Concepts about infant health, growth, and weaning: a comparison between nutritional scientists and Madurese mothers

Nutrition education is a critical component of programs designed to improve nutritional status, yet it often fails because of differences in the concepts underlying the educational message and those motivating mothers' behavior. To illustrate this discrepancy in the context of infant feeding we compare the views of nutritional scientists' and mothers in Madura, Indonesia on (a) health and disease and (b) the relationship of foods to the concepts of state-of-health, infancy and growth. The relationship of these concepts to mothers' practices and nutritional scientists' recommendations are also explored. Views of the nutritional scientist were drawn from the published literature and those for the Madurese mothers' from ethnographic and survey data gathered between February 1983 and June 1984. While mothers and nutritional scientists both seek to give a diet appropriate for a stage of infancy, their definitions of key concepts differed. Nutritional scientists recommend feeding infants high quality clean foods in amounts sufficient for maintenance, activity and growth. Underlying these recommendations are the concepts of disease as a deviation from the norm, food as a source of pathogens as well as nutrients, infancy as a period of physiological growth, and poor growth as an indicator of disease. All infants have the same type of nutrient requirements. Madurese mothers perceive health and its components as a process of balance. Balance is partly attained either by feeding rice soon after birth or by withholding rice until after one year of age. This concept results in two distinct but coexisting types of requirement and weaning patterns for infants. The important development during an infant's first year of life is 'growth' from a vulnerable state in the 'neonatal' period (40 days) to a state of independence and reason (akal) in late infancy (greater than 7 months). To foster 'growth' in rice-fed infants, mothers force-feed increasing amounts of quality foods. Once akal is achieved, mothers no longer feed quality foods or increase amounts of food, and the infant, not the mother, initiates feeding. These comparisons suggest how nutritional scientists can help improve the process of communication in nutrition programs. First they can describe and analyze the mother's as well as their own conceptual framework to arrive at approaches and messages that blend together points of views. Second, by studying the consequence on infants of mother's behavior, nutritional scientists may gain further insight into the biological processes leading to good nutrition and refine messages and interventions accordingly.