Health for the Millions, Vol. 7, No. 4 & 5-6, Aug. & Oct. - Dec. 1981
Item
- Title
- Health for the Millions, Vol. 7, No. 4 & 5-6, Aug. & Oct. - Dec. 1981
- extracted text
-
I
No. 4
A
Bimonthly
of
the
Voluntary
Health
Association
of
India
AUGUST
1981
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramongala
Bangalore-56001
iadia
Jess
Mater
•■I
HEALTH FOR THE MILLIONS
Vol. VII
No. 4
August 1981
'i
CONTENTS
1. Water, Sanitation
and Health
3. Water in Dry Hills
5. Sanitation with
- . Participation
9. Jf/alking Less for More
Water
10-11. Voluntary Agencies and
Sanitation, and
Disposal Systems used
in India
16. A School for Cleanliness
17. Low Cost Drugs Page
18. News from the States
Editor : S. Srinivasan
Executive Editor : Augustine
Veliath
Production : P. P. Khanna
Assistance : P. George and
John Agacy
Circulation : L. K. Murthy
Owned and published by the
Voluntary Health Association of
India, C-14, Community Centre,
Safdarjung Development
Area,
New Delhi-110016, and printed
at Printsman, New Delhi.
Editorial
■
Our previous issue was focussed on drugs. This
issue has the theme water and sanitation. We aim to high
light some issues on water and sanitation as relevant to
India.
The problem of water and sanitation is complex in a
country as diverse as ours. Many of you would have your
own experiences to narrate. You would have attempted
to introduce better water supply and sanitation facilities in
your community. Or you may know somebody who has
tried. The result may have been a success or a failure or in
between. Write to us and share with us and all our fellow
readers. Write to us also on any experiences related to
health which you feel should be more well-known.
Incidentally, we are in the so-called International
Drinking Water Supply and Sanitation Decade (1 981 -90).
Please see the back cover.
We owe much editorial help and guidance for this
issue to Shri T. Vijayendra —who was also the Executive
Editor of this magazine for some time in 1 979.
In the last issue on drugs we were similarly helped
in the design by many, and chiefly by Mira Shiva, our
colleague. Mira is an M. D. and an unusual person. She
is always bubbling with ideas and facts. Like her historical
namesake she has a tremendous commitment and a pas
sion for VHAI philosophy and goals. We failed to men
tion this in the last issue, an editorial oversight deeply re
gretted. Her contribution in this issue includes the piece
on Safai Vidyalaya and the column on drugs.
*
*
*
We have been receiving many enquiries about the
delay in publication. This is chiefly due to a series of
unanticipated delays. We will be back on schedule
end of the year.
Water, Sanitation and Health
Water affects the health of a
poor people in a cruel way. Water
is essential for health. It makes up
nine-tenths of the human body's
volume and two-thirds of its weight.
No one can survive without water
for more than a few days. The
amount and quality of water avail
able to people is directly related to
their economic wellbeing.
Most diseases can be prevented
by the correct use of water. In
India, 60 per cent of the diseases
can be eliminated with clean drink
ing water to the people. And 80
percent of the diseases can be cut
down by good clean drinking water
and sanitation facilities. Would it
make more sense to teach more of
water management and sanitation
in our medical colleges, nursing
schools and many other health re
lated courses, than the many not
so relevant items in the curriculum ?
Water-caused diseases related to
lack of proper water and sanitation
could be divided into five types :
Water-borne—spread by drink
ing or washing hands, food or
utensils in contaminated water.
Water-caused Morbidity and Mortality for Asia, Africa and Latin America
Infection
Infections
thousands
lyear
WATER-BORNE
Amebiasis
400,000
30
DISEASES
Diarrhoeas
3-5,000,000
5-10,000
Polio
80,000
10-20
Typhoid
1,000
25
Deaths
thousands
lye ar
Average
Relative
no. of disability*
days lost
per case
7-10
3
3-5
2
3,0004-
2
14-28
2
3
•
800,000
1,000,000
20
7-10
12,000
Very low
500-3,000
Trichuriasis
(whipworm)
500,000
Low
7-18
WATER-BASED
DISEASES
Schistosomiasis
(bilharzia)
200,000
500-1000
600-1000
DISEASES WITH
WATER-RELATED
VECTORS
African trypanosomiasis
1,000
(sleeping sickness)
800,000
M?laria
5
150
1
1,200
3-5
2
30,000
20-50
3,000
1-2
7-9,000,000
50-60
100
4
WATER-WASHED
DISEASES
Ascariasis
(roundworm)
Leprosy
Onchocerciasis
(river blindness)
FAECAL DISPOSAL
DISEASES
Source :
Hookworm
2-3
3
3-4
after Julia A. Walsh and Kenneth S. Warren, Selective Primary Health Care : An Interim Strategy for Disease
Control in Developing Countries, The New England Journal of Medicine, vol 301, no 18, November 1, 1979, p 967.
* 1 means the sufferer is bedridden; 2 able to function to some extent; 3 able to work; 4 experiences minor effects.
health for the millions/august
1981
COMMUNITY HEALTH CELL
326. V Main, I Block
Korambngala
Bangalore-560034
India
1
which acts as a passive vehicle
for the infecting agent. Waterwashed—spread by poor per
sona! hygiene and insufficient
water for washing. Lack of pro
per facilities for human waste
disposal is another contributing
factor.
Water-based—trans
mitted by a vector which spends
a part of its life cycle in water.
Contact with water thus infected
conveys the disease-causing
parasite through the skin or
mouth. Water-related vectors
—contracted through infection
carrying insects which breed in
water and live near it, especially
when it is stagnant. Faecal
disposal diseases—caused by
organisms that breed in excreta
when sanitation is defective.
The table on the previous page
shows figures for Africa, Asia and
Latin America (1977-78).
Social and Economic
Costs
The social and economic costs
to a poor society because of waterrefated sicknesses can be quite
disastrous. Typical consequences
are : loss of income and human
productivity, resulting in more
poverty for the family; and loss to
gross national product. In India,
water-borne diseases alone claim
73 million work days every year.
The cost, in terms of medical treat
ment, has been estimated to be
around 500 crores of rupees every
year.
In almost all villages in India,
it is still the burden of women to
procure water from wells, ponds,
rivers and other sources far and
near. This itself results in spending
enormous amount of time for a
few litres of water. Could this time
be used better with a better water
supply system ?
In India, the problem of water
supply in both rural and urban
areas is further complicated by
class and caste factors. The upper
classes and the "higher" castes
manage to control the better sour-
ces of water, leaving the less
hygienic of the not-so-hygienic
water to the less privileged. Or in
many cases none at all.
Water and Sanitation
Clean or safe drinking water by
itself may not prevent water-related
diseases in the community. Water
with improved sanitation and ex-
0
PATHS TO SAFE WATER AND SANITATION
( Courtesy U NICEF)
SOURCES OF
POLLUTION/
INFECTION
EXCRETA
REFUSE------WASHING —
PESTICIDEBAD WATER
SOURCE-—■
IMPROPER
STORAGE
POLLUTED/
INFECTED.'
’.WATER:''
ACTION TO IMPROVE SANITATION
Improve sanitation and water quality -^^1
Provide more water, improve personal cleanliness
WASHING AND CLEANING
DRINKING
COOKING
BATHING
FOOD PRODUCTION
DISEASES RESULTING FROM
POLLUTED WATER, LACK OF
SANITATION AND PERSONAL
HYGIENE
WATERBORNE
cholera, typhoid, infectious hepatitis
WATER-WASHED
scabies, yaws, leprosy, trachoma
(Courtesy UNICEF)
Protect source, avoid infection
WATER-BASED
schistosomiasis, guinea worm
Achieve total piped water coverage of population
("Safe Water and Sanitation for all")
WATER-RELATED VECTORS
malaria, sleeping-sickness, yellow fever
Improve excreta sanitation and education -^^■1
FECAL DISPOSED
hookworm, clonorchiasis, fasciolopsiasis
SAFE WATER
and
PROPER REFUSE
and
WASTEWATER
DISPOSAL
creta disposal and health educa
tion can result in significant health
improvement. Clean water can
easily get polluted—at source,
during transport or storage, or
during and after usage. All these
many ways of contamination of
water can result in a number of
debilitating diseases.
More than 5,65,000 villages in
India and almost all major towns
and cities suffer from a lack of safe
water supply and proper sanitation.
The problem is immense and com
plex but surmountable to a large
extent. The tremendous need for
action at all levels is obvious.
HEALTH FOR THE MILLIONS/aUGUST
1981
WATER IN DRY HILLS
The Story of Sukhomajri
(How does one bring back water to a water-scarce area—where trees have been felled madly,
and where there are no nearby streams nor easy access to ground water ? The Sukhomajri
story describes an on-going experiment of people's participation in environmental conserva
tion).
Sukhomajri is a village in the
Shivalik hills some twenty-five
kilometers from Chandigarh. Until
three years ago Sukhomajri was a
drought prone village—if the mon
soon failed, as it often does, the
kharif crop of maize would wither
away in August. The rabi crops of
gram and desi wheat would not
bear a grain. Sukhomajri ran chro
nic deficits of food and fodder.
Conventional irrigation was not
possible as canals could not be
brought into the hills. There were
no perennial streams nearby, and
ground water, if at all, was far too
deep. Where could one possibly get
water in these dry hills?
Uncontrolled Grazing
Villages in the Shivaliks typi
cally are settlements in the flood
plains of the hillocks. The hill spurs
begin where the agricultural fields
end. These hill sides, though
mostly government reserve forests,
are and have always been the graz
ing ground for village cattle. Un
controlled grazing and indiscrimi
nate cutting of trees for fuel and
commercial purposes has caused
widespread denudation in these
hills, leading to severe erosion in
the monsoon rains.
Until three years ago the hill
sides that form the backdrop of
Sukhomajri were among the worst
of the denuded Shivaliks. There
were virtually no trees and grasses
in these hills because of uncont
rolled cattle grazing. Due to the
health for the millions/august
The dry hills of Sukhomajri before the experiment...
lack of trees and grasscover, the
hills would virtually melt under the
monsoon rains.
Transformation
That was some three years ago.
Today the villagers in Sukho
majri can produce at least two
assured crops even in an year of
drought. They have begun using
better seeds and fertilizers with
higher yields. They have stopped
grazing their cattle in the surround
ing hills. Trees and grasses have
started growing in the hills. Sukho
majri is more prosperous today
than three years ago. There is more
food and fodder produced in the
village now. The physical environ
ment—the natural resource base
around Sukhomajri, is more stable
and productive today than it was
three years ago.
1981
This transformation is the result
of an experiment that the Central
Soil and Water Conservation Re
search and Training Institute at
Chandigarh took up in 1978.
Scientists from this Institute began
an operational research project in
Sukhomajri. The idea was to de
monstrate under real life conditions
the viability of scientific techniques
of soil and water conservation.
The scientists learned soon that
their techniques of soil and water
conservation would not go very
far unless grazing was stopped in
the hills. They asked the villagers
to stop grazing of cattle. A few
agreed but most did not. Some
even showed the scientists the
way out of Sukhomajri ! Environ
mental conservation might be cru
cial in the long run but the villagers
were more concerned about their
3
Traditionally, irrigation benefits are options were considered : One
tied to land ownership : If you own was for the Institute to post an
land you benefit from irrigation in employee in the village and
proportion to your land holding. run the project and the other
If you are landless, hard luck ! was to help the villagers set
However, if the landless had water up an organization of their own to
rights they could trade these in tun the project while the Institute
cash or in kind, particularly where gradually withdrew from the daythere is a net water deficit as at to-day responsibility. The first
Problems of......
Sukhomajri in spite of the dam. alternative was clearly full of pit
Happily, the scientists were will
This was resolved when the falls—the Institute would have to
ing to learn. Their innovation paid
villagers among themselves agreed divert attention from research to
off when they built a small earthen
that every family would get an perpetually run a village develop
dam by plugging one of the ravines.
equal share of water, irrespective ment project. Given the life saving
The dam would control erosion
of land holding. This system has quality of water, the Institute
and flooding downstream by hold
worked for over a year now and employee in the village could
ing back monsoon flood waters
there have been instances of trad become a centre of power and
from the hills. It would irrigate
ing surplus water for share cropp power does corrupt. The cost of
village agricultural landsand above
ing rights and other favours in running the project would be high,
all it would induce villagers to stop
kind.
making irrigation costly to the
grazing in the hills to protect their
The second problem was how villagers and, most importantly,
own valuable asset—the dam, from
to manage and maintain the pro this way the project would never
getting silted up. Irrigation would
ject. Someone would have to res be owned by the villagers, i.e., the
increase consumption right away
pond to water demand, regulate onus of sustaining the enthusiasm
and would lead to environmental
distribution, collect water charges of the villagers would always
conservation in the long run.
and arrange repairs. Also, though remain on the Institute.
So far so good.
the villagers had now agreed to
Therefore the second alternative
Water Management
abstain from grazing the hills in was chosen.
Irrigation brought in more pro their own interest, there would be
Project personnel helped the
blems. Firstly, how do you distri deviants and someone would have villagers set up an Association as a
bute the water so that everyone, to monitor them and bring social duly registered society. This Asso
landed and landless, feels involved? pressure to bear on them. Two ciation has taken over the opera
tions and maintenance responsi
“'and after the experiment.
bility. The Association has em
ployed a young, literate villager on
a part-time basis to distribute
water and collect water fees.
Printed copies of equal (hourly)
denomination are used for water
distribution and exchange. Institute
staff continue to oversee the pro
ject and will withdraw gradually.
As of now the experiment
seems to be working. There has
been no grazing in the hills. The
village Association is performing
well.
The experiment has been repli
cated at another village nearby and
can be replicated in hilly terrains
all over the country.
short term grazing needs. They
feared loss of access to the hills
for ever, and even appropriation
by government of village common
lands at the foot of the hills. What
is more, there was nothing tangible
and significant in the short run for
the villagers to rally round.
4
HEAL!H FOR THE MILLIONS./aUGUST
1 98 1
T. VIJAYENDRA
Sanitation with Participation
—is it. possible?
Sanitation and excreta disposal in urban and rural areas are complex problems. There are
no ready-made solutions. Solutions for particular communities have to be worked out
in consultation with the people who are likely to use them, the implementing agency and
competent technicians. In this article, we discuss primarily the experiences of an urban
agency and the related issues of participation in sanitation.
The unsafe disposal of faecal
matter and the lack of potable
drinking water are major causes of
morbidity in India. They are typi
fied by the large number of deaths
in our country. In the case of
human excreta disposal systems,
the situation is particularly bad
because few people take interest
in it, and discussion is considered
impolite to the extent of being even
vulgar ! The attitude among even
educated Indians seems to be :
Please keep it out of sight and do
not mention it while we are eating,
There are also wrong beliefs that
flush latrines and underground
sewerage are the proper things,
and it is because of our poverty,
our cities and villages are dirty.
Some people are also aware of the
plight of the Harijans who have to
carry it on their heads in many
parts of the country.
serious problems and even if we
had the money, critics say that it
is probably worse than the present
situation.
Meanwhile, surveys continue to
show that the vast majority of the
Indian population suffers from
parasitic infections and soil-trans
mitted helminths. Research con
ducted among slum dwellers and
rural populations near Delhi, Cal
cutta, Bombay, Aurangabad and
Lucknow, are reported to indicate
that the lowest percentage suffer
ing such infections is as high as
36.2% which is one-third of the
population. The level of infections
is generally quoted to be around
66% and often as high as 80%.
The plans of the Government of
India include provision of safe
drinking water for its entire urban
Urban Sanitation—Haves & Have nots
Explosive Situation
In reality, the situation is quite
explosive. The growing urban
problem is making the problem
frighteningly serious. More and
more people are using railway
tracks and bylanes making the city
and towns literally hell holes. Less
and less Harijans are prepared to
do the job. The cost of the sewer
system and treatment plants is
prohibitively large and we just
cannot meet the situation. The
existing sewer systems are facing
HEALTH FOR THE MILLIONS/AUGUST
In nine of the major states and
union territories, 40% of the house
holds are without latrines while
in the eastern states and union
territories, 40% of the households
are without latrines. In Manipur,
Tripura and Meghalaya this figure
is less than 10%. In general only
20% of the rural population has
some sort of access to toilets. And
the figures for urban populations
(see box) are quite shocking and
can now be expected to be worse,
because of increasing populations,
than at the time of the National
Sample Survey,
No. of urban households in the country
using toilets connected to the sewerage
systems.
20%
No. with exclusive use of toilets in the
urban areas (the remainder share with
other households or use public toilets).
7%
No. of urban households with
water-borne latrines connected to
septic tanks.
33.3%
Percentage of urban population with
no toilets.
33.3%
— National Sample Survey, 1978
I 98 I
14%
Percentage of urban population serve
with bucket latrines.
bucket privy. Apart from being un the population of the country at
healthy and a strong source of that time would be covered. Also,
disease, they are extremely un there are tremendous possibilities
pleasant. People prefer to do it in of drinking water and river water
the open than use them. Its most pollution because of the sewage
damaging weakness lies in the system. The sewage system takes
employment of human beings in up as much as 40% of the pumped
such dehumanising work. Mahatma water supply in the town. The large
Gandhi was very moved by their amounts of sewage sludge has to
plight and did much to remove the be disposed of in rural areas (in
social stigma. He initiated several cases of urban drainage). This is
programmes for Bhangi Mukti and only shifting the problem to the
Methods Adopted
founded the Harijan Sevak Sangh. rural areas. The sewage system and
There have been broadly four
These programmes have contributed flush toilets are typical products of
strategies in dealing with the dispo
significantly to the development of Western industrial revolution. The
sal of human excreta (see the box
an alternative, cheap and safe Western approach typically comes
below). This is of course apart
latrine.
from ecology considerations and
from the traditionally predominant
not from cost considerations or the
way of open air defecation in the
impossibility of providing latrines
Appropriate
Economics
fields, open grounds, railway lines,
for everyone, because they have
dirty nallas and riverbanks. In the
The underground sewer system flush toilets in most houses.
latter cases, it is particularly humi
Different countries are experi
is
an alternative to the bucket
liating for women to go necessarily
menting with different methods :
latrines.
But
the
costs
are
prohibi
either early in the morning or after
composting
dark. In Bombay, cases have come tive for this system and therefore incinerating toilets,
toilets,
biological
toilets,
oil flushed
is
to
be
ruled
out
in
the
considera
to light where they were raped on
toilets,
vaccum
systems,
aerobic
tion
of
any
lowcost
options
for
the
such occasions. (It is this section
tanks,
etc.
Evidently
there
are
many
entire
country.
To
get
an
estimate
of the population also that is the
technologically
possible
solutions
of
the
all-India
picture
:
At
the
pre
victim of the most important and
the biggest group of diseases sent rate of taxation if the entire and which one will be appropriate
revenue of the central and state depends on all the social factors of
known as enteric diseases).
governments was to be exclusively a situation—economic, social and
One-third of the urban popula used for 60 years for provision of cultural. Solutions in India have to
tion in our country is served by the underground sewerage, only half be low-cost, technologically simple,
so that people with little training
can use it and of course it has to
Four Ways of Excreta Disposal
be ecologically sound. The last
METHOD
means
the possibility of using the
1
2
3
4
waste as manures. Gandhian and
With water
Yes
Yes
No
No
other agencies have worked to
With transport
Yes
No
Yes
No
wards precisely such a solution.
and rural population by 1990. There
are also plans to provide facilities
like toilets; adequate drainage and
garbage disposal services. How
ever, in the rural areas, only 25%
of the population is to be brought
under the sanitation programme
during the period of the water
supply and sanitation decade,
1981-1990. The problem is medi
cal, social and managerial.
Work in India
—Flush toilet connected-]
to sewer
—Z qua privy connected
to sewer
—Flush toilet joined to septic tank
—Cesspool, aqua privy
biogas plant
6
Buckets &
bore hole
latrines
Compost
P»t
latrines
The oldest method —squatting
in the field —is still used in majority
of rural areas. This method is still
an excellent method and can be
slightly improved by covering the
excreta with mud. The saprophytic
bacteria in the upper layers of the
soil destroy the pathogens in the
excreta. The result is a stable
humus-like product and if the
HEALTH FOR THE MILLIONS/AUGUST
I 98 1
not only use it for the latrine faci
lities, but also to bathe and wash
clothes.
Users and non-users
Initially the greatest users were
the mobile population. Among the
regular users were the rickshaw
pullers of Patna town. Over the
years other people have joined.
Taking washing powder for cleaning hands
The first category is the shop
keepers and their assistants, hotel
boys, etc. Secondly, people who
Sulabh Shouchalaya
come for shopping also use them.
So market facility too has become
Sansthan
important and pays well. Today
The history and work of this people from middle class come in
Gandhian organisation in Patna cars. Muslim women in Burkha
has already been discussed in this too come and use it with confi
magazine. (Public Latrines for dence. The Sansthan also has rules
Urban Poor, Decemberl 979. Contact for free facilities to those who
address : Shri Bindeshwar Pathak, cannot afford it.
Sulabh International, Near Reserve
Bank, Patna-800001.) The Sans Participation and...
The most noteworthy feature
than propagates essentially a pit
privy with a water seal. The credit of the Sansthan is the participation
of the Sansthan is that it has help of the people. The income in
build and propagate it in mass scale Patna, for instance, rose from Rs.
and has made necessary modifica 500/- per day to 600, 1100, 1500,
tions. The users of the Sansthan 2000 and now it is Rs. 2200/-. It is
health for the millions/august
important to note that their income
is from the beneficiaries and in the
form oflOpaise and 5 paise per
use of the latrine and not from the
donations from rich people. That
the Sansthan is self-sufficient in
this public facility, is an unique
thing in the world. How has this
come about ? The Sulabh Shouc
halaya facilities are neat and clean.
It is so clean that my friend who
Photo ; Madhu Sarin
materials spread out, it dries
rapidly. This can also serve as an
excellent manure for fields. How
ever, this method is not fit for urban
areas because of aesthetic consi
derations and for want of space.
Even in rural areas with extensive
cultivation particularly in rice fields
and in the rainy season, it becomes
difficult. Lack of sun keeps the
stench longer and pathogens do
not die out easily. People working
in the fields get and spread enteric
diseases rapidly. Also, the explod
ing numbers of people force us to
search for other viable alternatives.
These present designs have taken
a long time to evoke through the
unsuccessful, foul-smelling and
dangerous latrines—which is one
of the reasons people are very re
luctant to construct latrines or use
them.
At present in India, there are
two methods in situations where
sewerage is not available. One is
the septic latrine and the other is
the modified pit latrine. The cost of
housing is common to both. The
latrine itself costs around Rs.2000/for the septic tank and around
Rs. 500/- for the modified pit
latrine known as Sulabh Shouchalaya.
1981
did not hesitate throwing in match
sticks and ashes, felt very embar
rassed and could not find a place
to throw them I People initially
hesitated and asked questions. But
now it is a seven to eight year old
institution. People know about it,
use it and pay for it without hesi
tation. A culture and a tradition
has been created which can be
called a civic sense and public
utility in the best meaning of the
term. Today people from all classes
come and use it
By and large, as a policy for a
new
town
(like
Hyderabad,
Howrah), the Sansthan asks for
a two-year 50% subsidy for main
tenance and feels confident that
of water supply and sanitation in community with the various techno
the community. The Sulabh Shou- logical solutions which are feasible,
chalaya Sansthan experience and ranging from simple source protec
tion and pit latrines to multiple
But one cannot be lulled by the that of Safai Vidyalaya (Ahmedahouse connections. Community
bad)
has
indicated
to
us
that
parti
success. There are still the poorest
choice should include the possi
cipation
by
the
community
is
not
of the poor, who cannot afford to
bility of rejection of any immediate
pay or do not live near the facility. impossible.
source
improvement. Although this
The location of the facility is
An excellent review of conclu
so chosen that 75% of the users sions from a wide literature on the may seem a negative outcome,
can pay for it. Poor people who participation of communities in each community has its own crite
live in slums cannot afford a latrine water supply and sanitation pro ria for calculating sets of trade-ofs,
of their own and a public facility. grammes is : Participation and so that their perceptions of the use
fulness and effects of improve
ments may differ considerably from
those af the agency. Besides, selfmade choices will ensure a greater
commitment than solutions pre
sented from outside."
after two years it will work out to
be self-sufficient.
Photo-. Madhu Sarin
Recommended Study
Sulabh Shouchalaya irila water logged area.
The location of the facility will
not function in a self-sufficient
manner. Creating a free facility on
the other hand, will increase
demands from places that can pay
and will kill the basic spirit of selfreliance.
The problem is tough and the
Sansthan has no ready-made solu
tions. In one place, a local
group of people have taken the
responsibility and they get Rs. 2/per month from local users. Today
three to four units are being tried.
Participation
Some form of participation or
the other has now been recognised
to be a key to successful systems
8
Education in Community Water
Supply and Sanitation Programme :
A Literature Review by Christine
Van Wijk-Sijbcsma (204 pages,
1979, Technical paper No. 12 from
International Reference Centre for
Community Water Supply). Some
authors of this book have observed
that handpumps are broken down
20 to 70% of the time. In some
countries village watsr systems are
breaking down faster than they are
being built. "A community is more
likely to cooperate in the imple
mentation, operation and mainte
nance of new systems if it has had
a say in the preparation of plans".
Many authors have stressed
"the importance of presenting the
Concludingly, it may be helpful
if we mention books and sources
for those readers intending to do
something in their communities.
The bibliography Low Cost Techno
logy Options for Sanitation: A
State of the Art Review (184 pages
by Witold Rybczynski, Chongrak
Polprasert, and Michael McGarry,
1978) offers an excellent summary
of the technologies relevant to
urban and rural settings in develop
ing countries, and is a guide to
hard-to-get technical literature.
The book Sanitation Without
Water by Uno Winblad and Wen
Kilama is an excellent book that
discusses technologies that could
be appropriate to Indian conditions,
with modifications. Similarly, the
booklet Small Excreta Disposal
Systems (published by the Ross
Institute) is an useful small refe
rence manual on the range of
options available for small com
munities. "Design formulas are
included when appropriate and (for
experienced people) it is possible,
using this booklet, to design the
main elements of the system". The
WHO publication of the same name
(.Continued on page 16)
HEALTH FOR THE MILLIONS/AUGUST
1 981
CHINU
Walking Less For More Water
The Evolution of India Mark II Pumps
Water. Where / get it ? Oh, I walk two hours every time, and two hours back. I do this twice
a day. Are we sick ? Oh 1 Often we have running stomachs, especially small brothers and
sisters. If only we could get a well in the village
"
—Nkobo girl.
Southern Sudan
resource requirements are esti
mated to be Rs. 7000 crores I
The two basic problems of
drinking water are : It is not avail
able easily and it is unhygienic.
And in those villages it is available,
it does not easily percolate to the
poor and the less privileged.
Plan was oniy Rs 3 crores, whereas
the Draft Sixth Plan (1978-83)
makes a provision of Rs 1458
crores. However, to meet the goal
of the Water Decade to provide
potable water to all by 1990, the
Some 1.53 lakh villages, out of
a total of 5.76 lakh villages in
India, are classified as "problem"
villages, that is, they are located in
remote, hilly or desert areas where
the water source is below a depth
of 50 feet or 1.6 km away; or
where the water contains elements
dangerous to health, endemic to
cholera and worm infestations ; or
where sources contain excessive
fluorides, chlorides, iron, etc. These
villages
without an adequate
water supply are not evenly distri
buted in the country. Some areas
like West Bengal, Karnataka and
Tamil Nadu are better off whereas
Assam, AP, Rajasthan, Himachal
Pradesh and Jammu and Kashmir
suffer severely. The table below
indicates the extent of the problem.
Percentage of villages without adequate water supply (1977-78)
The government has attempted
to give priority to the problem
under such schemes as Acce
lerated Rural Water Supply Pro
gramme (1972-74 and 1977-78)
and the Minimum Needs Pro
gramme (1977-78). By 1978, some
58,000 villages are reported to
have been covered. The expendi
ture during the First Five Year
HEALTH FOR THE MILLIONS/AUGUST
198 1
Water Below
The exploitation of ground
water has invariably emerged as
Percent
Name of the State
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
58
69
24
18
50
3
36
10
11
23
11
52
7
27
2
61
80
38
41
33
33
N.A.
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
Himachal Pradesh
Jammu & Kashmir
Nagaland
Tripura
Manipur
Meghalaya
Sikkim
Total average
26
Source : GO I Report
(Continued on page 12}
9
A study of the work of some
voluntary agencies in the matter of
sanitation is helpful in planning for
communities elsewhere in the
country. D.K. Mishra in the Oxfam
Report, A Survey of Selected Sani
tation Projects in India (March
1981) has this to conclude : "Sani
tation is yet to become a priority
for the 'last-man', whether residing
in a rural or an urban area, as his
needs are different...The living
conditions of the urban poor
are more unhygienic than their
counterparts in villages. When a
sanitation programme is designed,
the priority areas should be urban
slums, and not rural areas". The
S.S.S. of Patna (see the article
Sanitation with Participation in this
issue), for instance, believe that
in rural areas, housing is a priority
and not sanitation. Hence they
refuse to talk of rural sanitation.
The Safai Vidyalaya, Ahmedabad,
is working mostly on a conversion
programme of bucket latrines,
which again is an urban concept.
The Institute of Public Health,
Poonamalle (Madras) is also doing
mainly extension work in rural
areas. Only the Maharashtra
Septic Tank
B
This is a device to break up the
sewerage into a sediment and an
effluent, both of which can be dis
posed of safely and without any
nuisance. Septic tank systems need
more water and are costly to
install. A 20-user septic tank with
out superstructure costs about Rs.
2,500. Therefore, its construction is
expensive. Meets technical stan
dards fully. Used extensively in
towns where access to a sewerage
line is not available. The system
has to be emptied periodically.
Bucket Privy
Quite commonly used in many
towns in India. Excreta is collected
JO
Gandhi Smarak Nidhi, Pune, has
attempted to work in rural areas
because of the availability of a large
number of subsidies in Maharashtra
State for sanitation work, and due
to a team of committed workers.
Finance is not a problem for the
MGSN generally.
However, the same (about
finance) cannot be said for most
rural areas in the country. Hence
low-cost options have to be thought
of. But with low-cost models, the
maintenance of the system, in the
long-run, depends primarily on the
user and his outlook and attitude.
Safai Vidyalaya, Ahmedabad, for
instance, takes the responsibility
for maintenance during the initial
period when people are learning
to use latrines, but in the long run
it is the people's responsibility.
The
MGSN,
established in
1950, organises training pro
grammes for social and municipal
workers on its ongoing projects.
Each project runs for a week. It
also arranges training programmes
in other states. The only condition
is that they need to be informed
directly in a bucket. Buckets are
removed manually or by wheel
barrows, bullock carts, etc. The
system as practiced is unhygienic
and is a health hazard to the com
munity and to the scavengers parti
cularly. It is quite an inhuman sys
tem. Condemns for life, those en
gaged in scavenging, as social
outcasts.
PRAI Type
This type of latrine was evolved
at the Planning Research and
Action Institute (PRAI), Lucknow.
Basically consists of a pit dug into
the ground with a depth of six to
ten feet. Pit is lined with honey
comb brickwork and cement mortar.
Sludge, earth, other minerals, etc.
Voluntary
Agencies
two months in advance. Through
the efforts of MGSN, some 50,393
latrines in various urban and rural
areas of Maharashtra were cons
tructed up to 1978-79. It also pro
duces pans (for the delivery end of
the latrines) together with the
Malpatra
Utpadan
Kendra,
and the Sarvodaya
Samiti, Andhalgaon, Bhandra
district. These last two organisa
tions are also involved in other
work similar to MGSN in rural and
urban areas around them.
Amraoti,
The Friends Rural Centre,
Rasuliya, Hoshangabad, M.P.,
had initiated the development of
water seal latrine pans in 1957 as
an extension of the famous Barputti latrine. The Vidya Bhawan
Rural Institute, Udaypur, has pro
posals to work on sanitation in
rural areas through 35 polytechnics
in the country. But its ideas are
reportedly vague.
and
Sanitation
The Kalyani Lutheran World
Service (LWS)
Settlement,
Kalyani, West Bengal, a colony of
Santhal tribals has an Oxfam Sani
tation Unit installed. About i00
people use it every day. The unit
appears to be underutilized. The
LWS is also working on a lowcost sanitary latrine which is a
water seal type dug well only one
foot deep and two feet six inches
> in diameter.
The Centre of Science for
Villages, Wardha, displays on its
demonstration plot the bachelor's
lavatory which is suitable for two
or three users and works on septic
tank principles. The Harijan Sevak
Sangh, New Delhi, is a national
organisation with Bhangi Mukti
and Bhangi Kashta Mukti among its
main programmes. The Delhi unit
of the Sangh assists in construc
tion of public latrines. The Gandhi-
gram Institute of
Rural Health
Disposal Systems used in India
found in faeces, accummulate in
this pit. When the pit is full, it is
emptied and reused. Pit fills at
the rate of one cubic foot peruser
per year. No danger of ground
water pollution in this system
unless the water is very high. Pit
latrine should not be fitted with a
flushing system. By using abun
dant water, the soil around the pit
gets saturated quickly
which
reduces the life of the pit.
Aqua Privy
This is an improved form of sep
tic tank. Requires less water. Can
health for the millions/auuust
1981
be built on any kind of soil. Settled
solids are removed from time to
time. Fresh water is not needed for
flushing. Ablution water is found
to be sufficient. Aqua privy meets
all sanitation requirements from a
health viewpoint. Does not require
scavenging. Can easily be used in
the provision of public latrines.
Bore Hole
Bore hole latrines are cons
tructed by boring a hole about
10 feet deep and nine to sixteen
inches in diameter. This system is
useful when there is little available
HEALTH FOR THE MILLIONS/aUGUST
and Family Planning, Ambathurai, Madurai, Tamil Nadu, has taken
up environmental sanitation work,
such as the installation of hand
flush latrines in villages in Athoor
block, drainage, the provision of a
protected water supply and smoke
less chullas, etc. These schemes
are generally run under the training
programmes for sanitation workers,
the funds being provided from the
programmes. The Institute has a
small work shed for the construc
tion of latrine pans, pipes, pit
covers etc. These components are
supplied to the beneficiaries at a
subsidised cost and the knowledge
is provided by the training staff.
The Institute is attempting to popu
larise water seal latrines and drai
nage schemes and the response
has been favourable.
According to Shri Bhau Nawrekarji, a pioneer who was responsi
ble for propagating the famous
Naigaon latrines villagers are very
suspicious of anyone who wishes
to introduce sanitary conditions.
They are reminded of the unhygie
nic conditions of urban latrines on
their visits to cities. However, ex-
space. The life of this style of
latrine is short. The bore may be
filled within 12 to 15 months when
7 to 10 persons use it regularly.
When the bore is filled, a fresh
bore is made. Disadvantages : May
require special mechanical equip
ment to bore the hole; chances of
subsidence are high.
Sulabh Swach
Shouchalaya (Sopa Latrine)
Commonly used in rural areas of
Maharashtra. This type of latrine
makes use of a special type of pan
and has a hinged tin flap at the
pan outlet. Flap closes after the
passage of faeces into the pit
(therefore flies do not hover
around). Pit is lined with honey
comb brickwork. The system re
1981
creta as organic manure holds
great interest to people in rural
areas. They realise chemical ferti
lisers alone are not sufficient for
better yields. So the way to
approach cleanliness and health,
says Nawrekarji, is to talk about
the wastage of excreta as against
its utility as manure. The villagers
respond positively to this and not
to sanitation by itself. Shri Nawrekar has successfully installed 20
gobar gas plants alongside the
latrines.
As the author of the above
quoted Oxfam report remarks, most
voluntary agencies are inspired by
the Gandhian philosophy. "This
seems to be an important factor in
this field in initiating any pro
gramme". Voluntary agencies also
enjoy greater freedom in experi
menting with low-cost latrines.
Some of them have succeeded in
doing noteworthy work. Govern
mentinstitutions on the other hand
have had little impact. This is
because of bureaucracy and a lack
of flexibility in their approach. A
humane exception seems to be the
Planning Research and Action
Institute (PRAI), Lucknow.
quires less water and is very
popular for its manure content.
Hand Flush Latrine
Consists of an especially made
squatting plate in which a water
seal pan is incorporated. The seat is
installed directly over the pit. This
type meetsail health requirements.
Can be located near or within
the dwelling unit. It is simple
and cheap to build in rural areas.
Manure Pit
A modification to the hand flush
type. Before the latrine is put to
use, the pit is partially filled with
grass, leaves, paper, etc. for com
posting. When the pit is filled, it is
covered with similar waste mate
rials and a layer of earth. The
squatting plate is then placed on a
second pit for continued use.
Manure from the first pit is taken
out after six to eight months.
11
{Continued from page 9)
a solution to man/ of the prob
lem villages. A large number of
such areas are in the rocky areas
of the country. Consolidated for
mations are present in the major
part of the country, including
almost the entire Indian peninsula
which consists of hard rock for
mations. Such hard rock forma
tions have led to the use of rigs
for drilling the terrain in search of
ground water, sometimes at depths
greater than 100 feet. The exploi
tation of ground water is the best
alternative for the widely dispersed
rural communities. Also it is safe
and potable even without filtration.
This cannot be said of most open
wells, rivers, lakes and ponds.
UNICEF's Role
The involvement of the UN
Children's organisation—UNICEFstarted with the successful use of
1 I rigs procured through UNICEF.
This was under an emergency pro
gramme to provide water supply in
the drought affected areas of UP
and Bihar during 1967-68. Their
continued effective . use in the
drought affected areas of AP and
Bihar led to schemes, involving the
government and UNICEF. These
schemes require the utilisation of
drilling rigs and the utilisation of
ground water for the rural water
supply programme in a big way.
The assistance from UNICEF
continued during the Fourth and
Fifth Plan periods. The emphasis
was on the supply of drilling rigs,
spare parts, accessories, etc. to
assist the State Governments in
exploiting
the ground water.
UNICEF has supplied till date more
than 200 rigs (There are more than
500 drilling machines today in the
country, counting those that are
with private agencies and voluntary
agencies like the Social Work Re
search Centre, Tilonia, etc. Many
of the States have gone in for pur
chase of indigenous as well as
12
imported
rigs). An estimated
number of 40,000 bores have been
made by the rigs supplied through
UNICEF. This benefits approxi
mately 25,000 villages.
High Breakdown Rate
A common feature of the initial
years of the Rural Water Supply
Programme was the frequent break
down of the cast-iron pumps which
were used to tap ground water.
These handpumps were designed
for single family use. They were
patterned on types earlier used in
rural areas in the West. As a result,
they were not suitable for commu
nity use. The Government of India
thus requested UNICEF in 1974 to
participate actively in the develop
ment of a heavy duty community
handpump which could stand up to
the strenuous requirements of pro
viding a continuous supply of safe
drinking water to a relatively large
number of beneficiaries.
Considerable R & D has been
invested in India in the Jalna or
Sholapur pump: low cost with low
maintenance needs. It was first
developed at the former Church
of Scotland Mission at Jalna in
Maharashtra during the late 1960’s,
and was then taken up at the
Sholapur Well Service. Its design
has been improved since, and
patented to prevent sub-standard
pumps being made by other firms
or agencies.
The Mark II
Continued efforts of the Govern
ment of India, UNICEF, CSIR,
WHO, etc. led to the development
of the India Mark 11 handpump. This
is an improved version of the
Sholapur pump. It is an all-steel
heavy duty handpump specifically
designed for community operation.
It is able to function for consider
able lengths of time without break-
II EALTH FOR THE MILLIONS/aUGUST
1981
THREE-TIER MAINTENANCE
SYSTEM
team situated at the block level.
The block team is in turn suppor
ted by the third tier: an even more
well-equipped mobile maintenance
team at the district level, Each dis
trict has one or more mobile main
tenance teams—one team for every
500-600 handpumps.
Costs Accruing
The UNICEF provides rigs for
drilling, the India mark II hand
pumps for pumping the water, and
training and advisory services for
installation and maintenance. The
annual drilling targets are in the
range of 150 to 200 wells per year
At Village level
down and/or the need for major
repairs.
One of the major reasons the
old cast iron pumps broke down or
were not in operation for long
periods of time was poor mainte
nance facilities. The Handpump
Rejuvenation and Maintenance Pro
gramme that began in 1974-75 had
therefore two aims : replacement
of old cast-iron pumps with the
India Mark II handpump and deve
loping a maintenance structure.
At block level
3-Tier System
The result of the latter was the
three-tier maintenance
system,
first developed as an outcome of
drought in Tirunelveli District,
Tamil Nadu 1975-76. The system
was a success and was adopted
by the Tamil Nadu Government for
the entire state. Subsequently, the
three-tier maintenance system is
being adopted in other states of
the country as well. The bottom
tier is a village handpump caretaker,
sometimes called the "barefoot
handpump doctor". This person
works at the village level on a
voluntary basis and is trained to
take care of minor maintenance.
Whenever a major job is required
on the pump, he sends a postcard
to the second tier: a maintenance
HEALTH FOR THE MILLIONS/aUGUST
per new rig depending upon depth
of aquifier, casing required, etc.
Till 1980, UNICEF had supplied
approximately 40,000 India Mark II
handpumps to the various states,
and another 16,000 pumps are on
order. The State Governments
have also placed orders with quali
fied Indian manufacturers including
the public sector unit : National
Small Industries Corporation. There
are strict ISI specifications for these
handpumps. Furthermore, UNICEF
has supplied more than 165 vehi
cles for the mobile maintenance
teams.
The cost of the Mark II pump
inclusive of pump, rod and cylinder
is Rs. 1500/-. It costs an average
of Rs. 15,000/- to Rs. 25,000/- to
198 I
drill a 150 feet deep hole of 4-6
inches diameter. In MP the costs
are reported to be less for drilling.
The annual cost of the three-tier
maintenance system has been esti
mated at about Rs. 1.5 lakhs for
500 pumps. Each India Mark II
pump therefore costs about Rs.
320/- per year to maintain which
compares with Rs. 500/- to Rs.
650/- required to maintain sub
standard pumps.
Confidence Again
The design of the pump itself is a
matter of great satisfaction to those
who were involved. A British Con
sumers' Association report called it
the best of its kind in the world.
"The India Mark II handpump and
the three-tier system have together
once again given us confidence in
rural water supply programmes",
says a UNICEF official, who earlier
faced a barrage of breakdowns
and maintenance problems that
looked almost insolvable for a long
time. The success of the Tirunel
veli experiment and the three-tier
system has resulted in many State
Governments taking a renewed
interest in handpumps. Community
participation at the village level
has been a key factor in the success
of the India Mark II pump and the
three-tier system.
Improved Health ?
The objectives of the UNICEF
and government agencies for drill-
At district level
13
ing and installation of pumps is to
reduce the incidence of water
borne diseases, thereby contribut
ing to a decline in infant and child
mortality and morbidity. Specific
objectives include : ensuring the
continuous availability of a mini
mum of 40 litres of potable water
per person per day; installing one
tube-well with dependable hand
pump for every 250 people; second
tube-well and handpump where
the population exceeds 250 or a
school or health facility exists; and
so on. Will health improve there
by?
dysentery and various diarrhoeal
infections are as much waterwashed as they are water-borne.
An improvement in the quality of
drinking water would not cut down
their incidence very much. Impro
ved water supply in some cases,
can increase health risks. Lack of
drainage can encourage mosquitoes
and other disease vectors. In India,
the population at risk from filariasis
has increased about 20-fold to over
125 million over the past 15 years.
One reason is believed to be im
proved water supplies without
drainage systems.
It may not, and it will not un
less improved water supply and
sanitation are coupled with health
education and community parti
cipation. Several diseases generally
thought of as water-borne are
affected not so much by water
quality as by the quantity of water
and the manner in which it is used.
This is true especially of the waterwashed diseases like scabies, skin
sepsis, trachoma and fungal infec
tions. Even diseases like bacillary
Voluntary Roles
There are other bottlenecks and
obstacles in providing potable water
to rural communities. One rig can
drill more than 1 00 wells in a year.
But the average in India has not
been more than 20 till date. This
is because the requests for drilling
and installation has to be routed
through State Governments. Then
there are local political forces and
groups that interfere with the
attempts of well-intentioned, targetoriented government officials. Even
when installed, the handpumps
continue to be used more by the
richer sections of the community
and the upper castes. The poor
shy away because of caste-domi
nation.
Voluntary agencies could faci
litate peaceful choice of a place
for the installation of the pump in
the village. They could help acce
lerate the flow of funds and facili
ties from the various government
agencies; ensure community parti
cipation and provide the link with
health by health education. Some
enterprising voluntary agencies in
the country have even procured
their own drilling rigs. Others could
do so, if feasible for them.
(Voluntary agencies interested in
implementation could contact for
further details : Raymond L.M.
Janssens, Project Officer, WES,
UNICEF, Lodhi Estate,
New
Delhi-110003. UNICEF training
kits are available to those interested
in starting their own programmes).
Ways in which water supply projects can lead to a worsening of the
relative position of the poor
• Dominant groups might receive a subsidized service
which the poor do not receive, e.g. individual supply to
their homes without a corresponding payment.
• Access to the new water supply might be restricted or
monopolized. This danger includes cases where the
design of the project appears to cover the poor as well,
but actual flow is limited or diverted, so that only the
dominant group benefits, e.g. by use of water for farm
ing purposes in such quantities that the supply does not
reach the homes of the poor.
© Water used for agricultural or commercial purposes by
dominant groups may increase their income in ways
which are not available to the poor; this can then lead to
changes which worsen not just the relative, but also the
absolute position of the poor—changes in land tenure,
for example, or the discontinuance of arrangements to
share food in times of disaster.
© Employment opportunities in the form of water carrying
may be lost.
14
© Eq ual contributions exacted from all inhabitants for the
construction or running costs of the water supply may
mean a charge which poor families are in no position to
afford.
® Voluntary work demanded at peak times in the agri
cultural work cycle may lead to a substantial decrease in
production.
© The power of the dominant group may be increased by
the patronage available, e.g. in the selection of a
water supply operator on a salary. At the least, the
village-level organization of the programme, in collabora
tion with a powerful external agency, will be a political
resource in terms of prestige.
Excerpted from Community aspects of rural water supply
and sanitation programmes at village level, Checklist no. 4,
by E.L.P. Messing and P. Kerkhoven, paper presented at
the Research Study Group Meeting on Appropriate
Technology for Improvement of Environmental Health at
the Village Level, New Delhi, 16-20 October 1978 qEA/
EH/RSG/Meet. 1/4, 2a.
’
HEALTH FOR THE MILLIONS/aUGUST
1981
COST OF THE WATER DECADE
NEEDS:
SERVICE LEVELS :
1990 population of developing countries needing water
supply and sanitation (in millions).
Case 1*
(100% coverage using 1980 WHO Target Urban
Service Standard Distribution)
Urban
Water Supply
70% house connection
30% standpipe
Sanitation
40% sewerage
40% septic tanks
20% latrine and
communal latrines
Water Supply
20% house connection
40% standpipe
40% handpumps
Sanitation
80% sewerage
20% latrine
Water
640
1,570
2,210
Urban
Rural
Total
Sanitation
650
1,670
2,320
COSTS :
Rural
Per Capita costs of alternative types of water supply
and sanitation (1978 USS)
Rural
Urban
Case 2*
(80% coverage with service standard as
suggested)
Water Supply
40% house connection
40% standpipe
Sanitation
25% sewerage
15% septic tanks
40% latrine and
communal latrines
Water Supply
10% house connection
30% standpipe
40% handpumps
Sanitation
10% sewerage
70% latrines
Water Supply
with house connection
with standpipe
with handpumps
S120
40
—
S150
40
25
Urban
250
100
30
250
—
20
Rural
Sanitation
with sewerage
with septic tank
with latrine
* Both sets of figures are only rough approximations. They
are bound to rise further when costs of operation and
maintenance are added to installation costs.
SOURCE : World Bank, Basic Needs : Water Supply and
Waste Disposal, Dec. 10, 979 pp. 6-7.
Wishing form WASH
Asking from AFPRO
The Water and Sanitation for Health (WASH)
Project is an USAID sponsored agency which
aims to provide centrally-funded services to
improve drinking water and sanitation "with a
minimum of administrative effort and delay".
WASH offers services to, among others, private
voluntary organisations in the AID developing
countries including India. Its services range from
general technical assistance, technology transfer
for water supply and sanitation, manpower develop
ment and training, and information support.
Furtherin- formation can be had from: Information
Director, WASH Project Coordination and Informa
tion Center, Room 1002, 1611 North Kent Street,
Arlington, Virginia, 22209, USA.
The Action For' Food Production (AFPRO)
is a non-profit organisation located in Delhi. It
coordinates, supports, evaluates and gives technical
guidance to food production projects of non
governmental and voluntary agencies. It works in
close collaboration with the Government of India.
HEALTH FOR THE MILLIONS/aUGUST
AFPRO also receives several enquiries and
requests for advice on appropriate technology re
lated to water, irrigation, agri- culture, animal
harnessed transport, solar and wind energy
biogas, rural latrines and housing, and recycling
of wastes, including polluted waters. For further
details, readers may write Jto AFPRO, C-17,
Community Centre, SDA, New Delhi-110016.
1981
15
I
to r3nh>ng3,
-'oc/;
A School For Cleanliness
Safai Vidyalaya, Ahmedabad, is search for technologies that are their own communities could con
housed in Parixit Sadan, named simple, low-cost and appropriate, tact Ishwarbhai, Safai Vidyalaya
after Parixitlal Mazumdar, one of those that require less water and Harijan Ashram, Ashram Road,
Readers Ahmedabad—380027.
the pioneers of the Harijan move are easy to maintain.
—Mira
interested
in
implementation
in
ment. Housed in the Vidyalaya are
the many lifesize models as well as
miniatures of the different types of
Container Gardening
latrines, chullas, soakage pits, etc.
The Vidyalaya offers trainning faci
In the tropics, where sunlight kets. Fragile containers can be
lities to government bureaucrats,
is abundant, a family with little reinforced with wire and string.
voluntary bodies,
school
and
Growing Food in Containers
or no land can produce fresh
college
students,
panchayat
food right at home—in con in the Tropics discusses sites,
officials, PWD engineers, sanitary
tainers. Container gardening is soil preparation, plant care, in
inspectors
and
others.
The
cheap, allows food to be grown sects and diseases, harvests,
Vidyalaya, which acts as an hono
with minimal exposure to chemi choice of plants, and productivi
rary adviser to the Gujarat Govern
cal substances, and is quick. ty. It has sections on roots and
ment, has been making concerted
Ceylon spinach, for example, tubers, fruits, vegetables, legu
efforts to motivate communities
yields
its first harvest in 24 days mes, spices and condiments, and
about the need to participate in
and seven more harvests within leaf vegetables. It also rates 11
their own sanitation by way of
188 days. One plant can produce crops and over 30 varieties sui
Shivirs (camps). Over a lakh bucket
as
much as 1.8 kilograms of table for container gardening
latrines were converted in 1969-77.
1
spinach.
both inside and out.
By the end of 1977, some 45,000
All
sorts
of
household
items
Available from: Mayaguez
were still to be converted. The
can serve as containers: plastic Institute of Tropical Agriculture:
Safai Vidyalaya's work has proved
bags, milk cartons, tin cans, USDA; PO. Box 70, Mayaguez,
to a significant extent, that change
wooden buckets, even old bas Puerto Rico 00708 USA.
can be created by determined
work.
As a training centre it has an
important role. Its concepts are
being increasingly accepted even
in rural communities. Ishwarbhai,
who is the prime force behind
Safai Vidyalaya, is an unassuming
man, enthusiastic and passionate
about his mission. He told VHAI
that he would be willing to con
duct training workshops in sanita
tion in English and in Hindi, at any
part of the country. Preferably,
such workshops would need to be
coordinated through the local or
state branch of the Harijan Sewak
Sangh. The host institution would
need to take care of Ishwarbhai's
travel, food and stay.
The emphasis behind much of
the work of Safai Vidyalaya is the
16
{Continuedfrom page 8}
discusses Management of Solid
Wastes in Developing Countries—
refuse collection and transport,
sanitary landfills, and composting
of urban wastes. Lastly, Arnold
Pacey's Rural Sanitation : Planning
and Appraisal (64 pages, 1980,
ITDG) : This is a booklet written
for hospital staff and community
development workers in third world
countries who are planning to
start sanitation or hygiene improve
ment programmes in rural areas.
(The books and references men
tioned above can be made available
through VHA! on request
—Ed. HfM.)
WE NEED YOU
Doctors
Wanted a Surgeon M.S., F.R.C.S.
and Physician M.D., M.R.C.P. for a
general hospital with 125 beds. For
further information please contact :
Administrator,
Mercy Hospital,
Baridih, Jamshedpur 831017.
Professionals
Hemkhail Trust requires for their
rural development project a group
of professionals—doctors, agro
chemists, geologists, engineers,
designers, teachers, sociologists—
to work together as a team. Interes
ted individuals/institutions may con
tact : Mr Yogendra Jain, Hemkhail
Trust, 139 Johari Bazar, Jaipur302003.
HEALTH FOR THE MILLIONS/AUGUST
1981
LOW COST DRUGS PAGE
DRUGS BULLETIN
DRUGS BULLETIN is brought out by the Department of Pharmacology, Postgraduate Institute of Medi
cal Education & Research, Chandigarh. Editor: Dr. V. S. Mathur.
The Bulletin publishes articles covering drug management of various diseases. Plus its regular
features are :
A.
B.
From the Desk of the Drugs Controller of India.
Generic names/Brand Name/Drug Houses and prices of drugs.
Sample
DRUGS USED IN PULMONARY TUBERCULOSIS
Generic Name
Streptomycin
Isoniazide
(From July '81 issue:
Vol. 4 No. 3)
Drug House
Presentation
Packing
Price
Rs. p.
Ambistryn-S
Sarabhai
Merstrep
Streptonex
Sugacin
MSD
Pfizer
HAL
Inj. 0.75 gm.
1 gm.
Inj. 1 gm.
Inj. 1 gm.
Inj. 0.75 gm.
1 gm.
0.75 gm vial
1 gm. vial
1 gm. vial
1 gm. vial
0.75 gm. vial
1 gm. vial
1.03
1.18
1.18
1.57
1.01
1.19
Ipcazide
Ipca
120 ml.
7.85
Isokin
Warner
Liquid : 100 mg/
5 ml
Tab : 100 mg
100 Tabs.
1000 Tabs.
3.94
30.38
Warner
Pfizer
Liquid : 50 mg/
5 ml
Tab. 300 mg.
Tab. 50 mg.
200 ml
10 tabs.
1000 tabs.
5000 tabs.
100 tabs.
1000 tabs.
5000 tads.
30 tabs.
1000 tabs.
1000 tabs.
100 tabs.
1000 tabs.
2500 tabs.
6.40
1.88
17.81
. 82.27
4.50
30.38
144.19
3.41
86.38
15.43
3.51
25.98
60.99
Brand Name
Isokin 300
Isonex
Tab. 100 mg.
Isonex Fort
Pfizer
Tab. 300 mg.
Nidrazid
Sarabhai
Tab. 50 mg.
100 mg.
Useful for health personnel with some knowledge of Pharmacology.
articlescan be made available at a later date.)
HEALTH FOR THE MILLIONS/aUGUST
1981
(Reprints of the more relevant
17
new
1981. There were 26 participants.
The main features were small group
discussions, games, exercises, etc.
There are also plans to hold a
VHW conference
during
the
Dushehra holidays at Bhopal.
*
*
*
Bihar
Kerala
Bihar VHA is planning a twoday convention for village health
workers of Palamau district at
Chandwa on October 2-3, 1981
and a physical assessment work
shop from November 2-7, 1981 at
Kurji Holy Family Hospital, Patna.
One of the emerging trends
among’ KVHS members is the
increasing interest in holistic health.
Holistic health was the theme of
their annual general body meeting
held on July 29, 1981. Dr. J C
Vijayan who had his training in
holistic health in the States was
one of the key facilitators at the
annual general body meeting be
sides George Ninan of VHAI. There
has been a great interest in VHS
and Communitv health among the
participants of diocesan develop
ment seminars, Kothamengalam
diocese. KVHS has been invited
to conduct orientation programmes
in community health for all the
community health projects in the
diocese.
For further details please contact
Mr. M. Zaman, Executive Secretary
of Bihar VHA at Kurji Holy Family
Hospital, Patna-800010.
West Bengal
Community health and develop
ment training is prominent in WB
VHA's activities and plans. The
VHA has already trained 23 Ch
trainees. A follow-up meeting is
planned for November 1981. WB
VHA is also helping to market the
goods of voluntary organizations
and to solve their marketing pro
blems, and making new posters on
health and development.
The future plans of WB VHA
include follow-up of trainees and
seminars and workshops on human
relations, holistic health, school
health, health education, commu
nity health and development, etc.
In addition, it is also planned
to organise three community health
develpoment training workshops
per year in various districts of West
Bengal and a statewide health and
development convention once a
year.
18
Uttar Pradesh
A workshop on health and
development
was
organised
from September 19-21, 1981 at
Rajpur, Dehradun, UP. The work
shop was sponsored by various
groups working in health, rural
development and related fields to
share their experiences, problems,
etc.
Tunnie Martin, coordinator for
the region, is planning another com
munity health workshop at Vigyan
Shiksha Kendra head office at
Attara, UP, from December 7-14,
1981.
Madhya Pradesh
MPVHA organised a workshop
for community and village health
workers from April 28 to May 3,
Research
and Development
Organisation,Tansen Road, Gwalior
—474002, has developed a very
simple and inexpensive field test
for fecal pollution of drinking
water, suitable for screening rural
water supply systems and large
scale screening of urban water
supplies. For details write to
Dr. J.S. Mahashabde, president
MPVHA, Indore
Eye Hospital
Society, 84 Jawahar Marg,Indore,
MP.
New Delhi
VHAI has designed a 15-month
course in community health team
training. This course emerged from
an evaluation of short term courses
in community health and develop
ment since 1974. The broad
objective of this programme is to
help prepare teams to participate
in building of healthy individuals
and health communities through
integrated development with em
phasis in people's involvement
using appropriate and local resour
ces and responding to community
needs.
The first training programme
begins on September 13 and ends
on December 15, 1982. This pro
gramme is for the groups working
with Bhil tribals in Western India.
The participants will meet at
regular intervals for the training
and spend a major part of their 15
months in their own place of work
implementing what they have
learnt. They will be visited by the
VHAI team twice during the course.
There are 15 participants for the
first such programme. The first
HEALTH FOR THE MILLIONS/AUGUST
1981
phase of the programme will be
held from September 14 October
11, 1981 at Mendha Community
Centre, Jobat, MP.
♦
*
*
how it can be cured and how it
can be prevented within the avail
able means or resources of the
village.
* To liberate people from
superstitious beliefs and a
certain fatalism
regarding
their health system.
*
*
*
This was no ordinary magician.
VHAI organised a workshop on It is a youth group of Nadiad who
planning and evaluation of commu along with the Sisters of Our Lady
Mahila Mandal Camp
nity health programme for organis of Pillar dispensary and Parish
Village health workers of Zaroli
ing secretaries of State VHAs from Fathers and Sisters conduct a
organised 10 seven-day camps
August 4-9, 1981 at Baroda, Health Education Programme every
in each of the Mahila Mandal
Gujarat. Some of the important summer in the villages around
villages. The basic idea of this pro
points that were discussed include Nadiad. This year 1981, the main
gramme was to combine what is
planning of new programmes, im organisers of the programme were
practised with theoretical know
provement of existing programmes, Fr. Valeriac Dias, D. N. C., Sr.
ledge. It was conveyed through
simple criteria of evaluation, im Agnes, Sr. Pilar, Sr. Nirmala and
group discussions starting from
ported food distribution, mobile Fr. Jerry Fernandez. The pro
actual happenings in their villages.
medical service,
etc.
Simone gramme was conducted in three
♦
♦
*
Liegeois and Sathyamala were re phases over two months.
source persons.
Bediapada dispensary has in
* A survey to find the prevalent
diseases and
the words formed GVHA that they have identi
Gujarat
people use to form the code fied 42 disabled persons in South
for the presentation of the Gujarat and a survey was going on.
Magic in Summer
An interesting aspect of this survey
programme.
of 1981
is that it is being carried out through
* The presentation of
the
the dairy cooperative societies. Dr.
About 300 to 400 villagers gather
Health Programme through
Ashwin Patel with others would
in the village square to watch the
puppets, drama and charts.
examine these cases and take ap
magician perform. It is 9.00 p.m.
*
A
follow-up
to
make
sure
propriate follow up action.
and the cool breeze of the evening
that the basic message was
under the neem trees is conducive
♦
*
*
understood and to find out
to some entertainment after the
how far people took steps
The GVHA organised a oneday's heat. The magician moves
to combat the prevalent dis month course in Community Health
in the crowd after having hypno
eases as a community.
and Development in Zankhvav from
tised his assistant and moving in
the crowd he touches an old kaka's
Fourteen villages were covered July 6-30. There were 20 partici
pagdi with his wand and his blind and the programmes were : scabies, pants from all over the state with
folded assistant immediately res worms diarrhoea, malaria and one priest and nineteen sisters. The
ponds from far away ''Its a kaka's cholera. The objectives of the pro resource team consisted of Fr. Jerry
from Gujarat and Sathya, Nirmala,
pagdi”. Telepathy I Extra sensory gramme were—
Nalini and Mira Shiva from VHAI,
perception ? Or just plain black
* To make people aware of their Delhi. The major highlight of the
magic ? And the crowd keeps
present health facilities to course is the follow up to be co
watching one trial after another
combat prevalent diseases.
ordinated by Fr. Jerry. He will link
with a sense of awe and wonder.
Claps and laughter follow. Sudden
* To work mainly with the with Ashok Subramanian for the
ly the magician's magic wand
backward classes who usually North Gujarat and with Ashwin
senses...worms in the people's
have no access to doctors or Patel for the South Gujarat teams
stomach. He asks the people if it
medical institutions due to respectively.
is true. Yes, they reply. And then
financial or other constraints.
The GVHA annual convention
siding the villages he invites a
will
be held from November 21-22,
* To bring about a certain unity
doctor standing closeby to explain
1981 at the Spiritual Life Centre,
in
the
community
through
this phenomenon : what is worms,
Bharuch.
health.
how it is caused, how it is spread,
COMMUNITY health cell19
HFALTH FOR THE MILLIONS/aI GUST 1981
326. V Main, I Block
KoramDnga la
Bangalore-560034
India
Andhra Pradesh
AP VHA's future plans include
seminars and workshops on evalua
tion of nutritional programmes,
educational materials, school health,
village health workers' convention,
etc.
*
♦
♦
During July-August '81, AP
VHA hosted two extremely suc
cessful workshops : Holistic Health
and Advanced TA. The Holistic
Health workshop was of six days
duration and attended by more
than 35 participants. The resource
team included Sr. Carol Huss and
Chinu, Renu, Mira and George from
VHAI. The sessions covered all five
dimensions of holistic health : self
prolonged indecisiveness, according
to the college sources, in granting
it permanent affiliation, sanction
for post-graduate courses, and re
cognition of the campus hospital
a teaching hospital. A recent ac
of the university has been to un
affiliate the college and deny it the
privileges of the Bangalore univer
sity. Through a notifica*’ .< and
press release, the first MBBS stu
dents who had joined in August
1980 were informed on July 19,
Karnataka
1981 that they would not be per
The St. John's Medical College mitted to appear for the examina
has been subject to major problems tions slated for August 10, 1981.
for the past one year. Strong differ
Meanwhile, St. John's has filed
ences have emerged between the a writ petition in the court seeking
privately run Catholic Medical among other things permission to
College- and the Bangalore univer- the management to continue ad
,ity. The university has shown a missions for 1981-82.
♦
♦
♦
responsibility, nutritional aware
ness, social and environmental
sensitivity, physical fitness and
stress management. There were
discussions on biogenics, yoga,
foot reflexology, dream counselling
and air, water and food pollution.
Many of the participants concluded
with contracts for- change and
exciting ideas and plans for imple
menting it in their respective insti
tutions.
News
Creative Winners
Health For the Millions joins
many grateful people in congratu
lating Dr. Pramod Karan Sethi for
being awarded the Ramon Magasaysay award ("the Asian Nobel
Prize") this year for community
leadership. Dr. Sethi's Jaipur foot
(see "New Hope for Rural Ampu
tees", in Health for The Millions,
October 1978, for fa detailed
description) has brought hope
to thousands of cripples in the
country.
We also congratulate Dr Robert
Sperry of the California Institute of
Technology for winning this year's
Nobel Prize for physiology and
medicine. Dr Sperry, who shared
the coveted prize {with Professors
David Hubei and Torsten N. Wiesel,
was awarded the prize in recogni
tion of his studies of the brain :
"brilliantly succeeded in extracting
the secrets from both hemispheres
20
ofthebrain and in demonstrating
that they are highly specialised and
also that many higher functions
are centred in the right hemis
phere." Some consequences of the
discovery of Dr. Sperry were ex
plored in our February 1981 issue
in "A Kind of Conspiracy".
—Ed. HFM
*
♦
♦
Commission for
Health and Human
Rights
It is accepted in principle that
physicians and other health workers
can and should be closely identi
fied with the cause of human rights.
Now, a formal commission is to be
formed : The International Medical
Commission (IMC) for Health and
Human Rights. A preparatory com
mittee has been set up to pave the
way for the commission, wh ch, it
is hoped, will be formally establi
shed in 1982.
The IMC will aim to secure the
widest possible commitment by
physicians and other health workers
to respect human rights and medi
cal ethics, and to stimulate a high
level of vigilance for breaches or
failure in observance of these princi
ples. The Commission will investi
gate situations and cases that do
not conform with the established
human rights principles, and take
action to secure observance of
these principles. It will promote
education of and exchange of in
formation among physicians and
other health workers concerning
the ethical principles of health work
and human rights. The contact
address of the Commission's pre
paratory committee is : P. 0. Box
105, 1225 Chene-Bourge, Geneva,
Switzerland.
♦
♦
*
HEALTH FOR THE MILLIONS/aUGUST 1981
OBITUARY
J P Naik
(September 5,1907—August 30,1981)
In 1930, he joined the Civil Disobedience Move
ment and was imprisoned for two years in the Bellary
jail. It was during his underground day's that he
adopted the name J.P. Naik (his earlier name was
V. H. Ghotge) by which he has been known ever after.
On his release from jail in 1932, Naik started rural
development work in a number of villages at UppinBetigeri in Dharwar district. Two of the villages in
district, namaly, Uppin-Betigery and Kardigud, were
awarded the Sir - Frederick Sykes Villages Improve
ment Shield fcr the Dharwar division in 1937.
In 1940, Rao Bahadur P.C. Patil, who was then
Education Minister of the princely State of Kolhapur,
invited him to assist in the educational reconstruction
of the State. Naik started his work as a part-time
Educational Adviser, but soon rose to the position of
Development Secretary. Characteristically enough,
Naik worked 18 hours a day but accepted no salary.
In 1948, he established the Indian Institute of Educa
tion. Simultaneously, he established Shri Mouni
Vidyapeeth, a rural institute at Gargoti in Kolhapur
district.
The list of participants at the meeting held in Delhi
to condole J.P. Naik's death would read like an Indian
Who's Who of education. But it is not only educa
tionists who will miss him.
Naik's concern for the poor, the underprivileged
and the oppressed, led him to take a keen interest in
the problems of health care especially for the rural
areas. He worked as a member on the Shrivastava
Committee, Gopalan Committee on Drug Addiction,
and on the ICMR —ICSSR Paneion Alternatives in
Health.
His most significant contribution in this
«
behalf is the report of the study group set up jointly
\ by the ICSSR and the ICMR entitled "Health for All :
\ An Alternative Strategy".
P
1
Naik began his working life at the age of five on a
(farm in a small village, Bahirewadi, in Kolhapur
’district.
The next phase of Naik's life began in 1959, when
Dr. K. L. Shrimali, the then Union Education Minister,
invited him to Delhi to assist him in the task of educationai reconstruction at the national level. Naik
refused to accept a salary and maintained himself
throughout his stay in Delhi on small earnings from
lectures, books and other writings. In May 1969.
Naik established the Indian Council of Social Science
Research and was its Chief Executive for the first nine
years.
Naik was not only an institution-builder but also a
prolific writer. Concern for the education of the people
stimulated most of his writings on education. Between
1942 and 1978, Naik wrote about 30 books and
edited five. He wrote innumerable papers for national
and international journals in addition to some books
and papers in Marathi and Kannada. People who
cherish good values in life will continue to find in him
an inspiration.
The emblem of the International Drinking
Watt Supply and Sanitation Decade has the
following components.
The image of a drop, which is readily
identified with drinking water and sanita
tion in all parts of the world.
• Within the large drop, signifying the
Decade as a whole, ten small drops re
present each year within the Decade.
• The sprinkling, configuration of drops
suggests the spreading of drinking water
and sanitation services throughout the
world, in line with the Decade goal of
"clean water and adequate sanitation for
all by the year 1980."
• The encircling olive-branch wreath symbo
lizes the United Nations' supporting and
promotional role in the Decade.
For Private Circulation Only
me TinesT oaoy Tooa
an advertisement
HEALTH FOR THE MILLIONS
Vol. VII No. 5-6
Oct.-Dec. 1981
the finest baby food
CONTENTS
1
Basics of Breastfeeding
3
Health Workers, this is How
4
A Letter from a Newborn
5
This is What You Tell the
Mother
9
Supplementary Feeding: the
right wa
13
Dear Administrator
14
Research Research Research
17
World Versus the Bottle
19
Genesis of the Bottle
24
Codes: Indian and WHO
27
Their Experiments with
Untruth
28
Further Reading
33
Drug Column
This issue is an advertisement for the world’s finest baby
food, known as breast milk. This advertisement is aimed at
the very “influential” people who often unwittingly work against
breast milk. We call them doctors, nurses, health workers,
health practitioners and what not.
The health services and the infant food industry have had
a big role in the decline of breastfeeding in urban and semiurban areas and threaten to do so in rural areas of India too.
Maternity ward and clinical practices often encourage bottle
feeding. Health practitioners have often contributed to the
problem. The abuse of anaesthesia, medication or surgery
during delivery interferes with the initiation of breastfeeding.
Very often health professionals are not motivated to the need
for promoting breastfeeding. They have no time to inform or
convince mothers to breastfeed.
Hospitals should be a focal point for health and nutrition.
But they seldom are. Health workers need to have close links
with families during the period of child bearing and child rear
ing. They can strongly influence infant-feeding practices.
But they rarely do.
Baby food companies provide health practitioners with a wide
variety of free goods and services. Paediatricians and other
health practitioners who are ‘wined, dined and gifted’ act as
apologists for the milk companies. And the wining, dining and
gifting add greatly to the cost of the product.
Admittedly, there is a great need for all to enforce the code
of ethical practices on babyfood companies. That can only
start with our own enlightened commitment to breastfeeding, in
theory and in practice.
Editor
: S. Srinivasan
Executive : Augustine Veliath
Editor
Production : P.P. Khanna
Assistance : P. George
Circulation : L. K. Murthy
Owned and published by the Voluntary
Health Association of India, C-14, Com
munity Centre, Safdarjung Development
Area, New Delhi 110016, and printed at
Hans Raj Gupta & Sons, New Delhi.
This issue is in two parts. The first part deals with what
everyone should know of breastfeeding. The emphasis is on
the role of health workers in promoting breastfeeding and
suggesting the right kind of supplementary feeding.
The second part speaks of the battle of the bottle which all
those who love children are waging against the unscrupulous
infant food industry and its supporters in high places. We
have ventured to spell out the individual role in this fight. If
you have ideas, please share. Write to us at VHAI.
In preparing this issue we have benefitted from the Jelliffe,
Morley, King, Cutting, Ebrahim and Ghosh. Materials supplied
from UNICEF and those collected by my colleague Chandra
have been of great help.
— Augustine J. Veliath
basics of breastfeeding
Q. How soon after delivery
should a mother start
breastfeeding?
A. A newborn baby should be put to the mother’s breast as soon as
possible. One or two hours after the baby is born is recommen
ded.
Q. At first the mother’s milk A. Yes. This milk is called colostrum. It helps protect the baby from
illnesses such as diarrhoea. A few days after the baby is born
is watery and sometimes
the milk changes colour and consistency, but it is just as nutri
yellow. Is this milk good
tious and healthful for the baby.
for the baby?
Q. Can all mothers breast
feed?
A. Yes, practically all mothers can. There are very few conditions
which prevent a mother from breastfeeding her child.
Q. How do you put the baby A. Most mothers know this. Only teach them if the molfeQws having
difficulty. Then follow these guidelines. The mo.tff^n§Kpuld be
to the breast?
comfortable. When the mother is comfdr^bre7 l!Te<njJ[k'-flows
easily. If the mother touches the baby’s cheek with her nbp^£, the
baby will automatically turn its head and open its mouth. Bog) the
nipple and the dark skin around ; the nipple should^bsW.the
baby's mouth.
'
Q. How often should the
mother breastfeed?
b-k
* A
. A
;•„« A.
A. Allow the baby to breastfeed whenever.; itx wants, eyep?"during
the night. For the first few weeks the bab^--wilKc^y: when it
wants milk and feedings will be frequent and irregular. Later, the
baby will be able to suck more milk at one feeding and there will
be more time between feedings.
Q. How long should a baby
be fed each time?
A. The baby should be allowed to suck for as long as it wants. At
first, the time may be quite short, five to ten minutes from each
breast. When the baby gets older and stronger it will suck for a
longer time because it needs more milk.
Q. Up to what age should a
child be breastfed?
A. It is good to breastfeed for atleast one year. After the first four
to six months, the mother should begin to give the baby additional
food to complement the breast milk. Breast milk is still important
for growth in the second year of life.
Q. How do you know if the
baby is getting enough
breast milk?
A. Most mothers produce enough milk so a baby can grow well for
the first four to six months of life. The mother should drink two
litres of fluids every day to make sure she can produce all the
milk her baby needs.
Measure the growth by weighing the baby regularly and note the
weight on a growth chart.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
Q. Should a baby be given
occasional feed from a
bottle?
A. No. Bottle feeding is dangerous. Milk and teats are easily con
taminated with germs from dirty bottles.
Q. How should babies be
weaned?
A. Gradually. Breastfeeding should not be stopped suddenly. Other
foods should be introduced and increased for two or three
months. The more other foods the baby receives, the less it will
suck. And the less the baby sucks, the less milk the mother
produces.
A small baby should not need extra feeds from a bottle. If the
baby cries, it should be put to the breast more often. Mother s
milk provides all the nutrients a young baby needs.
From Guidelines for the Training of Community Health Workers in
Nutrition. Published by World Health Organisation and adapted by
SALUBRITAS.
understanding let down reflex
Dr. G.J, Ebrahim in his book Breast Feeding—the biological option,
says the let-down reflex is the most crucial physiological mechanism
in successful lactation. Any factor interfering with the suckling at
the breast by the infant will interfere with this mechanism and affect
milk secretion, eventually causing the breasts to dry up.
On the other hand, regular and repeated emptying of the breast by
suckling will stimulate milk secretion and flow.
In order to establish lactation the baby should be put to the breast
as soon after delivery as possible, allowing time for the baby and the
mother to recover from the rigours of labour. After this the breast
should be offered ‘on demand’ in order to establish a flexible regime
of feeding.
HYPOPHYSIS AT BASE OF BRAIN
Hormones are released from here
‘nto blood and thus sent to breast
Increases mHk production
( hormone, prolactin )
Any ‘top feeds’ or feeds of glucose water will only serve to interfere
with and weaken the let-down reflex by removing the stimulus of
suckling, and should be avoided.
LET-DOWN REFLEX
The regular offering of the breast ‘on demand’ requires close
mother-infant interaction which occurs best when the infant is
nursed in the same bed in close contact with the mother, instead of
in a distant nursery where easy access is not possible.
PROLACTIN REFLEX
Pushes milk towards
the nipple
(hormone, oxytocin)
BREAST
SUCKING REFLEX
Sends impulses to
hypophysis by the
When lactation fails, in most cases it is due to lack of adequate
suckling stimulation through inadequate mother-infant interaction or
compliance of the mother with pressures to reduce the frequency or
duration of suckling (e.g. the rigid routine of a maternity ward or
family pressures), or due to anxiety and uncertainty in the mother. ’
vagus nerves'
The secretion of prolactin is proportional to the stimulation of the
nipple and the areola.
A confident approach in which the mother is encouraged to offer
the breast readily without any reservation helps to overcome her
anxiety and shyness, and also provides for proper development of thp
let-down reflex.
1
2
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
health workers, this is how
(David Morley : See How They Grow.)
You, as a health worker, have a key role in helping the process of
breastfeeding. The health worker's main contribution is to provide
confidence and emotional support.
Pay attention to minor details like :
Eye to eye
Cry
Odour
Interaction
Oxytocin
Prolactin
MOTHER
i INFANT
* holding the baby
* position of mother during feeding
* protractility of the nipples
* baby's reaction and response to the feeding situation
Encourage routines and practices which help to reinforce the desire
to breastfeed like :
* rooming in
* close body contact
* flexible feeding routines
Show how to hold the baby. Hold the baby in crook of the arm so
that the head is free to move about and the back is supported. During
suckling hold the baby close enough for his chin to touch the breast.
If the breasts are engorged, tell the mother
not to stop nursing but
feed the baby more frequently.
If the baby is not sucking well
massage the breasts
express the milk to release the tension in the breasts.
MOTHER i
(David M orley : See How They Grow.)
This is what you do to promote feeding 1
In the early days put the baby to the breast at least 10 minutes on
either side increasing the time to 20 minutes by the third day.
INFANT
Touch
Eye to eye
High-pitched voice
Odour
Warmth
Interaction
Time giver
Advise mothers to breastfeed their child as long as they can. The
minimum is six months.
When you admit a nursing mother or a sick infant to the hospital make
sure there are opportunities for breastfeeding.
Above all be committed to breastfeeding and learn its management.
T + B lymphocytes
Macrophages
Bacterial flora
*
*
*
Early suckling of the breast following delivery.
Frequent sucking of breasts.
Minimize anxiety by socially supportive behaviour that helps to
ensure an uninhibited let-down reflex.
*
Introduce semi-solids from about four months of age when the
breast milk begins to decline in quantity and the child’s growth
begins to falter.
*
Emphasize on quantifying the food at different stages and a
gradual switch over to the family food by one year.
*
Emphasize the basic family food rather than special foods for
the young child.
*
Emphasize on frequent feeding because of the bulky nature of
the diet.
*
Ensure that well-intentioned supplementary feeding program
mes do not end up as nutritional tragedies by discouraging
breastfeeding. Let supplementaries be just that—supplementaries.
encourage the
following
practices
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
3
i
a letter from a newborn
To
Doctor/Nurse
Your Hospital
Your Town
Dated today
Dear Doctor/Dear Nurse,
This is the most crucial year of my life.
your mercy.
I need my mother. I need love.
Will you deprive me of these?
And I am at
I need my mother ’ s milk.
My brain needs a lipid rich milk. I need protection
from diarrhoea. I need protection from allergies . Will
you be ruthless enough to deprive me of breast milk, my
only defence against these dangers?
Will you expose me to millions of bacteria, to the con
taminated water and the dirty nipple so early in life when
I could comfortably sip the warm, made-for-me milk of my
mother?
Will you sacrifice my future for a drug company? Will
you? Will you trade me for a paperweight, or a pencil stand
or free samples that you received from the milkfood
companies?
My mother believes you and looks forward to you for
information. Will you make a mockery of her trust by not
telling her about (breast) feeding me right? Or would you
betray her trust by giving her wrong advice and point to
the bottle?
In short, will you give me a passport to malnutrition,
a sickly childhood and problematic adult life? Will you
dear doctor, will you dear nurse?
Yours sincerely,
The newborn
HEALTH FOR the MILLIONS/OCT-DEC. 1981
j
this is what you tell the mother
There are reasons and more reasons for breastfeeding. Yet the
most important reasons can be summed up under these headings:
the baby
the mother
the milk
the family
the nation
Your baby is unique. Your baby needs food. Your baby needs Ibye.
Your baby needs you, the mother. Breastfeeding is one act through
which you can meet all these needs of your baby.
Practically for the first six to nine months your baby is an external
foetus. In the womb your baby took his nourishment from the
placenta. Now out in the world your baby takes the nourishment
from your breast.
As a human being the most unique part of your baby’s body is his
brain, and his peripheral nervous system. The brain is predominantly
a lipid rich structure. Therefore the growth of baby’s brain should be
a proper balance between lipid and protein nutrients. Human milk is
lipid rich. Cow’s milk and other substitutes are not.
Your baby needs protection from diarrhoea and other respiratory
ailments.
Breastfeeding protects against infections like diarrhoeal disease in
conditions of poor hygiene and in hot weather. This is because
breastmilk contains specific antibodies against diarrhoea-causing
organisms. Besides cleanliness of breast milk, its lack of opportunity
for contamination, physical closeness and restricted micro-environ
ment between mother and baby also contribute to minimising the
danger of diarrhoea.
Studies all over the world, and particularly the developing countries,
have shown that deaths due to diarrhoea are at their highest when a
baby is being weaned.
Bottlefed babies are more prone to have allergies. Many factors
are responsible for food allergy in young children. Cow’s milk protein
is the commonest allergen.
The high incidence of allergic diseases with bottlefeeding was
recognized in the USA, several decades ago, when it was found that
infantile eczema and other conditions were seven times as common
in bottlefed infants consuming undenatured cow’s milk. Human milk
protein on the other hand is non-allergenic.
According to Drs. Uma Patel and Arati Handa, mother’s milk gives
the best nutrition, lots of security, immunity against diseases like
night blindness, typhoid and polio. It gives the best satisfaction
against hunger, otherwise overfeeding can lead to obesity in child
hood. Diseases like tonsils, ear infection, and lung swelling, fever,
flu, chicken-pox etc., are seen less amongst breastfed babies. Also
swellings and boils near the anus are rare. Mother’s milk contains
such immunological factors upto one year.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
5
In the prevailing socio-economic and hygienic circumstances in
most technologically less developed countries, bottle feeding is a
highly hazardous process, and most likely to lead to diarrhoeal
diseases with greater severity and mortality.
Contaminated water supply, inadequate fuel, poor storage facilities,
and inadequately cleaned bottle and teat all work against the health
of the baby.
You do not serve merely as a passive transmitter of immunity.
Instead, your mammary gland is able to react to the microbes
brought to it by the infant and respond with a fast production of
specific antibody.
The babies who are bottlefed are more likely to die than those who
are breastfed. Bottlefed babies die of infection and malnutrition.
Your baby is your achievement. Child birth in itself was an
experience. Nature has intended that breastfeeding too will be an
enjoyable experience. Breastfeeding your baby will make you for
ever closer to the baby.
It is your privilege and duty to be the first answer to your baby’s
biological and emotional needs.
You can transform the simplest and cheapest foods you eat into
breastmilk, perfectly suited for your baby.
If you cannot breastfeed do not use a
bottle. Feed the baby with a spoon
from a cup
Even a poorly nourished woman, thanks to some metabolic adapta
tions, can produce the right volume and composition of milk.
Remember almost all mothers can breastfeed. Even if you cannot,
do not feed with a bottle. Feed with a cup and spoon.
It is enough to eat the locally available food. You need not buy
any special feed. You may need to eat little more than usual (about
500 calories more).
You, the mother
Breastfeeding helps you to get your body back into shape. Breast
feeding helps your uterus return to its pre-pregnancy condition. The
little fat you may have gained during pregnancy is converted into
energy in the milk.
The study of Masters and Johnson have pointed out that nursing
women have higher level of interest in sex than non-nursing mothers.
Breast feeding delays ovulation and therefore the next pregnancy.
In communities where breastfeeding is universal and offered ‘on
demand’, it has been observed that about a third of the total volume
of milk ingested in the day and a third of the total number of feeds in
24 hours are during the night between 8 p.m. and 6 a.m. If you learn
to express your milk and store it safely you do not have to be consta
ntly near the baby. Even working mothers can continue to breastfeed.
China, Sweden and many other countries have proved that indus
trialization need not prevent mothers from breastfeeding.
Do not believe in advertisements that suggest that women who
breastfeed are more modern and fashionable. In fact in many
western countries more and more mothers are taking to breastfeeding
their babies.
For your baby no milk can be better than your own.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
3
the milk
“Cow’s milk is
best for baby cows
and breastmilk
is best for babies
M.C. Latham”
As one expert puts it: Human milk is the original ready-to-serve
24-hour convenience food representing a unique supply and demand
system, with output related to the sucking stimulus and need as
expressed by appetite and thirst.
Undue modesty and embarrassment inhibits breastfeeding. But
with minor modifications in clothing, you can nurse your baby any
where discreetly.
The convenience of breastfeeding becomes apparent immediately
after delivery when the baby is put to breast. You as a mother do
not require any mathematical formula. There is no anxiety as to
whether the milk will agree with the child, no problems of formula
buying, no worry over whether there is enough, whether the bottles
are steriles and whether the holes in the nipple are of the right
size. While breastfeeding, you are free from these worries and
harassment. Mother’s milk is always right and it is always there. It
has been in use over two million years. With breastmilk you cannot
overconcentrate the feed. The baby takes as much as he needs and
wants. Your breast becomes refilled after about two hours and
operates on an approximate supply and demand basis with output
adjusted automatically to the baby’s needs of both food and water.
In catering terms it is a selfservice system. In warmer climates, the
baby’s additional fluid needs are also taken care by the increased
secretion of low solute human milk.
Breast feeding
nutrition
1. Development of marasmus:
urban child
Food of the young has evolved with each species. Different species
of mammals secrete milks of different composition. Drs. Derrick
S. Jelliffe and E.F. Patrice Jelliffe in their classic work go great lengths
to compare and contrast cow’s milk and human milk. Biochemical
and physico-chemical properties of cow’s milk and human milk are
very far apart. For example, the main whey proteins found in two
milks show great often almost opposite, differences in composition.
Breastmilk is richer in lactoferin, lysozyme and 1 gA and it has no
Betalactoglobulin. All these have important roles to play in the baby’s
growth. Cow’s milk curd is tough and rubbery while the curd of
human milk is soft and flocculent.
Almost all the carbohydrate in human milk is lactose. Lactose is
a curious nutrient. It is found only in mammal’s milk. Lactose is
high in human milk (7 per cent), much more than cow’s milk (4 per
cent). The high lactose content in breastmilk ensures a readily
available source of lactose for the large and rapidly growing human
brain.
Cow's milk is very different from human milk in everyway. Both are
highly complex, unique biological systems, so that comparisons have
to consider not only differences in amount concentration and specific
composition of ingredients, but also their subtle interactions and
inter-relationships. For example, the calcium content of breastmilk
is considerably less than that of bovine milk and yet it has higher
absorption and causes a much lower incidence of hypocalcaemia of
the new born.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
Studies of two children reveal
the relationship between wea
ning and the onset of malnutri
tion
W - weaning
D = diarrhoea
ST=standard
weight curve
K~ kwashiorkor
2. Development of kwashiorkor:
(Courtesy UNICEF)
“Breastmilk is a living fluid containing active white blood cells,
enzymes, immunoglobalins and other substances. These all help to
protect a baby against infection. They are destroyed when milk is
processed and put in a tin”, says Dr. William Cutting and others in
their commentary to TALC slides on Breastfeeding (available with
VHAI).
3
the milk
“Cow’s milk is
best for baby cows
and breastmilk
is best for babies
M.C. Latham”
As one expert puts it: Human milk is the original ready-to-serve
24-hour convenience food representing a unique supply and demand
system, with output related to the sucking stimulus and need as
expressed by appetite and thirst.
Undue modesty and embarrassment inhibits breastfeeding. But
with minor modifications in clothing, you can nurse your baby any
where discreetly.
The convenience of breastfeeding becomes apparent immediately
after delivery when the baby is put to breast. You as a mother do
not require any mathematical formula. There is no anxiety as to
whether the milk will agree with the child, no problems of formula
buying, no worry over whether there is enough, whether the bottles
are steriles and whether the holes in the nipple are of the right
size. While breastfeeding, you are free from these worries and
harassment. Mother’s milk is always right and it is always there. It
has been in use over two million years. With breastmilk you cannot
overconcentrate the feed. The baby takes as much as he needs and
wants. Your breast becomes refilled after about two hours and
operates on an approximate supply and demand basis with output
adjusted automatically to the baby's needs of both food and water.
In catering terms it is a selfservice system. In warmer climates, the
baby's additional fluid needs are also taken care by the increased
secretion of low solute human milk.
Breast feeding
nutrition
1. Development of marasmus:
urban child
Food of the young has evolved with each species. Different species
of mammals secrete milks of different composition. Drs. Derrick
S. Jelliffe and E.F. Patrice Jelliffe in their classic work go great lengths
to compare and contrast cow’s milk and human milk. Biochemical
and physico-chemical properties of cow’s milk and human milk are
very far apart. For example, the main whey proteins found in two
milks show great often almost opposite, differences in composition.
Breastmilk is richer in lactoferin, lysozyme and 1 gA and it has no
Betalactoglobulin. All these have important roles to play in the baby’s
growth. Cow's milk curd is tough and rubbery while the curd of
human milk is soft and flocculent.
Almost all the carbohydrate in human milk is lactose. Lactose is
a curious nutrient. It is found only in mammal's milk. Lactose is
high in human milk (7 per cent), much more than cow’s milk (4 per
cent). The high lactose content in breastmilk ensures a readily
available source of lactose for the large and rapidly growing human
brain.
Studies of two children reveal
the relationship between wea
ning and the onset of malnutri
tion
W— weanina
D = diarrhoea
ST = standard
weight curve
K-kwashiorkor
2. Development of kwashiorkor:
village child
(Courtesy UNICEF)
“Breastmilk is a living fluid containing active white blood cells,
enzymes, immunoglobalins and other substances. These all help to
protect a baby against infection. They are destroyed when milk is
processed and put in a tin’’, says Dr. William Cutting and others in
their commentary to TALC slides on Breastfeeding (available with
VHAI).
Cow’s milk is very different from human milk in everyway. Both are
highly complex, unique biological systems, so that comparisons have
to consider not only differences in amount concentration and specific
composition of ingredients, but also their subtle interactions and
inter-relationships. For example, the calcium content of breastmilk
is considerably less than that of bovine milk and yet it has higher
absorption and causes a much lower incidence of hypocalcaemia of
the new born.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
I
COMPOSITION OF HUMAN AND COW'S MILK
Nutrient per 100 ml
Human Milk
Cow’s Milk
Protein
1.2 g
3.3 g
Carbohydrate (Lactose)
7.0 g
4.8 g
IT WILL C.O9T THE
Fat
3.8 g
3.7 g
FAMILY R»- 120-60 ■
A MONTH
Electrolytes and Minerals
Sodium
15 mg
58 mg
Potassium
55 mg
138 mg
Calcium
33 mg
125 mg
Phosphorus
15 mg
96 mg
Magnesium
4 mg
12 mg
IT WILL COST The
FAMILY Rs. 113.40
PER MONTH-
Human milk has higher levels of Vitamin A, absorbic acid, and
Vitamin E than does cow’s milk.
The concentration of minerals is over three times greater in cow’s
milk than in human milk.
h'Cow’s milk has six times as much
times as much calcium and sodium.
phosphorus, three and half
Remember cow’s milk is intended for the young of a different
species which is hoofed, horned, walks on four legs and eats grass.
family
Rs. 103.00
PER MONTH .
While human milk is intended for an infant who will walk erect on
his two legs and who has an enlarged brain with large and complex
frontal lobes with centres of learning intelligence, foresight and
processing of complex data.
Unsupplemented human milk is all that is required to sustain
growth and good nutrition for the first six months of life in the babies.
Breastfeeding the baby makes substantial savings in the family
budget. According to a study conducted in Maharashtra:
—To feed a child with Lactogen it will cost the family Rs. 120.60 a
month.
milk, \n\ll Cost
Tire Family
80-40.
PER- month .
—To feed the child with Glaxo Sunshine—Rs. 113.40 per month.
— To feed the child with Amulspray—Rs. 108.00 per month.
—To feed the child with milk—Rs. 80.40 per month.
£ It is the mother who can feed the baby most economically. Mother’s
milk costs the family almost nothing.
It is cheaper to feed a lactating mother than to use formula foods.
See that the pregnant mother eats well. Remember that she needs
support and encouragement for breastfeeding. Share her responsi
bility in child care. Help her with her house work.
family Almost
ssoTHIHQ •
8
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
Any attempt at promoting bottlefeeding is an antinational activity.
Because all those who do that work towards the "erosion" and
“subversion" of a valuable national asset which is in the hands of
the poorest of the poor.
4
the nation
Assuming that there are 22 million nursing mothers in India, the
annual human milk output of India according to Dr. C. Gopalan,
would be 3.7 million tonnes. Even at the rate of three rupees a
kilogram (the cost of buffalo milk in Delhi) the monetary milk
amounted to Rs. 1,100 crores which is four times the entire health
budget of India including that of the centre, states and union terri
tories. To this one must add the enormous savings involved in
treating gastro-intestinal diseases in children.
Government are seldom aware of the most important consequences
of breastfeeding namely health promoting and birth spacing effects.
Both are important economic and social benefits for national develop
ment but are difficult to measure quantitatively.
Rs. noo CRORES
Rs. 262 CRORES
CASH VALUE OF
India's Annual
AVAILABLE
human
MILK IN INDIA
Breastfeeding is the life line of infants. Very often governments
fail to protect this life line. People who make money out of baby
foods have a lot of resources. Remember our own government is
wavering. The spirit is willing. But the pulls are too many. Today
the infants of your country need you to put a little pressure on the
government to get a legislation enacting the code of infant foods and
feeding bottles. Then your country will need you to enforce the code.
Remember changes in health practices dq notnfapl^place without
the active participation and by health workers ancrHfe^lth consumers.
HEALTH OUTLAY
1979-80
Help monitor the code, strengthen and support e'ddcfltional work
and mobilize popular organization. -S’f
’■
■(
r
o
if*. ■-
___________________________
Start these foods from 4 months of age.
At least, start by 6 months of age.
supplementary feeding
DAL
the right way
EGG
Do we need to bottle
feed the baby at all?
KHICHRI
The answer is no.
SAG
VEGETABLES
CHAPATI
Even at the supplemen
tary feeding stage we
do not require formula
foods and feeding bot
tles. That is the view of
world’s best paedia
tricians.
Dr
Shanti
Ghosh,
India’s most eminent paediatri
cian is among them. In her book
Feeding and Care of Infants
and Young Children she has the
following
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
suggestions.
“Start
these (ordinary, easily available)
foods from four months of age.
At least start by six months of
age." The feeding plan sugges
ted by her are on pages 10 and 11.
FOR ONE
or
Morning
125gO
Milk
FOR ONE
YEAR OLD CHILD
1 Sugar
1 Slice
or
^Kator,
Rice
Morning
Suji
Kneer
I
125gfesS
1 Sugar
Milk
1/2 Katori
Suji Halwa
1 Katori
Khichri
1 Banana
5
D
l
1 Slic e
1/2 Chapati
or
or
10 O’clock
10 O’clock
YEAR OLD CHILD
1 Chapati
1/2 Katori
Atta Halwa
1/2 Katori Dal
Green Vegetables
1 Banana
D
or
Noon
Noon
1 Katori
Rice
1 /2 Katori
Khichri
y2 Katori
Green
Dal Vegetables
11/2 Chat>ati
or
or
2 O’clock
% Katori
Sufji Halwa
|
2 O’clock
% Katori
Khichri
1/2Katori Atta Halwa
1 Slice
□ - o
125 gS
4 O’clock
4 O’clock
1 Slice
kp Katori J^Kcitor-i
Rice
Suji Halwa
Night
Milk
1 Slice
J
1 Sugar
1 Slice
1/2 Chapat
Night
1 Katori Khichri
1/2 Katori
Rice
Rice-based diet
1/2 Katori
Dal
1 Chapati
Wheat-based diet
1/2 Katori Dal
FOR TWO YEARS OLD CHILD
|3
Morning
RECOMMENDED FOOD INTAKE FOR ONE TO TWO YEARS OLD CHILD
~
Dry wt
Name of food
1 Sugar
1 Slice
(g)
Proteins
Quantity
Nutrients supplied
Dry
Cooked Calories
(g)
1/2 Chapati
Carbohydrates,
RICE
60
206
4*1
WHEAT
88
300
10-6
Bv B2,Niacin, Bg,
Carbohydrates,
Proteins
PULSE
50
167
11-1
B1 , Niacin,
Carbohydrates,
Proteins
MILK
2 50
168
8-0
SUGAR OR
JAGGERY •
15
60
—
GREEN LEAFY
VEGETABLES
50
—
—
OIL
11
99
—
—
—
10 O’clock
1 Banana
1/2 Katori
Khichri
1 Chapati
Noon
1 Katori
Khichri
fa Katori
Dal
1 Chapati
2 O’clock
Groundnuts
4 O’clock
125gffiS
Milk
Roasted Gram
2 Slices
1/2 Katori
Green
Dal________ Vegetables
Wheat-based diet
s
11
A, D , B2,Bg y
1 Chapati
Night
2 Chapatis
I
VEGETABLES
8. FRUITS
Recommended if
economically feasible
Proteins
Calcium
Carbohydrates
Carotene, B2, Bg,
Iron, Calcium
Fat
(essential fatty acids)
—
Total value
1000
33-8
I Katori Rice = 2'Chapatis
1 Chapati =
Katori Rice = 1 Banana =2 Small slices of bread
1 Kator_L = 200 ml
v^Reauirements of one year old child : Calories 1000; proteins 17 g
the north
The experience of Sweden and
Hungary shows that breast
feeding is not necessarily in
compatible with industrializa
tion.
WHO Collaborative Study
Breastfeeding is increasing in
industrialized countries includ
ing the United States, England,
France, Japan and Norway.
UNICEF
the south
Evidence from the developing
countries indicates that infants
breastfed for less than six
months or not at all, have a
mortality rate five to ten times
higher than those breastfed for
months or more.
Halfdan Mahler, WHO
Chinese mothers
show how
Given the devastating effect of maternal employment on breast
feeding that has been observed in other parts of the world, the
measures taken by the Chinese to facilitate breastfeeding are worthy
of note.
All mothers employed in factories, are given two months’ maternity
leave, with pay, following the delivery of an infant, in order to be
sure that breastfeeding can be well established. Thereafter, special
provisions are made in order to make the continuation of breast
feeding possible. In factories, infant nurseries or creches are
routinely provided.
Mothers arriving for work leave their babies in the nurseries and
in the course of an 8-hour shift, will be given, and expected to take,
two half-hour breaks during which they go to the nursery and breast
feed their infants.
In the rural communes, maternity leave varies and is generally
without pay, but breastfeeding is no less routine. There the work
pattern is such that special provisions are not necessary.
Although the pattern varies by region and season, farmers trad
itionally arise at day-break and go to the fields to work for a few
hours. At around 9 a.m., they return to their homes for breakfast,
then work for two or three more hours, until noon.
Lunch is followed by a long rest period, especially during the hot
summer months, and then another work period of approximately three
hours in the late afternoon. Nursing mothers thus breastfeed their
babies on awakening in the morning, when they return home for
breakfast, at lunchtime, and after their late afternoon work period.
better mother care
A recent International Labour Organization Convention report
(1975) notes certain world wide trends for maternity protection,
including : (1) extension of maternity protection schemes to new cate
gories of women workers, (2) prolongation of the period of statutory
or prescribed maternity leave (or flexibility as to how much is taken
before or after birth), (3) more liberal provision of extended or extra
leave during the child’s infancy, (4) higher rates of maternity benefits,
(5) more effective protection against dismissal during pregnancy and
after confinement, (6) greater encouragement of breast feeding and
wider provision of nursing breaks for mothers, (7) more adequate
attention to the safety and health of women during pregnancy and
lactation, and (8) establishment of social security schemes of public
bodies or day nurseries to care for infants and children of working
parents.
_
ln the Modern World by
Derrick B. Jelliffe and E.F. Patrice Jelliffe
(second edition)
12
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
dear administrator
hospitals
Dos
To
Initiate breastfeeding as soon as
possible after delivery within the
first half an hour.
Administrator
Your Hospital
Your Town
Encourage and permit mothers to
keep their babies with them to
facilitate on demand feeding.
Dear Administrator,
Are you aware that the Nestle’s nurses dressed in blue and distri
buting Lactogen in your hospitals are promoting the myth of bottle
feeding among your patients ? This is a promotional and advertising
activity that is against the International Code of ethical marketing
urged by the WHO/UNICEF.
Many infant food companies follow these aggressive marketing
practices in developing countries like ours. Many doctors, nurses and
administrators unwittingly help them by default—even though they
themselves do not believe in bottlefeeding, they allow the infant food
companies to promote their products by posting those ‘nurses’ in
their OPDs or by putting up big posters of healthy babies and tins of
baby food in their paediatric wards.
Your personal philosophy may be against promotion of “health”
drinks and feeding bottles, and for breastfeeding. And yet,
your action of letting the infant food industry use your premises to
distribute its wares, may be resulting in serious harm to many
patients. The patients who could improve their nutritional status by
balanced eating of natural foods may be directing their scarce
resources into purchase of processed “health" drinks—and the reason
may be because they perceive your hospital encouraging this trend.
So, friend, join hands with VHAI and others, and take’ action to
stop the exploitation by the infant food and health drink companies.
And if you have thought it out, don’t stop there—help others to
realise the serious harm being caused by the aggressive sales pro
motion activities of these companies in the Third World.
Help implement the dos and donts (see next column).
Sincerely,
Child-lover
P.S. We'd be delighted io hear from you about your efforts to stop
exploitation.
Start complementary feeding only
after 4 to 6 months.
Make facilities
available
to
mothers of hospitalized children
so that they can continue to
breastfeed.
What more can your hospital do?
Establish breast milk banks
paediatric centres.
in
Set up lactation units to
— reestablish
— reinforce, and
- initiate lactation
Donts
Discourage supplementary feed
ing of water or formula.
Discourage contraception
interferes with lactation.
that
Do not allow sales promotion of
products to be used as breast
milk substitutes or bottlefed
supplements and feeding bottles
to the public.
Do not use hospital facilities fur
promotion of artificial feeding.
Do not allow the hospital staff to
become promotional tools of
bottle feeding or channels of
distribution of samples of
breast milk substitutes.
Do not demonstrate artificial
feeding in the hospital premises.
Do not allow personnel paid by
companies producing or selling
bieast milk substitutes to work
in the hospital.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
13
Gerrard, J.W.
54:757, 1974.
research
reserach
research
“Breastfeeding: second thoughts,”
Pediatrics.
“Breastfed infants are less likely to develop respiratory and gas
trointestinal infections and allergic reactions. Infants slowly develop
their own immunologic defences in the months after birth, and breast
feeding is a hygienic, gradual method of protection during the transi
tion to immunologic independence. Best protection is achieved when
the infant receives breast milk alone for, at least, the first six months
of life. Pediatricians should be aware that this is particularly important
in areas where contamination of cows’ milk and other foods is likely
and where medical facilities are inadequate.”
Puffer, R.P. and Serrano, C.V. “Patterns of mortality in child
hood.” Pan American Health Organization, Scientific Publication
No. 262, 1973.
The investigation studied 35,000 childhood deaths in 13 widely
scattered project sites in Latin America. Among infants dying of
diarrhoeal disease at 28 days to five months, 51.7% died who were not
breastfed as compared to 31.7 who were breastfed and not weaned.
Among babies in the same age group who died of nutritional defici
ency, 51.5% died who were not breastfed as compared to 34.1% who
were breastfed and not weaned. The authors conclude: “This is im
portant indirect evidence of the protective value of breastfeeding.”
infant
mortality
Plank, S. and Milanesi, “Infant feeding and infant mortality in
rural Chile” Bulletin WHO, 48:203-210, 1973.
“During 1969-70, 1712 rural Chilean mothers were interviewed to
see if their feeding practices contributed to infant mortality. There
were three times as many deaths among babies given bottles before
the age of three months as among those who were wholly breast fed...
As living standards improved, weaning was accelerated and a higher
proportion of children were fed on the bottle alone. The anomalous
consequence was that infant mortality rose with income.”
Cunningham, A.S. “Morbidity in breastfed and artificially fed
infants,” The Journal of Pediatrics. 90:726-729, 1977. (Study in
Cooperstown, N.Y.)
illness
“Breastfeeding was associated with significantly less illness during
the first year, especially if continued beyond 4i months of age ..The
health advantage of breastfeeding was still evident after controlling
for prenatal educational status. In better educated families the
difference in significant illness between infants who were artificially
fed and those who were breastfed for prolonged periods of time was
two-to threefold.”
Ellestad-Sayed, J., et. al. “Breastfeeding protects against infec
tion in Indian infants," Canadian Medical Association Journal 190295-298, 1979.
hospitalization
14
“Fully bottlefed infants were hospitalized with infectious diseases
10 times more often and spent 10 times more days in hospital durinq
the first year of life than fully breast-fed infants... Breastfeeding was
strongly protective against severe infection requiring hospital admis
sion and also against minor infection. The protective effect which
lasted even after breast-feeding was discontinued, was independent
of family size, overcrowding in the home, family income and education
of the parents. Measures to achieve breastfeeding for virtually all
infants, particularly in northern communities, should be qiven hioh
priority”.
y
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
“More about infant diarrhoea" British Medical Journal. 2:1562, 1977.
Experience at the gastroenteritis unit of the Queen Elizabeth
Hospital for Children, London, in 1971 and 1972 has recently been
reviewed, re emphasizing several important points. Firstly, only two of
the 608 children seen there with gastro-enteritis were breastfed
compared with 14% of matched infants in the community served by
the hospital, showing yet again the supreme importance of breast
feeding in the prevention of this disease."
diarrhoea
Lambert, J.N. Letter from the National Planning Office, Port
Moresby, Papua-New Guinea, July 12, 1978. Reprinted in U.S.
Senate Hearing Report, Marketing and Promotion of Infant Formula in
the Developing Nations, 1978, Pages 810.
“A survey carried out in Port Moresby revealed that of 136 infants,
(35%) were artificially fed. Sixty-nine per cent of these children were
malnourished compared with 26% of the breastfed infants. Twentythree per cent of the artificially fed infants were below 60% weight for
age [severely malnourished] compared with just 3% of the breastfed
infants." [The study led to national legislation making baby bottles
and nipples available only by prescription.]
malnourished
Surjono, D. et al. “Bacterial contamination and dilution of milk
in infant feeding bottles,” Journal of Tropical Pediatrics, 1979.
"Mothers in the waiting rooms of two urban hospital MCH Clinics
and two rural health centres (Central Indonesia) were asked to provide
a sample of the milk from the bottles they were using to feed their
infants Twelve different brands of commercial formulas were
encountered while two mothers used unprocessed cows’ milk One
third were less than 50% of proper strength.. -J of the samples had
bacterial densities in excess of 10,000 per ml the control samples
mixed properly showed fewer than 100 organisms/ml...improper pre
paration of milk feeds leading to gross bacterial contamination and
incorrect formula strength occurs in a substantial proportion of cases
using bottle feeds...Children receiving bottle feeds should be classi
fied as ‘high risk’."
bacteria galore
Murray, J. and Murray, A. “Breastmilk and weights of Nigerian
mothers and their infants” American Journal of Clinical Nutrition.
32:737,1979.
Companies manufacturing infant formulas sometimes attempt to
justify the distribution of their products in developing countries on
the following premises: undernourished mothers are unlikely to be
able to provide adequate nourishment from their breastmilk alone for
the normal growth of their infants; prolonged lactation is likely to
intensify any existing maternal undernutrition...[The study] shows
clearly that mothers, undernourished by nonfamine standards of
contiguous African nations were able to provide enough breast milk
for normal growth of their infants to six months of age without detri
ment to their health."
all mothers can
Rosa, F.W. “Breastfeeding and family planning,” PAG Bulletin
5:3.1975.
“It is estimated that breastfeeding prolongs birth interval by about
four months on the average in urban areas and about eight months
in rural areas...Supplementary infant feeding substantially reduces the
duration of postpartum amenorrhea [period of no ovulation]...Thus
in developing countries approximately one-third more protection is
provided by lactation amenorrhea than by family planning programme
contraceptive methods...In another study the main factor leading to
an increase in birth rate from 40 to 64 among Canadian Eskimos was
reported to be the introduction of bottle feeding. The increase in
birth rate could even be correlated with the proximity to the nearest
trading center providing canned milk!"
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
declining
birthrates
15
Larsen, S.A and Homer, D.R. “Relation of breast versus bottle
feeding to hospitalization for gastroenteritis in a middle-class
U.S. population,” The Journal of Pediatrics. 92:417, 1978.
“Of the 107 infants admitted with acute gastroenteritis during the
study period, only one was being breastfed at the time of admission...
The data in this study strongly indicates that breastfeeding plays a
major role in protection against intestinal infections. This effect is
almost as dramatic in a modern, middle-class U.S. community as in a
developing country with rudimentary environmental sanitation.”
research
research
research
Kanaaneh H. “The relationship of bottlefeeding to malnutrition
and gastroenteritis in a pre-industrial setting” Journal of Tropical
Pediatrics. 18:302-306, 1972. (Study in three Arabic villages in
Israel.)
“The beneficial influence of breastfeeding on morbidity from gas
troenteritis among infants as well as its greater nutritional adequacy
in supporting growth up to six months of age in a pre-industrial
setting is shown in this study; the incidence of malnutrition is essen
tially nil among the two exclusively breastfed groups and rises
gradually to approximately 30% of those who were exclusively bottle
fed for the greater part of the six-month period The protective antidiarrhoeal function of human milk is particularly noted during the
susceptible early months of life. Infants who were supplemented
with fresh cows’ milk or with powdered milk from a cup had a signi
ficantly lower incidence of hospitalization from gastro-enterities than
infants who were supplemented with powdered milk from a bottle for
any period of time, further attesting to the direct relation of this
incidence to the method of feeding rather than to the infants' deterio
rating state of health.”
About baby foods there are many myths, some invented by multina
tional corporations (which have a terrible reputation among those
working for rural health care) and some by our own indigenous
brands. The fact is that breast feeding is best. Ah, but, say the
baby fooders, some women are physically not equipped to breast
feed; so these have to use artificial milk foods.
Not true again. In villages in Sattari, Goa, women feed their new
born children ragit or nachhne as it is known in Goa, the cheapest of
the millets.
If you feed your child with nachhne, you’ll hardly need any tinned
milk. The recipe is a non-monopoly, and we’re publishing it
because we know that a multinational already has plans to enter the
“ragi business”.
These plans will almost certainly wreck the poor man's diet in this
country, as it will unsettle ragi prices.
The baby food (ragi) recipe is as follows:
Soak 2 heaped tablespoons of ragi in water overnight Next morning
grind to a fine paste. Let the mixture settle in a vessel of water for
2 hours. After that period, pour out the surface water (which contains
the ragi skins etc.) and repeat the procedure, this time allowing the
water to settle for half an hour only.
Immersion of ground ragi is important as indigestible portion of
the millet go out with the water, leaving behind a soft, easy-to-digest
meal that can be fed even to fifteen day old children.
After throwing out the water the second time, add a little milk,
sugar or gur to taste, and cook on a slow fire for about five minutes
or till desired thickness is obtained. Feed warm to the child.
(Courtesy: Infant Formula Programme}
baby
food
from
ragi (nachhne)
Norma Alvares
Courtesy : The Great Village Catalogue—Options for Rural India
16
HEALTH F0R the MILLIONS/OCT-DEC. 1981
world versus bottle
In the 1960s the Protein Advisory Group (PAG) of WHO,, FAO/
UNICEF stressed the importance of breastfeeding and pointed out
problems with artificial feeding.
In 1978, UNICEF and the Pan-American Health Organization
(PAHO) sponsored the first international meeting between paediatri
cians and representatives of the infant food industry in Bogota,
Colombia. Subsequently the PAG sponsored similar meetings in
New York, Paris and Singapore.
In 1974, the World Health Assembly (WHA) unanimously adopted a
resolution calling on each member state to do everything in its power
to promote breastfeeding, including regulating sales promotion of
infant foods.
In 1975, a report on “Priorities in Child Nutrition" to the UNICEF
Executive Board by Drs. Jean Mayer and Johanna Dwyer, of Harvard
University, stressed the importance of breastfeeding and the need to
control breast milk substitute marketing.
In 1978, a second, more sharply worded resolution was adopted by
the WHA because the prior resolution had limited effect.
In 1979, the WHO/UNICEF meeting on Infant and Young Child
Feeding brought together national governments, United Nations
agencies, experts, the infant food industry, non-governmental organi
zations, including consumer groups. This meeting produced a
framework for further international action, including the development
of a Code of Marketing.
Breast feeding
drawbacks of the bottle
Breasi feeding is nutritioa'?, safe, inex
pensive, snd heSps protect tefr-sts sgeinst
(Courtesy UNICEF)
disease.
. Dottle feeding vriih
powderixl miik can
cause malnutrition
and ill-health because:
Parents may not be able
to read the ir.i auctions
on the tin.
They nay r.oi be t-ble
to afford enough of the
milk powder and may
over-dilute it.
So the baby can become
malnourished and
vulnerable to disease.
The water which is used
to mix the milk powder
may not be safe.
Parents often cannot
sterilize the feeding
bottle and baby may
drink in germs.
In August of 1973 the British development magazine “New Inter
nationalist" helped to open public debate on the impact of infant
formula in developing countries when it published an interview with
two Third World medical specialists. The debate opened the door
to scandal six months later when the British charitable organization
“War on Want" published an investigation of the industry titled
“The baby Killer". When a group in Switzerland published a trans
lation and labelled it “Nestle Kills Babies", the company sued for
libel and the resultant court case brought the company’s methods
of marketing and distribution under close public scrutiny.
Just before the court brought in its verdict, Nestle, with other
Industries (ICIFI) came up with a code of ethics for its members—
something which the United Nations Protein Advisory Group had
sought four years earlier.
The day before the Swiss court brought in its verdict. Nestle with
drew all charges against the publishers of “Nestle Kills Babies"
except the one concerning the title of the publication. The group
was convicted, and the judge also announced that there was cause
for the company to rethink its ways.
In the United States a religious order, the Sisters of the Precious
Blood, filed a suit against another manufacturer—Bristol-Myres—and
was able to influence changes in its policies. The National Council
of Churches also put its weight behind the issue through the Inter
faith Center on Corporate Responsibility (ICCR), an affiliate designed
to analyze the social performance of major US corporations, and
public awareness of the issues grew. By July 1977, another US
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
17
based group, the Infant Formula Action Coalition (INFACT), had
mobilized a public boycott of all Nestle products, demanding action
to prevent artificial formula from getting into the hands of people who
did not have the “means or facilities to use them safely’’.
Some important changes in promotional practices have taken place
in the last five years. For example, some major firms have agreed to
suspend use of mass media to advertise infant formulas; many for
mula tins now carry the message that “breastfeeding is best’’; and
use of company “milk nurse’’ soliciting mothers personally in mater
nity wards and in private homes has apparently been curtailed in
some places.
Many forms of promotion continue, however, which focus on
influencing health workers and hospital routines. And the line bet
ween promotion and “information” or “services” becomes increasin
gly difficult to define.
Most importantly, the controversy has ignited an explosion of
awareness about the seriousness of infant feeding problems. What
was once the subject of modest discussion in medical journals and
nutrition congresses has now evolved into a major international
concern. National governments and international aid agencies are
launching new programmes to promote and protect breastfeeding,
while researchers are busy finding new evidence confirming that
“breast is best”. As this activity reaches the hospital and clinic level
commitment to promote breastfeeding can actually be translated into
significant increases in the number of breastfeeding women and
healthier babies.
Hopeless, dreadful. Their busi
ness is to sell milk, it isn’t to
look after children .. (In Singa
pore) I found that Nestle had
nurses, these girls dressed as
nurses, dragging a good lacta
ting breast out of the baby’s
mouth and pouring in baby
milks.
Dr. Cice/y Williams, interview
with The Lansing Star, October
1978.
Courtesy UNICEF
does
nestle
kill
babies?
{Adapted from:AppHed Communication)
In an interview broadcast on West German radio stations last year,
Dr. Elizabeth Hillman, a paediatrician on the staff of the Kenyatta
National Hospital, Nairobi, said: “A short while ago ... the Nestle's
representatives came to visit us at the hospital to ask if we had any
opinion about the War on Want publication which had been translated
in Switzerland and titled: “Nestle kills Babies.” They really wanted
us to say that the Nestle Co. did not kill babies, and we discussed
this at length with them and were not able to say of course that
Nestle either does kill or does not kill, statistically speaking. But, to
illustrate the point, I mentioned to these two gentlemen that there
was a child over in our emergency ward . . . who was very near to
being dead, because the mother was bottle feeding with the Nestle's
product (Lactogen, a milk preparation), and for interest I asked
whether they would like to see the baby. I took the two representati
ves over into our emergency ward and as we walked in the door the
baby collapsed and died. I had to leave these two non-medical gentle
men for a moment . . . and help with the resucitation procedure It
was unsuccessful. And, after the baby was pronounced dead, we all
of us watched the mother turn away from the dead baby and put the
can of Nestle's milk in her bag before she left the ward . .Ina sense
. . . it was a vivid demonstration of what bottlefeeding can do,
because this mother was perfectly capable of breastfeeding. They
walked out of that room, very pale, shaken and quiet and there was no
need to say anything more . .
From Third World Action Group
_______ Berne, Switzerland.__
18
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
the genesis of the bottle
In the beginning was cheese. And everybody said cheese. The
cheese industry grew.
Alongwith cheese came whey. The cheese fathers did not know what
to do with the whey.
They all put their heads together and said let us dump the “whey”
this good-for-nothing whey.
So it was. They found the dumping sites. But dumping sites were
far away. They needed people and vehicles to carry this good-fornothing whey. But people and vehicles cost money. The cheese
fathers were not happy.
“Let there be pigs”, cheese fathers said. So there were pigs and lots
of pigs. And the cheese fathers fed the whey to the pigs and the
pigs were happy. But the cheese fathers were still not very happy.
The cheese fathers put their heads together again, there should be a
better use for this wicked good-for-nothing whey. Lo and behold!
they found one. Let's add a little this and a little that to the wicked
good-for-nothing whey. And let’s call it humanised milk and let’s feed
it to the children of the world.
Thus bottle feeding was born. The cheese fathers were happy. “This
is the ideal food”, the cheese fathers told the world. “You must be
joking”, said the cow. “A very cruel joke indeed” said all those who
love babies.
(Courtesy: David Morley: See H ow They Grow.)
This is the true (hi)story of British baby food industry and is retold in
India by A.J.V.
HfiALTH FOR
THE MILLIONS/OCT-DEC. 1981
T9
they say . .
As a medical representative,
my main responsibility is to
promote the
Nestle infant
formula products . . . We give
away Nestle infant formulas . . .
to doctors, pediatricians, and
of course to mothers too . . .
In return for these free samples,
the recipients would of course
recommend, in one way or
another Nestle formulas.
Statement of a “medical
representative’’ of Filipro,.
Nestle’s Philippines subsi
diary, September 1978
University Hospital stopped
the milk nurses from coming
on the wards. But now they
come not in uniform to see
patients. They come during
visiting hours when we are not
around to stop them. They are
often friends of the government
nurses and they make new
friends with liberal gifts and
samples . . . But they still find
out names and visit mothers in
their homes. Supposedly they
are only allowed to pay visits if
the doctor or nurse agrees.
But this is not true. They still
find a way.
Dr S K Teoh, Obstetrician,
University Hospital, Kuala
Lampur, Malaysia, 1978
All the pediatrics confer
ences are organized by the milk
companies.
It defeats the
purpose of these conferences.
Doctors are understandably
‘grateful’ to the companies, so
they tone down their voices . . .
Dr Mohammed Sham Kasim,
General Hospital, Kuala
Lumpur, Malaysia, July 1978.
Promotion is intense and it
works. They do it for the
survival of the companies. We
have to counter them with
breast feeding promotion for
the survival of Thai babies.
Pediatrician, Ramathibodi
Hospital, Bangkok, Thailand,
August 1978
20
international network
: *Thp infant formula campaign became a truly international effort
w^h the formXn of The International Baby Food Action Ne work
(IBFAN), a cooperating coalition of over
organizations in thirty
countries. IBFAN was formed after the October 1979 WHO/UNICEF
Meeting on Infant and Young Child Feeding when parucipatmg
Ton governmental organizations recognized the need for international
consumer pressure to force the Internationa infant food industry to
halt unethical promotion. Through IBFAN, information on industry
promotion, WHO code progress, citizen action and scientific research
is shared among concerned groups world-wide.
IBFAN has stimulated citizen campaigns in many nations. Each
IBFAN group concentrates on companies based in their own country,
but many extend their efforts to include pressure on Nestle, the
world’s largest infant milk promoter.
The United Kingdom Baby Milk Action Coalition, for example, has
focused public protest on Glaxo and Cow & Gate, two major British
formula firms, and started their Nestle Boycott on July 10,1980.
Swedish groups have begun a boycott of Semper, a local firm pro
moting infant formula in Turkey, and include Nestle and Denmark's
Dumex in their other citizen action efforts. A coalition of church,
women’s and consumer organizations in Japan have brought the
issue home with plans for a joint boycott of Japanese formulla com
panies and Nestle.
IBFAN members are active in the Third World, as well. In Malaysia,
the Consumers Association of Penang has monitored formula indus
try activity and issued a memorandum to the Ministry of Health
revealing numerous violations of both the Malaysian cod of ethics
and the WHO/UNICEF marketing recommendations. The Center for
Study and Social Action in Panama has produced a thorough report
on infant formula marketing with recommendations for firm regulation
of industry activity. The Breastfeeding Information Group in Nairobi
gives regular seminars for mothers in Kenyan hospitals and has
issued public letters of protest against continued formula advertising.
A further IBFAN priority is the monitoring of industry’s marketing
practices. IBFAN’s international network of contacts has gathered
extensive evidence of continued infant formula promotion violating
WHO/UNICEF recommendations. This information is shared throu
ghout the IBFAN network and with WHO.
IBFAN depends on citizen participation. Because of limited finan
cial resources, IBFAN particularly needs your assistance in monitor
ing industry activity. Write to IBFAN in care of either INFACT,
1701 University Ave, SE, Minneapolis, MN 55414 USA, or the Geneva
Infant Feeding Group, 13 Ave du Mervelet, 1209 Geneva, Switzerland.
three planks
lactating mother with a mixed diet of locally available S’"® to
SlnaefooTsOnebas°erd on the ™°nthsand
to introduce least cost
ZtTs9 X^T^tTTli^Xd^/rom lSimiX^Lfr?mT ?
with continuing lactation into the second year of ^ife3' ab T
b’n
less well-to-do circumstances.
Y ' °f llfe’ Particularly in
HEALTH FOR the MILLIONS/OCT-DEC. 1981
we believe . . .
“Those of us who believe that
four million years of evolution
are wiser than two generations i
of formula feeding, think the
burden of proof that formula is
as good or better, lies with the
formula feeders’’, says Dr
Gerald Gaull, Professor of Pae
diatrics at the Mount Sinai
Medical Centre in New York.
Dr Gaull, who is also a resear
cher in mental retardation, be
lieves that mother’s milk has a
significant and beneficial effect
on brain development. Having
studied the presence of an
amino acid called taurine in the
brain of 16 animal species, he
has found that the brain of the
human foetus has more taurine
than any other amino acid and
that levels of the substance are
higher at birth than in adult
hood. “This suggests that in
some, as yet undefined way,
taurine plays a role in the deve
lopment of the immature brain’,
he says. Dr Gaull has found
that the concentration of tau- I
rine in mother's milk is 40
times greater than in cow’s ;
milk.
stop: you too have a role
The questionnaire on pages 22-23 should allow you to briefly sum
marize information on infant formula promotion in your community.
Space limitations may restrict complete answers, however, so please
feel free to write on additional sheets. Also feel free to duplicate the
questionnaire and give copies to other interested individuals.
A few hints may help you in gathering relevant data and complet
ing the form:
1)
If you are unfamiliar with infant formula sold in your area, visit
a few pharmacies and stores. Write down the brand names
of the formulas. Read their labels. Are they written in a local
language? Do they mention the superiority of breastfeeding?
Do they have pictures to explain preparation? If not, please let
us know.
2)
Libraries, newstands, radio stations and magazine publishers
can supply information on direct advertising of infant formulas.
Please send us actual examples of recent advertisements. Or
take pictures.
3)
To gather information on free samples and other promotional
methods, visit maternity wards, pediatric wards, and maternalchild health clinics. Introduce yourself to pediatricians, nurses
and other health workers, and explain that you're studying infant
feeding practices, especially the use of artificial infant milks.
Discuss local infant feeding practices and the activities of the
companies that sell the milks.
4)
If it is allowed, take pictures of infant formula advertising (pos
ters, calendars etc.) in hospitals. Be sure to identify the place
and date of the pictures. Black and white photos are best.
5)
Record the name, place and date of the people and places you
visit and in which you see examples of infant promotion.
Assure the people with whom you speak that you will not use
their names without their permission.
6)
The details (date, place, quantity, type etc.) about each example
of promotion are very important. If the people you interview
give only general information, be sure to ask them to specify
these details: when did it happen? which company was invol
ved? what exactly happened?
We are deeply grateful for your help in gathering these data.
bizarre
feeding?
Recently in India, Rao (1975) has made the strange-suggestion
that human milk could be collected commercially by breast pump
and pasteurized, or even spray-dried. As he points out, cattle in
India produce only 250 litres per year, whereas it has been estimated
that poorly nourished Indian women can secrete almost 200 litres in
the first year of lactation. Such women might receive part of their
earnings in food and meals, and part as cash.
The idea initially seems bizarre, as human milk is usually conside
red a non-profit-making commodity. However, it may be noted that
other body tissues are sold, including blood and sperm. It would,
in fact, only institutionalize and mechanize the age-old wet-nursing
principle, and conform to the concept of using human resources as a
national economic asset, especially in highly populated, less indu
strialized circumstances.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
21
Questionnaire on Infant Formula Promotion
Direct Advertising
Is infant formula advertised in magazines, newspapers, radio, TV, calendars, posters, etc?
Type of Ad
(poster? radio?)
Date of Ad
Brand Name
D
--- ----------------------
No. If Yes, please describe the advertisements:
Yes
Description of Ad*
(Written content, size, pictures, etc.)
Location of Ad
(which city? clinic? magazine?)
-------- ------ ------------------------------------------------------------------------
1
2)
_______
3)
------------------------------------------------------------------ ----------------------------------------------------------
_
------------------------------------------------------ —
Consumer Promotion
Are baby booklets, brochure, bottles, clothing, posters, wristbands or baby shows provided or supported by baby milk companies?
If Yes,
Yes No
please give specific information on several examples :
Typ° of Gift
(booklet? bottles?)
Company Name
D
2)
Where Seen)Received
(Name of clinic, etc )
Date Seen
or Received
____________ .
Description of GiftjEvent*
(given to whom? quantities? content? etc.)
____________________
3)
4)
Company Personnel
Do employees of infant formula companies visit local hospitals, clinics, stores, health ministries, etc.?
If yes, please provide these details on recent visits :
Yes
No
HEALTH FOR THE MILLIONS/OCT-DEC.
Where Do
They Visit?
Which Company?
Purpose of Visit
:
D
2)
No. Visits
per Month
Do They Talk
With Mothers?
Do They Distribute
Literature? Samples?
:____
_
3)
4)-
---------------------------
-------------------------------------
YOUR NAME
Can your name be cited as the source of this information?Yes
O R G A NIZ ATI 0 N________________________________ __
A D D R ES S
*
If possible please provide original, copy or photograph.
** Use additional sheets if necessary.
No
■4!
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
Free Sample
Are free samples of infant formula donated to hospitals or clinics by formula companies?Yes
No. If Yes, please provide this
information on recent donations by various companies :
Date of
Most Recent Donation
How Many Cans Each
Months?
Which Brand?
Do Doctors and
Nurses Request Samples?
D
________________
2)_____________________ ___________________________________________________________________________________________________ _
_______________
__ _____________
3)
_________________________
4)
____________________________
_ ____________ ___
Promotion to Health Personnel
What sorts of donations are made by formula companies to doctors, nurses, medical students or others?
Donated by
Which Companies?
When
Donated?
Donated
To Whom?
D ascribe Donation (type, quantity, monetary
amount purpose, etc.)
Written Literatures*
Free Samples for Personal Use
.
Medical Equipment
Payment for Travel
Payment for Meetings
Payment for Dinners
Personal Gifts
Research Funding
Other
Please Return to :
C0
% of Mothers
Given Samples
Infant Formula Action Coalition
1701 University Avenue, S.E.
Minneapolis, MN 55414 U.S.A.
Phone : (612) 331-2333
OR
to : VHAI,
C-14, Community Centre,
SDA, New Delhi-110016.
India
codes: indian and who
... o r'nntmvprsv raqed worldwide over the harm wrought
t "^Thaalth especS in the Third World, by the unbridled
promotion o" freastmilk substitutes by the multinationals.”
P “Investigative reportmg showed that the^sale^ta^tics^used^were not
entirely sc^Pa'%U®|aa^t^Svi||Page selling. New mothers were lured
(e.g n“rs®®).dllv harraqe of free samples in hospitals. Even some
to the bottle by the barrage onr
breastmi|k substitutes. Such
efforts®Xe particulady successful in milk-poor countries in Asia
and Africa.”
UN action
“Then UN agencies like the World Health Organization and UNICEF
entered the fray. A Code of Conduct was adopted in May 1981, in
Geneva. In essence, it aims at combating infant malnutrition ow\g
to the improper and unwarranted use of breastmilk substitutes.
“Its main premise is, ‘nothing should be done to discourage a
mother from breastfeeding her baby’.”
This is not from a report by a journalist or a historian. It is,
guess hard, courtesy an advertisement entitled The Amul Code of
Conduct by the Gujarat Cooperative Milk Marketing Federation Ltd.,
Anand, Gujrat.
Indeed, especially since the WHO had passed a code of conduct
in May 1981 for marketing of breastmilk substitutes, there have been
a spate of good-school boy advertisements from the infant food
companies themselves. With such good friends, who needs enemies?
Even enemies like the US government.
WHO code
Efforts to promote and protect
the practice of breastfeeding
can save one million infant
deaths each year.
James Grant
Executive Director, UNICEF
*
*
*
Substituting the bottle for the
breast also doubled the population explosion.
Dr. John W. Gerrad
Professor Paediatrics
Dr. Leonard K.T. Tan
Prof. Preventive Medicine
University of Saskatchewan
The WHO code aims at “providing safe and adequate nutrition for
infants, by the protection and promotion of breastfeeding, and ensur
ing proper marketing practices for breastmilk formula, other milk
products, foods and beverages used as a partial or total replacement
of breastmilk, feeding bottles and teats”. The code is directed at
the general public and mothers, health care systems, health workers,
persons employed by manufacturers and distributors, governments.
industry and monitoring and regulating agencies. The WHO code
( was overwhelmingly voted for by 97 countries including India. No.
table dissenters were the US, Chad and Bangladesh The ball is
now entirely in the courts of individual countries.
Indian code
The Government of India's Ministry of Social Welfare constituted
an 18-member working group in February 1980 to go into the whole
gamut with reference to India. Many months have passed. The
working group has apparently finished its job The Indian code is
1 stil lingering awaiting parliamentary enactment If the babyfoo0
lobby has its way the Indian Code is probably condemned to linger
aboutlhe InditXdL6 Th"? info™ation has been made available
replaced bv*
substitutes" has been
j;
“as the marketing of these bottled 9larketin9 of feedincj b ‘pa
3 77
pulous
manner".
A survey
In r
"
per cent
of mothers
using conducted
infantfnJ
Bombay
revealed that
that 93
cautions like sterilising the bottle
f ds d'd not take necessary P
24
HEALTH FOR THE MILLIONS OCT-DEC. I98’
amul dada
“We are now ten times the size
of Glaxo,” he goes on. “Inci
dentally, my daughter was never
put on baby food!”
—Varghese Kurien
Chairman of National Dairy
Development, and Amul
Indian Express March 15, 1981
*
*
*
“Paediatrician
Dr.
Anand
conducted a study on 200 pati
ents in Bombay of whom 55 per
cent (all under one year) were
fed on artificial milk. Of these
families only 12% had contin
uous water supply, 18% knew
the correct formula for making
baby food and 93.7% did not
sterilise properly. A leading
manufacturer avers that, ‘tins
are only sold in cities, where
people have the education, the
means and the facilities to use
baby food safely. Yet tins are
being sold in remote shacks in
the Himalayan region!
—Femina, February 8—22, 1981
*
*
*
Unfortunately, the tendency
among health professionals in
recent times is to be passive
spectators and, at times, even
active instigators of artificial
feeding.
_~G.J. Ebrahim
8
tow-cost
food
The basic aim of the code is to preserve breastfeeding practices
in rural areas and arrest further inroads of infant foods in urban
areas. The working group warns that “the bottle is fast replacing
the breast in urban and semi-urban areas with disastrous results for
the baby. This tendency will spread into rural areas unless it is
checked in time.”
Apprehensions
The working group observes that as against a licensed capacity of
81,000 tonnes per year of infant milk foods, the actual production is
only 36,000 tonnes. It recommended that any future increase in the
licensed capacity of manufacturing infant foods in the country should
be looked into more closely and carefully.
It is interesting to note that because of the vulnerability to the
infant food industry (IFI) lobby within the working group, the initial
drafts recommended tallies remarkably with that of the IFI lobby.
Strong opposition from Dr. R.K. Anand, Chairman of the Medical
Committee of the Consumer Guidance Society of India, who was
belatedly made a member of the working group, and from the Chair
man of the working group, resulted in work on sterner draft regula
tions. These regulations point out to strong curbs on advertisments
of infant foods and feeding bottles. Some paediatricians apprehend
these strong curbs and even a total ban, for their own reasons. Said
the head of the paediatrics department of one of Delhi's large
government hospitals: “I need money to run my magazine (Indian
Paediatrics, a journal); where am I going to get that from? I have to
solely rely on the advertisements I get. The government should not
ban advertising totally.”
(Copies of the WHO Code are available with VHAI on request:
Please include postage when writing.)
tom wiffels ko gussa kyon aata has?
In 1975, I met Tom Wiffels, a young Dutch doctor who was running
a modern hospital in a remote area of Kenya. Frequently Tom would
express anger upon seeing a mother bottlefeeding her baby. One
day he exploded, seized the dirty blue plastic bottle a woman was
giving her infant and threw it out of the window.
As part of his daily work Tom spent hours explaining the virtues of
breastfeeding to African mothers, trying to undo the results of the
seductive advertising to which they had been exposed. When he
arrived at Tabaka hospital, decorative posters urging women to
bottlefeed their babies covered the hospital walls. At first, Tom
made large signs reading Mother’s Milk is Better, which he pasted
over the advertisements. Deciding that was ineffective, he eventually
ripped the posters off the wall.
—FOOD MONITOR
The Central Food Technological Research Institute (CFTRI) in
Mysore, India, has developed a new low-cost, nutritious weaning
food supplement based on locally available cereals and legumes and
using equipment available in Indian villages. The product
contains malted ragi (finger millet) powder and malted green gram
(mung bean) powder. A daily supplement of 50-75g of this product
corrects any protein deficiency in a child. Malting of the food grains
increases the calorie density and enhances the nutritive quality
and digestibility of the product. The product costs about Rs. 5 - per
kilogram which is less expensive than commercially available brands
of weaning foods.
—Courtesy IOCU
health for the millions/oct-dec. 1981
25
a health robbery
The Great Health Robbery: (Baby Milk and Medicines in Yemen)
—A new film and book from Oxfam.
Oxfam has launched a film and a 60 pages book, both entitled, The
Great Health Robbery. Both focus on the tragic, frequently fatal, effects
of the marketing of baby foods and medicines in the Yemen Arab
Republic. The Yemen case illustrates a problem throughout the
Third World where European manufacturers are attempting to carve
out new markets for their products without taking into consideration
the context within which their products will be used.
“The producers of artificial baby milks are promoting their products
in countries where their use is inevitably dangerous. They are still
promoting the image of happy, healthy, bottle-fed baby in countries
where the end result is all too often a shrivelled, marasmic corpse.”
Dianna Melrose, author of The Great Robbery and a member of
Oxfam’s Public Affairs Unit, spent some time in Yemen examining
the excesses of marketing of baby milks and inapproiate medicines—
and the effects.
Note:
The Great Health Robbery (book) costs £1.30 (plus 25p postage)
and is available through Third World Publications 151 Stratford
Road, Birmingham.
The Great Health Robbery (film) will be available for hire to interested
groups and organisations.
Contact Oxfam’s Visual Aids Department for details.
aggressive persuasion
As reported in Business India (18 January 1981), Nestle offered
Rs. 50,000 to a member of a government committee in charge of drafting
a code for baby food marketing. Ostensibly, the offer was made as a
“donation” to the health association of which the committee member
is president. Nestle also spent Rs. 1,50,000 on a dinner party for a
major pediatric conference in Bangalore, India (see also Ibfan News,
December 1980) Says Business India:
This, apparently, is part of a big push by the multinational com
panies to get the support of the crucial decision-making seg
ments—doctors and mothers I Doctors in Gujarat have reportedly
received cars as gifts, and it is not uncommon for medical per
sonnel to be given round-the-world trips courtesy the big manu
facturers.
The article, entitled “The Dirty Tricks of Baby Food Giants,”
further reports that the Nestle offer nearly succeeded in ge>ting from
the governments drafting committee a very weak industry (ICIFI)
code. Dr. R.K. Anand, medical advisor to the Consumer Guidance
Society of India, told Business India:
Happily, that was not accepted and I think that we will be confor
ming more to the guidelines of WHO/UNICEF. . . . But it does
show how these people can mount an aggressive and yet subtle
campaign to undermine the very code of ethics that is supposed
to keep them under control I
strong feelings
I have strong feelings because
I have frequently seen babies
die unnecessarily because they
were bottle fed, babies that
would have lived to become
useful world citizens had they
been breastfed. I have shared
the grief and sorrow of their
mothers, and I have felt great
frustration at not being able to
do more to prevent needless
sickness and death.
Dr Michael C. Latham
Professor of International
Nutrition and Director of
Programme on International
Nutrition Sciences, Cornell
University.
If a super power were to
burn the rice fields of a deve
loping country and dump on it
an unsafe substitutes made
from its own left-overs, would
the rest of the world look on
silently? The baby food situa
tion is not only similar, it is
much worse since the food
destroyed is a complete diet
and the consumers are infants
who can eat little else.
Article in The Statesman,
Calcutta
There are . . . artificial food
companies, milk companies,
who are able to divert that
tradition
(breastfeeding) to
brainwash the nurses, to brain
wash everybody until we think
this is not the way you should
really feed your baby.
Dr E A R El-Awadi, Minister
of Health, Kuwait President,
World Health Assembly.
—Ibfan News February 1981
26
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
-■ J________________________ _z_____
their experiments with untruth
(Ad copies with a reader's comments)
CERELAC
“Baby’s nutritionally complete cereal food. Complete with milk,
sugar and love’’.
1.
No company can tin love for your child.
2.
You can buy milk, sugar and cerealc separately at
much less.
3.
Cerelac is not nutritionally complete.
“Doctors recommend Farex”.
FAREX
.
No conscientious doctor would ever do.
ANGEL
“Mother’s Angel baby milk food is as’ gentle as your love
This is an insult to your love.
“Angel is homogenised’’.
;.
A
.A
And so is mother dairy milk in Delhi.
“Now your baby has all the nutrition he needs’’.
False statement. Such a baby food is yet to be
invented.
“Yet another crisis you could do without baby screaming for its
feed: the glass feeding bottle lying shattered on the floor."
BABY CARE BOTTLES
Do not bottlefeed. Breastfeed. You will never need a
spare, bottle again. For supplementary feeding use
cups and spoons.
“Adds variety to your baby’s food".
NESTUM
You don’t need nestum to add variety to your baby’s
food. You can give fruits, cooked and mashed
vegetables, dais with rice, wheat or potatoes.
“Unbreakable".
LITTLE’S POLY CARB
FEEDING BOTTLE
POOPCEE
May be, but all bottles are difficult to sterilise. They
can be unclean.
“For a mother to feed her baby like this every four hours just isn’t
convenient."
For a mother it is never convenient to boil water,
sterilise the bottle each time, to mix the infant feed
correctly using the right formula, keeping the nipple
clean and feed the child a substandard product.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
27
further reading
1, Human milk in the modern world by Derrick B. Jeiliffe end E.F.
Patrice Jeiliffe: ELBS, 1979. Rs. 751- pages 500. Available through VHAI.
Discusses the psychosocial, nutritional and economic consequen
ces. Stresses the need for a system of infant-feeding based on a
blend of modern scientific knowledge as well as adequate environ
mental hygiene and food supply. This book has attained the status of
a classic in the field.
2. Breast-feeding, the biological option by G.J. Ebrahim. ELBS,
1980:$Rs. 13.75 pages 90. Available through VHAI.
Presents in a concise form, some of the advances made by scien
tific research into the nutritional and immunological properties of
breast milk and the biological importance of the mother’s in the
nutrition of the infant. One of the neatest books on the subject.
3. Regulation and Education: strategies for solving the bottle
feeding problem: by Ted Greiner. Cornell International Nutrition
Monograph Series No. 4 (1977) Rs. 20. Pages 80. Available from VHAI.
Second in a series of monographs written by the author and dealing
with breast and bottle feeding. Good discussion of communication
and education of the public. A work of studied scholarship.
4. See how they grow by David Morley and Margaret Woodland:
ELBS. Pages 280. Rs. 27. Available from VHAI.
Discusses breastfeeding (Chapter 8) and other issues related to
appropriate child growth in developing countries. Recommended for
MCH workers.
5. The feeding and care of infants and young children by Shanti
Ghosh, VHAI, New Delhi. Rs. 12j- Pages 118.
Also available in Hindi. Available from VHAI a short monograph
on Breastfeeding and the Child. Useful, practical manual and appro
priate for Indian children.
6. TALC slides on Breastfeeding. The entire set available from
VHAI. The 24 slides describe normal suckling and ways of preventing
difficulties. Rs. 20 j- for the set.
7. The baby killer. A War on Want investigation into the promotion
and sale of powdered baby milks. By Mike Muller
Well written document covering the episode. Third edition (1977)
Could be made available from VHAI or from War on Want 467
Caledonian Road, London N7 9BE, U.K.
r
i
!
i
i
8. Proceedings of workshop on breastfeeding and supplemen
tary foods, edited by Aree Valyasevi and Jean Baker.
The “Proceedings of Workshop on Breastfeeding and Supplemen
tary Foods” was held in Bangkok, Thailand in November, 1979 The
booklet contains brief synopses of the major addresses made durina
the conference.
y
. O
28
.Xs
Should you wish additional information concerning the confprpnrp
or copies of the booklet, please contact:
Office of Nutrition
Development Support Bureau
United States Agency for International Development
Department of State
Washington, D.C. 20523
Or
Nutrition Institute
Ramthibodi Hospital
Bangkok, Thailand
Although supplies are somewhat limited, every effort will Hp
to fulfill your request.
y
WHI be made
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
News
a beggar at her feet
I have seen Him in the Beauty of all that is delight;
I have felt His Presence comforting in the darkness of my night
I have known the awesome feeling of awaiting Him in death,
I have feared to meet the Mighty One in my own sinfulness.
But now, I have discovered Him in the mystery of prayer
That tells me He is loving me in every single care.
He’s wanted to make known to me His Father’s Love complete,
And so I found Him, humbly a Beggar at my feet.
And now I know His message as He lives among us here.
If God is Love and nothing else, to all of us He's near.
He only pleads for us to be aware of Great Love—
Of the Father, Son and Spirit as they call us from above
And so, in love and love Himself, I pledge Him all I own,
To give myself and all I am to make that message known.
And some day in His Goodness, when my time on earth is done,
I’ll find myself in Fullness with the Beggar in His Home.
Sister Anne Cummins, S.C.M.M., passed to
her heavenly reward on October 30, 1981.
region administration team of the Medical Mission
Sisters.
Sister Anne is known throughout the country
for her association with community health.
She also assisted valuably in preparing the
two general chapters of the Medical Mission
Sisters held after the Vatican Council.
She had a career as a prominent lawyer in
Philadelphia till the age of 38. Then she joined
the Medical Mission Sisters. After her novitiate,
her first mission in 1970 was Delhi. She became
staff member of a newly rising health associa
tion, which became the Voluntary Health
Association of India.
The new Association was dedicated to social
justice in the provision and distribution of health
care. It gives a new confidence to people by
encouraging and teaching them how to preserve
and improve their own health.
It aims to help people keep up and enjoy
complete all round health, physical, environ
mental, psychological, and spiritual.
Sister assisted in organising VHAI throughout
the country. She was a pioneer in popularizing
the movement for training village health workers.
She served a term as Assistant in the Northern
I
EALTH FOR THE MILLIONS OCT-DEC. 1981
Her dedication to the poor was evident to all
who knew her. Her radiant personality and enter
taining songs made her welcome wherever she
went.
The past three years she had been suffering
from cancer. In spite of weakness, she was able
to continue effective work almost to the very end.
She was buried in the village cemetery at
Masihgarh, near Holy Family Hospital, New Delhi.
Towards the end of her annual retreat at Patna,
about a year ago, she had a mystical experience
of God’s intimate Presence—as a Beggar. It
lasted several hours.
This unusual union with God in love was really
indescribable. Yet, for her own memory and for
her friends, she captured the idea of it and
expressed it as best she could through the
above poem. It is indeed fascinating and highly
inspiring.
29
murray days
are here again
The Laugesens, Murray and Helen were accor
ded a warm welcome at the VHAI office on
November 17. Murray expressed his happiness at
the growth of VHAI and particularly its publica
tions programme—his brain child. According to
him, the experience he gained in India and partic
ularly with VHAI has come very handy, now in his
work with the New Zealand Government. Helen is
editing a church magazine. They were both en
route to Goa on a holiday. This is their first visit
to India since they left VHAI and India in 1977.
At a reception Fr Tong and other members of
the staff nostalgically recalled the "Murray days”
in the office.
Murray Laugesen who had joined the Coordi
nating Agency for Health Planning as a com
munity health consultant laid the foundation for
VHAI’s publication programmes.
Helen Laugesen, working as a volunteer in
VHAI wrote the text of Better Chile/ Care which
has by now appeared in 17 languages.
team-bhil-ding
On September 14, 1981, 20 participants working
among the Bhil tribals of MP, Rajasthan and
Maharashtra gathered in Mendha, MP to attend
the first course in Community Health Team Train
ing (CHTT), organised by VHAI.
Born out of the training experiences of VHAI's
community health team and the feedback from
previous participants, this training programme has
many novel features; (i) to train a team of two or
more persons from each centre, (ii) to involve the
entire staff of each centre directly or indirectly in
the work of the participants, (iii) to build up a
regional team of participants so that they can
support each other. This is possible as all parti
cipants are within 20-100 kilometres of each
other.
the end of the course, resource persons will once
again visit the centres of participants to assess
the progress of the participants. The course
finishes at the end of 15
. months v(December 1982)
with a one-week closing seminar.
This course is being coordinated by Dr Sathyamala. Other resource persons include Simone,
Ruth, Nirmala and Nalini. They have just comple
ted one round of visits to the participants’ cen
tres after the one month residency, and are hope
ful that this course shall help the participants
to implement what they learn.
of mimes and men
A new course design is being tried out to
facilitate implementation of the training. The
course is for 15 months. During this time the particiapants’ first meet for an initial one-month resi
dency course in which the concepts of commu
nity health and techniques of working with the
community are discussed. Following this, re
source persons visit each participant’s centre, to
give the entire staff of the centre an idea of the
orientation given to the participants and to help
them get started in community health work.
Twenty four health educators from as many
rural health programmes in Andhra Pradesh
came together to experiment with pantomime,
puppets, flannels and other low-cost educational
methods. The three-day workshop organised in
Hyderabad by AP VHA was conducted by the
Amrutavani team led by Br. Hubert. Augustine
Veliath from VHAI served as an additional re
source person.
Five regional meetings at intervals of two
months each are designed to encourage and help
participants in their work. Relevant inputs will
also be given during these meetings. Towards
The workshop was also noteworthy for the
cooperation received from government organi
zations like the National Institute of Nutrition,
the Department of* Family Welfare, and the Natio
nal Students’ Service Scheme.
30
HEALTH FOR THE MILLIONS,OCT-DEC. 1981
news from the states
bihar
karnataka
Another Unconvention
Undrugging the Millions
Bihar organising secretary, Zaman, writes
that the village health workers’ convention
on October 2-3, 1981, at Chandua, Palamau,
was a success. A detailed report will be
published in the next issue of Health for the
Millions, Meanwhile, BVHA has decided on the
theme “Health for all by 2,000 A.D. through
people’s participation towards health care’’, for
its next annual general body meeting in early
1982.
The Karnataka VHA conducted a seminar on
low cost drugs and drug policy at St. John’s
Medical College, Bangalore, on October 3, 1981.
Many recommendations were made by the par
ticipants akin to those emerging out of‘Health
for Millions’ April-June 1981 issue on drugs. One
of the recommendations called for a greater
openness and understanding of indigenous
medicine systems. It was felt that the State
VHA would need to initiate a regular dialogue
with the State government health authorities.
Otherwise all voluntary efforts would not be
adequate.
gujarat
west bengal
Eyewash Indeed
According to Dr. R.R. Doshi of the famed
Chikhodhra Eye Hospital, all the expensive oint
ments (tetracycline and other antibiotics) are of
little use in combating the conjunctivitis epidemic.
His formula is a cheap but effective eyewash:
sulphacetamide eye drops. The Chikhodhra
hospital is ready to provide it in bulk by litres at
cost price or in eye-drop bottles at 25 paise each.
The market price for each such bottle is Rs. 2.
The formula, in case the reader wants to prepare
it, is: One kg. of sulphacetamide sodium powder
(Rs. 175 per kg.) to 10 litres of distilled water.
Tight Strings
Fr. M.A. Urrutia, treasurerand acting secretary
of Gujarat VHA, has taken up a new assignment
as Resident Representative of Misereor in India.
He will be based in New Delhi. It is hoped
GVHA’s loss will be the gain of Misereor and
others in Delhi.
West Bengal VHA has been going great for
the past two years, thanks to the enthusiasm and
leadership of the organising secretary, Mr D.P.
Poddar and his select band of resource
persons like secretary Dr Joyce Biswas and
Dr U. Sen of Calcutta Urban Service and other
well wishers like the Cl Ml and MCC. The efforts
are doubly creditable because WBVHA has
been running on a shoe-string budget for
sometime. A report of the VHA's latest com
munity health development training programme
makes interesting reading. It was organised,
August 24 to September 22, 1981, at Durgapur’s
E.S.I. institute. For practical experience the
participants were divided in three groups and
placed at three different projects: CINI; Rama
krishna Mission, Narendrapur; and Calcutta
Urban Service, Uluberia project. The next such
training—which has attracted attention from
neighbouring Bangladesh—will be held in the
district of Howrah, February 15 to March 17, 1982.
kerala
southern region
A “Desertion”
Wholeness for a Million
Sr. Carol Huss, Sr. Celine and George Ninan
of VHAI were resource persons for a holistic
health workshop, October 11-16, in Trivandrum
for workers mostly of the Health for a Million
project. The workshop, which was almost
entirely in Malayalam aroused keen interest
among the participants and several plans for
implementation were drawn up. The trio were
also resource persons for yet another holistic
health workshop, this time for two days, October
25-26, at MGDM hospital, Kangazha. The two
days were also marked by keen participation.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
The Southern Region VHAs had their steering
committee meeting at Madras September 28-29,
1981. Major points of discussion included the
expectations from the regional team, the role of
steering committee, the newsletter and restruc
turing of VHAI. Sr. Muriel of TNVHA said one
of her plans for the future was to have a seminar
on alternative medicine. APVHA is preparing
its ground for workshops on nutrition, school
health and education aids in development.
Fr Bernard Moras has been appointed Secretary
of the Karnataka VHA. The meeting concluded
with an emphasis by George Ninan to work in
more creative ways and new programmes.
31
New Organisations
handicapped physically, not fiscally
Chances are that your hospital will, in the
near future, order its requirement for gauze for
bandages from MESH.
Production of gauze bandagesis one of the
newest ventures of this Delhi based leprosy reha
bilitation programme.
Maximising Employment to Serve the Handi
capped (MESH) believes in training the handi
capped and helping them to sell their products.
MESH today markets hospital bedhseets, cotton,
blankets, table cloths, bed covers and napkins,
not to talk of broilers.
It all began in 1964 when in Bethany, on the
outskirts of Delhi, a Leprosy Rehabilitation
Society came into being.
The villagers began first with weaving. Soon
a poultry project was started. Fifteen looms now
produce at full capacity. The dyeing on yarn,
hemming, fringing and knotting give additional
employment to residents. From the first pick up
of 36 dressed broilers, the production is running
over 1000 per month. In the last fiscal year each
industry had close to one lakh rupees in sales.
VHAI has a special reason in wishing all the
best to MESH. Late Edwin Nabert and his wife
Joan were both active in building up MESH. It is
Joan who took over and expanded the handloom
wing of the organization. MESH expects Joan to
return to India to continue to guide the organiza
tion. Ravindra Nath from VHAI has already
joined MESH.
Others who have been responsible for building
up MESH are Mrs Marilyn Wingard who organizes
the broiler sales, Dr (Mrs) Dorothy Chacko, the
Gilmores who set up the poultry project, and the
Campbells who donated their Landrover.
The Lutheran Church of America has agreed
to fund the project for three years. CASA, the
Mennonite Central Committee and IMEX of
Sweden have come forward to buy the products.
If you believe in maximizing employment to
serve the handicapped, you can purchase MESH
products. Please drop a line to MESH at shop
No. 1 M.M.T.C./S.T.C. Colony Shopping Centre,
New Delhi-110017.
school for applied research (SAR)
Philosophy
SAR is a trust, voluntary body devoted to rural
development. It was established in June 1978 to
try in the direction of techno-economic develop
ment of rural masses. Its emphasis is on new
technological gadgets based on appropriate
technology tuned for the conditions and environ
ments of rural people. SAR is recognised by
the department of science and technology,
Government of India.
Activities
Projects
development of agricultural implements;
mini and midi chilling plants for milk;
design and planning rural filters and house
hold filters for portable water;
4. softening of technology in respect of food
and chemical products for small scale
industries;
5. compaction machines—agricultural waste
recycled to form briquetes to be used as a
fuel.
1.
2.
3.
Successes
SAR creates:
1. awareness among rural people about
science and technology through discus
sions and introduction of gadgets;
2. developing products useful for day to day
life from locally available skills;
3. use of natural resources of energy like wind,
water, solar and bio-degradable materials;
4. to groom students from rural areas in the
skill of product development, management
and marketing and to encourage them to
set up industries in rural areas.
34
Received gold medal from World Intellectual
Property Organisation, Geneva, for innovation in
design for developing ‘Balwan’ bullock cart and
is now available for manufacture all over India
through National Research and Development
Corporation, New Delhi. Designed and developed
aerators, tableting Machine and improving the
thermal efficienty of wick stoves.
Finance
All activities of SAR are financed by the
members of the Trust. Particular projects are
financed by NRDC, CSIR and UGC.
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
r
rural development
Lalbhai Group Rural Development
Fund
Narottam Lalbhai Rural
Development Fund
Arvind Mills Premises, Naroda Road, Ahmeda
bad—380 025, Gujarat.
Arvind Mills
Premises,
Ahmedabad-380 025, Gujarat.
It is registered as a public charitable trust
created by Lalbhai Group of Industries in
Ahmedabad in 1979.
Address
Naroda
Road,
It is a public trust established in 1978 and
started work in ten selected villages in Gujarat.
Created by Lalbhai Group.
Philosophy
Philosophy
To bring into the process of development the
forces of creativity and critical enquiry so that the
challenges of development can be effectively met
by the people themelves.
Stimulating, initiating and setting into motion
a process of development which within a specific
span of time would become self reliant and self
perpetuating, whilst reducting the disparities
between various levels of rural society.
__ Activities
Activities
Two major programmes. Courses like:
1. creative management of income generation
amongst the rural poor for eleven months,
and
2. creative utilization of information for eight
months.
Besides this there are short term courses for
women involved with Child Development
Schemes.
Finance
Funded by Lalbhai
Ahmedabad.
Group
of Industries,
Operations in various sectoral areas like
agriculture, social and farm forestry, horticulture,
fodder development, animal husbandry, minor
irrigation, rural industries, appropriate techno
logy usage, rural housing, rural electrification,
roads, bio-gas, medical services, health care,
nutrition,
sanitation, non-formal education,
functional literacy, vocational training, rehabilita
tion of the handicapped persons etc.
Finance
Mainly from Lalbhai Group, Ahmedabed. Also
from banks and financial institutions and
government sources.
Future Plans
Future Plans
Plans to have its own campus with in-house
facilities to undertake its programmes.
To expand its activities to another ten villages
by the year end.
Residential Training Course
>
The Christian Community Health and Develop
ment Training and Research Institute, Santhipuram, Ambilikkai, Madurai District-(Pin 624612)
will begin their next popular training course for
male and female workers sponsored by health
organisations, voluntary institutions, and church
hospitals implementing community health pro
jects, from January 1982. During the 18 months
period, trainees will be given concurrent field
training for one year followed by independent
supervised field training for 6 months in the
sponsor’s project area.
Minimum educational qualification desired is a
pass in old SSLC (or) pass in Higher Secondary
course (i.e.) plus two. Medium of instruction is
English.
Write to Director
application form, etc.
For
Reprints of this
assoe on Breastfeeding—
PLEASE CONTACT :
Voluntary Health Association of India
C-14, Community Centre
S.D.A., New Delhi-110016
Training for prospectus,
HEALTH FOR THE MILLIONS/OCT-DEC. 1981
35
Mother and Child Health
We have
torn into pieces
in
this book
139 Pictures
WHERE THERE IS NO DOCTOR
well, not quite that way.
All chapters of Where There is no Doctor are
available separately for use in training sessions
classrooms.
(in size 19.5x22.5 cms)
for training of dais (traditional birth attendants)
and peripheral health workers.
Dos, Donts, and risk situations colour coded.
Script available separately.
The price varies from Rs. 0.50 to 2.50
Trial edition / Gestafaxed.
Very limited copies Rs. 35 plus postage & packing
Write for copies to VHAI.
Write to VHAI.
Do your health worker talk any of the follow
ing language ?
□ Hindi
□ Urdu
□ Bengali
□ Gujarati
□ Marathi
□ Kannada
□ Malayalam
□ Tamil
□ Telugu
□ Oriya
□ Punjabi
If yes,
V
they have to explain about sexually tranmitted diseases to people?
If yes, we have a booklet for them.
It is BETTER CARE IN VENEREAL
DISEASES.
This booklet explains all what a peripheral
health worker should know about venereal
diseases, in 52 visuals with text.
It easily slips into your pocket and has protec
tive plastic cover.
Its price is Rs. 5.50. On all orders received on
or before January 29 the price will be Rs. 4.90.
Write to VHAI.
36
HEALTH
for the MILUONS/OCT’DEC. 1981
Position: 232 (12 views)