Sit up to feed your baby and you will have no problem…An Explanatory Model of Childhood Ear Disease and Gender Inequality in Jumla
My paper applies the explanatory model of illness to the maternal understanding of childhood ear disease in the district of Jumla and discusses these findings in the broader context of gender in Nepal. The explanatory model describes the way in which people understand the meaning, causes and consequences of their illness in their cultural context, and attempts to appreciate how the ‘social world affects and is affected by illness’. It is important to recognise a mother’s explanatory model for childhood illness as it helps determine her early recognition of symptoms, timing and type of health-care seeking, treatment completion and follow-up.
Chronic ear infections are a common preventable cause of deafness, chronic ill-health and, rarely, death in children in low resource settings, including Nepal. Childhood ear infections are so common, that they can seem normal and of low health priority. Acute ear infections are simple and inexpensive to treat, which prevents chronic infection, yet many children receive no assessment or intervention. Chronic ear infections are a disease of poverty and its social determinants; malnutrition, low parental education level, low parental income, overcrowding, lack of access to clean water and sanitation. The children most at risk of ear infections are also the ones with least access to health education, health care and research.
As part of a public health project I performed in depth semi-structured interviews with 17 Jumli women and a larger quantitative survey of 519 women and 937 of their children. All of the participants were subsistence farmers living in villages outside the district capital, most had not attended school and all were married with children in their household.
The commonest explanatory model of ear infections was that they were caused by milk going in the baby’s ear while the mother breastfed lying down. The belief that poor maternal feeding practices are responsible for ear infections is damaging as new mothers are often separated from their baby for a large part of the day while working in the fields, so considerable breastfeeding takes place at night while sleeping. Women in Jumla have very difficult lives, full of work and suffering and responsibility for their children’s ear infections is an undeserved additional burden. In fact, breastfeeding is protective against ear infections and prone feeding is irrelevant. I argue that in the context of gender inequality in Jumla, this is another example of control over women’s bodies, relationships and lives.
The Principle Investigators (PIs) of this research have agreed to make available the raw data of this survey for this paper.