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Chapter1 review of related literature of unwanted pregnancy

Nutrition and Family Planning Linkages: What More Can Be Done? The food-people-resources balance, now and in the future, is a critical determinant of the quality of life.

  1. Breastfeeding for Infant Health and Nutrition Figure The benefits of breastfeeding are constantly becoming better understood.
  2. A study to determine factors contributing to abortions among will review related literature on basic rights are threatened by an unwanted pregnancy.
  3. The effect of child mortality on birth spacing can act in several ways.

At the same time, programmes in family planning, health and nutrition are widely pursued to improve maternal and child health, with expected longer-term demographic effects. This in turn came to concentrate on the triangle of breastfeeding, birth spacing, and infant nutrition and maternal health. The importance of macro-level issues of food-population-resources remain well-recognized, but such a crucial topic required more time and resources than were available.

Considerations relating to programmes were felt to be more immediately applicable by the UN and donor agencies. The Symposium was chaired by Ms K. Three papers were presented. The Symposium papers, discussions and related literature form the basis for this article.

Breastfeeding delays the return of fertility in the mother, thus contributing to longer birth intervals.

Acknowledgments

Better nutrition promotes infant and child survival, which in turn tends to increase birth intervals. And all these processes benefit the health and well-being of the mother. This is illustrated in Figure 1. Interactions of breastfeeding, birth spacing and nutrition. The interactions are finely-tuned, developed as part of human evolution.

They are worth understanding - some only recently worked out and still being researched - and are discussed in more detail below. A practical message emerged from the Symposium, at which the different disciplines present found to their slight surprise they were talking much the same language about the same conclusions from different starting points: Indeed these could be better integrated.

Breastfeeding for Infant Health and Nutrition Figure The benefits of breastfeeding are constantly becoming better understood. Breastfeeding reduces exposure to pathogens in the environment, gives protection by immunization, provides anti-bacterial and antiviral substances, and supplies the correct mix and density of nutrients; it also has very little direct cost. Bottle feeding, which is the usual alternative in early life, tends to be contaminated, non-ideal in terms of nutrients, and not affordable to many families in poor societies.

A continuity has evolved to bridge the gap between the safety of the womb and the shock of post-natal life, when the gut suddenly replaces the placenta as an interface with the world. The immature infant gut is adapted to the nutrition and protection of breast milk. Antibodies from colostrum and breast milk protect the gut and provide some immunity against other infections. Antibiotic activity in breast milk proteins is being shown to be selective against precisely certain of the harmful bacteria that cause infantile diarrhoea.

The hazards of sudden exposure of the fragile gut to foreign materials is now being realized. In fact, a steady decrease had been observed by the early twentieth century. But breastfeeding decline chapter1 review of related literature of unwanted pregnancy increased use of artificial feeding did not immediately result in population increase. But is breastfeeding decline an inevitable result of modernization?

This and other examples from Australia, Eastern Europe, Scandinavia and the USA shows that the decline in breastfeeding is not an unavoidable result of industrialization if the necessary measures for its promotion and support are taken.

Breastfeeding and Birth Spacing Figure Breastfeeding directly contributes to increased birth intervals by tending to reduce the resumption of fertility in the mother. This is more pronounced with exclusive breastfeeding. The SCN Symposium stressed that lactational amenorrhoea is particularly relevant to providing an opportunity in the first months after birth for counselling women on modern family planning methods, and that it is complementary to these not a substitute.

A major step forward was recently taken when an international group of experts met in Bellagio, Italy, in August 1988 to review the evidence for the contribution of breastfeeding to family planning. Recent research by Dr Short and associates on a well nourished group of Australian women breastfeeding their babies examined the probability of becoming pregnant over a 24 month period after the birth.

Lactation delays the resumption of fertility by physiological neuroendocrine mechanisms. Briefly, suckling at the breast affects hormone chapter1 review of related literature of unwanted pregnancy that maintains the production of milk prolactin and, probably through other pathways, depresses the hormone levels necessary for fertility inhibiting ovulation and producing amenorrhoea.

The frequency of suckling is important, increasing milk synthesis and secretion and decreasing chances of fertility. An inhibitory peptide is secreted by the mammary alveoli to stop further milk synthesis if the alveoli are not emptied regularly. The WHO Collaborative Study from 1976-78 indicated a consistent and close relationship between the duration of breastfeeding and the duration of post-partum amenorrhoea.

The same conclusions were reached in many other studies, e. Bongaarts6, who demonstrated that the duration of breastfeeding explains most of the variation in the duration of post-partum amenorrhoea. Another factor claimed to influence the length of lactational amenorrhoea has been the nutritional status of the mother, with shorter amenorrhoea period in better nourished women.

Dr Short, however, reported that in their studies and those of some others, women in developed countries, on an optimal plane of nutrition, still achieve prolonged periods of lactational amenorrhoea. Such observations have been used to look at questions like the overall influence of breastfeeding practices on population growth, via its contraceptive effect; and the extent to which breastfeeding offsets contraceptive needs.

It has been claimed that lactational amenorrhoea is the single most important variable among the proximate determinants of natural fertility7. A World Bank analysis8 has pointed to the significant effect of breastfeeding in reducing the total possible number of births to a great majority of the couples in developing countries who do not use modern contraceptives.

Chapter1 review of related literature of unwanted pregnancy

A major step towards reducing the excessive fertility that is currently fuelling the population explosion, concluded Dr Short, would be to persuade both developing and developed countries to do their utmost to support and encourage prolonged breastfeeding. Breastfeeding, thus, in addition to its nutritional and health values needs to be promoted and supported as a child-spacing strategy.

Longer birth intervals will reduce total numbers of children per women as well as benefiting both mothers and their children in the other ways described here. One of the earliest observations of malnutrition was of kwashiorkor as the disease of the displaced child - displaced by a new pregnancy. Short birth intervals have often since then been related to malnutrition. They are also related to infant and child mortality - although this operates in both directions, as discussed in the next section.

Nonetheless, anything that prevents too-short birth intervals will benefit the youngest child - including family planning programmes directly, and as an additional indirect result of breastfeeding. As Dr Huffman pointed out in her paper, birth intervals of less than two years have frequently been associated with low birth weight, high infant mortality, growth retardation, high morbidity and inferior nutritional status.

  1. The Symposium thus emphasized the importance of training both health and family planning workers, before they can educate and encourage mothers to take full advantage of breastfeeding potentials.
  2. Indeed the decision to have rapidly-succeeding pregnancies for this reason may be taken without experiencing a child-death in the family, if it is perceived that this risk is high, to insure against possible future deaths and reach the desired family size before the reproductive cycle of the family is complete. Although an integrated approach has been stressed, breastfeeding has only infrequently been promoted in population projects.
  3. They focussed on women actively exposed to different degrees of reproductive stress by carefully studying the period of overlap. In fact, a steady decrease had been observed by the early twentieth century.
  4. This is illustrated in Figure 1. Sensation seeking, message sensation value and implications for teen pregnancy literature review and conceptual framework.
  5. The link of nutrition to survival or mortality is clear.

The advantage to the child of adequate birth interval goes beyond maintenance of breastfeeding. The burdens of time and stress on the mother tell on her ability to nurture the family, and these are worsened by too-close pregnancies. Her health itself may suffer, as discussed later - a serious blow particularly to poor families with many children.

This stresses another way in which too-short birth intervals are disadvantageous - through family economics: Part of the motivation for short birth intervals, ironically, may itself have an economic perspective, in ensuring for old age, encouraging rapid births to reach large desired family size. In a sense this contributes to a vicious circle, as more births will be wanted when mortality is high: The health impact of family planning will clearly be greater if it has a specific effect on birth intervals.

But a considerable number of the births prevented by family planning programmes are due to sterilization.

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This, while preventing any further birth, is usually not associated with adequate birth intervals for the preceding pregnancies. This is important in the long-run, as part of the motivation for smaller family size, hence eventually reduced population growth rates. The link of nutrition to survival or mortality is clear. The effect of child mortality on birth spacing can act in several ways.

As implied earlier, the death of a breastfed infant will tend to lead biologically to resumption of fertility. But conscious decisions may be made to replace the child as soon as possible - perhaps before the mother has recovered from the previous pregnancy. Indeed the decision to have rapidly-succeeding pregnancies for this reason may be taken without experiencing a child-death in the family, if it is perceived that this risk is high, to insure against possible future deaths and reach the desired family size before the reproductive cycle of the family is complete.

Here too, we are dealing with a cycle that can benefit from deliberate intervention to break. In this case, for example, promoting infant and child nutrition and survival can gradually establish more motivation for longer birth intervals, hence acceptance of family planning. Drs Martorell and Merchant gave evidence in their paper that spacing reproductive events is necessary for maternal recovery.

The phenomenon has been reported to be common among women in a number of poor areas: Although lactation is generally associated with post partum amenorrhoea, partly because of prolonged breastfeeding in many developing countries, perhaps as many as one third of all pregnancies occur in lactating women.

They focussed on women actively exposed to different degrees of reproductive stress by carefully studying the period of overlap. Two extreme situations were compared: While the emphasis of the paper was on mothers themselves, their results showed that reproductive stress also adversely affects the infant. It is interesting to note the results of the National Institute of Nutrition, India, in which pregnant and lactating women were under even greater stress: In reporting the results of these studies Ramachandran concluded that irrespective of the duration of lactation and period of gestation, women who continued lactating during their pregnancy had lower body weights than their non-lactating pregnant counterparts.

Here too, the differences were more marked in the small group of those working women becoming pregnant in the first 6 months of lactation.

  • Her health itself may suffer, as discussed later - a serious blow particularly to poor families with many children;
  • Longer birth intervals will reduce total numbers of children per women as well as benefiting both mothers and their children in the other ways described here;
  • The frequency of suckling is important, increasing milk synthesis and secretion and decreasing chances of fertility;
  • Their babies had also lower birth weights.

Their babies had also lower birth weights. These results pointed to the fact that overlap should be prevented and birth intervals need to be adequate.

Using the fertility-inhibiting effect of exclusive breastfeeding, later followed by other family planning chapter1 review of related literature of unwanted pregnancy, another pregnancy can be planned at a more appropriate time and with reasonable spacing. Integrating Nutrition and Family Planning Activities The mutual benefits of breastfeeding and family planning programmes mean that they will be more successful if they are integrated.

Both nutritional support and birth spacing have impacts on mortality reduction and nutritional status improvements. Breastfeeding is now recognized as a child survival strategy. Keeping a child alive is associated with preventing another birth, since the death of an infant is usually followed by another pregnancy. Some reasons for integration are shown in the box below. Exclusive breastfeeding can be used to protect against conception in the early months after birth when lactation has induced amenorrhoea.

Its contraceptive effect will however wane over time and therefore should not be regarded as a substitute to other family planning methods, but as a complement to them. Even with the gradual appearance of other contraceptive devices in the world market, exclusive breastfeeding has remained the only protection many women in developing countries have whether due to non-accessibility or non-acceptability against another untimely pregnancy.

In 1975 it was stated that more births were averted in the third world countries by breastfeeding than by any modern method of contraception Rosa12. But the fact is that many such women are not protected against pregnancy even when breastfeeding can no longer prevent fertility.

These will benefit most from integrated programmes where family planning and breastfeeding promotion are offered together.

Family planning programmes can increase their coverage and thus effectiveness by including many women who do not want to use contraceptives until menses have resumed, if they encourage these women to exclusively breastfeed.

  • This would then lead to detailed aspects of implementation, such as providing a similar message from different field workers, ensuring appropriate referrals during and after pregnancy, and so on;
  • As implied earlier, the death of a breastfed infant will tend to lead biologically to resumption of fertility;
  • Keeping a child alive is associated with preventing another birth, since the death of an infant is usually followed by another pregnancy.

Even if contraceptive supply and demand are not constrained - as in reality they often are - significant declines in breastfeeding may place greater pressure on family planning services than can, presently, be coped with. In this regard, breastfeeding can help to use scarce family planning resources more efficiently.