Frequent child death remains a powerful shaper of

Frequent child death remains a powerful
shaper of maternal thinking and practice.
In the absence of firm expectation that a
child will survive, mother love as we
conceptualize it (whether in popular
terms or in the psychobiological notion
of maternal bonding) is attenuated and
delayed with consequences for infant
survival. In an environment already pre-
carious to young life, the emotional de-
tachment of mothers toward some of
their babies contributes even further to
the spiral of high mortality—high fertil-
ity in a kind of macabre lock-step dance
of death.
The average woman of the Alto expe-
riences 9.5 pregnancies, 3.5 child deaths,
and 1.5 stillbirths. Seventy percent of all
child deaths in the Alto occur in the first
six months of life, and 82 percent by the
end of the first year. Of all deaths in the
community each year, about 45 percent
are of children under the age of five.
Women of the Alto distinguish be-
tween child deaths understood as natural
(caused by diarrhea and communicable
diseases) and those resulting from sor-
cery, the evil eye, or other magical or su-
pernatural afflictions. They also
recognize a large category of infant
deaths seen as fated and inevitable.
These hopeless cases are classified by
mothers under the folk terminology
“child sickness” or “child attack.”
Women say that there are at least four-
teen different types of hopeless child
sickness, but most can be subsumed un-
der two categories—chronic and acute.
The chronic cases refer to infants who
are born small and wasted. They are
deathly pale, mothers say, as well as
weak and passive. They demonstrate no
vital force, no liveliness. They do not
suck vigorously; they hardly cry. Such
babies can be this way at birth or they
can be born sound but soon show no re-
sistance, no “fight” against the common
crises of infancy: diarrhea, respiratory
infections, tropical fevers.
The acute cases are those doomed in-
fants who die suddenly and violently.
They are taken by stealth overnight, of-
ten following convulsions that bring on
head banging, shaking, grimacing, and
shrieking. Women say it is horrible to
look at such a baby. If the infant begins
to foam at the mouth or gnash its teeth or
go rigid with its eyes turned back inside
its head, there is absolutely no hope. The
infant is “put aside”—left alone—often
on the floor in a back room, and allowed
to die. These symptoms (which accom-
pany high fevers, dehydration, third-
stage malnutrition, and encephalitis) are
equated by Alto women with madness,
epilepsy, and worst of all, rabies, which
is greatly feared and highly stigmatized.
Most of the infants presented to me as
suffering from chronic child sickness
were tiny, wasted famine victims, while
those labeled as victims of acute child at-
tack seemed to be infants suffering from
the deliriums of high fever or the convul-
sions that can accompany electrolyte im-
balance in dehydrated babies.