Parsons BBA in Design + Management Senior Thesis Presentation Spring 2009. Student: Arielle Scoblionko, Faculty: Robert Rabinovitz, Associate Professor, School of Design Strategies, Parsons The New School for Design

1. HAU
aids in ethiopia:
born without rights
a two step communication system
arielle scoblionko

2. introduction
navigation
project introduction; spring 2008
design development; course overview 6
project topic exploration; brainstorm 8
project brainstorm; brainstorm inspiration 10
hiv/aids prevalence; demographics 12
hiv/aids prevalence; africa 14
hiv/aids prevalence; ethiopia 16
problem overview; understanding hiv/aids 18
project introduction; 2008-2009 school year
senior thesis; course overview, 20
design development (spring 2008) review; inspiration 22
project topic exploration; childhood 24
project research; inspiration 26
introduction; problem statement 28
identifying the problem
the epidemic; hiv/aids 30
hiv/aids; scientific overview 32
scientific overview; hiv/aids victims 34
hiv/aids victims; children 36
child hiv/aids victims; physical and mental effects 38
child hiv/aids victims; psychological and social effects 40
child hiv/aids victims; economic and political effects 42
child hiv/aids victims; global mortality effects 44
effects on children; mother to child transmission 46
mother to child transmission; breast feeding 48

3. aids in ethiopia:
born without rights
understanding the problem
understanding the larger context; social environment and development 50
understanding the larger context; socialization 52
understanding the larger context; childhood 54
understanding the larger context; childhood in africa 56
understanding the larger context; motherhood 58
understanding the larger context; motherhood in africa 60
understanding the larger context; breast feeding 62
understanding the larger context; breast feeding in Africa 64
breast feeding; prevalence 66
breast feeding prevalence; femininity 68
breast feeding and femininity; motherhood 70
breast feeding and motherhood; cultural significance 72
breast feeding and motherhood; common practices 74
breast feeding practices; health 76
breast feeding health; hiv/aids relationship 78
child hiv/aids; in africa 80
child hiv/aids: in ethiopia 82
understanding the community
ethiopia; country overview 84
ethiopia, cultural overview 86
ethiopian culture; family planning 88
ethiopian cultural roles; men 90
ethiopian cultural roles; women 92
ethiopian cultural; children 94
meet the people; personas 96

4. introduction
navigation
current solutions
overview; hiv/aids, global 98
critique; hiv/aids drug treatment and scientific advancements 100
critique; hiv/aids outreach, and organizations 102
critique; hiv/aids shelter 104
critique; hiv/aids, volunteer services 106
critique; hiv/aids, breast feeding alternatives 108
critique; hiv/aids, abstinence 110
expanded research
research opportunities; global needs 112
inspiration; human rights 114
inspiration; the big pictures 116
diseases; malaria 118
diseases; diarrhoeal 120
diseases; chytridiomyosis 122
diseases; simian immunodeficiency virus,feline immunodeficiency virus 124
prototyping
opportunities; areas of intervention 126
selected area of focus ; prevention 128
inspiration; all of us the movie 130
inspiration; dr. mehret mandefro, ethiopian-american hiv/aids specialist 132
initial brainstorm; process 134
expert feedback; dr. mehret mendefro 136
solution; draft 1 138
expert feedback; dr. mehret mendefro and HIV-positive patients 140
solution; draft 2 142
solution; draft 3 144
solution; draft 4 146
expert feedback; dr. mehret mendefro 148

5. aids in ethiopia:
born without rights
intervention
overview; problem 150
overview; context 152
supporting research; gift 154
supporting research; game 156
supporting research; adornment 158
supporting research; methods of change 160
supporting research; educational and verbal impact 162
overview; hau 164
hau; elements 166
hau; description, modified deck of cards 168
hau; description, pendant 170
hau; the system 172
hau; the complete s ystem, distribution 174
hau; future opportunities 176
project resources
bibliography 178
images 180

6. project introduction; spring 2008
design development: course overview
T here are many broadly
applicable principles that can be
used to enhance the design
development process in any
context. Design Development is a
one semester course that
addresses these fundamental
principles in a conceptual as well
as practical manner. The course
encourages studying the ways in
which design processes unfold
from many perspectives which
affords opportunities for
developing the insight required to
recognize critical junctures that
offer opportunities for increasing
creativity and efficiency.
1.
6

7. aids in ethiopia;
born without rights
Design Development(spring 2008):
Identifying the Problem
image inspired by “2.”

8. project introduction; spring 2008
project topic exploration; brainstorm
8

9. aids in ethiopia:
born without rights

10. project introduction; spring 2008
project brainstrom; brainstorm inspiration
10

11. aids in ethiopia:
born without rights

12. project introduction; spring 2008
hiv/aids prevalence; demographics
A Global View of HIV infection; 30-36 million living with HIV, 2007
ADULT PREVALENCE (%)
15.0% - 28.0%
5.0% -< 15.0%
1.0% -< 5.0%
.5% - < 1.0%
.1%-,< 5%
<.1%
No data available
UNAIDS global report on the HIV epidemic, 2008
12

13. aids in ethiopia:
born without rights
4. Cameroon Project, AIDS orphan 6. AIDS orphan; South Africa
Young girls
effected by
HIV/AIDS.
3. Stanley, HIV positive and malnourished; Upendo Village, Kenya 14. 7. Mekdes is being dropped off by her aunts at an
AIDS orphanage in Addis Ababa, Ethiopia

14. project overview
hiv/aids prevalence; africa
A Global View of HIV infection; 30-36 million living with HIV, 2007
ADULT PREVALENCE (%)
15.0% - 28.0%
5.0% -< 15.0%
1.0% -< 5.0%
.5% - < 1.0%
.1%-,< 5%
<.1%
No data available
Africa,2007
UNAIDS global report on the HIV epidemic, 2008
14

15. aids in ethiopia:
born without rights
South Africa’s Department of
Health estimates that 18.3%
of all African adults (15–49
years) were living with
HIV in 2006 (60:3).
8. Villagers in Masogo, Kenya attend a funeral for a suspected AIDS victim.

16. product introduction; spring 2008
hiv/aids prevalence; ethiopia
A Global View of HIV infection; 30-36 million living with HIV, 2007
ADULT PREVALENCE (%)
15.0% - 28.0%
5.0% -< 15.0%
1.0% -< 5.0%
.5% - < 1.0%
.1%-,< 5%
<.1%
No data available
Ethiopia,2007
UNAIDS global report on the HIV epidemic, 2008
16

17. aids in ethiopia:
born without rights
Of Ethiopia’s
77 million people,
3 million
are HIV-positive,
each day birthing
1,000 new
infections (61) .
43. Francois, 4 months old here, and weighing 3 kg (6 lbs 9oz). He was born in an isolated village in west senegal, weighing very little, but otherwise healthy.
Some volunteers stumbled upon his village, “at that point he was quite near death and weighed only 1.4 kg (3 lbs 1 oz). they worked tirelessly one on one with
this baby’s mom for 3 weeks to reestablish breastfeeding and offer supplemental high-calorie feedings. On the day this photo was taken, [the photographer] trav-
eled with [a] friend who had worked closely with [the] family...[he was] still very tiny for his age, but the most he had ever weighed in his life. [They} learned he
had also recently gotten over malaria, which by all laws of medicine and common sense should have been the end of him. he was quite anemic, but nonetheless
thriving.”

18. project introduction; spring 2008
problem overview; understanding hiv/aids
HIV:and like all viruses replicates insideVirus) is a
retrovirus,
HIV (Human Immonodeficiency
host
cells. A retrovirus is a genetic material composed of
ribonucleic acid (RNA), and uses an enzyme, reverse
transcriptase, to convert RNA to DNA. HIV reproduces
by invading other cells. Upon cell invasion the virus
produces more infectious particles by converting viral
RNA into DNA and then making many RNA copies.
The switch from RNA to DNA and back to RNA makes
combating HIV difficult because each switch offers
opportunities for error and viral mutation (mutation
means that the virus can outwit human response).
Once viral copies are made they break out of the cell,
destroying it and infecting other cells (62: 22-23).
10. Healthy white blood cells 11. HIV virus infecting cell; image by Jeff Johnson
18

19. aids in ethiopia;
born without rights
AIDS: T cells whichthe immunethe body’s overall
primarily CD4
HIV attacks
organize
system,
immune system. After infecting a CD4 T cell (by
penetrating the cell’s wall) the virus becomes part of
12. White blood cell infected with AIDS
the immune system, disabling full expulsion of the
virus. The body attempts to produce more CD4 cells
but once their number declines to a certain level the
immune system shuts down. These later stages of HIV
are referred to as AIDS (Acquired Immune Deficiency
Syndrome) (62: 22-23).
23. AIDS viruses budding from a white blood cell's membrane: Image by Matthew Christopher 13. AIDS positive cell

20. project introduction; 2008-2009 school year
senior thesis: course overview
S enior Thesis is a two
semester course intended to draw
upon and test competencies
developed in previous courses.
By employing and refining skills
of research, analysis, explanation,
persuasion, and presentation this
project demonstrates an intimate
understanding in the emerging
field of Design Research. AIDS
In Ethiopia; Born without Rights
represents four years of study,
channeling unique talents to
understand, communicate,
research and design for unfamiliar
people in unfamiliar places.
Photograph by Harold Davis
20

21. aids in ethiopia:
born without rights
Senior Thesis (2008-2009):
Intervention/Innovation
image inspired by (2).

22. project introduction; 2008-2009 school year
design development (spring 2008) review; inspiration
Sudan - almost 500,000
children refugees caused
by violence and civil war 5.
These children
are born without
rights.They
Ghana - 3% of the population
endure the from 15-49 are currently
infected with the AIDS virus 5.
consequences
Ethiopia - this country of
of their parents’ Uganda - more than 940,000
children are orphaned due to
70 million has more than
5 million orphans, their
actions. the AIDS pandemic 5. parents lost to famine,
disease, war and AIDS 5.
Zambia - 47% of the population
is younger than 15 with only
7% receiving aid of any kind 5. 5.
22

23. aids in ethiopia:
ethiopia;
born without rights
The rapid spread
In many ways, scientific
research has delineated
of HIV is a global the means by which
mother to child
epidemic. transmission
In developing can be prevented. The
countries, up to primary challenge now
50% of infant facing the HIV community
is how to implement, in
contraction is
arange of settings,
due to breast the benefits of these
feeding (63: 1). discoveries.
18. 16. AIDS orphan, Uganda

24. project introduction; 2008-2009 school year
project topic exploration; childhood
“In biology,
survival is the ultimate
criterion of
adaptation,
achieved not only through
spawning and protection
of the newborn but also
indirectly through the social
processes involved in the
provision of food, sharing of
information, and maintenance
of social order - in all
animals. A[n
understanding]
of child[hood] care in
any human population must
begin with how adaptive
functions are socially
and culturally
organized in
the local environment of
the child” .
(44:12-13)
24 21.

25. aids in ethiopia:
born without rights
Perceptions of childhood vary
amongst cultures, demographic regions, time periods,
religions, and races. Despite childhood differences, all
17. 44.
people are connected by the common inability
to bypass the early biological stage of life, childhood.
Therefore, all children are entitled to the basic
human rights that ensure a healthy physical,
mental and spiritual development. However,
many children are denied these fundamental human rights
due to social, cultural and environmental
constraints. As a global society bound by
our biological commonalities, it is our responsibility
to protect future generations and
ensure the continuation of human existence.
45. 18. Photographer: E. Obi-Akpere; Buhona, Ethiopia

26. project introduction; 2008-2009 school year
project research; inspiration
22.
“ Newsweek magazine announced, in its 1997 special issue on children, that breast feeding
may boost a child’sintelligence. But the New York Times warned of the dangers of HIV
infected mothers passing the virus to their infants through their milk (Meier 1997). And
Time magazine told the story of a female Army pilot, Emma Cuevas, who asked to be released from
the service to breast feed her baby after her six-week maternity leave was up. She was denied this
option, though experts on her behalf claimed a constitutional right to breast feed” .
(64: 1)
26

27. aids in ethiopia:
born without rights
22.

28. project introduction; 2008-2009 school year
introduction; problem statement
C urrently fourteen percent of children in Ethiopia are
stripped of their human rights due to HIV/AIDS exposure,
33 – 50% of which contract the fatal virus through their
mother’s breast milk. Ethiopia faces unique HIV
transmission challenges due to the societal significance of
breast feeding, which secures a woman’s role and rights
within a community. Globally we have battled the
HIV/AIDS epidemic through governmental interventions,
volunteer services, antiretroviral treatments, education,
sexual protection, and scientific and medical advances, all
of which are compatible within the first world countries in
which they were created. In order to restore human rights
to children, there is a desperate need to implement, in a
range of settings, the benefits of these discoveries.
24. Blumenfeld, David: Ethiopia, Tshay Tefera, 2 yrs
28

29. aids in ethiopia:
born without rights
26. Johannesburg, South Africa. Child Living with HIV/AIDS at Nkosi’s Haven 27. Otwandani Orphanage: Soweto, South Africa. Ishmael 2 yr old AIDS orphan reaches up to be held. 25. Bati, Ethiopia: Relief Centre. Child awakened
to make sure she is alive.

30. identifying the problem
the epidemic; hiv/aids
“In Ethiopia 1,000,000
children under the age
of 14 have lost at least 1
parent to AIDS.That makes
Ethiopia the country with
the most HIV positive
32.
children” .
(22)
30

31. aids in ethiopia:
born without rights
33. African child 31. HIV positive children, Africa

32. identifying the problem
hiv/aids; scientific overview
TRANSMISSION ROUTES MYTHS
HIV requires a host cell to HIV is found in body fluids 1. Once a person becomes
stay alive and replicate. To and cannot live long outside infected with HIV he will die
replicate, the virus creates the body. In order to
new virus particles inside a transmit HIV, body fluid 2. HIV can be cured
host cell and those particles must be passed from an HIV
carry the virus to new cells. positive person to an HIV 3. HIV positive people
Once infected, the T-helper negative person. engageing in sexual activity,
cell turns into a HIV do not need a condom
replicating cell. T-helper cells primary transmission routes:
play a vital role in the body’s 4. HIV only affects gay men
immune response. There are 1. Sexual contact (anal, and drug users
typically 1,000 T-cells per vaginal, or oral)
one millmeter of blood. HIV 5. People over 50 can’t get
will slowly reduce this 2. Sharing needles/syringes HIV
number until a person’s
count drops below 200. 3. Mother to child: labor, 6. HIV is the same as AIDS
When this happens, a person delivery or breast feeding.
has progressed from HIV to 7. Once infected with HIV, a
AIDS. 4. Blood transfusions women can’t have children
35. Healthy Red Blood Cells
32

33. 1 HIV homes in on the aids in ethiopia:
CD4+ T cell
born without rights
2 HIV RNA chain 6 New envelope is
converts to DNA assembled with
HIV virus
1
inserted
6
2 Outer
2
envelope
is removed
3 HIV RNA chain
converts to DNA
5 DNA
3 commands
5
Diagram of HIV attacking 4
chromosomes
inside nucleus
4 HIV DNA to make more
CD4+ T cell and reproducing penetrates
cell nucleus cell nucleus
HIV
CD4+ T Cell
7 HIV bursting
7 from the cell
36.

34. identifying the problem
scientific overview; hiv/aids victims
In 2007,68% of
“Every day, over
6,800 persons
all new HIV become infected
HIV and over
76%
infections and
with
5,700 persons die
of all deaths
from AIDS” .
(66: 10)
due to AIDS
occured in sub-Saharan
Africa .
(66: 12)
15. This child was born ten weeks premature and is HIV positive. 19. An HIV positive orphan, Nairobi, Kenya. 46. An HIV-infected man lies on a hospital bed in
Jakarta, 30 November 2007.
34

35. aids in ethiopia:
born without rights
In sub-Saharan Africa ,
the estimated number of
children (under 18)
orphaned by AIDS
more than doubled
between 2000 and 2007.
UNICEF estimates that by
48. HIV-positive children 2010 there will be 18.4
The WHO estimates that in 2015 AIDS million children
will cause one in six deaths in sub-Saharan Africa
in Africa (62: 21) . 47. Cambodian HIV positive woman Mut Dem San, 29, lies on the floor of the health center
orphaned by AIDS .
(62: 66)

36. identifying the problem
hiv/aids victims; children
“From the beginning of the HIV pandemic through 2002,
four million children
under 15 years of age worldwide became infected” (64: 3).
37. Ethiopian boy
In 2007, globally,
2.5 million
children The World Health Organization estimates that
(under the age of
15) were living with
500,000 children under the age of 15 died
HIV/AIDS.
(66: 7) 38. Children at an Outpatient Treatment Center; Lerra village, southern Ethiopia. Photo: AFP/GETTY
from AIDS or related causes in 2003 alone.
36

37. aids in ethiopia:
born without rights
Most children Ethiopian children ages
are infected with the virus 5 to 14 are called ”windows
of hope” because the
duringpregnancy, future is in their hands (67:16) .
delivery or while
breast feeding.
About 50% of infants
who get HIV from their
mothers die before
their second birthday. 39. Women wait to get treatment for their malnourished children at an Outpatient Treatment Center 37. A mother holds the hand of her malnourished
boy at a Red Cross Red Crescent centre in the
Wolayita region in the South of Ethiopia.

38. identifying the problem
child hiv/aids victims; physical and mental effects
failure to thrive* fever * fatigue * rash * prone to infection * respriraatory manifestions * haematological manifestations
pheumocystis carinii pneumonia * viral infection * lymphoid pulmonary lesion * delayed mental development * sore throat
A malnourished boy is portrayed at a feeding 25.
centre in Damota Pulassa, southern Ethiopia.
38

39. aids in ethiopia:
born without rights
psychological effects * central nervous system manifestation * headache * gastrointestinal symptoms
The first symptoms of HIV infection can resemble symptoms of common cold or flu viruses * swollen lymph nodes * social alienation
Eleanor Bentall/Tearfund, 13-month-old Abusch 91. A malnourished HIV+ child with tuberculosis.
23. Demisse Mada is one of tens of thousands of
severely malnourished children in Ethiopia. Picture:
Eleanor Bentall/Tearfund.

40. identifying the problem
child hiv/aids victims; psychological and social effects
The impact of HIV/AIDS on children is
seen most dramatically in the rising numbers
of children and adolescents orphaned by AIDS.
UNICEF estimates that over 15 million children,
12.3% of all children in sub-Saharan Africa, have
been orphaned by AIDS, and the number is
rising. Orphans who grow up “unloved, uncared
for, and unsocialized [are] thought more likely to
become criminals.” The growing number of orphans presents
a pressing public issue regarding child
care because the dependency rates increase,
placing demands on the government and society to
provide education, health care, and social support (62: 90).
African Orphans.
40

41. aids in ethiopia:
born without rights
As young adults (ages 15-25) fall ill Africa The burden of family
is at risk of loosing an entire care increasingly
generation. “The loss of falls on the maternal
older people means skills and knowledge grandmother
are not passed on - ‘institutionlal as the pandemic grows.
memory’ is lost” (62: 83) .
Child & Grandmother. Property of VOA news.
“The burning question is
what happens when today’s
grandmothers
die; AIDS means the
next generation
of grandmothers
Fatuma Hillow and her grandmother Batula Guha Property of Nkoni Cameroon Women Group. Grandmother on Kanazi Island. Property of Helmi Maria, travel writer.
will be absent” .
(62: 83)
Chronicle photo by Michael Macor

42. identifying the problem
child hiv/aids victims; economic and political effects
HIV/AIDS greatly decreases worker
productivity which affects agricultural
development and related labor, consequentially
leading to famine. Malnutrition, resulting
from famine, increases risk of transmission
and intensifies active viruses. “Day in the Life of Africa.” Photograph by Pictopia.
42

43. aids in ethiopia:
born without rights
The increasing dependency
“It is in the interest of on government aid
the nation state, for “adversely affects economic
growth by depressing
healthy mothers the national savings rate and
to supply the next reducing future
generation of domestic resources
workers and citizens” (64: 2). available for investment” (62: 64).
42. Magwa Tea Field Workers, South Africa.
“... disease creates
poverty and despair
and erodes institutional
capacity...” (62: 92).
40. Ethiopian landscape. 41. 49. Farmer Mekonnen Shumbulo stands with his son, Mule, 2, in his maize field

44. identifying the problem
child hiv/aids victims; global mortality effects
“Population growth
decreases through premature
deaths; a reduction in
fertility; and changing
sexual behaviors. As the HIV/
AIDS epidemic progresses
there are fewer women of
child-bearing age. HIV-
positive women are less likely
to conceive and carry the
Children affected infant to term” (62: 61). And, while
by HIV/AIDS suffer condoms and abstinence
can protect against diseases,
from poverty, they also decrease fertility rates
(contributing to decreasing
homelessness, 34. populations) in many African
communities where children
discrimination, are essential to societal
and early death. functioning.
50. Ethiopia: Three children’s bodies lie in a makeshift morgue at the South Oromia clinic.
44

45. aids in ethiopia:
born without rights
“Increased deaths in young adults are the most measurable
effect of AIDS.” By 2010 life expectancy could
fall to under 27 years of age in some areas of Africa. “How
will this affect societal ability to function?” (62: 57-61).
Maso Aliyi mourns his dead child, Shibre Aliyi, at his home in Ethiopia. Image sourece: LA Times.
HIV/AIDS leads to rising infant
and child mortality, falling
life expectancy, changes in
the population size,
growth, and structure all of
which have enormous effects on
national psyche, economy,
and social welfare.
51. Archived from “Bombs fall on Babylon.” 52. Relatives mourn over the the body of a one
year old child who died of malnutrition. Darfur,

46. identifying the problem
effects on children; mother to child transmission
mother to child transmission
HIV transmission from an “The overall risk of MTCT of
hiv-positive HIV is substantially increased
by maternal factors: high
mother to her child can
viral load in plasma, a
occur during pregnancy,
low cd4+ cell count, and
labour, delivery or AIDS, by vaginal delivery
“MTCT”
breast feeding. or prematurity...” . (63: 1)
Photograph by Niall Crotty
53. Photograph by World Health Organization An Akiye woman and her baby. August 19, 2008. Photo by Pernille Bærendtsen
46

47. aids in ethiopia:
born without rights
MTCT can be
The risk of
reduced from 15-25%
to under 2% by combining
administration of antiretroviral
prophylaxix during pregnancy
and delivery, elective ceasarean
avoidance of
section and
breast feeding.
54. 55. 56. 57.

48. identifying the problem
mother to child transmission; breast feeding
replacement feeding is
“When
acceptable, feasible,
affordable, sustainable
and safe, HIV infected mothers
should avoid breast feeding completely” (63:1) .
58. 59.
48

49. aids in ethiopia:
born without rights
“The impact
of HIV infection on
infant feeding
practices is a significant
public-health
issue, for two reasons:
61. malnutrition is
“Where breast feeding is an underlying cause of
common and prolonged, 60% of child deaths,
transmission through and underweight
breast-feeding may account
is the leading
for up to half of HIV underlying cause of
infections in infants and disability and
60.
young children” (63: 1) .
62.
illness worldwide” (63: 3).

50. understanding the problem
understanding the context; social environment and development
understand how
“To
children grow up
under varied environmental
conditions, one must “Patterns of
be willing to go to where
social organization
conditions already
those
exist, to examine them and behavior such
67. Chinese mother and child as mating patterns and
respect
34. Ethiopian mother and child 66. Hippo mother and child
with and emotional display rules,
in detail, and to change one’s
assumptions in the face of which vary across
new observations” (44: 9) . species in
much of the animal
kingdom, vary
across populations in
63. Elephant mother and child 64. Menaksi temple, dreaming in mother’s 65. Gorilla mother and child
homo sapiens” .
(44: 11)
arms
50

51. aids in ethiopia:
born without rights
HIV and AIDS are
causing untold human
suffering. In some
countries, the virus is
reversing
decades of developmental
69. Photo by Kevin Fleming/CORBIS
progress. “While the
epidemic’s evolution
has varied across regions,
there is one common
68.
denominator: HIV and
67. Geoffrey Owino, the youngest of
Christine Kanga’s five children, is HIV- AIDS are increasingly a
positive. Christina used to run a successful
tailoring business but has not been able
to work for a long time. Instead she gets
disease of the young and
up for short periods each day to teach
her eldest son how to sew - an attempt
most vulnerable,
particularly girls” (65).
to pass on vital skills to her family’s next
generation. © World Food Program, Vanessa
Ethiopian mother & child. Sebastian Rich Photo. Vick. Sebastian Rich Photo. 69.

52. understanding the problem
understanding the larger context; socialization
71. 72. 73. 74.
Socialization is, “the process through which
individuals acquire the knowledge ,
skills, and dispositions that enable
them to participate as more or less effective
members of groups and the society” .
(44: Foreword)
80.
76. 75. 77. 78. 79.
52

53. aids in ethiopia:
born without rights
“A population tends
to share an environment,
symbol systems for
encoding it, and organizations
and codes of conduct
for adapting to it...Human
adaptation...is largely
attributable to the operation
81. 82. of specific social
organizations...following
culturally prescribed scripts...
No account of ontogeny in
human adaptation could be
adequate without inclusion
of population-specific
patterns that establish
pathways of behavioral
development of children” (44: 12).
84. 83.

54. understanding the problem
understanding the larger context; childhood
70.
The nature of childhood in any human
population begins with how adaptive functions
are socially and culturally organized in the
local environment .
(44:12-13)
54

55. aids in ethiopia:
born without rights
86. 85.
Africa, Photographer: Alastair McNaughton
85. 88. 87.

56. understanding the problem
understanding the larger context; childhood in africa
The model of African
childcare is referred to as the
pediatric model,
“because its primary concern is
with the survival, health, and
physical growth of the infant...
The American [model] is
the, “pedagogical ,
because its primary concern is
behavioral
with the
development and its
preparation for educational
interactions” (44: 25).
89. 90. 91.
56

57. aids in ethiopia:
born without rights
The fundamental differences in
child rearing prohibit the implementation
of medical, scientific, and social advancements
thathelp a country economically, politically,
and socially thrive. In order to improve the
quality of life in third world nations,
design must be conducive to the culture
in which it will exist. If advances penetrate
youth culture, improvements will
sustain the aging of generations. 92. 93.

58. understanding the problem
understanding the larger context; motherhood
94. 95. 99.
When functioning as the primary
caregiver, mothers of all
species and cultures “are
motivated by a 97
concern for the health and survival
of their infant” (44: 23) . 96. 98.
58

59. aids in ethiopia:
born without rights
“Some experts liken
the sensual tie
between mother and
child to the exclusivity of
the monogamous
marriage bond” .
(64: 6)
100. 102.
“The cultural
variation in beliefs about
pregnancy begins with
beliefs about the causes
of conception, which 103.
can express meanings
and values central
to the identity of a
101.
culture” (59: 1). 104.

60. understanding the problem
understanding the larger context; motherhood in africa
“In virtually all the social and
cultural contexts of indigenous
Africa, childbearing is
necessary for moral
virtue, spiritual continuity,
and material well-being;
the more descendants one
has, the better off one is
considered to be” (44: 33).
106. 107.
pregnancy encompasses physiological, psychological, spiritual,
The experience of
and socio-cultural dimensions. Because the future of any given culture depends heavily on
women’s procreative abilities, these abilities carry strong social significance.
Thus, every culture takes upon itself the regulation and management of women’s pregnancies (59: 1).
105.
60

61. aids in ethiopia:
born without rights
barren woman
“A or
childless man
is [Africa’s] image of the worst possible
fate: an incomplete person
who has not attained the foothold
necessary for full adulthood
and spiritual continuity .
In some African socieites, such people are
108.
pitied and feared” .
(44: 32)

62. understanding the problem
understanding the the larger context; breast feeding
“In the United States, maternal Universally, a woman’s
breast feeding has biological purpose
long been advocated as a key to
good mothering, womanly
is to reproduce. Gaining
honor, and even to women’s respect as a mother
109. citizenship...The notion of breast
feeding as a mother’s obligation requires a commitment
to both her child and the larger to breast feeding
social body extends from the because it personally
colonial days, when nursing was
and publicity solidifies a
a mother’s sacred duty” (64: 9).
woman’s maternal status.
Breast feeding, which
is often considered the
measure of the mother,
112. physically and 114.
spiritually, literally
and metaphorically,
represents the transference
of mother to child.
110. 111. 113. 115.
62

63. aids in ethiopia:
born without rights
116.
“Breast feeding plays
heavily into our notions of
“good” and “bad” mothers,
which touches on one of the
dominant emotional issues 119.
of the twenty first century: “Mother’s bodies, female sexuality, and the act of feeding at
the relationship the breast embodies anxieities addresing whether women’s
between breast feeding bodies are “pure” or “dangerous.” The questions surrounding
breast feeding “provides a lens with which to sharpen our focus on the
and motherhood” (64: 1) .
117. 118.
conflicts shaping and dividing women’s lives” (64: 1-2).

64. understanding the problem
understanding the larger context; breast-feeding in africa
In traditional Ethiopian
societies women often refuse
breast feeding
alternatives because
they fear stigmatization
family and the
by the
community. If a woman
does not breast feed,
it may be assumed
that she is HIV-positive,
exposing her to the 59. Himba Mother and Child. 121. Young Himba Girl.
physical and emotional “A woman's worth is measured in terms of her
abuse associated with role as a mother and wife,” status of which are
the virus .
(70)
59. Young Himba Woman. 120.
reinforced through the act of breast feeding (45: 114).
64

65. aids in ethiopia:
born without rights
“The HIV [breast Ethiopian women are expected to breast feed
for it is safe, nutritious and ensures infant-mother
feeding] story is so
bonding, which is an important element of the
powerful because it
native culture (71: 84).
literally and
metaphorically
tells us which
mothers have
dangerous
bodies” (64: 2) .
122. HIMBA MOTHER AND CHILD 3 , Artist: Michael Sheridan. Redbubble.com 122.

66. understanding the problem
breast feeding; prevalence
126.
“Up to 94% of
infants in the world
123. are estimated to be
ever breast fed,
79% continue at one
year, and 52% at
two years, with an
estimated median duration
of breast feeding of 21
124.
months” (63: 3) . 125. 127.
66

67. aids in ethiopia:
born without rights
128. 131.
“Nearly all infants in Globally an estimated
developing countries 41% of infants under four
months of age and 25%
are initially breast fed,
under six months are
and most continue exclusively breast fed;
until at least six months of in sub-Saharan Africa 23%
of infants under six months
age but often into the of age are exclusively
second year” (63: 3) . breast fed” (63: 3).
129. 130.

68. understanding the problem
breast feeding prevalence; femininity
The Tempest, Giorgio Barbarelli da Castelfranco. Birth of Venus, Sandro Botticelli
The female sex is globally recognized through the presence of breasts.
68

69. aids in ethiopia:
born without rights
Spirit Spouse. Virgin and Child, Jean Fouquet. Le Dejeuner Sur L’Herbe, Edouard Manet.
The breasts, across space and time, embody the essence of female sexuality.

70. understanding the problem
breast feedng and femininity; motherhood
the essence of woman lies in reproduction
Motherly differences aid
in defining relationality
within society. Motherhood
creates a heirarchy
133.
amongst women, separating
mothers from “other”
women deemed less moral.
Motherhood
is essential to the
Motherhood is a class
making and marking duty (64: 11) .
creation of female
identity. The act of
motherhood physically
differentiates
women from men .
(64: 52)
131. 132. 134.
70

71. aids in ethiopia:
born without rights
Woman who “see child
primary
rearing as their
responsibility
in life, and one that is
ultimatley theirs alone ”
is what sociologist Linda Blum
refers to as “exclusive
motherhood” .
(64: 5-6)
135. 136. 93.

72. understanding the problem
breast feeding and motherhood; cultural significange
By Maitum Information Office, August 2007
“Breast feeding has
long been advocated as a
mothering,
key to good
womanly honor, and even to
women’s citizenship...
137. “Breast feeding baby in Ethiopia.”
According to sociologist Pam Carter, breast feeding is The notion of breast-feeding as
a“conversation about femininity” and a mother’s obligation to
both her child and the larger
“obligations of the maternal body to the larger social
body” (64: 2). social body extends from the
colonial days, when nursing
was a mother’s sacred
duty...when it was considered
a mother’s civic duty to
the growing republic” (64: 19).
138. 93. 139.
72

73. aids in ethiopia;
born without rights
To be respected
as a mother a women
is expected to properly
raise her child, which
requires a commitment 143.
to breast feeding. The “lens [on] breast
feeding reveals the
In the current era, breast
feeding has become
collision of public and private
“the measure of concerns with the maternal body” (64: 7).
motherhood. This issue [of
motherhood] confounds
the gender basis of
citizenship
140. and obligation to
[society]: women
serve the nation through
motherhood, and men,
through the military” (64: 3).
141. 93. 142.

74. understanding the problem
breast feedng and motherhood; common practices
144. 145
According to the World Health Organization states
that “the optimal feeding pattern for overall child
survival is exclusive breast feeding for
the first six months, and continued breast
two years and beyond, with
feeding for up to
148.
complementary feeding from age six months” . (63: 5)
146.
74

75. aids in ethiopia;
born without rights
In Ethiopia,
approximately 96% of
infants are breast fed at
some point.
147.
148.
“Breast feeding can
range from a six-week dose of
bonding
‘ ’ to an intense,
several year relationship” (64: 3).
148. 149.

76. understanding the problem
breast feeding practices; health
Exclusive
breast-feeding
enables
children to
achieve optimal
growth,
development
and health. Ethiopian children welcome an aid convoy. Photograph by Crispin Rodwell.
76

77. aids in ethiopia:
born without rights
Nursing is an
important part of overall
maternal and child
health. It may reduce
a mother’s risk of ovarian
cancer and osteoporosis
while promoting weight
loss, child spacing
(less than 2% risk of
becoming pregnant) and
a fast return of the uterus 151.
to its prepregnant state. A lack of exclusive
Breast milk provides breast feeding
optimum nutrition, during the first six months
stimulates psychosocial of life contributes to over
and neurological
development, and strengthens one million
a child’s immune system.
Breast feeding may avoidable child
also heighten IQ, increase
visual acuity, condition
deaths each year . (1)
the body to better process
fats and cholesterol, prevent
obesity, and enhance
facial, dental, and speech
development (9: 4) , (63: 3).
150. 151.

78. understanding the problem
breast feeding health; hiv/aids relationship
“Available interventions can substantially reduce the
risk of transmission during pregnancy, labour and
delivery, but not yet during breast feeding” .
(63: 3-4)
153. 154.
For HIV-positive mothers, the decision about
breast feed can be difficult. Many
whether or not to
women are reluctant to get test for HIV due to the wide
spread associated stigma. So, with unknown
status women must weigh the risk of breast
feeding, exposing the child to HIV, against using
replacement feeding, which increases the
likelihood of death from other infections and
diseases. According to UNICEF, “babies who do not breast
feed are six times more likely to die from diarrhoea or
respiratory infections than babies who do breast feed” (63: 3-4).
67. A young HIV-positive mother holds a photo of herself and her two children. She will die prematurely 152.
leaving her children as orphans. Photography by Andrew Petkun, sourced from AVERT.org.
78