  Wagstaff  (2000). See  also the recent  series  of 44 World  Bank  country  studies of
Socio-Economic  Differences  in Health, Nutrition  and  Population  eg. Davidson  et al. (2000)  Ghana. The
figures  presented  in  the  series  have  been  tabulated  from  data  collected  through  the  multi-country
Demographic  and  Health  Survey  (DHS) program.  An  asset  index  was developed  dividing the  population
into  quintiles  on  the  basis  of  visible  aspects  of  wealth,  ownership  of  consumer  items  and  dwelling
characteristics,  such as  water  source  and toilet  facilities.  Household  assets were assigned weights. Asset
scores were standardised.
8 Such countries include Mauritania, Nigeria, Ghana, Lesotho, Mali, Uganda. (NB. The careful  wording of
this sentence. Food production is reported to be rising!)
9 The FAO (1996:83) Sixth Food Survey  concluded  on  the  basis  of  analysis  of  data  from  developing
countries  that  overall  food  deprivation  and  poor  nutritional  status  (of  under  fives)  go  together to
some  degree,  but  there  are many exceptions to this trend.  Two  out  of  five  countries  with  a  high
degree  of  food  deprivation  had  only  moderate  prevalence  of  weight  deficiency,  while one  in  ten
countries  with a  low  degree  of  food  deprivation  had a  high  prevalence  of weight  deficiency.
10 See for example the case of Mali described  in Johnson and Stout (1999: 48) in which improvements  in
infant mortality and take up of health measures has not been matched by malnutrition  indices for  stunting,
wasting and under nourishment which have markedly deteriorated from  1987 to 1996.
11 For  Sub Saharan Africa  and South Asia—the regions  with the  highest  child  malnutrition  rates—the
authors identified  per  capita  food  availability and  women's  education as two  areas which seemed to be
priority  for  future  reduction  in  child  malnutrition. This is somewhat  surprising as these two indicators
rose in Africa while under-nutrition increased.
12 See  Oppong (in progress (b)).
13 See Oppong (1980); Oppong and Abu (1985; 1987).
14 See Oppong and Abu (1987) and Oppong and Wery (1994) .
15  See the recent attempt in Maxwell et al. (2000) to devise an index of care comprising different  health
and maternal variables.

45

10 Research  progress in this  field  was difficult  until  breast  feeding  definitions  and categories had
been  established  and  recognized  (WHO 1991). WHO and UN1CEF  have  defined  She  most  important
elements  of  infant  feeding  practices. See UNICBF  (1990);  World  Health  Assembly  (WHA) (1994);
WHO/UN1CEF (1990), They  include; initiation  of breast feeding within  one hour  of birth; frequent on
demand  feeding  (including  night  feeds);  exclusive  breast  feeding  (breast  milk  only  -no oilier  liquids
or  foods  consumed); breastfeeding  complemented  with  locally  available  and hygien.ica.lly  prepared
appropriate  foods  from  the  age of around  six months;  increased  breastfeeding  during  illness and
recovery;  continued  breast  feeding  for  up to  two years or  beyond,  while  also  giving  nutritionally
adequate  and sale  complementary  foods.
17 For example in the case of the United  Kingdom  Gardiner  (1997)  notes  that for three decades of the last
century  domestic  chiidcare  was neglected  by socio-economic  research  and remained  a taken  for granted
unknown  domain.  Caring  for dependent  adults  and disabled  children  got  more  attention.  The relative
neglect  of parenting  by feminist  researchers  in that  country  has been  partly  attributed  to pressure on
feminist  academics to remain  silent about  motherhood.  Meanwhile the British  official  definition  of "carer"
also adopted  in the academic  literature actually excludes people involved  in caring for healthy  able-bodied
children; an approach  copt1")'-*"'1 «'i(h the Scandinavian  on<* in which  care is used  to include  the work
involved  in lookisif  aiie>  o1' I,,  >\lt>,t including  clntd.'i'  This  semantic  difference  reflects  the very
different  national  p*il <.•<.
(Gardiner  1997: 185 cites
Ungerson  1990; 9),
4  Researchers  at WHO and ILO have  worked  on these  measurement  issues  for some  time  eg. Anker
(1994)  and  Goidschmidt  Clermont  (1987 and  1994) who discuss  and summarize  problems  involved in
documentation of occupational  and domestic roles in the region.
w  In. this regard see the exceptional pioneering work of Popkin and others in the Phillipincs adopting time
use studies etc. (See Popkin  (1980); Popkin & Solon (1976); Popkin et al. (1989); Popkin & Doan (1989),

\% i Mson to child  care 

M iu

f  t'

J ''

In depth  studies  have  been  designed  by Macro  International  and undertaken in Mali  and Ghana  which

seek to begin to fill  this gap. (see  Caslle et al. 2001).
*' Caring is recognized  as applying  to three kinds of relationship between the cared  for and caring. In one
the relationship is unequal and the caring services are commanded  or possibly bought. In another the cared
for  are  unable  to provide  services  for themselves  because  they  are too young,  too old or too ill  and
therefore dependent  upon care. Third there are reciprocal  eare relationships (Waerness  1984).
'" In  Sub Saharan  Africa  according  to 1)1 IS findings  babies obtain a considerable part of their breast  milk
during the night when they sleep with their mothers.

Sec tor example  Brakohiapa  el al. (1999) on the need  for sensitive burping of infanis to release  trapped

gas.

Biut  lib1  ii
''  (i')ii1  ib  r
v hii.li M

n  "A  p.ip. i
(Jit phn (' •

<  ililti n . f'

1

d hl  i t t i, 5

1  ul  diS(, i

hn. (out!
< (, 

\ \ j i i iM

<  11 ' l it  i  UM iitit 

h f i 'i 

i t ut 

I  i (dei man  (I "J'

j t t t i i . it  u n e, e g.  M e ad
I  Popkin  c! al.  (1976),

<> t<  > s n od  i>r>  ( h i ld  d e v l o pn
Si  I1  i  ^ i . U i d i n o l h'  > -  t a le 
t n . ni  i<
I' 'i it H  >1 i lu  J i M i h 'M  n i i a i i t'  .<).<
I  • ! > (, p ' ._ ill 
n M i l-

fill1  brll  I  O ) )'
S'1'  B,i1«  burnt

ll>t 

f  [

hi'oin m« ( ore d'lvoirc,

'inn1-1  fium  a  Ghanaian
1>( ith  (hi  Farm;  Daitv

n  >)i

H i ll

i»

1

• t o!

< \ )

) I

> Hi'ioi,,  1 oi  developing
h>  i•.  an it mu  M*H  D'III  ted  injuries,
nil!'  m1 M pw-  sc hiz>iphrenia,  war,

«  .  d> \ ( 1 < | it i!  ( si  d t - V -l

lit  d

tu'i.

In the  seventies  the work  of  Jelliffe  and JellilTe ( 1978) was a major 

landmark  in  setting  breast

feeding in its global  context  of human and  economic  development and world  health..

See for example  Longrnore  (1959:195) on Johannesburg  in the middle of the past  century where  things
had  changed so much, that many of the people in a township felt  that children  were more of a burden  than a

' 1 ,1 

A l l K LI 

t  I  il  H  ,  •
\l> > I  > n il „  •  1

S i j ' ) i ! i( 

n ' lv  n il  ' Mi  ;

I  < t 1 ) l r l - h l" 
infants.

IP I! 

iM '  T  i

i 

f> i

!.'i  >  > the International  Labour  Office  and elsewhere. (See

U H i «trUd>\  iii a political  period  when  cotton  stopped  coming  to  the
iii^  i mt'u i  I a 1 to st<),y al home  and so were  able  to nurse  their own.

46

Research  Review  NS 17.1 (2001)  25-47

the 

32 According  to  recent FAO  (1998) reports the  emerging  empirical  evidence  supports  the  contention
that 
impact  of  Structural  Adjustment  Programs  on  rural  women  fanners  has  been  mainly
negative and  accordingly  detrimental  to  food security (FAO  1998: 29).
33 See Townsend  (1997) on Botswana  for  an approach to studying male parental responsibilities over the
life cycle.
34 Between  1950 and  1985 the recorded  female  labour force participation  rate in developing countries rose
from 37%  to 42%. By now globally 45 percent of females  15 to 64 are recorded  as economically active.
35 The picture  of women's  work  is  difficult  to draw  with  accuracy,  since so much of the  work  of women in
the  developing  world  is  on  family  farms  and in  small  scale  enterprises  and  still  remains  officially
undocumented.  See for example  Oppong  ed.  (1987) and Adepoju  and Oppong  eds.  (1994).
36  Admittedly  information  on women's  workloads  is often  difficult  to  obtain  and there  are several  well
known  methodological  problems  involved,  linked  to  seasonality  of  work,  informality,  multiplicity  of
activities  and bias  of  informants  and  researchers  (On Africa  in  particular  see Anker  1994).  It  is not
unknown  for women  to work  intensively  every  day regardless  of the  season,  with  working  days  lasting 18
to 20 hours, while  men folk  purport to ignore  that  women  are working.
37  However  attempts  to  document  and  compare  the  impacts  upon  women's  employment  and  work
schedules of recession, structural  adjustment  programmes,  globalisation and deregulation processes  have
been  hampered  by  a lack  of  comparable  data  from  different  periods  in  time and  different  localities  and
occupational categories (Baden 1993).
38  T he traditional  means  have  been  very  effective.  They  include  sexual  abstinence  post  partum  and
exclusive  breast  feeding.  Significantly  the  shorter  and  less  intensive  breast  feeding,  associated  with
mother's  work  and maternal child  separations  and early  shifts  onto  mixed  feeding  regimes, cuts  down the
length  of  post  partum  amenorrhea and is consequently implicated in shorter birth  intervals.
39  See the case  of  Tanzania  described  by Howard  and Miller  (1997).  Attention  is  drawn  to the greater
labour  burdens  of  women,  their  increased  responsibilities  to  provide  for  themselves  as  well  as  their
children,  while  social  support  from  kin has largely  broken  down.  Instances  of  infants  and toddlers  left
alone  while  parents  work  indicate the profundity  of the  problem.
40 See Stewart  (1998), Editorial  in The Canadian  Journal  of 
41 See the recent  World  Bank  (2000)  volumes  in which  the poor  speak.
42  Cf. Elder  1974 and 1990.  Contemporary  African  accounts  of family  violence  give  the impression  it is
mounting  eg. Appiah  and Cusack  eds.  (1999).
43  Significantly  the reconciliation  of family  and working  life,  and  the  ways  in  which  changing  gender
roles  are affecting 
these,  has recently  been  reckoned  to be one of the  most  pressing  policy and  political
issues  facing  all European  societies  (Walby  1998:xiv).
44  Etzioni  (1993)  has  graphically 
parenting  to  the  paid 
by  the fact  that paid  child  minders  are paid  less  than  janitors  or  zoo  keepers!
45  Note  Palmer-Jones  and Jackson's  (1997)  commentary  on h ow development  programs  themselves m ay
result  in the escalation  of women's  bodily  energy  expenditure  leading  to serious  but unconsidered  somatic
suffering.
46 Eg.  Fukuyama  on The Great  Disruption 

from
labour  force  which  has  occurred,  while  the devaluation  of children  is  indicated

Psychiatry,

indicated  with 

respect  to the U S, the shift  in time  allocation 

(1999).

47