母乳教育和兩個印度孩子的命運

LUCKNOW, India — That’s Mishty Yadav on the right. At 28 months, she looked huge in her mother’s arms, as if she spent nights on a gold throne dipping cookies into buffalo milk.

印度勒克瑙——右邊的是米什蒂·亞達夫(Mishty Yadav)。她28個月大，在母親懷裏看起來體格碩大，彷彿夜裏都是坐在黃金寶座上吃着餅乾蘸牛奶。

But it turns out the reason she caught my eye was because, in contrast to so many children, Mishty is healthy. And here in the Indian state of Uttar Pradesh, where the majority of children under the age of five are malnourished and stunted, what looks normal starts to change.

不過，後來我發現，她之所以引起了我的關注，是因爲她很健康，與太多的孩子不一樣。這裏是印度北方邦，多數五歲以下的嬰幼兒營養不良、發育遲緩。什麼叫做正常，也就有了變化。

In rural villages like this one a normal child looks like 5-year-old Shanvi Yadav, there on the left — very small and very thin.

在這樣的鄉村裏，“正常”孩子長得像左邊的五歲大的莎薇·亞達夫(Shanvi Yadav)一樣——又瘦又小。

So Mishty is barely half Shanvi’s age but may weigh even more than her. They live about 100 feet from each other, but their opportunities to grow up healthy, both physically and mentally, are vastly different. When I met them and spoke to their families, I was struck by how early child-rearing practices were likely to result in dramatically different life trajectories for the two kids. When most mothers in these villages care for their children, they do so based on traditional practices. And tradition, even when misinformed, can be hard to go against.

因此，儘管米什蒂剛到莎薇一半的年紀，體重卻可能比她還大。她們住的地方相距大約百尺，身心健康成長的機率卻有着天壤之別。當我認識她們並與其家人談話之後，我深有感觸：早期育兒實踐很可能會讓這兩個孩子走上截然不同的生活軌跡。這些鄉村裏的母親養育孩子的時候，多數人遵循的是傳統做法。而傳統，即便是謬誤，也會很難抗拒。

When Nicholas Kristof asked one mother in Jalim Kheda whether or not she was giving water to her month-old infant, she said she was not. Only breast milk. Hearing this, her mother-in-law and neighbors started scolding her for not giving the child water. Many villagers provide infants with water when it is hot to cool them off.

在賈裏姆凱達，紀思道(Nicholas Kristof)詢問了一位母親是否給她一個月大的嬰兒喂水。答案是否定的，她只餵母乳。聽聞此言，她的婆婆和鄰居開始訓斥她沒有讓孩子喝水。天熱的時候，許多村民會用給嬰兒喂水的辦法來給他們降溫。

“Anything the baby is taking that is not breast milk [such as water] is replacing breast milk,” says Shawn Baker, head of nutrition for the Bill and Melinda Gates Foundation. “And breast milk has been designed over several million years of evolution to be the perfect nutrition. It’s perfectly synchronized to the infant’s needs.”

“嬰兒攝入的任何除母乳之外的東西（比如水），都是在擠佔母乳的空間，”比爾及梅林達·蓋茨基金會(Bill and Melinda Gates Foundation)的營養議題總監肖恩·貝克(Shawn Baker)說。“經過幾百萬年的進化，母乳是最佳營養品。它與嬰兒的需求完美契合。”

As peer pressure weighed on the mother, she finally gave in and said she would start giving her baby water. The influence of tradition is strong, and in many cases, unhealthy. A nutritionist with us hurriedly told the mom that she was on the right path and not to give water.

周圍的壓力落到了這位母親身上，她最終投降，表示自己會開始給孩子喂水。傳統的影響力是強大的，在很多情況下卻並不健康。與我們同行的一名營養專家匆忙告訴她，她是對的，別給孩子喝水。

One of the best ways to break out of the cycle of misinformation is through education. That’s what Nisha Yadav, who earned a bachelor’s degree, credits for knowing how to raise Mishty.

打破這種謬誤的一種最佳辦法是教育。米什蒂的母親尼莎·亞達夫(Nisha Yadav)擁有學士學位。正是因爲教育，她懂得如何撫養自己的孩子。

When Nisha was pregnant with Mishty, she went to a private clinic to receive prenatal care. Every day she took iron and folic acid tablets as well as multivitamins. Iron tablets are key during pregnancy to prevent the mother from becoming anemic.

當尼莎懷着米什蒂的時候，她去了一傢俬人診所來接受產前護理。每天她都要吃鐵片和葉酸片，以及多種維生素。鐵片是預防母親在懷孕期間貧血的關鍵。

Mishty was born at a private hospital in Lucknow and started breast-feeding shortly after. Exclusive breast-feeding lasted six months, upon which complementary feeding was introduced. Nisha breast-fed for the recommended two years before stopping.

米什蒂在勒克瑙的一傢俬人醫院出生，並且很快就開始了母乳餵養。純母乳餵養持續了六個月，然後添加了輔食。尼莎根據推薦讓母乳餵養持續了兩年，最後才斷奶。

Just down the road is a different story.

就在路的另一端，則是不一樣的故事。

Babli Yadav, Shanvi’s mother, was taken out of school after eighth grade to help earn for the household. When Babli was pregnant, she was given iron and folic acid tablets but she didn’t take them because they made her feel nauseous.

莎薇的媽媽芭布里·亞達夫(Babli Yadav)在八年級後被迫輟學彌補家用。當芭布里懷孕的時候，她收到了鐵片和葉酸片，但是沒有吃，因爲這些讓她感到噁心。

Shanvi was born at home and breast-feeding didn’t begin until day 10. There is a myth that the mother’s milk should not be given during the first few days.

莎薇是在家裏出生的，直到第10天才開始母乳餵養。當地有個錯誤觀念，認爲母親在剛生下孩子的那幾天是不能母乳餵養的。

“There’s a very strong tradition of giving honey or giving something before being given the breast,” says Baker. “But the early milk is incredibly rich in maternal antibodies. Everything the mother has been protected against is being transferred to protect the infant.”

“這裏有一個很強的傳統，在母乳餵養之前，要先給孩子蜂蜜或者其他的東西，”貝克說。“但初乳有着非常豐富的母源抗體。所有保護母親的東西都會轉移到嬰兒身上。”

When Babli transitioned to breast-feeding, it was irregular, and eventually stopped after one year. Babli says their diet is poor.

當芭布里轉爲母乳餵養後，也不是很經常，並且最終在一年之後就停止了。芭布里說他們的飲食很差。

You can see the physical manifestation of malnutrition in the photo. But physical health is not the only concern. Studies show that cognitive development is severely hampered in malnourished children. They drop out of school earlier and are at a greater risk of dying.

你可以從照片中看到營養不良的切實表現。不過，身體健康並不是唯一的問題。研究表明，營養不良兒童的認知能力發育會受到嚴重阻礙。他們輟學較早，死亡的風險也更大。

On this trip I have been fascinated by the tension between factual knowledge and tradition. It has given me an appreciation for how difficult health interventions can be. Simply transmitting knowledge is very unlikely to change behavior. But looking at these two kids, you see the stakes.

在這次旅行中，事實知識和傳統之間的衝突深深地吸引了我。這讓我瞭解到健康干預可能會有多麼的困難。單純地傳播知識好像並不能改變習慣。但看着這兩個孩子，你就會看到其中的利害關係。