In a study of 357 first time mothers in a squatter community of Recife it was found that 1 in 10 were less than 15 years old and 60 per cent less than 20 at the time of their first delivery. Two groups of mothers were distinguished, viz. adolescent mothers with a mean (SD) age at first delivery of 16.7 (0.78) years and older mothers with a mean (SD) age at first delivery of 25 (0.79). More than a third were living in common-law union. Of the adolescent mothers only 58 per cent were living with the child's father. A further 23 per cent had received financial support from their own parents during the pregnancy. The rest were expelled from home. The adolescent mothers were generally worse off with a per capita income generally half of that of older mothers. About a quarter of all children studied were below the 10th centile of NCHS standards (23 per cent by weight/age; 28 per cent by height/age). The undernourished first born was 2.5 times more likely to have an adolescent mother, four times more likely to be in a household with low income, and two times more likely to have an illiterate mother as compared to the first borns who remain well nourished. The implications of these findings for urban primary health care programmes are further discussed.

Skin-to-skin mother/infant contact as a means of warmth for newborns of low birth weight (less than or equal to 2500 g) was studied in 132 infants admitted consecutively during the cold season July/September at the Central Hospital in Maputo. The mean (+/- SD) birth weight was 1788 g (+/- 304 g) and the gestational age 34 weeks (+/- 2.7). Fifty-seven (43 per cent) infants were born outside the hospital and were referred. The ambient temperature ranged from less than 22 degrees C to 32 degrees C. Skin-to-skin contact as the principal means of warmth commenced in more than a third by age 3 days and in more than a half by age 5 days after periods of observation to exclude clinical problems. The infants were kept warm using conventional methods during observation. Re-admission to the intensive care unit was required in nine cases: four for diarrhoea; two for respiratory infection; two with jaundice; and one for poor suckling. Infants were discharged home at a mean (+/- SD) weight of 1864 g (+/- 227), and age 15.6 d (+/- 7.9). Skin-to-skin contact, either by itself or in combination with other methods of warmth, was reportedly followed at home by 67 per cent of the mothers who received home visits. No infant needed readmission for hypothermia either from the neonatal wards or after being discharged home. At follow-up, when body weight had reached greater than or equal to 2500 g, the outcome was graded as 'good' in 64; 'satisfactory' in 6; and 'poor' in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

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More than three-quarters of humanity lives in the developing world and up to 80% of the population there lives in rural areas. In the.villages and hamlets of the Third World, the greater proportion of the world's babies are being born and brought up in the traditions and practices which have existed for many generations. In the past two decades a considerable investment in medical education and the expansion of health services has been made in all developing countries and yet only a few of them have been able to achieve the objective of universal health coverage. There are several reasons for this failure. Where maternity care is concerned much of it is likely to be due to not taking into account the customs and belief systems of the rural society.Rituals and beliefs exist in varying forms in different societies, especially around the time of important milestones in the life cycle. We find birth and naming rituals, rituals marking the attainment of adulthood, weddings and funerals. These rituals have been described as the Rites of Passage in the anthropological ritual. The time of childbirth is associated with so much joy and at times so much of tragedy that it is not surprising that pregnancy and childbirth are at the centre of many customs, practices, and rituals.When studying pregnancy and childbirth in the peasant society the most striking finding is the young age at marriage, which usually takes place around the onset of menarche. In some instances betrothal takes place even earlier, the young bride going to stay with the husband and his family after menarche. In Tanzania amongst the Wazaramo of the coastal region the average age of mothers at the time of the birth of their first baby is 16.6 years. In Hyderabad, India it is 16.2 years and the same is also true for rural Java. In some cultures there is a prior ceremony of initiation at puberty associated with the practice of the Pharonic circumcision. In all cases, however, there is a period of apprenticeship during which the older girl has been learning to care for her younger sibling.In all traditional societies child-bearing is a social phenomenon, a part of everyday family life, and not a medical condition. Births occur within the family environment largely supported by friends, family members and kinsfolk. It is customary in many cultures for the pregnant woman to go to her mother's home to have her baby. It is always the village birth attendant who is consulted and not the medicine man or shaman. In several cultures pregnancy will be kept secret until the 7th month to avoid the evil eye and this certainly creates problems with regard to antenatal care. In others, as in Java, pregnancy is announced early and celebrated with ceremonial feasts and rejoicings.