A Dose of Care

Even as the United States Agency for International Development sends hundreds of millions of dollars worth of food to developing countries, a strange but important nutritional problem is being overlooked: The children of women who suffer from severe stress and poverty sometimes seem to give up and refuse to eat. Studies suggest that this stems from maternal detachment — the breakdown of emotional connection between traumatized mothers and their children.

It isn’t a new phenomenon. In the 1920s, Dr. Josephine Baker of the New York State Department of Health observed something similar among a group of severely malnourished babies in the chronic ward of the New York Foundling Hospital. Typically, these infants died despite care and feeding. But when Baker took them from the hospital and sent them to nurturing foster homes, nearly half survived.

Likewise, during the 1980s, Sally Grantham-McGregor, a child health researcher working in Jamaica, demonstrated that teaching poor mothers the basic techniques of mothering — holding and playing, and communicating with smiles, gestures and questions — could help their ailing children achieve remarkable developmental gains. And these gains were much greater than those that could have been achieved with food and medical care alone.

Today, Unicef and the World Health Organization agree that counseling should be an important part of food aid programs. Once feeding programs are in place, it costs very little to train community health workers. One organization, Play Therapy Africa, which runs feeding and counseling centers in Ethiopia, is training aid workers in these methods in 50 centers. The one-time expense of $278,000 — the cost of training and monitoring the health workers — is a pittance compared with the millions of dollars spent on food alone.

Unfortunately, most aid economists overlook counseling. When the journal Lancet recently reviewed strategies to reduce malnutrition, these methods weren’t mentioned at all.

Vulnerable children require more than food and medicine; they need affection. To nurture them, we need to nurture the mothers on whom their lives depend.

Helen Epstein, the author of The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa.