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Modernization, urbanization, and nutritional care

Marian F. Zeitlin and Ratna Megawanei


Child-care beliefs and practices evolve to meet the needs of children within changing families and societies. Production technologies, economic structures, formal and non-formal institutions, and ideologies influence the care of young children. Nutritional care varies among premodern agrarian, modern industrial, and postmodern knowledge-based settings. Vital families in which parents and children learn together currently are emerging as the most favourable environment for child care. Policy implications of historic trends are: 1) nutritional care should be added to the definition of children's rights; 2) functional indicators of nutritional care should be built into systems that monitor children's well-being; 3) care services should be available to the whole child in the whole family, through multi-purpose networks of agencies and activities; 4) child and family development programmes should teach parents to enhance children's nutritional care and development; 5) the care motto "Preserve, Protect, Promote" should expand to "Rediscover, Relearn, and Readapt" beneficial caring from the past.


We create new strategies for child care against a backdrop of accelerating social and technological change. It is important to examine historic and secular trends in care in order to engage in sustainable planning. As shown in UNICEF's Conceptual Framework, resource availability is a basic determinant of the adequacy of care. Economic structures, formal and non-formal institutions, and political and ideological superstructures mediate the availability and allocation of resources for the care of young children.

According to recent philosophers, we have entered an era in which the pace of change in these structures outstrips the vocabularies and the logical assumptions that we use for problem-solving. When early humans began to use complex tools, a spear was no longer merely a stick tool attached to a stone tool. By analogy, we have entered an age in which language cannot be used merely for description, analysis, and rhetoric. Like the spear, speech acts, in their entirety, now are recognized as tools used to create shifting social realities. To quote philosopher Rorty, "The talent for speaking differently rather than arguing well is the chief instrument for social change"[1].

This article considers the ways in which we speak of child care not so much a description of the world that is "out there," but rather an extension of existing assumptions that may or may not apply to our evolving needs. It presents trends in the institutions and ideologies governing care and their implications for the nutrition of young children. In the language of early childhood development, the purpose of this presentation is to create a scaffold, a structure to facilitate our invention of a new vocabulary adequate to the tasks of protecting, supporting, promoting, rediscovering, relearning, and readapting care at the turn of the millennium.

In this intentionally speculative article, we synthesize and interpret aggregate trends relating modernization and urbanization to child care and nutrition. We summarize these trends from more than 350 references reviewed in our forthcoming book Strengthening the Family: Implications for International Development [2]. In this summary, our choice to highlight certain aspects over others inevitably is subjective. Its goad is not to argue for a single perspective, but to stimulate other child-care professionals to exercise their own capacities to think and "speak differently."

The article analyses care at three levels of modernization: premodern, modern, and postmodern. Urbanization and population expansion are considered as part of the modernization process, given that close to 50% of the world's expanding population will be urban at the turn of the millennium. The article examines the process of secular change in dimensions of care that are important to nutrition. These dimensions include the non-formal and formal institutions governing care, economic resource control and responsibility, ideologies, and speed of technological change.

The evolution of care

The cross-cultural literature on child care [3, 4] reveals that care practices are the visible tip of the iceberg of an evolutionary process through which parents adjust their behaviours to the risks they perceive in the child's environment, the cultural and economic expectations they have of their children, and the skills required by the working conditions they expect their children to encounter as adults. Child-care customs are codified systems of beliefs and practices. These cultural codes evolve as compromise formulas that optimize the probability of accomplishing the parents' and the society's multiple long- and short-term goals.

The family kinship unit is the major non-formal institution that provides care. According to the above definition, child care is interwoven with the roles of the family. The tasks performed by families for their members include physical maintenance; maintenance of morale and motivation; control of behaviour; socialization and education; acquisition of new members and new units through sexual partnership, procreation, and adoption; launching of juvenile members from the reproductive unit of the parents" generation to form the reproductive unit of the next generation; and reversing the dependency of care, so that the generation who was cared for as children now care for the dependent generations younger and older than themselves [5]. Although these family tasks hold true across levels of development and types of societies, they are accomplished through different care practices and ideologies, with differing implications for nutrition.

Stages of social development and implications for nutritional care

The account that follows presents an overview of general or "modal" changes believed to be common to many populations. It should be kept in mind that a great deal of variation in the processes of change occurs across time and among specific populations.

Social evolution affects production technologies, the social structures and roles that support these technologies, and the various levels of resource control. These determine the food and care pathways that provide for and protect the child, as well as the life skills that the child must learn from her carers and care environment.

Early premodern families

Inferences drawn from the evolutionary fossil record are openly speculative and subject to dispute. Nevertheless, it is interesting to note that recently discovered fossil evidence has been interpreted to suggest that it was not tool-using on savannah grasslands, but rather advances in child care that promoted upright stature of our transitional ancestors 4.4 million years ago [6]. Our newly alleged forebear, Australopithecus ramidus, is thought to have evolved not on the open plains but in thickly wooded flood-plains. The small canine teeth of these chimp-like bipeds apparently indicate that females selected mates based not on how they bared their teeth against rivals, but on their ability to care for infants. In this theory, upright posture conferred the advantage of being able to carry infants and food at the same time.

The earliest types of human families on which we have information do not practice private ownership of land and animals. Small tribal groups of hunter-gatherers tend to be cooperative, permissive, and lacking in organizational hierarchies. Infants tend to be spaced at intervals greater than three years and to remain close to their mothers. Herders and pastoral nomads, who own animals but not agricultural land, tend to have patriarchal and polygynous families [7, 8]. Women's work is limited to caring for small animals, dairying, food preparation, and child care [9]. Families still living in these two modes can be difficult to integrate into the global dialogue. Their mobility makes it difficult to educate and provide health care for their children. Their concepts of property, time, obedience to authority, and attentiveness to tasks sometimes are incompatible with participation in modern labour markets. Yet fossil records of some pre-agricultural populations reveal tall adult stature and few signs of weanling malnutrition, suggesting adequate nutritional care when resources were adequate [10].

Premodern institutional families

Societies engaged in traditional agriculture, crafts, and trade are divided into those practicing communal land ownership and those practicing private land ownership [11]. In sub-Saharan Africa, communal land ownership was predominant until recently. With the exception of the newly independent socialist states, most populations of Europe and Asia have practiced private land ownership for many generations.

Polygyny, as a family form, is well suited to shift ing agriculture on communal land farmed by labour intensive technologies [11]. Each additional wife and her children permit the family to farm more territory and to achieve economies of scale in domestic labour and trade. All children born to a man's wives are legally his. Male children may be more desired, but female children also have high value and in some populations are better nourished than males, possibly because they stay with the mother nearer to food preparation.

On privately owned land, however, strong cultural safeguards for the sexual fidelity of women are important. To sustain the kinship unit across generations, family land must be passed to male heirs whose paternity is beyond dispute. Cross-cousin marriages often are preferred because brothers whose children marry reunite the land and other possessions divided by separate inheritance. Monogamy predominates, and male children are agreed to be of highest value to the family.

In spite of ethnic variations, both types of agrarian families are recognized as institutional families, organized around agricultural production, traditional crafts, or other family business ventures. When successful, they have hierarchical authoritarian governance extending beyond the nuclear family. Large family management requires a high degree of cooperation and social skills. The status of all family members tends to be measured by the size of the pyramidal hierarchy gathered beneath the leader(s) and the amount of production resources under control. If land is privately owned, it may be measured by land-size. Many children are needed and valued as workers, apprentices, and next-generation managers of lands and enterprises. Concentration of decision-making in the few at the top and simple repetitive technologies encourage children to learn obedience and cooperation rather than decision making and autonomy. The highest family value is responsibility [12,13]. Mate selection is arranged by elders to optimize family holdings.

Institutional families and their folkways remain common. Their sons and daughters make up the elite of most developing countries. In fact, much of our dialogue on child care concerns ways of converting the values and folkways of institutional families to the practices of modern families.

Implications for nutritional care

With the transition from small nomadic bands to agrarian families, economic decision-making and responsibility for care become increasingly centralized and concentrated in a social hierarchical structure. This centralization peaks in the large lineage stage of communal land ownership, when all significant decisions are made by the tribal elders. With private land ownership, decision-making and responsibility for care fall to the senior owner of the land parcel or other traditional production resources. In both cases, institutional families are producers, employers, consumers, and social welfare agencies in one. The family engaged in farming or crafts can be expanded, because extra hands can produce extra food and other products. Its caring boundaries are elastic, although standards of care may be at subsistence levels.

Technologies are repetitive, and the pace of technological change is so slow that highly sophisticated schooling and academic skills are not required (although the social skills needed to negotiate in these hierarchies may be cognitively demanding). Margaret Mead termed these societies "post-figurative," meaning that the young could learn life skills by imitating adults [14].

Weaning-age malnutrition typifies agrarian development in the fossil record. Subsistence diets of plant foods are less nutrient dense than diets based on animal products from hunting and herding. Survival and reward structures determine the ways in which families carry out the seven family caring tasks. In institutional families, these structures do not accord priority to the nutritional care of young children. The large pyramidal hierarchy of lineage land ownership teaches children to contribute economically, starting at the bottom of the status ladder. With increasing age, status and merit are rewarded by increasing entitlement to available resources, of which food is the most visible. Young children in apprenticeship for the priesthood and other high offices, however, may start at a higher status level and may receive symbolic foods and meals from ceremonial animal sacrifices [15].

Private ownership of land or other inherited resources that are perceived to be limited makes sufficient child survival absolutely essential and excess child survival problematic. Nutritional ideologies tend to develop that deprive all weanling children to some degree. These belief systems permit parental manipulation of survival with the discreet favouring and disfavouring of certain children and the survival of the hardiest of the others [16].

Modern families

The modern family evolved with industrialization, science, and technology. With the growth of specialized wage labour outside the kinship network, the small nuclear household, rather than the large extended family, became the unit of decision-making, and children were trained to become decision makers. From the mid-1600s in England, there was heightened regard for the infant as a person, the woman's role as a mother, intimacy and privacy for the couple, and love, personal attraction, and compatibility as the basis for mate selection [17]. The need to train children in specialized skills that may differ from those of their parents calls for out-of-home schooling or apprenticeship and greater investment of resources per child, hence fewer children. Industrial production causes migration to cities. Where neighbours are strangers, the modern family becomes a "haven in a heartless world" [18]. The highest family value is emotional satisfaction [13].

Even where industrial growth is absent, the export of raw materials and the expansion of consumer markets, the mass media, and the civil service lead to the specialization of labour and the formation of modern urban families in developing countries. This change in Nigeria and Ghana has been described as "a movement toward monogamy, a strengthening of the conjugal bond over all others, a strengthening of the parent-child bond over all relationships external to the nuclear family, and ultimately an emphasis on what parents owe children rather than what children owe parents" [19].

Into the 1970s, successive waves of technological expansion raised living standards in both capitalist and socialist economies. In both types of state, the modern family's vital statistics were far better than those of the premodern institutional family and of all previous forms of the family. Quantum changes in income, mortality rates, life expectancy, nutrition status, educational opportunities, and other indicators of the quality of life occurred in response to industrialization, modern health care, education, and other aspects of scientific and socio-economic-development. Society is considered to be better off with these changes than without them.

Yet negative consequences have emerged to dominate the postmodern picture. The successes of both the capitalist and the socialist economic systems erode the high levels of social responsibility that evolved in the institutional family [20]. In capitalist societies, as family relationships turn away from cooperative economic endeavour, the emotional fulfillment of the family takes on a self-centred focus, nurtured by consumer marketing. In socialist societies, the state takes over the social responsibility of the family.

To remain profitable, the capitalist economy expands the sphere of needs that can be met through market-mediated exchanges. Expanding markets render more and more human activities into commodities to create opportunities for economic growth [17]. This process goes on at the expense of traditional crafts, entertainment, social support, personal relationships, and even biological functions when bottle-feeding replaces breastfeeding and when children are conceived through artificial insemination.

Implications of changes for nutritional care,

With the transition to industrial wage labour and the modern family, economic decision-making and responsibility for care become divided into formal public institutional functions on the one side and private, non-formal nuclear family functions on the other. In socialist systems, nonprofit state institutions tend to take over the out-of-home responsibilities for economic decisions and for providing care. In capitalist systems, private for-profit institutions predominate, at least in theory, over state services.

This differentiation of previous functions of the family into a public institutional domain of responsibility and a more limited private family domain has been termed the movement toward "public familism [17]. The United Nations Children's Fund may be considered to represent the advance guard of this expansion of responsibility for children's welfare from the family to the public sector. The UNICEF nutritional care initiative, per se, is a wave in the advancing tide of this movement, as it now places responsibility for care at the agency level.

Mead termed the modern stage of technological change "cofigurative," since both parent and child generations participate in determining needed life skills. Children now need greater mastery of flexible academic skills; for parents, child-bearing becomes less essential. Their wage labour can provide the surplus savings needed for old-age support, and social institutions may care for the elderly. Social survival also is less dependent on handing down the production capital of kinship units from one generation to the next.

Implications for nutritional care are highly favourable. With declining child mortality and reduced parental need for children, the number of births can be limited. Parents increasingly become aware that their children need high levels of nutritional investment, cognitive stimulation, and interaction with adults in order to be cofigurative and to compete effectively in the labour markets outside the safe haven of the home. Newly modernizing parents can expect a high payoff from successful children, in terms of consumer goods and improved housing.

Postmodern families

Postmodernism is characterized by a concern with inner process and a close examination of small units rather than general theorizing about big ideas. Modernization progressively differentiates institutions, roles, and classifications [21]. Postmodernism remerges or dedifferentiates modern categories [22], because many previous distinctions have diminished meaning in the information era. The distinction between goods and services no longer applies to computer software, which is a good when sold on disk, but a service when sold on-line. Television blurs differences between art and life. Telecommuting merges workplace and home. Powerful computers mix variables from anthropology, biology, communications, demography, economics, psychology, and sociology in population research that tests hypotheses from these disciplines simultaneously.

Post moderns no longer think cheerfully of the future but view with awe and apprehension the unthinkable social changes that may be brought about by biotechnology and by increases in global information transmission by a factor of up to 60,000. Religious fundamentalists at one extreme and environmentalists and new age movements at the other express disillusionment with conventional concepts of progress. Postmoderns see social inequality increasing in the presence of diminishing natural resources and global stagnation of conventional economic growth. Public familism declines as conservative forces propel the privatization of state services.

A proliferation of consumer goods and marketing targeted to individual fulfilment, on the one hand, and an infusion of information technology into the workplace and the home, on the other, have relocated decision-making to the level of the individual. Persons living and working together engage in privately conducted specialized forms of technical employment. These technical tasks cut across the disciplinary categories created by the industrial revolution's differentiation of labour.

Preparing children for this autonomy tends to make them precocious and unruly. Relationships with children, spouses, and friends may be negotiated as disposable consumer goods rather than as production resources to be treasured and passed on to future generations. The highest value is personal fulfilment, and the individual at a minimum must "get a life." Status still is displayed in consumer goods but tends to be measured individually by defining one's style and following one's bliss.

The postmodern family consists of many small, free-flowing groupings that include nuclear and a few traditional families plus single parents (usually females), matriarchal, co-parents, adopted children, test-tube babies, surrogate mothers, and gay and lesbian families, with or without formal marriage contracts. Mates are joined for whatever duration by creating shared narratives, ideologies, or images that give meaning to their lives. The meaning so created is consensual and may shift when potential new partners appear.

Decision-making at the individual level gives new meaning to democracy, religious freedom, and cultural diversity. Residents of this postmodern world encounter many beliefs and multiple realities, an exhilarating and disruptive profusion of world views. They participate in a society that has lost its faith in absolute truth, a society in which individuals choose what to believe [23]. Personal identity is deconstructed and redefined in terms of the individual's choice of commitment to future goals, or of a shifting collage of imagery and myth.

The postmodern home is a switchboard for scheduling the activities of its individual members. It has been described as "the saturated family," whose members feel their lives scattering in intensified busyness [24]. Family members become embedded in a multiplicity of relationships. The technologies of social saturation have created family turmoil and a sense of fragmentation, chaos, and discontinuity. In industrialized countries these technologies include the car, telephone, television, and jet plane. In the urban sprawl of developing countries, the density and diversity of slum neighbourhoods also create social saturation, with less privacy. The postmodern family is permeable [25]. Instead of providing the haven for intimacy in a heartless world, it sponsors anonymous intimacy with strangers through electronic mail, chat rooms on computer bulletin boards, 900 numbers, 12-step programmes, religious revival halls, the blur of strip-malls, and street-side markets in slums and shanty towns.

No longer a refuge of harmony, serenity, and understanding, the home is a site of competing personal needs among people of different ages and genders, who have diverse ideologies and social affiliations. Yet the best of postmodern families are what Elkind [25] terms "vital families," discussed in the following section, in which the needs of all members are negotiated and honored equally, including needs for security, intimacy, understanding, and togetherness.

Implications of changes for nutritional care

In Mead's terminology, the postmodern stage is "prefigurative," meaning that parents no longer have the knowledge to prepare their children for the future and must rely on the child to become more competent than her elders [14]. A certain desperation may pervade this reliance on children to be wiser than their parents. New information technologies create an economy that rewards strong cognitive skills, high performance speed, and lifelong flexible learning. Humans compete with evolving machines and with cheaper, less skilled labour of less advantaged classes and nations. Time taken off to bear and care for children competes increasingly with adult agendas. Children are hurried without regard for their developmental readiness and are neglected [25]. They also are valued as symbols of adult life fulfilment for as long as adults continue to appreciate them in this somewhat narcissistic way.

Child nutrition may benefit from the attempt to achieve perfect parenthood. It is more likely to suffer from compromises made by parents juggling multiple lives, for whom parenthood is one agenda crammed with conflicting priorities. In industrialized countries, microwave ovens and instant, frozen, fast, and convenience foods make it possible for each person to eat differently and at different times. In the cities of developing countries, small eateries and food vendors serve the same function. The concept of the competent, prefigurative child may lead parents to appease rather than influence their children's limited food preferences. When adults are too busy, child-feeding may be haphazard and monotonous. The need to turn small time slots with children into "quality time" or to appease the child while mother engages in work or business leads to a focus on the child's pleasure or whim (sweet snacks) rather than on nutritional health.

The postmodern family is adult-centered and the vital statistics of its children are declining. Care of children is provided by commercial child care, supplemented by increasingly stressed social services. In families, older members contest their child-care duties. When families break apart, courts mediate these contests.

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