Breastfeeding and infant care as ‘sexed’ care work: reconsideration of the three Rs to enable women’s rights, economic empowerment, nutrition and health

Women’s1 lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women’s reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women’s care and domestic work (known as the ‘Three Rs’), is an established framework for addressing women’s inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women’s empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women’s and children’s health. It is therefore necessary for the interaction between women’s reproductive biology and infant care role to be recognized in order to support women’s human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding–like childbirth–is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as ‘sexed’ care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women’s ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers’ engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents’ time-consuming care responsibilities, for both infants and young children and related household work

Medicalization of eating and feeding

A variety of developments over the past century have produced the conditions in which eating and feeding are transformed from practices embedded in social or cultural relations into explicit medical practices. The rise of medical science, expansion of the pharmaceutical and food industries, escalating concern over diet‐related diseases and conditions, and growing anxiety over infant and childhood development have contributed to a process of medicalization. Medicalization is a sociological concept that analyses the expansion of medical terminology, interventions, or practitioners into areas of the life that were previously considered outside the medical sphere. For instance, under‐eating has previously been defined using theological language, as an act of fasting demonstrating a saintly character. Such practices are now understood through medical terms of anorexia nervosa, malnutrition, or general diagnoses such as “eating disorders not otherwise specified.” Individuals engaged in under‐ or over‐eating practices are increasingly defined by medical concepts (anorexia nervosa and obesity) and treated in medical spaces (hospitals, clinics, or rehabilitation centres) through medical interventions (pharmaceuticals, surgery, psychotherapy, or dietary regimens). Likewise, infant feeding (breast or formula) is understood as a practice that requires monitoring and instruction from medical practitioners. Further, eating in general is progressively invested with medical significance. Foods and diets are touted as possessing a therapeutic or health enhancing capacity that indicates an individual’s or population’s present and future health. Due to the high regard for, and influence of, medical science in the West, medicalization studies primarily focus on Western contexts. Medicalization does have an impact on non‐Western societies and the developing world, however its influence emanates from Western biomedicine, industries, and policies. There is important work to be done in examining the process of medicalization in non‐Western contexts, however this article is limited to the Western context ( Hunt, 1999). To analyse the medicalization of eating and feeding it is important to first sketch the theoretical and historical background of medicalization as a sociological concept. The relationship between eating and medicine is extensive. In order to focus the discussion, three examples are used – under‐eating, over‐ eating and infant feeding. This background focuses the analysis of the forces driving the medicalization of eating and feeding. Finally, in elaborating the influences and consequences of the medicalization of eating and feeding, some of the central ethical implications are identified and discusse

Determinants of intra-household food allocation between adults in South Asia - a systematic review.

BACKGROUND: Nutrition interventions, often delivered at the household level, could increase their efficiency by channelling resources towards pregnant or lactating women, instead of leaving resources to be disproportionately allocated to traditionally favoured men. However, understanding of how to design targeted nutrition programs is limited by a lack of understanding of the factors affecting the intra-household allocation of food. METHODS: We systematically reviewed literature on the factors affecting the allocation of food to adults in South Asian households (in Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan, Sri Lanka) and developed a framework of food allocation determinants. Two reviewers independently searched and filtered results from PubMed, Web of Knowledge and Scopus databases by using pre-defined search terms and hand-searching the references from selected papers. Determinants were extracted, categorised into a framework, and narratively described. We used adapted Downs and Black and Critical Appraisal Skills Programme checklists to assess the quality of evidence. RESULTS: Out of 6928 retrieved studies we found 60 relevant results. Recent, high quality evidence was limited and mainly from Bangladesh, India and Nepal. There were no results from Iran, Afghanistan, Maldives, or Bhutan. At the intra-household level, food allocation was determined by relative differences in household members' income, bargaining power, food behaviours, social status, tastes and preferences, and interpersonal relationships. Household-level determinants included wealth, food security, occupation, land ownership, household size, religion / ethnicity / caste, education, and nutrition knowledge. In general, the highest inequity occurred in households experiencing severe or unexpected food insecurity, and also in better-off, high caste households, whereas poorer, low caste but not severely food insecure households were more equitable. Food allocation also varied regionally and seasonally. CONCLUSION: Program benefits may be differentially distributed within households of different socioeconomic status, and targeting of nutrition programs might be improved by influencing determinants that are amenable to change, such as food security, women's employment, or nutrition knowledge. Longitudinal studies in different settings could unravel causal effects. Conclusions are not generalizable to the whole South Asian region, and research is needed in many countries

Programming of metabolic effects in C57BL/6JxFVB mice by in utero and lactational exposure to perfluorooctanoic acid

Perfluorooctanoic acid (PFOA) is known to cause developmental toxicity and is a suggested endocrine disrupting compound (EDC). Early life exposure to EDCs has been implicated in programming of the developing organism for chronic diseases later in life. Here we study perinatal metabolic programming by PFOA using an experimental design relevant for human exposure. C57BL/6JxFVB hybrid mice were exposed during gestation and lactation via maternal feed to seven low doses of PFOA at and below the NOAEL used for current risk assessment (3–3000 μg/kg body weight/day). After weaning, offspring were followed for 23–25 weeks without further exposure. Offspring showed a dose-dependent decrease in body weight from postnatal day 4 to adulthood. Growth under high fat diet in the last 4–6 weeks of follow-up was increased in male and decreased in female offspring. Both sexes showed increased liver weights, hepatic foci of cellular alterations and nuclear dysmorphology. In females, reductions in perigonadal and perirenal fat pad weights, serum triglycerides and cholesterol were also observed. Endocrine parameters, such as glucose tolerance, serum insulin and leptin, were not affected. In conclusion, our study with perinatal exposure to PFOA in mice produced metabolic effects in adult offspring. This is most likely due to disrupted programming of metabolic homeostasis, but the assayed endpoints did not provide a mechanistic explanation. The BMDL of the programming effects in our study is below the current point of departure used for calculation of the tolerable daily intake.The authors wish to acknowledge the support of the biotechnicians from the team of Hans Strootman at the RIVM animal facilities. Further technical support was provided by Piet Beekhof, Hennie Hodemaekers, Sandra Imholz (RIVM), Mirjam Koster (UU), Stefan van Leeuwen (RIKILT), Jacco Koekkoek and Marja Lamoree (VU). This study was funded by the European Community’s Seventh Framework Programme [FP7/2007–2013] under grant agreement OBELIX 227391

Gender and sustainable food systems : a feminist critique

In IDL-2279

Banking system trust, bank trust, and bank loyalty

Purpose The purpose of this paper is to test a model of banking system trust as an antecedent of bank trust and bank loyalty. Six determinants of trust and loyalty are included: competence, stability, integrity, customer orientation, transparency, and value congruence. The study provides insights which determinants are crucial for explaining bank trust and bank loyalty, and thus for rebuilding trust and loyalty. Design/methodology/approach Survey among 1,079 respondents of 18 years and older in The Netherlands on person trust, system trust, bank trust, and their scores on determinants of trust and loyalty. Structural equations modeling (AMOS) has been performed to provide insights into the relationships between concepts such as person trust, system trust, bank trust, and bank loyalty. The importance of determinants to explain bank trust and bank loyalty has been assessed as well. Findings Integrity is the most important determinant of bank trust. Transparency, customer orientation, and competence are also significant. Trust is a strong predictor of loyalty. Determinants explaining bank loyalty are: competence, stability, transparency, and value congruence. System trust is also a determinant of bank trust. The meaning of these results is discussed in the paper, as well as the managerial implications of these findings. Research limitations/implications Data were collected in May 2014 with a large sample, when the financial crisis came to an end. Distrust still remained as a consequence of the crisis. Banks are now rebuilding trust and loyalty. This research provides indications which determinants of trust and loyalty are important in this process and should be focused upon. A longitudinal study how trust and loyalty are developing would give insights and feedback on managerial actions. Practical implications Results provide insights into the causes and reasons of (dis)trust. From this study, banks get insights with a priority matrix which determinants are below par but important for specific banks and should be focused on and improved at the short term. Social implications Trust in banks and other financial institutions is crucial for the functioning of the banking system and for society at large. Restoring trust is a matter of fundamental changes of the bank-customer relationships, not only by communication but by sincere behavior (integrity) and benevolence in the customer interest. Originality/value The authors are not aware of research using all six determinants (competence, stability, integrity, customer orientation, transparency, and value congruence) to explain and predict bank trust and bank loyalty, and their implications for trust and loyalty in banks