impairment fram placental transfers are adequate cause for continuin concern. on the bright side, the Perinatal Study reports fairly low use of these substance by pregnant wrn: 7.3% used tobaccLo, 2% smoka cannabis, and 17% drank alohol (68% of these reported one drink or less per week) (Jamaica-?VH, 1989). Preliminary results of the study als, reported moderate levels of support seeking by pregnant _wcmen wtien_ feeling "sad" _and_ needing help during the pregnancy: 51.2% received this help from the baby's father, _and_ 35.5% from the woman's mother (JamaicaiMOH, 1987).

4 INFANr AND CHILD MORBIDITY AND MORIALIIY The corditions of a child's lealth can determine the health of the adult; therefore, it is worth looking at tihe major heelth concerns of children in Jamaica. Additionally. as we see how mothers are feeding and oaring for their children we get more of a sense of the cormitions of motherhood and the constraints faced by the women. Congenital anomalies and perimatal morbidity are common causes of infant mortality in the world and are believed to be the result of high fertility in older wcmen and teens (World Bank, 1987). lhe rates for the various categories of malformations are omparativeJ.y luw in Jamaica (Jamaica-MOH, 1989) though there appears to be scme clustering by region, time, and birth weight. St. Ann, Trelawny, Manchester, and Westmoreland had 20% higher risk than expected; further, there was an increasing risk of firding congenital defects as birth weight increased. Results frma the Perinatal Study irdicate that low birth weight is less a concern than prematurity. The study also found that the largest group of perinatal deaths is due to intrapartum asphyxia; significantly, these are the deaths which have been the most responsive to interventions in the West (Lofgren & Polberger, 1983). Potential impacts by improving obstetrical services are discussed further in the section on Delivery Services. Other major health problems for infants include diarrheal diseases and malnutrition (Grantham-MG4regor, 1982; Melville et al., 1987; Powell et al., 1988; Sheffer et al., 1981; Bailey, 1988). Fonaroff (1975) claimed that hospital admissions and deaths for children 1 to 5 years of age were mostly for malnutrition and gastroenteric diseases. The malnutrition experienced then may have important implications for maternal health now if the effects were lasting; the children who suffered impaired development during the 1970s are delivering babies now. Fortunately, there does not seem to be any evidence of unusually high numbers of obstructed births as is commonly seen in Africa as a result of child malnutrition. Alsc xmiparisons made between 1970 and 1978 found decreasing incidence of protein-calorie malnutrition ill children under 5 (from 50.2% at normal weight to 61.1%; World Bank, 1987). Improvements may have leveled off however; in 1978 6.8% of preschool children were moderately malnourished and 1% were classified as severe. In 1905 6.9% were moderately, and 1.1% were severely, malnourished (Powell et al., 1988). Malnutrition in young children in the Third World often has its roots in lack of breastfeeding or poor weaning practices which, coupled with diarrhea, result in chronic infections, {eight loss or failure-to-thrive, and nutritional deficiencies. Early weaning was in fact, identified as the single most important factor causing malnutrition and infant mortality in Jamaica in the late 1960s (Jelliffe, 1968). The government responded and in 1977 launched a public health education campaign with the prcmotion of breastfeeding as one of the five main messages (Baer, 1981). The campaign 8