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The period from shortly after 1900 to 1945 was characterized by some benefits of Crown Colony status for most territories. lnfant mortality rates, which ranged from 150 to 200 per thousand live births, began to decline steadily by the late 1920s, dropping below 100 by 1945 (26). Public health improvements accelerated beginning in the late nineteenth century, and then again from about 1918 to 1937 (27-29).
Economic conditions did not improve, however, and the social structure remained unchanged. During the late 1930s, the Caribbean experienced profound social unrest caused by the impact of the depression on local social conditions. Consequently special attention was focused on the economic hardships that the region was enduring. This attention included nutritional assessment studies. A report, issued in 1946, on the British West Indies was prepared on the basis of a study tour of the territories by B.S. Platt (30) over a three-month period, most information being gathered second-hand from medical officers of the region. Most detailed observations focused on school-age children. In hospital and institutional settings Platt observed a condition that was:
. . . probably identical with famine or starvation oedema and the oedema of low protein diets, actually seen in hospitals in St. Kitts, Jamaica, and Puerto Rico, occurring in infants and young children of mothers who, generally being unmarried, had to support themselves and their babies by working in the urban areas or on plantations and elsewhere. Breast-feeding was therefore scanty and the infants' diet consisted mostly of carbohydrate, e.g., arrowroot, cereal gruel, or even sugar and water.
Platt made no other observations of very young children, and the task of examining infants and pre-school children was left to J.C. Waterlow (31). His report, published in 1948, is cited by nearly all contemporary studies as evidence of baseline infant feeding data (see also 32, 33). Water-low's study, however, is clinical, not dietary. Evidence was obtained from 15 "sugar babies" with fatty liver or kwashiorkor, 11 in Jamaica, two in Trinidad, and two in British Guiana (Guyana). The case histories provided in the published study are devoid of notes on dietary history. However, it is claimed that in all but one case children were weaned abruptly and too early and then fed a protein-deficient diet. It is not clear how the following general observations on normal feeding were obtained:
In the West Indies babies are usually weaned at 7-9 months, but many of the cases in this series had been weaned at an earlier age.... The West Indian baby's main food after weaning is porridge made of maize, arrowroot, sweet potatoes, plantains or oatmeal. This is generally supplemented with fruit juice and sometimes with green vegetables. Most babies get some milk, either fresh cow's milk or sweetened condensed milk.... Finally, nearly all babies are given "bush tea"-that is, infusions of leaves and herbs. [31]
If Waterlow's "usual" weaning period is considered to be a mode or median figure, then West Indian weaning times have remained relatively constant over the past 25 years. This figure is similar to those found in 1970 (see table 1). The statement that other foods are introduced "after weaning" must be interpreted to indicate that they are not given before the child is weaned. Such a conclusion is contrary to other evidence I have cited from this period and before. The mistaken conclusion from this single state meet, more than any other, has probably shaped current opinion about traditional feeding and suckling practices in the Caribbean region.
In Guyana there is a similar absence of good empirical observations of breast-feeding practices in the report of the Nutrition Committee of 1937 (34). However, in that report observations are undoubtedly grounded on information from the Infant Welfare and Maternity League work that had started in 1917. The report states:
Prevalent customs in this colony as to infant feeding are undoubtedly the cause of much malnutrition and infantile debility. The use of "bush teas" and "paps" of infinite variety, given to infants almost from birth inevitably results in disordered alimentation and nutritional unbalance and the energies of the League are concentrated through the attending physician, health visitor and nurse-midwife in combating these deeply rooted customs. [34]
It is important to note that the use of paps and bush teas in infant feeding from a very early age appears to be clearer in Guyana's past than in Jamaica's; this is perhaps a reflection of the relative strength of the plantation environment in the two economies. In Jamaica, the rise of the peasantry in the post-emancipation period was dramatic, as there were suitable and abundant rural lands for the establishment of farming villages remote from the dominant plantation areas. In Guyana, however, the strength and brutality of coastal plantations were pervasive. The interior regions were inhabited by indigenous peoples, and a wall of forbidding jungle was a major challenge to those considering a move from the coastal plantation life. Consequently, feeding patterns adapted to the demands of plantation economy life have deep roots indeed.
In the first quarter of the twentieth century, observations regarding breast-feeding practices are found in the reports of colonial officers who were sensitive to high mortality rates, particularly infant mortality rates. Let us review these reports, travelling from Jamaica south and east along the islands, ending in Guyana, on the South American continent.
The tradition of blaming illnesses, malnutrition, and death on maternal "dietary errors," "faulty feeding," and the like is quite clear in this early (1911) report from Jamaica:
I believe that the chief danger to child life here is improper feeding and the sheer downright ignorance on the part of the mothers of the most elementary rules of nursing and tending their offspring. [35]
This following from a 1922 report could have been written in the 1970s regarding the problems of early weaning:
I have no doubt that this heavy infantile mortality is in a large measure due to poverty, overcrowding and underfeeding. The stamina of the parents is reduced from insufficient and improper feeding, the mothers cannot produce breast milk in sufficient quantity, and it is well known that there is no satisfactory substitute for the mother's milk in early life. Nearly all the digestive troubles begin with artificial feeding. This is a difficult problem and requires skilled handling, which the poor mothers are quite unable to satisfactorily perform; further from having to go out to work, the baby is left in charge of some kind-hearted but untrained person. Unsuitable food is given and the digestive organs seriously impaired. [36]
Whether the author's notion regarding the insufficiency of breast milk was correct or not, the point is clear that feeding of breast-milk substitutes was practiced in Jamaica as a supplement to breast-feeding. Then as now, this was viewed as a key etiological factor in infant morbidity and mortality. Unfortunately there is no information on the frequency of this behaviour, or on the components of the artificial feed.
Moving southeast to St. Vincent, we find the use of arrowroot a common practice in 1913:
Owing to their poverty, women feed their children on arrowroot or what they have instead of milk; the result is a high infantile mortality of gastroenteritis. [37]
In the following, some sensitivity to the impact of the plantation economy on St. Vincent in 1915 is demonstrated:
I should like to emphasize one etiological factor [with regard to infant mortality] -improper feeding-the deleterious effect of which upon an infant is frequently evident in the case of a mother employed as a labourer on an estate continuing her work during and especially shortly after pregnancy. The child is frequently left to be attended to by a brother or sister just a few years older. It often does not get milk, but milk and breadslops from the first, or water sugar and bread-slops which the parents call "tea." [38]
This sort of description and analysis is rare, but points to the socio-economic context of feeding and malnutrition in the Caribbean that has roots in the far past of this plantation economy and the plantation economies of most of the territories throughout the English-speaking West Indies. Here there is evidence of the causes for early breast-milk substitutes and the subsequent mortality associated with it years before the wave of infant-formula promotion in the post-war years. The problem is linked to an older type of multinational business exploitation, the plantation colony.
To continue the journey down the island chain to the lovely spice island of Grenada, consider these reports of the use of paps in a pattern of mixed feeding:
"Bread tea", flour and arrowroot pap are the usual substitutes which the nursing mother provides for her tender infant while she is away at work during the greater part of the day. [39]
Here there is evidence of the length of breast-feeding. Apparently, it was for a longer period than that practiced 50 years later (see table 1).
Most of the children suffer from over-nursing, their mothers keep them at it for sixteen to eighteen months during the last seven or eight months the children draw an abundant supply of a highly un-nutritious fluid from the breast. This fills up the stomachs of the poor infants to the exclusion of some other nursing medium which may have been given instead. As a result the vitality of the children gradually falls below par, swelling of the entire body takes place; this goes on for a few weeks and death ensues. No amount of advice will prevent the women from carrying on this deadly habit, as they are firmly of opinion that a prolonged period of nursing will delay pregnancy. [39]
Moving finally to Guyana (British Guiana), one finds abundant evidence of early weaning and early pap and tea supplementation in infant diets during the early part of this century. Observations are provided by medical officers, practicing physicians, and other social workers in the colony at that time. Some of the earliest investigations into feeding were made by the Mortality Commission, which looked into the causes for the alarmingly high mortality rates reported at the turn of the century. The commission found in 1905 - 06 that:
In the country districts [cow's] milk is used to a large extent by the East Indians as a substitute for or as additional to the mother's milk.... Among the other labouring classes, especially of the black and coloured races, milk is not used to the extent it ought to be; it is unfortunately regarded as too expensive a food and its sufficiency as a food for infants is doubted. While this is the case in the country and in the villages it is accentuated in Georgetown.... The following have been mentioned as the substitutes for milk used by mothers of the labouring classes of the colony: Paps made of cornflour, cornstarch, arrowroot, barley, sago, conquintay, wheaten flour, oatmeal, plantain, crushed biscuit and bread.... Sweetened water with ten percent of milk flavoured with cinnamon and other spices and called "tea, barley water, sweet oil, honey and water with not unfrequently the addition of spirits, and minttea. [40]
The commission questioned at least 25 "knowledgeable" witnesses on the ". . manner in which infants are fed." The statement regarding mixed feeding by Dr. Wishart (40, pp. 25-26) was typical of the recorded testimony given in 1905-06:
There is a fair amount of breast-feeding done but still it is not by any means as general as it ought to be, and in many cases the breast-feeding is only partial. The mothers very often have sufficient milk, but they think that it is not enough nourishment and that the infant should have something in addition. They often resort to condensed milk, and even to farinaceous foods, which are totally unfitted for nourishing the child.
Of key importance in the Guyanese picture is the comparison of the breast-feeding practices of East Indian and African settlers. Both ethnic groups arrived on the plantation with the breast-feeding practices characteristic of their respective homelands. The East Indians, however, did not experience the culturally disintegrating impact of slavery. East Indians arrived primarily as indentured labourers following slave emancipation in 1838, the largest numbers arriving between 1844 and 1917, a full two centuries after the beginning of African slavery (41). In table 1, the comparison in breast-feeding practices shows East Indians weaning their children later than Afro-Guyanese in 1971. The contrast was much sharper 55 years earlier, as one medical officer observes:
The unspoilt coolie [East Indian] mother is beyond praise for her devoted care in rearing her infant at the breast. It is an inspiring sight to see her, even in the throes of sickness and suffering continue to supply it with its only perfect food. Her reward is the preservation of her child from that plague of bottle-fed infants, entero-colitis....
In the [Afro-Guyanese] villages many, perhaps most, of the infants are bottle-fed almost from their birth. The result is a very high death-rate among them, largely due to entero-colitis....
Many of these deaths could be entirely prevented by the simple process of restricting the infants to their natural diet until the period of dentition. [42; italics added]
Here the use of the bottle is mentioned along with the general practice of supplementation of breast-milk feeding before teething begins.
In summary, the pattern of early weaning and supplementation with milk, bush teas, carbohydrate gruels, and condensed milk was widely practiced in the Caribbean during the first part of the twentieth century. The harmful health consequences of these practices were well known by 1925. Many medical observers connected these feeding patterns to women's work patterns.
V. CONCLUSIONS
This historical sketch of breast-feeding practices in the Caribbean leads to conclusions which challenge some of the assumptions regarding traditional infant feeding made by modern observers; and it raises questions regarding the socio-cultural processes which have been responsible for changing these practices.
1. The romantic and idealized notion that traditional mothers exclusively breast-fed their infants until six months of age is simply not supported by the evidence from 1900 onward. Mixed feeding with paps or carbohydrate gruels by the third or fourth month, and with bush teas from the first month, certainly goes back to the first quarter of the century. Supplementation "almost from birth" with a wide variety of liquids was mentioned as a problem in urban British Guiana (Guyana) in 1905. In 1916 bottle feeding was widespread among Afro-Guyanese, and was not unknown in Jamaica by at least the 1940s. Although infant formula had become the supplementary food of choice for use in bottles by 1970, a wide variety of liquids and liquified carbohydrate gruels have been fed and continue to be fed in bottles.
2. Malnutrition, morbidity, and infant death due to early weaning and supplementation with poor and unsanitary diets have been recognized as problems in the Caribbean from the first quarter of this century. Bottle feeding was seen to be associated with widespread infant bowel disease in Guyana in 1916. However, the production and promotion of infant formulas in the years following World War I I have coincided with a shift to earlier weaning and supplementation, and are associated with hospital evidence of increased marasmic infantile malnutrition. This study was, however, unable to separate commercial promotional influences on practices from the influences of accelerated economic change, urbanization, cultural "modernization," and other changes occurring during the same period. All, however, were parts of a generally unregulated economic growth common in many dependent Third World countries over these years.
3. Early supplementation and weaning have been associated with poor working mothers since the first quarter of this century. This suggests that feeding practices have tended to be adaptations to the necessities of material conditions of life which, since slavery, have encouraged separation of mother from infant. This points up the neocolonial nature of these societies to this day. However, the data reviewed here do not prove that women always adapt perfectly, and are not motivated to feed their children in ways more consistent with the interest of dominant economic forces than in the interests of their own families and children.
In general, breast-feeding practices in the Caribbean or elsewhere cannot, and indeed should not, be described and explained without a full understanding of the context of women's lives. To suggest that Third World mothers can be easily influenced to behave in ways that conflict with the best interests of their children and of their families' long-term survival is to underestimate their wisdom and guile. However, to suggest that mothers are capable of accurately assessing the health and nutritional risks of their infant feeding practices is equally incorrect when one reflects on the difficulty of assessing the outcome of diet when the scientifically determined risks are not known in advance. Furthermore, to continue to place responsibility for infant and young child malnutrition on the faulty feeding practices of individuals, distracts needed attention from the social structures of underdevelopment which are the ever-present sources of oppression of women, poverty, and ill-health in regions such as the Caribbean. Our attention should shift to infant nutrition policies which affect these structures in ways that enhance women's opportunities and desires to breast-feed. More remarkable than lactation, that crucial evolutionary accomplishment of our mammalian species, has been the ability of women to bear and nourish children successfully under the nearly insurmountable and inhuman obstacles perpetrated by man.
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