He is also minor advisor to students working on:

• The impact of carotene-rich food supplementation on Vitamin A and iron status of lactating women in Zimbabwe[10,11]
• An five-year follow up evaluation of a food-based vitamin A pilot project in Singida, Tanzania[12]
• Management issues in Iodine deficiency programs in Tanzania and the Central African Republic[13]
• Exclusive breastfeeding in Uppsala, Sweden[14]
• The prevalence and determinants of exclusive breastfeeding in two rural districts in Zimbabwe
• Iodine deficiency in Zimbabwe

For over 20 years Ted has been involved at national and international levels in program and policy issues related to breastfeeding and other nutrition issues. His first publications established the first scientific evidence that commercial marketing of baby foods had a negative influence on how women feed their babies. [15,16]

At an international meeting in 1977, Ted pointed out the importance of women's time as a factor that needed more attention in the context of health and nutrition programs. "Certainly the unequal burden carried by women is a problem crying out for intervention. While we have begun to realize the folly of recommending changes in food habits which require the purchase of more expensive foods, we may have to re-evaluate nutrition education which requires more time input on the mother’s part (e.g., the preparation of multimix weaning foods in the home). One promising and relatively unexplored method of intervention is to educate fathers to take a more active role in child care as well as other traditionally women’s activities." [17] Since then he has written several papers on the issue of the working woman’s right to breastfeed. [18-22] His overall policy stance was expressed in the brochure he produced together with colleagues at ICH and UNICEF for the WABA Forum in Bangkok in December, 1996 [23]. This has been refined and included as part of a WABA website he worked with me to put together on the issue of the Breastfeeding Rights of Working Women.

Another of his areas of interest has been the design of breastfeeding programs, particularly at community level. In 1981 he wrote a paper [24]on community-based aspects of breastfeeding programming--that is, everything except health worker training which, though important, is unfortunately the only aspect that has received much attention. This paper was said to be influential in the process which led up to the Innocenti Declaration. For example, here he argued that each country needs a national breastfeeding coordinator and this was included as an Innocenti target. Unfortunately, one of points he made has been lost: having such a person is valuable, but the real issue is accountability. He points out that vaccination rates only began to increase when someone actually got in trouble if vaccines that happened to arrive at the airport on Sunday and spoiled because no one picked them up. Many people may worry about it, but real improvement will more likely come when someone is responsible for improving breastfeeding practices.

In 1982, Ted introduced the concept of "protect, support and promote," first at a meeting in Sweden and later in a paper for a USAID - funded research consortium. [25] The language was quickly taken up by UN and other agencies, but not the major concepts, as explained in a paper published in 1993. [26] The crucial point is that it is inappropriate to promote breastfeeding until programs are in place to protect the breastfeeding that is already going on from commercial and other threats and to provide women with the support they need to succeed.

For one year in 1978-9, with funding from the Rockefeller Foundation, Ted assisted the government and donor agencies in Yemen to determine the reasons that bottle feeding was increasing so rapidly, causing great harm to maternal and child health. [27] A baseline study of infant feeding practices was conducted in three urban areas.

Several months later, he returned to help pilot test a breastfeeding promotion program. In the town of Ibb, several measures were taken to raise the awareness and skills of health workers at the local maternal and child health clinic. An anthropologist, a nurse and a local woman who had breastfed her own children were hired to develop and implement both a clinic-based and a community-based intervention strategy.

One and a half years later a repeat study of infant feeding practices showed that at three months of age the proportion of babies breastfed in Ibb increased from 52% to 83% and the proportion doing so without concurrently bottle feeding increased from 37% to 45%, but the latter was not statistically significant. At the same time in another urban area where breastfeeding had been promoted early but not during the year of the study, there was no change in breastfeeding duration. In a third area breastfeeding declined during this period, perhaps reflecting the fact that the local maternal and child health center seemed to have decided that breastfeeding was doomed and worked more on teaching proper bottle feeding instead.

Ted believes that artificial feeding, like caesarian section, can save lives when needed in an emergency. However, clearly it is inferior and should be used with care. He has studied the economic losses associated with artificial feeding but feels that these are a minor component of the harm done [28-31]. He was the major author of the WABA Action Folder for the 1998 World Breastfeeding Week on this theme as well as the Action Folder for the year 2000 on breastfeeding as a human right.

That breastfeeding is a human right means that society must make changes to provide the support women and children need, such as the six months’ paid leave women need to achieve exclusive breastfeeding. He has been an active participant in the Maternity Protection Alliance which has joined unions, governments and others in successfully advocating for a stronger ILO Convention (183) and Recommendation (191) on Maternity Protection. Like voting rights, there should be no question about how much the social changes needed to support breastfeeding cost. And, like voting, there is no question of forcing someone to take advantage of these rights.

I hope you enjoy these breastfeeding papers as I did when I was producing this website. Many of them will be useful for people working to protect, support and promote breastfeeding in their own country. If you have any question or comments, Ted will be happy to read it in his guestbook. Although he travels a lot, he will always answer as soon as it is possible for him to do so."

Denise Arcoverde
Webmaster

(Below I have asked Ted to write something about his other interests in life.)

"My other areas of professional work besides breastfeeding include overall policy and program issues related to nutrition in developing countries, the life cycle approach to nutrition (which suggests that more attention is needed to women's nutrition, especially in adolescence), and practical approaches to overcoming micronutrient deficiencies. My students and I have worked extensively with dietary approaches to prevent vitamin A deficiency. The most impressive project I have cooperated with is the Comprehensive Nutrition and Blindness Prevention Progam run by the Worldview International Foundation in Bangladesh. [32], [33], [34]

I love living in Stockholm. I live a seven-minute bike ride from where this picture was taken.

Stockholm is a city on water -- you can do sightseeing by boat!

I work in another beautiful old city, Uppsala. It is a forty-minute train ride from Stockholm. The mass transit is so good here that I don’t need a car. Weather permitting, I bicycle to the train station every day. I have lakes on at least one side of me nearly the whole way. And I am travelling on special bicycle paths that reduce one’s exposure to risks and pollution.

But you still need a helmet! Bicycling is the best way to reduce pollution and energy waste in commuting to work or running errands. One gets exercise while saving money!

I love reading in the little time I set aside for it and in particular look forward to each new book by my two favorite authors, eerily both from the state of Indiana: Kurt Vonnegut and Dan Simmons.

Along with work and family, the biggest influence on my life has come from Sant Kirpal Singh, founder of the Science of the Soul, not a religion, but promoting spirituality within all religions.

Ted Greiner 

Publications

1. Persson V, Greiner T, Bhagwat IP, and Gebre-Medhin, M. The Helen Keller International Food Frequency Method may underestimate vitamin A intake where milk is a normal part of the young child diet. Ecology of Food and Nutrition.38:57-69, 1999.

2. Persson V, Greiner G, Islam S, and Gebre-Medhin M. The Helen Keller International Food Frequency Method underestimates vitamin A intake where sustained breastfeeding is common. Food and Nutrition Bulletin 19:343-346, 1998.

3. Persson V, Ahmed F, Gebre-Medhin M and Greiner T. Relationships between vitamin A, iron status and helminthiasis in Bangladeshi school children. Public Health Nutrition 3(1):83-89, 2000.

4. Persson V, Ahmed F, Gebre-Medhin M and Greiner T. Increase in serum beta-carotene following dark green leafy vegetable supplementation in Mebendazole-treated school children in Bangladesh. European Journal of Clinical Nutrition 55:1-9, 2001.

5. Persson V, Winkvist A, Hartini TNS, Greiner T, Stenlund H. Variability in nutrient intake among pregnant women in Indonesia: implications for the design of epidemiological studies using the 24-hour diet recall method. Journal of Nutrition 131:325-330, 2001.

6. Shirima R, Greiner T, Kylberg E, and Gebre-Medhin M. Exclusive breastfeeding is rarely practiced in rural and urban Morogoro, Tanzania. Accepted for publication, Public Health Nutrition.

7. Shirima R, Gebre-Medhin M and Greiner T. Information and not socio-economic factors is associated with early infant feeding patterns in rural and urban Morogoro, Tanzania. Accepted for publication in Acta Pediatrica.

8. Monárrez J and Greiner T. Anthropometry in Tarahumara women of reproductive-age in northern Mexico: is overweight becoming a problem? Ecology of Food and Nutrition 39:437-58, 2000.

9. Agnarsson I, Mpello A, Gunnlaugsson G, Hofvander Y, and Greiner T. Infant feeding practices during the first six months of life in a rural area in Tanzania. East African Medical Journal 78, 2001 (in press).

10. Ncube TN, Malaba L, Greiner T, Gebre-Medhin M. Evidence of grave vitamin A deficiency among lactating women in the semi-arid rural area of Makhaza in Zimbabwe. A population-based study. Accepted for publication, European Journal of Clinical Nutrition.

11. Ncube TN, Greiner T, Malaba LC, and Gebre-Medhin M. Supplementing lactating women with pureed papaya and grated carrots improves vitamin A status. A placebo-controlled trial. Accepted for publication, Journal of Nutrition.

12. Kidala D, Greiner T, Gebre-Medhin M. Positive effects of vitamin A intervention may be masked by helminth infections. Accepted for publication, Public Health Nutrition 3:425-431, 2000.

13. Peterson S, Assey V, Forsberg BC, Greiner T, Kavishe FP, Mduma B, Rosling H, Sanga AB and Gebre-Medhin M. Coverage and cost of iodized oil capsule distribution in Tanzania. Health Policy and Planning 14:390-399, 1999.

14. Aarts C, Kylberg E, Hörnell A, Hofvander Y, Gebre-Medhin M, and Greiner T. How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data. December, 2000, International Journal of Epidemiology 29:1041-6, 2000.

15. Greiner T and Latham M. The influence of infant food advertising on infant feeding practices in St. Vincent. International Journal of Health Services 12:53-75, 1982.

16. Greiner T. The promotion of bottle feeding by multinational corporations: how advertising and the health professions have contributed. Cornell International Nutrition Monograph Series No. 2, 1975.

17. Greiner T. Breast-feeding in decline: perspectives on the causes. In: Jelliffe DB et al (eds), Lactation, Fertility and the Working Woman. London: IPPF, 1979, pp 61-70.

18. Rea MF, Venâncio SI, Batista LE, Dos Santos RG, and Greiner T. Possibilidades e limitações da amamentação entre mulheres trabalhadoras formais. Revista de Saúde Publica 31(2):149-156, 1997

19. Greiner T. Breastfeeding and work. Int J Gynecol Obstet 47 (Suppl):S51-53, 1994.

20. Greiner T. Breastfeeding and maternal employment: another perspective (guest editorial). Journal of Human Lactation 9(4):214-215, 1993.

21. Greiner T. Breastfeeding and working women: thinking strategically. Background paper prepared for the UNICEF Workshop on Work, Women and Breastfeeding, Brasilia, May 26-June 1, 1990.

22. Van Esterik P and Greiner T. Breastfeeding and women`s work: constraints and opportunities. Studies in Family Planning 12: 184-197, 1981.

23. Lhotska L, Clark D, Greiner T, Kylberg E, Omer-Salim A. Strategies for the breastfeeding rights of working women. Workshop and brochure presented at the World Alliance for Breastfeeding Action Global Forum, Bangkok, Thailand, 2-6 December 1996.

24. Greiner T. Action Programmes at community level for increasing breastfeeding, June, 1981. Nutrition Planning 4:(4):59-60, Abstract No. 1824.

25. Greiner T. Infant feeding policy options for governments. Report to the USAID-funded Infant Feeding Study Consortium: Population Council, Cornell University and Columbia University. November, 1982.

26. Greiner T. Infant and young child nutrition: a historic review from a communication perspective. Introduction to: Koniz-Booher (ed.) Communication Strategies to Support Infant and Young Child Nutrition. Cornell International Nutrition Monographs 24-25 (combined), 1993, pp. 7-15.

27. Greiner T. The Planning, Implementation and Evaluation of a Project to Protect, Support and Promote Breastfeeding in the Yemen Arab Republic. PhD Dissertation, Cornell University, Ithaca, NY, 1983.

28. Greiner T. Some economic and social implications of breastfeeding. UNICEF Journalists' Seminar on Breastfeeding. Harare, Zimbabwe, January, 1983. (Published in Thomas M., Investment Appraisal of Supportive Measures to Working Mothers in Developing Countries. Commonwealth Secretariat, London and WHO, Geneva, 1984.)

29. Almroth S, Greiner T and Latham MC. The economic importance of breastfeeding. Food and Nutrition (FAO) 5(2):4-10, 1979.

30. Almroth S and Greiner T. The economic value of breastfeeding. FAO Food and Nutrition Paper No. 11, 1979. Published in English and French.

31. Greiner T, Almroth S and Latham MC. The economic value of breastfeeding (with results from research conducted in Ghana and the Ivory Coast). Cornell International Nutrition Monograph Series No. 6, 1979.

32. Greiner T. Rapid appraisal before impact evaluation studies. World Health Forum 18(1):66-67, 1997.

33. Greiner T and Mitra SN. Evaluation of the impact of a food-based approach to solving vitamin a deficiency in Bangladesh. Food and Nutrition Bulletin 16(3):193-205, 1995.

34. Greiner T and Mannan MA. Increasing micronutrient intakes in rural Bangladesh: An NGO's search for sustainability. In: Scaling Up and Scaling Down: Overcoming Malnutrition in Developing Countries, Marchione T (editor). London: Gordon and Breach, 1999, pp. 157-177.

35. Zhao Y, Niu AM, Xu GF, Garrett MJ, Greiner T. Early infant feeding practices in Jinan City, Shandong Province, China. Asia Pacific Journal of Clinical Nutrition 12(1):104-108, 2003.

36. Persson V, Hartini TNS, Greiner T, Haakimi M, Stenlund H and Winkvist A. Vitamin A intake is low among pregnant women in Central Java, Indonesia. International Journal of Vitamin and Nutrition Research 72(3):124-132, 2002.

37. Monárrez-Espino J, Martínez H, Martínez-Juárez V, Greiner T. Nutritional status of indigenous children at boarding schools in northern Mexico. Accepted for publication, European Journal of Clinical Nutrition.

38. Monárrez J, Martínez H and Greiner T. Iron deficiency anemia in Tarahumara women of reproductive age in Northern Mexico. Salud Pública de México 43(5):392-401, 2001.

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