The Ngaglik study: an inquiry into birth interval dynamics and maternal and child health in rural Java.

Preliminary analysis of the Ngaglik Study has been able to confirm much of what we knew about birth interval dynamics from past retrospective studies, while also adding new insights into birth spacing and maternal and child health in rural Java. In Ngaglik, a median duration of breast-feeding of over 2 years is associated with durations of lactational amenorrhoea of over a year on average, despite the very early introduction of other foods in the infant diet. Postpartum abstinence appears to play a role in birth spacing for many women, though as previous research has shown, it does not extend throughout the breast-feeding period and tends to be more abbreviated among younger, higher socioeconomic status individuals. The extent to which maternal nutrition affects the return of postpartum fecundity will be a central topic for more detailed investigation, though preliminary results do not lend support to nutrition as a major determinant. The anthropometry of women during pregnancy shows strong evidence of nutritional stress during the third trimester and, in general, provides valuable data for comparison with other Indonesian and international data. Maternal nutritional measurement during the postpartum period is perhaps even more valuable, since few studies anywhere have recorded detailed patterns of change during the months following childbirth. Among Ngaglik women, for example, upper arm measurements show very low values immediately after parturition, rising during the early months postpartum prior to a gradual decline. Nutritional indicators for lactators are somewhat higher than for non-lactators over the first year postpartum. Morbidity data for both mothers and children show frequent reported illness episodes and a wide variety of modern and traditional treatment patterns. The more than 8 000 observations of infant growth provide one of the few sources of such information for an Indonesian population, and data on primary tooth eruption will be used to relate dentition patterns to exact ages of child. A distinctive feature of the Ngaglik Study is the inclusion of attitudinal data and information on beliefs and customs, which will aid in interpreting behaviour patterns, will allow future detailed analysis to be set in a cultural context, and will help in the design of modern health and nutrition intervention programmes aimed at women and children during their most vulnerable stages of the life-cycle.