Parent-offspring conflict and the cultural ecology of breast-feeding

Lactation constitutes a major focus for research in international health because of its dramatic impact on child survival; evolutionary biology has investigated lactation as an important aspect of parenting strategy, with implications for understanding parent-offspring conflict. These perspectives are brought together in an attempt to develop integrated models for an issue of key international health concern: the duration of exclusive breast-feeding and the timing of weaning. This analysis highlights the relevance of evolutionary theory for practical problems in public health, and it suggests the utility of public health outcomes for addressing evolutionary questions. Thomas McDade received his Ph.D. degree in anthropology from Emory University in 1999 and is currently an assistant professor in the anthropology department at Northwestern University. His research interests include biocultural perspectives on issues related to health and human development, with current attention focused on the cultural and evolutionary ecology of human immune function.     

Socio-Cultural Determinants of Health-Seeking Behaviour on the Kenyan Coast: A Qualitative Study

Background

Severe childhood illnesses present a major public health challenge for Africa, which is aggravated by a suboptimal response to the child''s health problems with reference to the health-seeking behaviour of the parents or guardians. We examined the health-seeking behaviour of parents at the Kenyan coast because understanding impediments to optimal health-seeking behaviour could greatly contribute to reducing the impact of severe illness on children''s growth and development.

Methods and Results

Health-seeking behaviour, and the factors influencing this behaviour, were examined in two traditional communities. We held in-depth interviews with 53 mothers, fathers and caregivers from two rural clinics at the Kenyan Coast. Biomedical medicine (from health facilities and purchased over the counter) was found to be the most popular first point of treatment. However, traditional healing still plays a salient role in the health care within these two communities. Traditional healers were consulted for various reasons: a) attribution of causation of ill-health to supernatural sources, b) chronic illness (inability of modern medicine to cure the problem) and c) as prevention against possible ill-health. In developing an explanatory model of decision-making, we observed that this was a complex process involving consultation at various levels, with elders, but also between both parents, depending on the perceived nature and chronicity of the illness. However, it was reported that fathers were the ultimate decision makers in relation to decisions concerning where the child would be taken for treatment.

Conclusions

Health systems need to see traditional healing as a complementary system in order to ensure adequate access to health care. Importantly, fathers also need to be addressed in intervention and education programs.     

"Kissing a Baby Is Not at All Good for Him": Infant Mortality, Medicine, and Colonial Modernity in the U.S.-Occupied Philippines

Feminist scholars have begun to consider the ways indigenous practices of child rearing were and are challenged in (post)colonial discourse and practice, and how these practices have become a terrain on which definitions of nation, state, and economy are contested. In this article, I adopt a historical anthropological approach to consider how Filipino child-rearing strategies were described and stigmatized in educational, public health, and public welfare discourses in the U.S.-occupied Philippines in the early 20th century. I demonstrate how public health practices and discourses that were generated as part of a "benevolent" campaign against high rates of infant mortality were strategically used as a weapon against Filipino arguments for independence. I also consider how discourses constructing Filipino caregivers as overly indulgent were linked to metropolitan concerns about production of the "new industrial man" and were used to develop a racialized critique of the cultural practices of Filipinos.     

Philosophy Behind Science: The European discoveries in prenatal ethnology and archeology of the mind

"On ne conna?t que les choses que l"on apprivoise, tu deviens responsable pour toujours de ce que tu as apprivoisé," Fedor-Freybergh once quoted in an editorial Saint-Exupéry. I remember Gupta quoting an old Indian physician on responsibility of the parents: "The somatic and mental characteristics of the child are predetermined. Valor, health, constitution, and intellect develop in the intrauterine child due to the physiological and spiritual harmony of his parents." The responsibility is not finished by medical observations or help to make the child become intelligent. I try to bring together some of the many ideas on prenatal life which grew during decenniums in Europe to blossom in sudden or quiet revelations and which are due to functions of the new being and the threefold or manyfold way behind him and his parents.     

THE LIMITS OF INTIMATE CITIZENSHIP: REPRODUCTION OF DIFFERENCE IN FLEMISH‐ETHIOPIAN ‘ADOPTION CULTURES’

The concept of ‘intimate citizenship’ stresses the right of people to choose how they organize their personal lives and claim identities. Support and interest groups are seen as playing an important role in the pursuit of recognition for these intimate choices, by elaborating visible and positive cultures that invade broader public spheres. Most studies on intimate citizenship take into consideration the exclusions these groups encounter when negotiating their differences with society at large. However, much less attention is paid to the ways in which these groups internalize the surrounding ideologies, identity categories and hierarchies that pervade society and constrain their recognition as full citizens. In contrast, this paper aims to emphasize the reproduction of otherness within alternative spheres of life, and to reveal the ambiguities and complexities involved in their dialectic relationship with society at large. To address this issue, the paper focuses on the role that ‘adoption cultures’ of Flemish adoptive parents with children from Ethiopia play in the pursuit of being recognized as ‘proper’ families and full citizens. The ethnographic research among adoptive parents and adoption professionals shows a defensive discourse and action that aims at empowering against potential problems, as well as a tendency to other the adoptive child by pathologizing its non‐normativity. By showing the strong embeddedness of adoptive families' practices of familial and cultural construction in larger cultural frames of selfing and othering, characterized by biologism and nativism, one begins to understand the limits of their capacity to realize full citizenship.     

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.     

Extraordinary Care for Extraordinary Conditions: Constructing Parental Care for Serious Mental Illness in Japan

This article presents an account of how Japanese parents in a family support group for mental illness constructed understandings of care for adult children with serious mental illness, primarily schizophrenia. I build from Janis H. Jenkins’s research on the “extraordinary condition” of schizophrenia to discuss “extraordinary care,” which parents practiced as a way to refute cultural and clinical beliefs about pathogenic families and degenerative diseases. Parents’ accounts of extraordinary care revealed a reliance on biomedical knowledge to treat the symptoms of mental illness coupled with an ongoing determination to improve children’s lives beyond what psychiatry could offer. Extraordinary care thus points to the therapeutic limits of biomedical psychiatry while also reinforcing the significance of social relations as families work toward recovery.     

Social economics of childhood glucocorticoid stress response and health

This study examines socioeconomic conditions, psychosocial stress, and health among 264 infants, children, adolescents, and young adults aged 2 months to 18 years residing in a rural Caribbean village. Fieldwork was conducted over a 9 year period (1988–1996). Research methods and techniques include salivary cortisol radioimmunoassay (N = 22,438), systematic behavioral observations, psychological questionnaires, health evaluations, medical records, informal interviews, and participant observation. Analyses of data indicate complex relations among socioeconomic conditions, stress, and health. Household income, land ownership, parental education, and other socioeconomic measures are weakly associated with child illness. There is no evidence that apparent material benefits of high socioeconomic status—such as improved housing, diet, work loads, and access to private healthcare—have important direct effects on child health in this population. However, social relationships, especially family environment, may have important effects on childhood psychosocial stress and illness. Abnormal glucocorticoid response profiles, diminished immunity, and frequent illness are associated with unstable mating relationships of parents/caretakers and household composition. We suggest that family relationships and concomitant stress and immunosuppression are important intermediary links between socioeconomic conditions and child health. Am J Phys Anthropol 102:33–53, 1997. © 1997 Wiley-Liss, Inc.     

Child health in rural Colombia: determinants and policy interventions

We study the determinants of child anthropometrics on a sample of poor Colombian children living in small municipalities. We focus on the influence of household consumption, and public infrastructure, taking into account the endogeneity of household consumption using two different sets of instruments: household assets and municipality average wage. We find that both household consumption and public infrastructure are important determinants of child health. We have also found that the coverage of the piped water network positively influenced child health if the parents have some education.     

Differential parental investment in families with both adopted and genetic children

Stepchildren are abused, neglected and murdered at higher rates than those who live with two genetically related parents. Daly and Wilson used kin selection theory to explain this finding and labeled the phenomenon “discriminative parental solicitude.” I examined discriminative parental solicitude in American households composed of both genetic and unrelated adopted children. In these families, kin selection predicts parents should favor their genetic children over adoptees. Rather than looking at cases of abuse, neglect, homicide and other antisocial behavior, I focused on the positive investments parents made in their children as well as the outcomes of each child. The results show that parents invested more in adopted children than in genetically related ones, especially in educational and personal areas. At the same time, adoptees experienced more negative outcomes. They were more likely to have been arrested, to have been on public assistance and to require treatment for drug, alcohol or mental health issues. They also completed fewer years of schooling and were more likely to divorce. In adoptive families, it appears that “the squeaky wheel gets the grease.” Parents invest more in adoptees not because they favor them, but because they are more likely than genetic children to need the help. I conclude that discriminative parental solicitude differs in adoptive and step households because adoptive families generally result from prolonged parenting effort, not mating effort like stepfamilies.     

Parental misclassification of child overweight/obese status: The role of parental education and parental weight status

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children’s activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children’s diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent’s own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child’s weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child’s overweight/obesity; this may reflect social desirability bias.     

Early-life exposure to parental mental distress and adulthood depression among middle-aged and elderly Chinese

Although mental illness among the middle-aged and the elderly has become a global public health issue and there is a burgeoning interest in the intergenerational transmission of mental health concerns in recent years, the long-term impact of parental mental health problems on child mental health conditions in developing countries remains unknown. Using the China Health and Retirement Longitudinal Study (CHARLS), which provides both contemporaneous and retrospective data collected from a nationally representative sample of Chinese residents aged 45 years and above, this study employed a multilevel modeling approach to investigate the association between early-life exposure to parental mental distress and adulthood depression among the middle-aged and elderly Chinese. Our study showed that childhood parental mental health problems predicted mid- and late-life depression in Chinese contexts and the result remained robust to a suite of robustness checks. Our exploration of potential pathways of the relationship found the following adversities that were associated with the exposure to parental mental distress in early life and may have contributed to the depression among the middle-aged and elderly: higher rates of childhood physical abuse by parents, poor childhood health, lower levels of educational attainment, poor physical health and individual economic status in adulthood. Further, our heterogeneity analysis indicated that the transmission effect was stronger for the elderly than the middle-aged and that the improvement of childhood SES mitigated the intergenerational transmission. We also found that childhood parental mental distress was potentially a moderator, which inhibited the recovery from depression. The findings will inform the design, implementation, and evaluation of relevant public health policies. It highlights the need for more efforts to prevent and mitigate the profound impacts of childhood parental mental distress on the late-life well-being of child generations.     

Health inequalities: new concerns about the children of single mothers.

OBJECTIVES--To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN--Reanalysis of data published in the childhood supplement of the registrar general''s decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS--Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION--Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation''s health should acknowledge the importance of material and social deprivation more explicitly.     

Going like Gangbusters: Transnational Tobacco Companies "Making a Killing" in South America

This article reports on the recent growth of transnational tobacco companies (TTCs) in South America. Although some scholarly attention has been directed toward such growth in Asia and eastern Europe, South America has also been targeted by the TTCs' aggressive expansionist practices in recent years. Fighting "Big Tobacco" is entirely different from combating most public health problems. Unlike cigarettes, most infectious diseases and maternal and child health problems never provide profits to transnational corporations and governments. Also, most public health problems (with alcohol being another notable exception) are not exacerbated by extensive advertising campaigns that promote the cause of the health problems. Supported by data gathered during three months of fieldwork in Ecuador, Peru, Chile, and Argentina in 1997, this article suggests that the TTCs' marketing strategies override cultural differences in the choices people make regarding smoking and health. Combining critical medical anthropology and public health, this article concludes that unless dramatic actions are taken, an avoidable outbreak of tobacco-related diseases will eventually reach epidemic proportions on the South American continent. It is also a "call to arms" for more medical anthropologists to investigate tobacco-related matters around the world.     

“A Massive Long Way”: Interconnecting Histories, a “Special Child,” ADHD, and Everyday Family Life

Focusing on one family from a study of dual-earner middle-class families carried out in Los Angeles, California, this article draws on interview and video-recorded data of everyday interactions to explore illness and healing as embedded in the microcultural context of the Morris family. For this family, an important aspect of what is at stake for them in their daily lives is best understood by focusing on 9-year-old Mark, who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). In this article, we grapple with the complexity of conveying some sense of how Mark’s condition is experienced and relationally enacted in everyday contexts. Through illuminating connections between lives as lived and lives as told, we explore the narrative structuring of healing in relation to Mark’s local moral world with the family at its center. We examine how his parents understand the moral consequences of the child’s past for his present and future, and work to encourage others to give due weight to his troubled beginnings before this child joined the Morris family. At the same time, we see how the Morris parents act to structure Mark’s moral experience and orient to a desired future in which Mark’s “success” includes an appreciation of how he is accountable to others for his actions. Through our analyses, we also seek to contribute to discussions on what is at stake in everyday life contexts for children with ADHD and their families, through illuminating aspects of the cultural, moral and relational terrain that U.S. families navigate in contending with a child’s diagnosis of ADHD. Further, given that ADHD is often construed as a “disorder of volition,” we seek to advance anthropological theorizing about the will in situations where volitional control over behavior is seen to be disordered.     

Bioethics and culture: an African perspective

The project of Bioethics seems to me to require paying attention to the cultural realities and assumptive frame of reference of different peoples. I assume that this must be one of the views of the organizers of this conference too and that this is why the idea of country reports is taken seriously. If I am right about this, then it makes sense for me to start my discussion with a very brief discussion of some aspects of the cultural realities of Africa with particular reference to the Yoruba of Nigeria. Then I will discuss how this world view raises issues for bioethics. Two aspects of people's worldview relevant to bioethical issues are their conception of the human person and their conception of cause. What they consider themselves to be, and what they consider to be the principles of causation will normally influence their attitudes to health and illness and their choices regarding health care. I will briefly discuss these issues with regard to the Yoruba worldview.     

Before your very eyes: illness, agency, and the management of Tourette Syndrome

In this article, I examine the ways that people with Tourette Syndrome (TS) manage the motor and vocal tics characteristic of this neurological disorder. To mitigate the powerful stigmas associated with TS, individuals must either remove tics from public view or strive to recast the way that they are perceived. Drawing on ethnographic research with TS sufferers in Indiana, I elaborate three strategies by which this is done, strategies referred to here as displacement, misattribution, and contextualization. These processes strongly affect both the symptoms themselves and the subjective experience of the illness. They also affect the perception of TS in the larger culture, associating the disease with florid symptoms like cursing--symptoms that, although not at all typical of TS, are the ones most resistant to these kinds of management. These patterns highlight how individual agency may actively shape the cultural construction of illness.     

The relationship between passive smoking and child health: methodologic criteria applied to prior studies

Most studies investigating the relationship between passive smoking and child health have found a significant effect on respiratory illness and lung function. The wide range of findings is based on diverse types of studies which use multiple criteria for respiratory illness, smoke exposure, and outcome variables. The aim of this review is to examine these studies in an attempt to focus attention on methodological criteria which relate to the strength of the association and likelihood of a causal relationship between passive smoking and child health. We examined 30 studies and judged their strength by examining (1) data collection, (2) surveillance bias, (3) definition of amount of smoking, (4) definition of illness, (5) detection bias, (6) outcome variables, and (7) control for confounding variables. Poor scores were noted in the use of "blinded" data collectors (37 percent of possible score), use of multiple specific outcome variables (51 percent), and definition of the quantity of smoking (56 percent). Good scores were noted in the detection of illnesses (98 percent), recall by study subjects of symptoms of illness (71 percent), control for confounding variables (81 percent), and definition of illnesses (86 percent). The range of scores for the studies was from 44 percent to 89 percent (of the total possible score). While a few well-designed studies demonstrate a significant effect of passive smoking on child health, most studies had significant design problems that prevent reliance on their conclusions. Thus, many questions remain, and future studies should consider important methodological standards to determine more accurately the effect of passive smoking on child health.