NUTRITION - FERTILITY INTERACTIONS IN DEVELOPING COUNTRIES : IMPLICATIONS FOR PROGRAM DESIGN

It is this apparent conflict, its policy implications, and the physiological and psychological elements of the nutrition-fertility interaction which are the subject of this report. The report examines the contraceptive effects of breastfeeding; good nutrition"s impact on breastfeeding (when infants receive food supplements, breastfeeding diminishes, ovulation returns, and fertility increases earlier in well-nourished women); and the effects of uncontrolled fertility on nutritional status and mortality. The report also outlines various psychosocial determinants of family size -- replacement, insurance, and investment births -- which must be considered in programs to reduce mortality and fertility. Any attempt to maintain a low net reproduction rate through low nutritional status will necessitate high mortality and severe deprivation and will be incompatible with those changes in personal motivation needed for voluntary adoption of the two child family norm. Modernization entails economic constraints and changing values which combine to encourage fewer children with greater investment per child. The following actions will encourage this process: (1) conveying the message that reducing infant mortality means a couple can achieve desired family size with fewer pregnancies; (2) providing integrated, community-based family planning, health, and nutrition services to complement those existing family planning, nutrition, or primary health care programs which are the most popular, powerful, and rapidly growing; (3) introducing modern methods of birth control soon after each birth, to take advantage of the contraceptive effect of breastfeeding as a back-up while mothers gain familiarity with the new methods; (4) reinforcing modern sector aspirations; (5) encouraging investments in child health, nutrition, and education; (6) promoting parent-child bonding and nucleation of the family; (7) reducing the social security function of children by establishing programs for the elderly; and (8) expanding women"s educational opportunities and participation in the labor force. A 242-item bibliography (1940-80) is appended.