Abstract : In Sierra Leone, where infant and child mortality rates are quite high, a large proportion of small children from 1 to 5 years are fostered: living away from their mothers. This paper examines the relationships between fosterage and child feeding practices and children's access to Western medical care especially among the Mende. Ethnographic data from field studies in Sierra Leone are combined with quantitative data from Serabu Hospital, which show that fostered children are underrepresented in hospital admissions and that young fosters present more problems of malnutrition. (Fostered girls appear to be at more risk in both these categories than boys.) Unlike young fosters, however, older ones do not appear to be at more risk than children with mothers. These results are related to patterns of intrahousehold discrimination in food allocation and access to medical treatment for young fostered children: especially those sent to elderly rural caretakers. It is unlikely that high rates of fostering are the sole reason--or even the most important one--for the Mende's high child mortality rates. It is clear that fostering plays important social roles for the Mende and is likely to continue as a central aspect of Mende childbearing practices, if not to increase, because of economic problems. Health programs must be designed to seek out those fostered children who might be disadvantaged. Health programs and surveys aimed at women and their children often miss fostered children and programs need to target them. Fosterage also raises questions about the usual approach to studying child mortality in developing countries--neither the household characteristics of the guardians nor the characteristics of the biologic parents may be reasonable indicators of the child's mortality risks. Social barriers within the foster family and geographic separation from parental influence are factors. (author's modified)
Notes : English
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