Safe Space

Down but not out...

2005-05-23T13:54:00.000-07:00

I've been under the weather recently, but I haven't dropped out completely. Meanwhile, I've found some other neat contextualizing articles. (Apparently, I'm way more into the reading/researching part of this than I am the writing...)

First, take a look at Why Nation-States and Journalists Can't Teach People to Be Healthy: Power and Pragmatic Miscalculation in Public Discourses on Health by Charles L. Briggs (Department of Ethnic Studies, University of California, San Diego). This was published in Medical Anthropology Quarterly September 2003, Vol. 17, No. 3, pp. 287-321, and if you can log on to AnthroSource, you can read it in pdf form. As usual, for the non-"elites" out there, I'm pasting the abstract below.

This article analyzes how Venezuelan public health officials collaborated with journalists in producing information about cholera in January December 1991. It uses Michael Warner's (2002) observation that such public discourse involves a contradiction: it must project the image of reaching an actually existing public at the same time that it creates multiple publics as it circulates. The analysis explores the language ideologies that hide complex sets of practices, networks, and material conditions that shape how public discourses circulate. At the same time that epidemiologists targeted poor barrio residents, street vendors of food and drink, and indigenous people as being "at high risk," health education messages pictured women in well-equipped kitchens demonstrating cholera prevention measures. The gap between these ideal audiences and the discrepant publics created by their circulation limited the effectiveness of prevention efforts and created a substantial chasm between public health institutions and publics they sought to reach, [public discourse, epidemics, health education, social inequality, Latin America]

Another titillating tidbit (available on AnthroSource) is Claiming Respectable American Motherhood: Homebirth Mothers, Medical Officials, and the State by Christa Craven in Medical Anthropology Quarterly June 2005, Vol. 19, No. 2, pp. 194-215. Again, the abstract:

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological child abusers, negligent mothers, and drug users and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.

So good...

Too much "sexy" for just one article...

2005-05-11T16:50:00.000-07:00

As we all know, one good article inevitably leads to another. Continuing with the theme of the day, check out Risk as Moral Danger: the Social and Political Functions of Risk Discourse in Public Health by Deborah Lupton. Published originally in the International Journal of Health Services, Volume 23, Number 3 / 1993, you can get this baby online, in pdf form. Enjoy.

the Abstract:

Risk is a concept with multiple meanings and is ideologically loaded. The author reviews the literature on risk perception and risk as a sociocultural construct, with particular reference to the domain of public health. Pertinent examples of the political and moral function of risk discourse in public health are given. The author concludes that risk discourse is often used to blame the victim, to displace the real reasons for ill-health upon the individual, and to express outrage at behavior deemed socially unacceptable, thereby exerting control over the body politic as well as the body corporeal. Risk discourse is redolent with the ideologies of mortality, danger, and divine retribution. Risk, as it is used in modern society, therefore cannot be considered a neutral term.

Elegant, wouldn't you say?

Another page turner (I anticipate) would be The Political and Economic Determinants of Health Outcomes: A Cross-National Analysis by Hugh F. Lena and Bruce London published in the same volume. Unfortunately, the full text isn't available online. I'll share the teaser with you, though.

Abstract:

This article investigates the impact of selected political and economic processes on the well-being of domestic populations within samples of 50 to 84 peripheral and noncore nations. Existing research by Cereseto and Waitzkin on the relative merits of market versus socialist systems for the provision of health and welfare needs of their populations is extended by employing a more complex model than the original study. More specifically, the authors assess the impact on measures of population health and mortality rates of regime ideology, state strength, multinational corporate penetration, and position in the world economy. In general, high levels of democracy and strong left-wing regimes are associated with positive health outcomes, and strong right-wing regimes have populations with lower life expectancies and higher levels of various measures of mortality. These findings support the conclusion that political systems make a difference in health and well-being independent of national (gross national product per capita) and international (investment dependency) economic factors.

Either it excites you, or it doesn't. This excites me.

This morning's winner-- Article with the most "sexy" is....

2005-05-11T01:55:00.000-07:00

By far, the sexiest article I've read in the past 8 hours has to be Risk, Responsibility, and Rhetoric in Infant Feeding by Elizabeth Murphy. First published in the Journal of Contemporary Ethnography, Vol. 29 No. 3 June 2000 291-325 and now available online from Sage, this is a winner. So, while I'm almost entirely incoherent at this hour, having spent a good part of the day trying to cobble together some theoretical basis for my argument out of Habermas, Foucault, and some other stuff that isn't relevant, I've circled back to a germane, good, and fairly self-evident point of reference.

Here's the abstract:

This article considers the way in which discourses around risk intersect with the ideology of motherhood in advanced liberal societies. Neoliberal citizens are urged to exercise prudence in the light of expert advice about minimizing risk through behavioral choices. The “good mother” is one who maximizes physical and psychological outcomes for her child, regardless of personal cost. Drawing on data from a longitudinal interview study of first-time mothers’ feeding practices, the moral context that arises at the intersection of these two discourses is explored. Experts advise mothers to breast-feed and warn of the short-, medium-, and long-term risks associated with formula feeding. Most mothers accept the validity of these expert claims and most initiate breast feeding. However, many abandon breast feeding long before experts recommend. This article considers how mothers deal with the threat to their identities as good, neoliberal citizens and mothers that arises from such feeding practices.

Alex and Weber

2005-05-09T21:11:00.000-07:00

Thanks to a kind comment, I've now found a great general anthro resource page -- check it out at http://alex.golub.name/log/. He just finished his dissertation, he works in Papua New Guinea, and, hell, did I mention he finished his dissertation? Anyway, this page has lots of great links, commentary, and general goodness.

Today's Project- Finagling Foucault, Visiting Weber

2005-05-09T18:09:00.000-07:00

I'm currently working on placing my arguments in a framework involving Foucault (nothing can be written without a good reference to Foucault these days) bureaucracy, and something else I haven't placed my finger on. There's a great article by Richard A. Hilbert I'm using as well-- Bureaucracy as Belief, Rationalization as Repair: Max Weber in a Post-Functionalist Age. It was published in Sociological Theory, Vol. 5, No. 1 (Spring, 1987), 70-86. You can easily find it on JSTOR, if you have access. The stable URL on JSTOR is:
http://links.jstor.org/sici?sici=0735-2751%28198721%295%3A1%3C70%3ABABRAR%3E2.0.CO%3B2-2 It's a wonderful reality check on what you thought you knew about Weber, and I love the discussion under The Subjective Dimension of Bureaucracy in Weber's Sociology-- epecially the idea of bureaucracy as "a mentality of trust that all such action can and will accord with" Weber's deliniation of the concept of bureaucracy and as a "mentality of conviction that all action should" be so.

The Code

2005-05-05T15:31:00.000-07:00

(Taken from http://www.ibfan.org/english/resource/who/fullcode.html)

The International Code of Marketing of Breastmilk Substitutes
Art. 1. Aim of the Code
Art. 2. Scope of the Code
Art. 3. Definitions
Art. 4. Information and education
Art. 5. The general public and mothers
Art. 6. Health care systems
Art. 7. Health workers
Art. 8. Persons employed by manufacturers and distributors
Art. 9. Labelling
Art. 10. Quality
Art. 11. Implementation and monitoring

The Member States of the World Health Organisation:
Affirming the right of every child and every pregnant and lactating woman to be adequately nourished as a means of attaining and maintaining health;

Recognising that infant malnutrition is part of the wider problems of lack of education, poverty, and social injustice;

Recognising that the health of infants and young children cannot be isolated from the health and nutrition of women, their socio-economic status and their roles as mothers;

Conscious that breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; that it forms a unique biological and emotional basis for the health of both mother and child; that the anti-infective properties of breast milk help to protect infants against disease; and that there is an important relationship between breastfeeding and child spacing;

Recognising that the encouragement and protection of breastfeeding is an important part of the health, nutrition and other social measures required to promote healthy growth and development of infants and young children; and that breastfeeding is an important aspect of primary health care;

Considering that when mothers do not breastfeed, or only do so partially, there is a legitimate market for infant formula and for suitable ingredients from which to prepare it; that all these products should accordingly be made accessible to those who need them through commercial or noncommercial distribution systems; and that they should not be marketed or distributed in ways that may interfere with the protection and promotion of breastfeeding;

Recognising further that inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries, and that improper practices in the marketing of breastmilk substitutes and related products can contribute to these major public health problems;

Convinced that it is important for infants to receive appropriate complementary foods, usually when the infant reaches four to six months of age, and that every effort should be made to use locally available foods; and convinced, nevertheless, that such complementary foods should not be used as breastmilk substitutes;

Appreciating that there are a number of social and economic factors affecting breastfeeding, and that, accordingly, governments should develop social support systems to protect, facilitate and encourage it, and that they should create an environment that fosters breastfeeding, provides appropriate family and community support, and protects mothers from factors that inhibit breastfeeding;

Affirming that health care systems, and the health professionals and other health workers serving in them, have an essential role to play in guiding infant feeding practices, encouraging and facilitating breastfeeding, and providing objective and consistent advice to mothers and families about the superior value of breastfeeding, or, where needed, on the proper use of infant formula, whether manufactured industrially or home prepared;

Affirming further that educational systems and other social services should be involved in the protection and promotion of breastfeeding, and in the appropriate use of complementary foods;

Aware that families, communities, women's organisations and other nongovernmental organisations have a special role to play in the protection and promotion of breastfeeding and in ensuring the support needed by pregnant women and mothers of infants and young children, whether breastfeeding or not;

Affirming the need for governments, organisations of the United Nations system, nongovernmental organisations, experts in various related disciplines, consumer groups and industry to cooperate in activities aimed at the improvement of maternal, infant and young child health and nutrition;

Recognising that governments should undertake a variety of health, nutrition and other social measures to promote healthy growth and development of infants and young children, and that this Code concerns only one aspect of these measures;

Considering that manufacturers and distributors of breastmilk substitutes have an important and constructive role to play in relation to infant feeding, and in the promotion of the aim of this Code and its proper implementation;

Affirming that governments are called upon to take action appropriate to their social and legislative framework and their overall development objectives to give effect to the principles and aim of this Code, including the enactment of legislation, regulations or other suitable measures;

Believing that, in the light of the foregoing considerations, and in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breastmilk substitutes, the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products;

THEREFORE:
The Member States hereby agree the following articles which are recommended as a basis for action.

Article 1. Aim of the Code
The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Article 2. Scope of the Code
The Code applies to the marketing, and practices related thereto, of the following products: breastmilk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement of breast-milk; feeding bottles and teats. It also applies to their quality and availability, and to information concerning their use.

Article 3. Definitions
For the purposes of this Code:
"Breastmilk substitute" means any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose.

"Complementary food" means any food, whether manufactured or locally prepared, suitable as a complement to breast milk or to infant formula, when either becomes insufficient to satisfy the nutritional requirements of the infant. Such food is also commonly called "weaning food" or "breastmilk supplement".

"Container" means any form of packaging of products for sale as a normal retail unit, including wrappers.

"Distributor" means a person, corporation or any other entity in the public or private sector engaged in the business (whether directly or indirectly) of marketing at the wholesale or retail level a product within the scope of this Code. A "primary distributor" is a manufacturer's sales agent, representative, national distributor or broker.

"Health care system" means governmental, nongovernmental or private institutions or organisations engaged, directly or indirectly, in health care for mothers, infants and pregnant women; and nurseries or childcare institutions. It also includes health workers in private practice. For the purposes of this Code, the health care system does not include pharmacies or other established sales outlets.

"Health worker" means a person working in a component of such a health care system, whether professional or nonprofessional, including voluntary, unpaid workers.

"Infant formula" means a breastmilk substitute formulated industrially in accordance with applicable Codex Alimentarius standards, to satisfy the normal nutritional requirements of infants up to between four and six months of age, and adapted to their physiological characteristics. Infant formula may also be prepared at home, in which case it is described as "home prepared".

"Label" means any tag, brand, mark, pictorial or other descriptive matter, written, printed, stencilled, marked, embossed or impressed on, or attached to, a container (see above) of any products within the scope of this Code.

"Manufacturer" means a corporation or other entity in the public or private sector engaged in the business or function (whether directly or through an agent or through an entity controlled by or under contract with it) of manufacturing a product within the scope of this Code.

"Marketing" means product promotion, distribution, selling, advertising, product public relations, and information services.

"Marketing personnel" means any persons whose functions involve the marketing of a product or products coming within the scope of this Code.

"Samples" means single or small quantities of a product provided without cost.

"Supplies" means quantities of a product provided for use over an extended period, free or at a low price, for social purposes, including those provided to families in need.

Article 4. Information and education
4.1 Governments should have the responsibility to ensure that objective and consistent information is provided on infant and young child feeding for use by families and those involved in the field of infant and young child nutrition. This responsibility should cover either the planning, provision, design and dissemination of information, or their control.

4.2 Informational and educational materials, whether written, audio, or visual, dealing with the feeding of infants and intended to reach pregnant women and mothers of infants and young children, should include clear information on all the following points:

1. the benefits and superiority of breastfeeding;
2. maternal nutrition, and the preparation for and maintenance of breastfeeding;
3. the negative effect on breastfeeding of introducing partial bottle feeding;
4. the difficulty of reversing the decision not to breastfeed; and
5. where needed, the proper use of infant formula, whether manufactured industrially or home prepared.

When such materials contain information about the use of infant formula, they should include the social and financial implications of its use; the health hazards of inappropriate foods or feeding methods; and, in particular, the health hazards of unnecessary or improper use of infant formula and other breastmilk substitutes. Such materials should not use any pictures or text which may idealise the use of breastmilk substitutes.

4.3 Donations of informational or educational equipment or materials by manufacturers or distributors should be made only at the request and with the written approval of the appropriate government authority or within guidelines given by governments for this purpose. Such equipment or materials may bear the donating company's name or logo, but should not refer to a proprietary product that is within the scope of this Code, and should be distributed only through the health care system.

Article 5. The general public and mothers
5.1 There should be no advertising or other form of promotion to the general public of products within the scope of this Code.

5.2 Manufacturers and distributors should not provide, directly or indirectly, to pregnant women, mothers or members of their families, samples of products within the scope of this Code.
5.3 In conformity with paragraphs 1 and 2 of this Article, there should be no point-of-sale advertising, giving of samples, or any other promotion device to induce sales directly to the consumer at the retail level, such as special displays, discount coupons, premiums, special sales, loss leaders and tie-in sales, for products within the scope of this Code. This provision should not restrict the establishment of pricing policies and practices intended to provide products at lower prices on a long-term basis.

5.4 Manufacturers and distributors should not distribute to pregnant women or mothers of infants and young children any gifts of articles or utensils which may promote the use of breastmilk substitutes or bottle feeding.

5.5 Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children.

Article 6. Health care systems
6.1 The health authorities in Member States should take appropriate measures to encourage and protect breastfeeding and promote the principles of this Code, and should give appropriate information and advice to health workers in regard to their responsibilities, including the information specified in Article 4.2.

6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. This Code does not, however, preclude the dissemination of information to health professionals as provided in Article 7.2.

6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.

6.4 The use by the health care system of "professional service representatives", "mothercraft nurses" or similar personnel, provided or paid for by manufacturers or distributors, should not be permitted.

6.5 Feeding with infant formula, whether manufactured or home prepared, should be demonstrated only by health workers, or other community workers if necessary; and only to the mothers or family members who need to use it; and the information given should include a clear explanation of the hazards of improper use.

6.6 Donations or low-price sales to institutions or organisations of supplies of infant formula or other products within the scope of this Code, whether for use in the institutions or for distribution outside them, may be made. Such supplies should only be used or distributed for infants who have to be fed on breastmilk substitutes. If these supplies are distributed for use outside the institutions, this should be done only by the institutions or organisations concerned. Such donations or low-price sales should not be used by manufacturers or distributors as a sales inducement.

6.7 Where donated supplies of infant formula or other products within the scope of this Code are distributed outside an institution, the institution or organisation should take steps to ensure that supplies can be continued as long as the infants concerned need them. Donors, as well as institutions or organisations concerned, should bear in mind this responsibility.

6.8 Equipment and materials, in addition to those referred to in Article 4.3, donated to a health care system may bear a company's name or logo, but should not refer to any proprietary product within the scope of this Code.

Article 7. Health workers
7.1 Health workers should encourage and protect breastfeeding; and those who are concerned in particular with maternal and infant nutrition should make themselves familiar with their responsibilities under this Code, including the information specified in Article 4.2.

7.2 Information provided by manufacturers and distributors to health professionals regarding products within the scope of this Code should be restricted to scientific and factual matters, and such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding. It should also include the information specified in Article 4.2.

7.3 No financial or material inducements to promote products within the scope of this Code should be offered by manufacturers or distributors to health workers or members of their families, nor should these be accepted by health workers or members of their families.

7.4 Samples of infant formula or other products within the scope of this Code., or of equipment or utensils for their preparation or use, should not be provided to health workers except when necessary for the purpose of professional evaluation or research at the institutional level. Health workers should not give samples of infant formula to pregnant women, mothers of infants and young children, or members of their families.

7.5 Manufacturers and distributors of products within the scope of this Code should disclose to the institution to which a recipient health worker is affiliated any contribution made to him or on his behalf for fellowships, study tours, research grants, attendance at professional conferences, or the like. Similar disclosures should be made by the recipient.

Article 8. Persons employed by manufacturers and distributors
8.1 In systems of sales incentives for marketing personnel, the volume of sales of products within the scope of this Code should not be included in the calculation of bonuses, nor should quotas be set specifically for sales of these products. This should not be understood to prevent the payment of bonuses based on the overall sales by a company of other products marketed by it.

8.2 Personnel employed in marketing products within the scope of this Code should not, as part of their job responsibilities, perform educational functions in relation to pregnant women or mothers of infants and young children. This should not be understood as preventing such personnel from being used for other functions by the health care system at the request and with the written approval of the appropriate authority of the government concerned.

Article 9. Labelling
9.1 Labels should be designed to provide the necessary information about the appropriate use of the product, and so as not to discourage breastfeeding.

9.2 Manufacturers and distributors of infant formula should ensure that each container has a clear, conspicuous, and easily readable and understandable message printed on it, or on a label which cannot readily become separated from it, in an appropriate language, which includes all the following points:

1. the words "Important Notice" or their equivalent;
2. a statement of the superiority of breastfeeding;
3. a statement that the product should be used only on the advice of a health worker as to the need for its use and the proper method of use;
4. instructions for appropriate preparation, and a warning against the health hazards of inappropriate preparation.

Neither the container nor the label should have pictures of infants, nor should they have other pictures or text which may idealise the use of infant formula. They may, however, have graphics for easy identification of the product as a breastmilk substitute and for illustrating methods of preparation. The terms "humanised", "maternalised" or similar terms should not be used. Inserts giving additional information about the product and its proper use, subject to the above conditions, may be included in the package or retail unit. When labels give instructions for modifying a product into infant formula, the above should apply.

9.3 Food products within the scope of this Code, marketed for infant feeding, which do not meet all the requirements of an infant formula, but which can be modified to do so, Should carry on the label a warning that the unmodified product should not be the sole source of nourishment of an infant. Since sweetened condensed milk is not Suitable for infant feeding, nor for use as a main ingredient of infant formula, its label should not contain purported instructions on how to modify it for that purpose.

9.4 The label of food products within the scope of this Code should also state all the following points:

1. the ingredients used;
2. the composition/analysis of the product;
2. the storage conditions required; and
3. the batch number and the date before which the product is to be consumed, taking into account the climatic and storage conditions of the country concerned.

Article 10. Quality
10.1 The quality of products is an essential element for the protection of the health of infants and therefore should be of a high recognised standard.

10.2 Food products within the scope of this Code should, when sold or otherwise distributed, meet applicable standards recommended by the Codex Alimentarius Commission and also the Codex Code of Hygienic Practice for Foods for Infants and Children.

Article 11. Implementation and monitoring
11.1 Governments should take action to give effect to the principles and aim of this Code, as appropriate to their social and legislative framework, including the adoption of national legislation, regulations or other suitable measures. For this purpose, governments should seek, when necessary, the cooperation of WHO, UNICEF and other agencies of the United Nations system. National policies and measures, including laws and regulations, which are adopted to give effect to the principles and aim of this Code should be publicly stated, and should apply on the same basis to all those involved in the manufacture and marketing of products within the scope of this Code.

11.2 Monitoring the application of this Code lies with governments acting individually, and collectively through the World Health Organisation as provided in paragraphs 6 and 7 of this Article. The manufacturers and distributors of products within the scope of this Code, and appropriate nongovernmental organisations, professional groups, and consumer organisations should collaborate with governments to this end.

11.3 Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them.

11.4 Nongovernmental organisations, professional groups, institutions, and individuals concerned should have the responsibility of drawing the attention of manufacturers or distributors to activities which are incompatible with the principles and aim of this Code, so that appropriate action can be taken. The appropriate governmental authority should also be informed.

11.5 Manufacturers and primary distributors of products within the scope of this Code should apprise each member of their marketing personnel of the Code and of their responsibilities under it.

11.6 In accordance with Article 62 of the Constitution of the World Health Organisation, Member States shall communicate annually to the Director General information on action taken to give effect to the principles and aim of this Code.

11.7 The Director General shall report in even years to the World Health Assembly on the status of implementation of the Code; and shall, on request, provide technical support to Member States preparing national legislation or regulations, or taking other appropriate measures in implementation and furtherance of the principles and aim of this Code.

My Mediocre, Unfinished Intro...

2005-05-03T17:48:00.000-07:00

"There are two things to which I am devoted: absolute academic and spiritual freedom, and the subordination of the state to the interests of the individual; expressed in other forms, the furthering of conditions in which the individual can develop to the best of his ability --as far as it is possible with a full understanding of the fetters imposed upon us by tradition; and the fight against all forms of power policy of states or private organizations. This means a devotion to principles of true democracy. I object to teaching of slogans intended to befog the mind, of whatever kind they may be."
-letter from Franz Boas to John Dewey, 11/6/39

I could tell from the mood that Dr. J had been by.

Mary, another volunteer, began her litany of four-letter words as I walked in the room. From experience, I found the frequency and severity of her profanity to be a reliable barometer for the level of any given week's crisis. I paused as the words sunk in. Dr. J, an administrator from a powerful women's NGO, had informed us that we could no longer distribute infant formula in brand-name boxes.

Over the next week, rather than finish a critical grant proposal for operational funding, instead of tending to the sick and dying patients in our charge, we traversed the city in search of plastic containers. Money that would have been used to buy soap, clothing, and food for indigent patients in our care was now being directed toward re-packaging infant formula. The Foundation, the organization for which Dr. J worked, was a powerful political force in East Timor. We were keenly aware that if HealthOrg were to succeed and grow here, we needed to keep HealthOrg and Rita, its director, in The Foundation's good graces. Since there was no money in the operating budget, my partner and I used donor funds.

The next day, and for many days after, I spent my afternoons cross-legged on the floor, removing the contents from each box of infant formula and stuffing them into my overpriced plastic containers. When the empty boxes crowded the floor of our tiny office, we'd carry them out to the fire pit where they would later be burned with the rest of the hospital's garbage. When we ran out of plastic containers, we bought more.

The delivered cartons of formula were soon draped with local weavings that once adorned the wall. If a representative from The Foundation visited, we didn't want Rita to get into trouble for propagandizing for the milk company. We also began hiding the empty boxes inside our cramped office until the end of the day so people didn't see piles and piles of empty formula boxes in the fire pit. Better to take them out just before the daily burn, lest we should raise eyebrows for trading in such large quantities of formula.

Since the formula's preparation instructions were printed on the boxes we were secreting away, we had to print our own pamphlets with instructions written in basic Tetum with crude drawings for our illiterate clientele. Each parent received verbal and visual explanations on preparation, but these were easily forgotten. These pamphlets, of course, required more money.

The International Code of Marketing of Breast Milk Substitutes[1] (here on referred to as The Code) had made its way to East Timor.

At what point did this well-intentioned mandate put forth by the World Health Organization transmogrify into a resource-draining thorn in the side of a small malnutrition organization? By what processes was the Code adopted and incorporated by the A Foundation as a political goal, and by what processes did it surface above other goals, with foci on other concernsperhaps more directly relevant to the lives of women and children in East Timor? In a larger sense, how are decisions made regarding what health concerns are and how they must be addressed at the local level? This paper poses the thesis that the "systematic assumption of realism in science" that the pro-breastfeeding lobby began fighting against has been reborn within the discourse of public health and breastfeeding. The internal contradictions, from the World Health Organization to The Foundation, are tacitly, oddly absent from the public health campaigns and inevitably absent from small-scale interventions. Somewhere, somehow, in the resistance of concerned groups to the power of the scientific hegemony that medicalized childbirth and infant feeding, that purported to gaze upon the object s of nature, femininity, motherhood, childhood, the naturalistic fantasy of breast milk and breastfeeding has replaced the old hegemony with a new one, thus generating another coercive, hegemonic gaze, reinforced by the legitimacy of science.

Everybody is aware of such banal facts. But that they are banal does not mean they don’t exist. What we have to do with banal facts is to discover - or try to discover - which specific and perhaps original problems are connected with them.
- Michel Foucault, Omnes et Singulatim: Towards a Criticism of ‘Political Reason’ "The Tanner Lectures on Human Values", delivered at Stanford University, October 10 and 16, 1979.

My argument is not that The Code is "bad", or that the activists, health workers, and other involved parties who work hard to enforce it are not dedicated to the idea of helping people, or indeed that they aren't actually helping people. Rather, I'd like to make the case that The Code, and the discursive structure that supports The Code, keep us from seeing the simple truth that each situation must be carefully considered in context, with its inherent nuances and dealt with critically. The question becomes, with the same goal in mind -- helping people -- what actions are best in this situation?

[1] See Appendix A for the complete Code.

A new, improved way to procrastinate...

2005-04-08T17:21:00.000-07:00

Ah, my first blog. I've been thinking of doing one for a while, though. This is where the real intellectual exchange can flourish these days. As long as you have the internet--another issue altogether. My hope is that I can ramble about ideas I'm working on and get some useful feedback. In exchange, perhaps some of my ideas or sources will be of use to someone out there. I'm a graduate student in anthropology, and I do work in East Timor. My interests, however, lie more generally in:

Health disparities, politics of health, East Timor, women, breastfeeding politics, consensus making, "choice", anthropology of violence, human rights, anthropology of activism, and hegemony

Feel free to drop me a line. Ideally, I'll have a bibliography posted soon--perhaps even an annotated one. (It'll be useful for me for my exams) I'll also put forth some of my key points for my thesis. I need to finish it in the coming couple of months.