This is a website Denise Arcoverde put together with me to some of the papers I have written more easily available.

I obtained a bachelor’s degree in biology and psychology at Colorado College in beautiful Colorado Springs where I loved both the liberal arts atmosphere and the high altitude atmosphere!

After receiving a masters degree in education at Washington University in St. Louis (the city of my birth) and working for a few years as a primary school teacher, I changed careers and studied nutriton, receiving a PhD in international nutrition and in communication, both related to the situation in developing countries, at Cornell University in Ithaca, NY, surely one of the best universities and loveliest towns in the east. Though an American, I lived for about 20 years in Sweden and am now also a Swedish citizen.

During those years I provided consulting services to the Swedish International Development Cooperation Agency, Sida, and other donor agencies but worked mainly as a “Docent” (doesn’t exist in the US academic system, but we translate it as “associate professor”) in International Child Health. This involved advising masters and PhD students and teaching graduate courses in nutrition, infant feeding and research methodology. I also headed a research group in in international nutrition at the International Maternal and Child Health section of the Department of Women’s and Children’s Health of Uppsala University Medical School.

My students did research on the following topics (the numbers are citations to articles listed below):

• Dietary issues in combatting Vitamin A deficiency in India, Bangladesh, and Indonesia [Viveka Persson, 1,2,3,4,5,36]
• Levels of anemia and overweight among the Tarahumara Indians of northern Mexico [Joel Espino Monarrez, 8, 37, 38, 46-48]
• The prevalence and determinants of exclusive breastfeeding in

1. a rural and an urban area of Morogoro, Tanzania [Restituta Shirima, 6,7]
2. Jinan City, China [Ying Zhao, 35],
3. among Bangladeshi immigrants to Stockholm (Zeenath Rehana–thesis available on this website), and
4. in a village in Tabora Region, Tanzania [Ingvor Agnarsson, 9]

• Vitamin A deficiency in Beijing and Guizhou, China [Jiang Jingxiong, 51]
• Studies aimed at improving the effectiveness of programs to prevent mother to child transmission of HIV in southern Africa (Mickey Chopra, in progress)
• Improving infant feeding counselling in the context of HIV in South Africa [Tanya Doherty, 44]
• Improving methods of iodizing salt among small producers in Tanzania [Vincent Assay, 41, 49, 50]
• Bacterial Contamination and Nutrient Concentration of Infant Milk in South Africa [Erika Andresen (nee Bergström), 52]
• Responses of HIV-Positive Mothers to Infant Feeding Counselling in South Africa (Hanna Eneroth, thesis available on this website)
• Dietary acculturation of Chinese residents in Uppsala (Su Hebate, thesis available on this website)
• Attitudes and practices related to cardiovascular risk factors among Chinese residents in Uppsala (Wen Chen, thesis available on this website)

I was also minor advisor to students working on:

1. The impact of carotene-rich food supplementation on Vitamin A and iron status of lactating women in Zimbabwe [Thodozile Ncube, 10,11]
2. An five-year follow up evaluation of a food-based vitamin A pilot project in Singida, Tanzania [Diana Kidala, 12]
3. Management issues in Iodine deficiency programs in Tanzania and the Central African Republic [Stefan Peterson, 13]
4. Exclusive breastfeeding in Uppsala, Sweden [Clara Aarts, 14]
5. The prevalence and determinants of exclusive breastfeeding in two rural districts in Zimbabwe (Rufaro Madzima)
6. Iodine deficiency in Zimbabwe (Judith Mutamba, thesis available on this website)
7. Prevention of childhood obesity in Beijing, China [Jiang Jingxiong, 39, 40, 42]
8. Health education to prevent anemia in India [Pernilla Ny, 43]

For over 30 years I have been involved at national and international levels in program and policy issues related to breastfeeding and other nutrition issues. My 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, I 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 I have written several papers on the issue of the working woman s right to breastfeed. [18-22] My overall policy stance was expressed in the brochure I wrote 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 Denise and I did on the issue of the Breastfeeding Rights of Working Women.

Another of my areas of interest has been the design of breastfeeding programs, particularly at community level. In 1981 I 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, I argued that each country needs a national breastfeeding coordinator and this was included as an Innocenti target.

Unfortunately, one of points I made has been lost: having such a person is valuable, but the real issue is accountability. 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 1981, I 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, I 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, I 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 survey 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.

I believe 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. I studied the economic losses associated with artificial feeding but feel that these are a minor component of the harm it does [28-31]. I 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 a minimum of six months paid leave to enable women to achieve exclusive breastfeeding. I have 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. 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, I will be happy to read them in my guestbook. I do not check it often but will respond eventually.

My other interests
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.

In late 2004, after 19 years at Uppsala University, I moved to Washington DC to work at PATH, a US-based non-profit NGO that works to improve health in low-income countries. While it works more broadly now, PATH started as an appropriate technology company and I now am director of one of its many programs for developing and introducing such a technology–in this case, a techology for fortifying rice called Ultra Rice. It’s a clever way to fortify rice with virtually any nutrients at any levels in a way that protects them from getting rinsed away when people rinse it before cooking it. It does not use any genetic modifcation and all ingredients are Codex Alimentarius compliant.

In Uppsala, my students and I 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 loved living in Stockholm, a city on water – you can do sightseeing by boat!

I worked in another beautiful old city, Uppsala. It is a forty-minute train ride from Stockholm. The mass transit is so good in both Stockholm and Washington DC that I have not needed a car in either place. Weather permitting, I bicycled to the train station every day in Stockholm. I had lakes on at least one side of me nearly the whole way. And I cycled on special bicycle paths that reduce one’s exposure to risks and pollution.

In the USA I don’t think such bicycle paths for commuters (as opposed to recreational cyclists) are common. Certainly they are not in DC and I have sadly had to give up commuting by bicycle and use the Metro instead. 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. I’ve developed an interest in the American Civil War and reading about it is my passion now.

Denise and I love being together. We loved Stockholm and now we love Washington DC too. We love visiting the many huge, free Smithsonian museums.

Along with work and family, the biggest influence on my life has come from Sant Kirpal Singh, founder of the Science of Spirituality, 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, Hornell 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, Venancio SI, Batista LE, Dos Santos RG, and Greiner T. Possibilidades e limitacoes da amamentacao entre mulheres trabalhadoras formais. Revista de Saude 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 Journalistsé 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 NGOés 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, Martinez H, Martinez-Juarez V, Greiner T. Nutritional status of indigenous children at boarding schools in northern Mexico. European Journal of Clinical Nutrition 58:532-540, 2004.

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

39. Jiang JX, Rosenqvist U, Wang H, Greiner T, Lian G, Sarkadi A. The influence of grandparents on eating behaviours of young children in Chinese three-generation families. Accepted for publication, Appetite.

40. Jiang JX, Xia X, Greiner T, Wu G, Rosenqvist U. Three-year school-based intervention to reduce the prevalence of obesity. Accepted for publication, Child: Care, Health & Development.

41. Assey VD, Greiner T, Mzee RK, Abuu H, Mgoba C, Kimboka S, Peterson S. Iodine deficiency persists in the Zanzibar Islands of Tanzania. Food and Nutrition Bulletin 27(4):292-299, 2006.

42. Jiang JX, Rosenqvist U, Wang H, Greiner T, Ma Y, Toschke AM, Risk factors for overweight in 2- to 6-y-old children in Beijing, China. International Journal of Pediatric Obesity 2006;1(2):103-108.

43. Ny P, Dejin-Karlsson E,Uden G, Greiner T. Health education to prevent anemia among women of reproductive age in southern India. Health Care for Women International 2006;27:131-141.

44. Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T. Effect of the HIV
epidemic on infant feeding in South Africa: “When they see me coming with the tins they laugh at me”. WHO Bulletin 2006;84(2):90-96.

45. Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U. A two year family based behaviour treatment for obese children. Arch Dis Child. 2005;90(12):1235-8.

46. Monárrez-Espino J, Greiner T. Iodine nutrition among indigenous Tarahumara schoolchildren in Mexico. Eur J Clin Nutr. 2005;59(10):1213-6.

47. Monárrez-Espino J, Greiner T, Caballero Hoyos R. Perception of food and body shape as dimensions of Western acculturation potentially linked to overweight in Tarahumara women of Mexico. Ecology of Food and Nutrition 43(3):193-212, 2004.

48. Monárrez-Espino J, Greiner T, Martá­nez H. Rapid qualitative assessment to design a food-aid basket for young Tarahumara children in Mexico. Scandinavian Journal of Nutrition 48(1):4-12, 2004.

49. Assey VD, Peterson S, Greiner T. Sustainable universal salt iodization in low-income countries - time to re-think strategies? Eur J Clin Nutr. 2007 Mar 21; [Epub ahead of print]

50. Assey VD, Mgoba C, Mlingi N, Sanga A, Ndossi GD, Greiner T, Peterson S. Remaining challenges in Tanzania’s efforts to eliminate iodine deficiency. Public Health Nutr. 2007 Feb 22;:1-7 [Epub ahead of print].

51. Jiang JX, Lin LM, Lian GL, Greiner T. Vitamin A deficiency and child feeding in Beijing and Guizhou, China. World J Pediatr. 2008;4(1):20-5.