The Handmaids Tale - short summary Essay Example for Free

The Handmaids Tale short summary Essay The novel The Handmaids Tale written by Margret Atwood is about how the government chose to control the way the community was run and control the lives of men and women. The novel tells the story from the perspective of a middle-aged woman named Offred who questions societys accepted beliefs and conventions. Offred is a handmaid in the Republic of Gilead who is constantly questioning the government beliefs and rules. Her character pushes the limits set out by the government. This is thoroughly illustrated through her defiance of against the social conventions, her methods of challenging them and the final outcome of her challenge. Firstly, Offred challenges many laws within The Handmaids Tale including socializing with the commander and Nick, and being in the sitting room. Handmaids are a class who are not to socialize with the commander; Offred explains, Its forbidden for us to be alone with the commanders (Atwood 128). She spends a large amount of time with the commander although she is well aware of the laws within the community. Being a handmaid Offred is not allowed into the sitting room. One night she wanders down to the sitting room to try something new, she is there to be independent; she likes to be on her own. I like this. I am doing something, on my own. The active Tense. Tensed. What I would like to steal is a knife from the kitchen, but Im not ready for that (Atwood 92). At this point Nick interrupts her. Nick and Offred are not allowed to associate with each other. I freeze, white was a mistake. Im snow in moonlight, even in the dark (Atwood 92). She breaks laws, knows what she is doing to be wrong but her need to test the laws convinces her to proceed. Secondly, the novel indicates that Offred breaks many laws by spending time alone with the commanders and her presence in the sitting room with Nick. Offred visits with the commander and plays scrabble with him. Id like you to play a game of Scrabble with me. he says (Atwood 130). In playing scrabble she breaks the law against handmaids spending independent time with commanders without the supervision of the wife. One night she heads down into the sitting room to do something rebellious. She has the thought of stealing. In the wood at midnight, magic flower. A withered daffodil with daffodils will soon be thrown out (Atwood 92). Shortly after Nick interrupts her. He puts his hand on my arm, pulls me against him, his mouth on mine, what else comes from such denial? Without a word. Both of us shaking, how Id like to. In Serenas parlour, with the direct flowers on the Chinese carpet, his thin body My hand goes down I could unbutton, and then. But its too dangerous (Atwood 92) Although she is cautious about her choices she still breaks the laws, she knows what she is doing and she still continues. Finally, while ignoring the laws, Offred gains many things including the need for and the suffering, excitement, laughter and love of a strong friendship. After her interaction with Nick she becomes confused and anxious You can wet the rim of a glass. This is what I feel like: this sound of glass. I feel like the word shatter. I want to be with someone (Atwood 97). She is afraid. She does not know what to think about this passion she is having. But this is wrong; nobody dies from lack of sex. Its lack of love we die from. There is nobody her I can love, all the people I could love are dead or elsewhere. Who knows where they are or what their names are now? They might as well be nowhere, as I am for them. (Atwood 97) The friendship she gains with the commander affects her in powerful ways, she begins to feel differently about herself. I am thirty-three years old. I have brown hair. I stand five seven without shoes. I have trouble remembering what I used to look like. I have viable ovaries. I have one more chance Circumstances have altered (Atwood 135). It is shown that her actions cause her confusion and she is in a state where she had begun to have hope. In conclusion, the author Margret Atwood follows the pattern of fictional novels with The Handmaids Tale by having the main character, Offred, constantly questioning the social beliefs and conventions in the Republic of Gilead. Offreds want for a better life is illustrated through her challenges against the social standards, her methods of testing them and the final outcome of her defiance. Sarah Driscoll January 17, 2005 Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Margaret Atwood section.

New Zealands Foreign Policy Analysis

New Zealands Foreign Policy Analysis Aaron Lloyd Over the last thirty years the economic rise of China has contributed to a worldwide shift in power. Discussing the current state of New Zealand’s relationship with both China and the United States of America (USA), this essay will outline likely future foreign policy choices. Authors such as Mosher and Krauthammer see the rise of China as a threat to the West that must be contained, a view which is not widely accepted. With reference to New Zealand’s recent economic and strategic success this essay will suggest that future foreign policy must work to deepen relations with both countries. New Zealand must not choose between China nor the USA, instead a broad based approach to trade and international relations should be maintained. In 2008 New Zealand was the first of the Organisation for Economic Co-operation and Development countries to sign a Free Trade Agreement (FTA) with China.[1] As a result China has overtaken the USA as our second largest trading partner, with exports increasing from NZ$2.3 billion in 2008 to NZ$6.7 billion in 2012.[2] In 2010 New Zealand set the goal of doubling two way trade with China by 2015, a goal which was achieved a full year earlier.[3] Speaking to the New Zealand Institute of International Affairs (NZIIA) in 2010 John Key described New Zealand China relations as â€Å"unquestionably and unashamedly an economic relationship†.[4] Without pausing the New Zealand and Chinese governments have been quick to capitalize on this recent economic success. The goal is now to further increase two way trade to NZ$30 billion by 2020.[5] On economic terms at least New Zealand’s relationship with China can be considered excellent. However, casting the net beyond economic measur es there are aspects of the relationship that remain sensitive to the New Zealand public. Whilst New Zealand has enjoyed an economically successful relationship with China, that success has not been as widely reciprocated in other areas of society. In 2012 Shanghai Pengxin – a Chinese firm – attempted to purchase dairy farms previously owned by New Zealand firm Crafar Farms.[6] The event caused an intense debate within New Zealand, to such an extent that the sale was subject to court order blocking the bid before it was eventually approved four months later.[7] Despite several years of significant economic involvement, defence engagement over the same period has been categorized as modest.[8] Reciprocal ship visits between the Chinese and New Zealand Navy have only been occurring since 2013.[9] This highlights a contrasting picture of New Zealand and Chinese relations. On the one hand a strong economic relationship, yet on the other a cultural and security relationship that is still in its infancy. This is in sharp contrast to New Zealand’s recent re- engagement with the USA. In the last decade New Zealand’s relationship with the USA has improved significantly. In the 1980’s defence and security ties with the USA were frozen following disputes over nuclear ship visits to New Zealand.[10] In the following twelve years military involvement was minimal with only limited intelligence sharing.[11] New Zealand’s profile in the last decade – characterised by difficult military involvement in Afghanistan – has been conducive to warmer relations with Washington.[12] In addition to New Zealand’s proactive involvement in Afghanistan and the Pacific region, the rise of China has given the USA more impetus to strengthen relations with traditional pacific based allies.[13] New Zealand’s anti-nuclear policy of 1987 remains in force, however both countries now agree this is a part of history and not limiting to future relations.[14] As a result New Zealand has resumed full intelligence sharing and combined military exercis es are again in occurrence. New Zealand Naval ships are once again permitted into USA ports and New Zealand is now in attendance at USA lead exercises such as the Rim of the Pacific Exercise (RIMPAC).[15] These improving trends lead former USA Secretary of State Hillary Clinton to refer to New Zealand-USA relations as â€Å"the strongest and most productive in 25 years†.[16] Political, diplomatic and defence relations have thus improved significantly since the 1980’s. These improvements, whilst significant in terms regional security and co-operation have not translated into broader economic advancement for New Zealand. Despite the significant advancement of the Chinese economy, the USA economy still remains strong. The USA is New Zealand’s third largest trade partner and for over a decade a free trade agreement has been sought.[17] A large focus of current trade negotiation is focused on the Trans Pacific Partnership (TPP). This is a twelve nation regional free trade agreement – which includes New Zealand and the USA – reported as bringing New Zealand up to US$4.1 billion in increased exports by 2025[18]. According to the Ministry of Foreign Affairs and Trade the TPP agreement is in its final stages, however these negotiations have been ongoing since 2008.[19] USA concern over intellectual property rights is cited as a reason for negotiation delay.[20] Whilst New Zealand enjoys a healthy economic relationship with the USA, long lasting trade negotiations are stalling future economic potential. Relations with China and the USA are thus contrasting. On the one hand New Zealand en joys an economic advantage from China, and on the other improved strategic and military ties with the USA. Future foreign policy must seek to maximise both. Based on the current relationship trends future policy directions can be surmised. New Zealand will wish to continue and build on the success of the economic relationship with China. In pursuing this advancement the issue of trade dependency has been raised. This is with reference to the historical context when New Zealand was largely dependent on trade with the United Kingdom. Risk diversification has therefore been highlighted as a key theme for contemporary trade policies. The TPP for example, involves many different countries and is seen as a way of spreading the risk to guard against potential future economic difficulties.[21] There is widespread agreement that future relations with China should not just be based on trade with little else. Powles for example believes that to truly capitalize on the economic relationship a greater depth of understanding of Chinese culture will be required in order to progress[22]. This is needed because New Zealand does not share the commonalitie s in history and language that it does with traditional Anglosphere partners. In the past this commonality has given New Zealand a greater voice and understanding despite our relative size and geographic isolation.[23] As the influence of Asia increases in the world, future policy decisions will thus require a greater depth of cultural and historical understanding. In achieving a deeper relationship with China, New Zealand must not jeopardise wider relationships with traditional or emerging partnerships. Outside of relations with the USA and China, New Zealand enjoys significant economic and diplomatic relations with many other countries. With Australia for example, New Zealand has spent considerable effort enhancing diplomatic relations. Closer Economic Relations (CER) which were both agreed between New Zealand and Australia in the early 1980’s, are an important example of this effort.[24] Australia remains New Zealand’s largest export market.[25] New Zealand has also succeeded in implementing free trade agreements with Hong Kong and Malaysia.[26] In the future these and other relationships will remain necessary in order to improve trade and maintain strategic balance.[27] While current and future foreign policy will work to strengthen relations with both the USA and China, it not must be at the expense of emerging or other traditional relations. New Zealand enjoys a wide range of international relations as a result of its independent foreign policy. Consensus is that relations with either China or the USA are likely to be strained if New Zealand loses objectivity and in the future New Zealand must continue to be seen as a friend to both but not aligned either.[28] New Zealand’s anti-nuclear stance saw John Key invited President Barrack Obama’s nuclear security summit in Washington recognition of New Zealand’s ability to maintain its independent voice against larger powers.[29] As the influence of China rises in our area, it is important for New Zealand to maintain an independent approach and ensure our own traditions remain intact.[30] This essay has discussed the current state of New Zealand’s relationship with both the USA and China, focusing specifically on recent economic and diplomatic relations. Examining in particular the strength of New Zealand’s recent economic success with China, it has been proven that New Zealand will wish this economic advancement to continue. Previous lessons of economic dependence have been learned and future trade policies will seek a wide base. New Zealand’s economic relationship with the USA – whilst surpassed by China – still remains significant and has many potential benefits in the years ahead. Diplomatic and military relations with the USA have largely become normalised again, whilst similar engagements with China are merely just beginning. A lack of cultural and historical understanding of China – compared to that of traditional Anglosphere partners – hampers contemporary involvement. Overall, it is evident that future foreign policy will want to capitalize on the successful aspects of both relations, but not at the expense of other traditional and emerging partners. BIBLIOGRAPHY Australia, New Zealand Ministry of Foreign Affairs and Trade, accessed: 12 February 2015. http://www.mfat.govt.nz/Countries/Australia/Australia.php Ayson, Robert. Choosing Ahead of Time? Australia, New Zealand and the US-China Contest in Asia. Contemporary Southeast Asia: A Journal of International Strategic Affairs 34, no. 3 (2012): 338-364. DOI: 10.1355/cs34-3b. Brady, Anne-Marie. â€Å"New Zealand-China Relations: Common points and Differences† New Zealand Journal of Asian Studies 10, no. 2 (2008) 1-20. http://www.nzasia.org.nz/downloads/NZJAS-Dec08/2_Brady_3.pdf China Export, New Zealand Trade and Enterprise, accessed: 07 February 2015 https://www.nzte.govt.nz/en/export/export-markets/greater-china/china/ Elder, Chris and Ayson, Robert, â€Å"China’s Rise and New Zealand’s Interests: A policy primer for 2030†, Centre for Strategic Studies Discussion Paper, No. 11 (2012). http://www.victoria.ac.nz/hppi/centres/strategic-studies/documents/DP11-12-Chinas-rise-and-NZs-interestsONLINE.pdf. Groser, Tim. Trading with China: A Success Story. New Zealand International Review 39, no. 5 (2014): 7-11. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=98383845site=eds-livescope=site. Jacobi, Stephen. â€Å"Turning dreams into reality† New Zealand International Review 36, no. 5 (2011): 17-20. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=65270856site=eds-livescope=site. Key, John. â€Å"New Zealand in the world† New Zealand International Review 35, no.6 (2010): 2-7. http://search.informit.com.au.ezproxy.massey.ac.nz/documentSummary;dn=536854149505279;res=IELHSS Key, John â€Å"Finding a way in a changing world† New Zealand International Review 37, no. 5 (2012): 10-13. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=79701425site=eds-livescope=site. Lanteigne, Marc. Chinese Foreign Policy: An Introduction. 2nd ed. London and New York: Routledge, 2013. Map, Wayne. The New Zealand Paradox, Adjusting to the change in balance of power in the Asia Pacific over the next 20 years, CSIS, (Centre for Strategic and International Studies), May 2014 http://reader.eblib.com.au.ezproxy.massey.ac.nz/(S(bjax1qdqmpglrgfmabxmblf5))/Reader.aspx?p=1687311o=76u=KGjZ3dJ3A9U3Dg/rttWjiw==t=1423524409h=464DE919F23875D4E7DEC547BE6938BB1CFF342Cs=16970573ut=173pg=1r=imgc=-1pat=ncms=-1sd=1# McKinnon, John. â€Å"New Zealand between America and China† New Zealand International Review 38, no. 6 (2013): 8-12. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=91978148site=eds-livescope=site. New Zealand-Australia Closer Economic Relations, New Zealand Ministry of Foreign Affairs and Trade, accessed: 12 February 2015. http://mfat.govt.nz/Trade-and-Economic-Relations/2-Trade-Relationships-and-Agreements/Australia/index.php Powles, Michael. â€Å"China and New Zealand at forty: what next?† New Zealand International Review 37, no. 6 (2012): 2-4. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=83342048site=eds-livescope=site. Sinclair, Paul, â€Å"New Zealand Expands Defence Ties With China – strategic discussion paper† Centre for Strategic Studies Last modified 24 July 2014. http://www.victoria.ac.nz/hppi/centres/strategic-studies/documents/18_New-Zealand-Expands-Defence-Ties-with-China.pdf. Trans Pacific Partnership (TPP) negotiations, New Zealand Ministry of Foreign Affairs and Trade, accessed: 10 February 2015. http://mfat.govt.nz/Trade-and-Economic-Relations/2-Trade-Relationships-and-Agreements/Trans-Pacific/index.php United States of America, New Zealand Ministry of Foreign Affairs and Trade, accessed: 10 February 2015. http://www.mfat.govt.nz/Countries/North-America/United-States.php 1 [1] Marc Lanteigne, Chinese Foreign Policy: An Introduction, 2nd ed. (London and New York: Routledge, 2013), 160-161. [2] â€Å"China Export†, New Zealand Trade and Enterprise, accessed: 07 February 2015 https://www.nzte.govt.nz/en/export/export-markets/greater-china/china/ [3] Tim Groser. Trading with China: A Success Story. New Zealand International Review 39, no. 5 (2014): 7. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=98383845site=eds-livescope=site [4] John Key. â€Å"New Zealand in the world† New Zealand International Review 35, no.6 (2010): 3. http://search.informit.com.au.ezproxy.massey.ac.nz/documentSummary;dn=536854149505279;res=IELHSS [5] Groser, â€Å"Trading with China: A Success Story,† 7. [6] Lanteigne, Chinese Foreign Policy: An Introduction, 160. [7] Ibid, 161. [8] John McKinnon. â€Å"New Zealand between America and China† New Zealand International Review 38, no. 6 (2013): 11. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=91978148site=eds-livescope=site. [9] Paul Sinclair, â€Å"New Zealand Expands Defence Ties With China – strategic discussion paper† Centre for Strategic Studies Last modified 24 July 2014. 1. http://www.victoria.ac.nz/hppi/centres/strategic-studies/documents/18_New-Zealand-Expands-Defence-Ties-with-China.pdf. [10] Robert Ayson. Choosing Ahead of Time? Australia, New Zealand and the US-China Contest in Asia. Contemporary Southeast Asia: A Journal of International Strategic Affairs 34, no. 3 (2012): 343-44. DOI: 10.1355/cs34-3b. [11] Wayne Map, The New Zealand Paradox, Adjusting to the change in balance of power in the Asia Pacific over the next 20 years, CSIS, (Centre for Strategic and International Studies), May 2014 http://reader.eblib.com.au.ezproxy.massey.ac.nz/(S(bjax1qdqmpglrgfmabxmblf5))/Reader.aspx?p=1687311o=76u=KGjZ3dJ3A9U3Dg/rttWjiw==t=1423524409h=464DE919F23875D4E7DEC547BE6938BB1CFF342Cs=16970573ut=173pg=1r=imgc=-1pat=ncms=-1sd=1# [12] Ayson, Choosing Ahead of Time? Australia, New Zealand and the US-China Contest in Asia, 344. [13] Ibid. [14] Ayson, Choosing Ahead of Time? Australia, New Zealand and the US-China Contest in Asia, 347. [15] Ibid, 346. [16] Hillary Clinton quoted in Stephen Jacobi â€Å"Turning dreams into reality† New Zealand International Review 36, no. 5 (2011): 17. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=65270856site=eds-livescope=site. [17] â€Å"United States of America†, New Zealand Ministry of Foreign Affairs and Trade, accessed: 10 February 2015. http://www.mfat.govt.nz/Countries/North-America/United-States.php [18] â€Å"Trans Pacific Partnership (TPP) negotiations†, New Zealand Ministry of Foreign Affairs and Trade, accessed: 10 February 2015. http://mfat.govt.nz/Trade-and-Economic-Relations/2-Trade-Relationships-and-Agreements/Trans-Pacific/index.php [19] Ibid. [20] John Key, â€Å"Finding a way in a changing world† New Zealand International Review 37, no. 5 (2012): 12. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=79701425site=eds-livescope=site. [21] Groser, â€Å"Trading with China: A Success Story,† 11. [22] Michael Powles . â€Å"China and New Zealand at forty: what next?† New Zealand International Review 37, no. 6 (2012): 2. http://ezproxy.massey.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=truedb=anhAN=83342048site=eds-livescope=site. [23] Ibid. [24] â€Å"New Zealand-Australia Closer Economic Relations†, New Zealand Ministry of Foreign Affairs and Trade, accessed: 12 February 2015. http://mfat.govt.nz/Trade-and-Economic-Relations/2-Trade-Relationships-and-Agreements/Australia/index.php [25] â€Å"Australia†, New Zealand Ministry of Foreign Affairs and Trade, accessed: 12 February 2015. http://www.mfat.govt.nz/Countries/Australia/Australia.php [26] Key, â€Å"New Zealand in the world† 3. [27] Chris Elder and Robert Ayson, â€Å"China’s Rise and New Zealand’s Interests: A policy primer for 2030†, Centre for Strategic Studies Discussion Paper, No. 11 (2012). 21. http://www.victoria.ac.nz/hppi/centres/strategic-studies/documents/DP11-12-Chinas-rise-and-NZs-interestsONLINE.pdf. [28] Powles, â€Å"China and New Zealand at forty: what next? 2. [29] Jacobi. â€Å"Turning dreams into reality†: 18. [30] Anne-Marie Brady, â€Å"New Zealand-China Relations: Common points and Differences† New Zealand Journal of Asian Studies 10, no. 2 (2008) 19. http://www.nzasia.org.nz/downloads/NZJAS-Dec08/2_Brady_3.pdf

Knowledge and importance of exclusive breastfeeding

Knowledge and importance of exclusive breastfeeding Breastfeeding is the most precious gift a mother can give her infant. When there is illness or malnutrition, it may be a lifesaving gift; when there is poverty, it may be the only gift. Ruth Lawrence, M.D. 1.1 Background of research Exclusive breastfeeding starts from a new born to the age of six months. It is an ideal and incomparable to any infant formulas created for them recently. As it has been known that breastfeed contains the perfect food for a newborn which has immunization to diseases, easy to digest and at the perfect temperature to be fed to infants. Breast milk is the natural first food for babies which provides all the energy and nutrient that the infant needs for the first months of life. The first breastfeed milk is known as the colostrums which can only be found in breast milk that contains all best nutrients for the new born babies. Colostrums contain antibodies that protect the baby from bacteria and viruses in the early age. It helps to increase the babys intelligence and growth and strengthen the close bond between mother and the baby ( Gartner et al. 1997). It strongly proven that breastfeed is the best food for a baby that no other food has the same nutrients values. Pregnant mothers should have the knowledge and awareness of the benefits of breastfeeding to newborn infants. This study is to find out how much the awareness and knowledge of 30 pregnant women in the antenatal and postnatal wards through questionnaires. They should be aware of the benefits of breast milk to infants and to their own health. Many women make infant feeding decisions before delivery and before any contact with healthcare professionals. Although health promotions campaigns are influential in educating women about breastfeeding, they often do not dissuade women from formula feeding once the decisions has been made. Antenatal preparations of pregnant women for breastfeeding rises awareness of the importance of breastfeeding, empower them with practical knowledge and skill in breastfeeding techniques, and prepare them for possible difficulties. Though many campaigns and seminars were done nationally to educate the public, yet the rate of exclusive breastfeeding is still to the unsatisfactory level. The rate of exclusive breastfeeding in Malaysia has been decreased from 92% ( in 1950s) to 78% (in 1970s) but there was a slight of increment in the early year of 1975( Da Vanzo, 1991) although for only less than 10%. Report done by the World Alliance for Breastfeeding Action (WABA, 2005) , showed that millions of babies fell sick every year as they were not breastfeed. The World Health Organization (WHO, 2002) estimated that more than 1.5 million babies died yearly may be avoided if the babies were given exclusive breastfeed, from birth to six months and continuously until the age of two years old. Malaysia has been doing a lot of promotions and activities lately to give the knowledge and importance of exclusive breastfeeding through activities such as World breastfeed week and Baby friendly Hospital. 1.1 Problem of statement Breast feeding have multiple benefit to the mother and child but there are still postnatal mother that are not confident and not interest to breast feed their baby. This problem might be due to lack of knowledge on information sources regarding breastfeeding. This research is done to elevate the knowledge between antenatal and postnatal mothers in this hospital. Breastfeeding offers irrefutable and long-lasting health benefits for both mother and baby, which are supported by a comprehensive scientific research. Many research and evidence base has been conducted and proven that the benefits of breastfeeding are undeniable. Ministry of Health has set and implements various strategy in promoting exclusive breastfeeding. One of the strategy is the Baby Friendly Hospital Initiative on 1993.The aim is neither than to develop an environment that support mother to breastfeed their baby, create a policy that control exclusive breastfeeding. On Mac 1998, Malaysia had been announced as the 3rd country in the world which all the government hospital has been given the Baby Friendly Hospital status. Over time, the percentages of births to subgroups with higher rates of breastfeedingparticularly Malays and more highly educated womenhave increased. However, there is also evidence of changes in rates of breastfeeding within these subgroups. Many Malaysian infants have a total duration of breastfeeding (including with supplementation) considerably shorter than WHO recommended six months of exclusive breastfeeding. The national breastfeeding policy has been revised in 2006, according to WHO all mothers are encouraged to breastfeed their babies exclusively from birth until 6 months of age and thereafter to continue until their child is 2 years old. Complementary foods should introduce when the baby is 6 month old. 1.2 Hypothesis The postnatal mothers have a higher level of exclusive breastfeeding knowledge compared to the antenatal mothers. 1.3 Significance Of Study The benefits of breast milk is undeniable, manufacturer are trying to create a milk that are at least having similar benefits and nutritional value as the breast milk, yet no strong research study has been conducted to prove it. Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mothers bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 600 extra calories a day in producing milk. The composition of breast milk depends on how long the baby nurses. Research shows that the milk and energy content of breast milk actually decreases after the first year. Breast milk adapts to a toddlers developing system, providing exactly the right amount of nutrition at exactly the right time. In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of a mothers milk provide these percentages of the following minimum daily requirements: Energy 29% Folate 76% Protein 43% Vitamin B12 94% Calcium 36% Vitamin C 60%10 Vitamin A 75% . 1.4 Research Objective 1.4.1 General Objective The aim of this study is to identify all antenatal and postnatal mothers have the confidence and knowledge to exclusive breastfeeding. 1.4.2 Specific Objectives 1.3.2.1 To examine the knowledge of antenatal and postnatal mothers towards exclusive breastfeeding 1.3.2.2 To educate antenatal and postnatal mothers with exclusive breastfeeding knowledge and understandings. 1.5 Significant of Project 1.5.1 The importance of this study is to find out the difference knowledge level between antenatal and postnatal mothers on exclusive breastfeeding. 1.5.2 This study needs to assess the knowledge level of the antenatal and postnatal mothers after informations, campaign and educations given by health care staff and to show the teaching techniques by them are effective. 1.5.3. The is to esure that it will increase the knowledge and improvements to induviduals involvements in exclusive breastfeeding 1.6 Scope of Project 1.6.1 The study sample is limited to antenatal mothers who was come for screening in labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward. 1.6.2 Antenatal mother who was not delivered baby from 30 January to 30 Mac 2011 1.7 Definition 1.7.1 Assessment Assessment is a process that follows a continuous cycle of improvement based upon measurable goals, involving data collection, organization and interpretation leading to planning and integration. 1.7.2 Knowledge Knowledge is the awareness and understanding of facts, truths or information gained in the form of experience or learning. Knowledge is an appreciation of the possession of interconnected details. 1.7.3 Exclusive breastfeeding Exclusive breastfeeding defined as no food or liquid other than breast milk , not even water, is given to the infant from birth until six months of age. 1.7.4 Antenatal mother Occurring or present before birth; during pregnancy 1.7.5 Postnatal mother post meaning after and natalis meaning of birth- is the period beginning immediately after the birth of a child and extending for about six weeks. CHAPTER 2 LITERATURE REVIEW 2.0 Introduction Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3-4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register quoted by Kramer MS , Kakumar R.( Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada) Mothers often are uninformed about the health benefits of any amount of breastfeeding, their ability to continue breastfeeding while employed, and the convenience and cost differential of breastfeeding as compared to formula feeding. Although there is a tendency in the literature to stress the time-intensive nature of breastfeeding, in fact it may require less time and attention than bottle-feeding (Barber-Madden, 1990). First, the promotion of breastfeeding without practical help and knowledge which led to many frustrated, unsuccessful breastfeeding attempts with subsequent backlash. Second, a much shorter hospital stay which does not provide adequate time for mothers milk to come in or for appropriate education and support. In Australia in 1993, a country which is known for its support of breastfeeding, the average hospital stay for vaginal delivery was still 5 to 7 days, and for C-section, 7 to 10 days. Australia also has the foresight to send home health visitors once the mother is discharged to offer further assistance and support. Third, the continued increase of women in the workplace, many times by necessity and not by choice, has influenced the incidence and duration of breastfeeding. A non supportive work environment makes breastfeeding difficult at best. Finally, the decline of breastfeeding has been assisted by the ambivalence of some health care professionals. This ambivalence is based on the lack of familiarity with current breastfeeding research, reliance on formula company nutritional information, and the very well meaning issue of not wanting to push breastfeeding because it might make the Mom who chooses artificial feeding feel guilty. Despite these initiatives, only 14.5 per cent babies were exclusively breastfed below six months in 2006, . In addition, only 19.3 per cent babies were exclusively breastfed below four months. Jaafar,2008 Compared with the findings of the National Health and Morbidity Survey 2 (1996), there was a significant decline of 9.7 % in the prevalence of exclusive breastfeeding below four months and a concurrent rise in the prevalence of babies who were predominantly breastfed but given additional water. Analysis of the breastfeeding pattern showed generally that exclusive breastfeeding rates were high in the first two months but dropped rapidly after the age of two to three months .It was also found after the age of two months, more than half of the breastfed babies were supplemented with infant formula and given other foods like commercial baby foods or home-cooked baby food while 20 percent of breastfed infants were supplemented with plain water.Few factors that contribute to early discontinuation of breastfeeding as follow : 2.1 Cultural Beliefs And Myths Of Breast Feeding The cultural beliefs, myths and ignorance have to be blame for the countrys poor breastfeeding performance. The myths that breastfed babies need water in addition to breast milk are wide spread in the country. Lack of knowledge and skill of mothers on when to start complementary food and how to maintain breastfeeding are other prohibitive factors, Complementary food, including water, should ONLY be introduced after the age of six months 2.2 Lacks Of Benefit And Facility Other factors according to Jaafar ( 2008 ) are the lack of benefits and facilities to promote and facilitate breastfeeding practices amongst women who also make up some half of the countrys working population. These include the absence of longer maternity leave, the lack of flexible working hours and missing childcare centers at work places. Breastfeeding patterns in Malaysia suggest that inadequate maternity leave may in fact be denying babies their right to mothers milk, and one of the reasons why only 1 in 7 infants were exclusively breastfed for the first six months of life in 2006. (Nadchatram ( 2008 ) According to Ministry of Health analysis of national breastfeeding data, exclusive breastfeeding rates in the country were high in the first two months but dropped rapidly after two or three months, roughly the period when maternity leave ends and working mothers return to paid employment.   In Malaysia, women are entitled to 8 weeks (60 days) paid maternity leave, 6 weeks short of the recommended 14 weeks by the International Labour Organisations Maternity Protection Convention 2000 (No. 183). Malaysia is not a signatory of the Convention. 2.4 Not Enough Milk Hussain (2003) has revealed that other factor for early discontinuation of exclusive breast feeding is not enough milk .In his study,54% of the sample express that this is one of the reason. The reason for not having enough milk might be highly influenced by the mothers emotional and psychological well-being. Low levels of stress, healthy nutrition, plenty of fluid intake, emotional support and nipple stimulation through babys sucking are all important contributors to breastfeeding success. However, living circumstances often dont allow perfect breastfeeding conditions: another child in the family, the death of a loved one, money worries etc. all add to an increase in stress levels. Other factors such as breast surgery can contribute to low amounts of breast milk. It has also been found that more women who gave birth by caesarean section Encountered breastfeeding problems, this may have various reasons such as the initial separation between mother and baby or the physical pain as a result of the surgery which ultimately affects the mothers ability to enjoy the breastfeeding experience. Chen ( 2006 ),conclude in his research that breastfeeding-friendly policies can significantly affect breastfeeding behaviors. However, an unfavorable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that womens work productive role and family reproductive role be respected and accommodated by society. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life. The length of maternity leave is positively associated with the duration of breastfeeding The International Labour Organization (ILO) recommends a period of maternity leave of not less than 14 week. However, the typical maternity leave in many Asian and Middle Eastern countries falls below these levels, only offering less than 12 weeks paid leave. In Taiwan, most companies provide only eight weeks of maternity leave. A national survey in 2005 showed that the rate of exclusive breastfeeding in Taiwan at one month postpartum was only 22.3%, and dropped to 16.7% at three month. To bring Taiwan in line with WHO guidelines, effective worksite strategies needed to be implemented to encourage new mothers to breastfeed in the workplace. 2.5 Levels of Influence and the Breastfeeding Decision 2.5.1 Health Professionals Roles Multiple studies indicate that health professionals support of breastfeeding is important in increasing breastfeeding rates (Lawrence, 1993, Winikoff Baer, 1980; Winikoff, Laukaran, Myers, Stone, 1986, 1987). Health professionals have made important promotion contributions, yet many health professionals who provide care to pregnant women and infants do not demonstrate explicit support of breastfeeding; nor do they have adequate knowledge about breastfeeding. In an American Academy of Pediatricians study, only 65 percent of pediatricians recommended exclusive breastfeeding for the first month and only 37 percent recommended breastfeeding continue for the first year (Schanler, OConnor, Lawrence, 1999). Many women do not initiate breastfeeding because they know they will be returning to full-time employment that will entail separation from the baby. Perhaps they believe that they will not be able to continue breastfeeding once they return to work, and they adopt an attitude of Why start something I will not be able to continue? (Fein Roe, 1998). Furthermore, women who return to full-time work wean their infants earlier than other women. It has been found, however, that expecting to work part-time following the birth of a baby did not affect initiation of breastfeeding. Part-time work of four or fewer hours a day did not affect duration of breastfeeding. Part-time work for more than four hours per day affected duration of breastfeeding less than full-time work (Fein Roe, 1998). Because of economic necessity and the need for other benefits such as health insurance, many women cannot afford to work less than fulltime. When possible, however, delaying separation from the infant and reducing the amount of time mother and infant are separated during the infants first six months increases the likelihood that breastfeeding will be successful (Stuart-Macadam Dettwyler, 1995). In a qualitative study carried out by MacLaughlin and Strelnick (1984), many women suggested it would be helpful to receive breast-feeding information about combining breast-feeding with working and to have open discussions of the topic with other mothers. A survey of 567 women who breastfed while employed outside the home showed that the most significant difficulty was role overload, a result of the multiple demands to which they were responding. This aspect does not differ markedly from what is found for non-breastfeeding, working mothers (Auerbach Guss, 1984). About 60 per cent from 451 mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies birth. The mothers age, education or parity, did not affect the rate of breastfeeding. Low birth weight, especially birth weight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottle feeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birth weight (Shiva , 2003 ) 2.6 Advantages of breast milk to babies Breast milk is best for newborn baby, and the benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients baby needs in the first six months of life, breast milk is packed with disease-fighting substances that protect baby from illness. American Academy of Pediatrics recommends exclusive breastfeeding for the first six months (although any amount of breastfeeding is beneficial). And scientific studies have shown that breastfeeding is good for mothers health, too. Numerous studies from around the world have shown that stomach viruses, lower respiratory illnesses, ear infections, and meningitis occur less often in breastfed babies and are less severe when they do happen. Exclusive breastfeeding (meaning no solid food, formula, or water) for at least six months seems to offer the most protection. A study by the National Institute of Environmental Health Sciences showed that children who are breastfed have a 20 percent lower risk of dying between the ages of 28 days and 1 year than children who werent breastfed, with longer breastfeeding associated with lower risk. The main immune factor at work here is a substance called secretor immunoglobulin A (IgA) thats present in large amounts in colostrums, the first milk mothers body produces for the baby. (Secretors IgA is present in lower concentrations in mature breast milk.) The substance guards against invading germs by forming a protective layer on the mucous membranes in the babys intestines, nose, and throat. 2.7 Advantages to breastfeed mothers A study of more than 33,000 Danish women who had given birth between 1999 and 2002 evaluated the effect of breastfeeding on maternal weight at 6 and 18 months postpartum compared to reported pre pregnancy weight. The authors calculated that a Danish woman with normal or obese pre pregnancy weight who gained 11-12 kg during the pregnancy and exclusively breastfed her infant for 6 months would be back to her pre pregnancy weight by then. At 18 months postpartum, women who exclusively breastfed for 6 months and continued breastfeeding until their infant was 12 months of age had the lowest probability of retaining 5 or more kg of weight no matter how much weight they gained during the pregnancy (Baker, 2008) 2.8 Conceptual framework The research conceptual framework will be carried out as shown in the flow chart below. INTERGRATED WARD HOSPITAL TUANKU AMPUAN NAJIHAH POSTNATAL MOTHERS ANTENATAL MOTHERS QUESTIONAIRE RESULT ANTENATAL MOTHERS POSTNATAL MOTHERS CHAPTER 3 RESEARCH METHODOLOGY 3.0 Introduction In this chapter the researcher will discuss the main aspect of the research methodology in detail. There are five aspects that consist of the research design, population, sampling and methods, study instruments, collection of data and limitation of study. 3.1 Study design The study uses a descriptive and quantitative method. The researcher will distributes the questionnaires to the respondents as the main instrument to collect data for the study. The collection and the analysis of data is done in two weeks. 3.2 Population and sample The population is all antenatal mothers who will be come for screening in the labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward in Hospital Tuanku Ampuan Najihah. 3.3 Study subject All 15 antenatal mothers who will come for screening in integrated ward from 30 January to 30 Mac 2011 and 15 postnatal mothers discharge from labour room during the study period. . 3.4 Sample size calculation The sample size will be calculated so that the study has the capability to detect clinically importance difference as statistically significant. The sample size also will be calculated to estimate effect with stated precision. Only 30 cases will be selected as the sample. 3.5 Study participants 3.5.1 Inclusion criteria All antenatal mothers who are conceiving their second child and above that warded from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward. 3.5.2 Exclusion criteria All antenatal mothers who are conceiving their first baby from 30 January to 30 Mac 2011 was not included in this study. 3.6 Data collection procedures 3.6.1 This study will be using questionnaires that will be given to the antenatal and postnatal mothers before and after the campaign. 3.6.2 Permission to carry out the study will be obtained from the Hospital Director and the Chief Matron. An inform consent will also being obtained from the respondents ( Appendix II / Lampiran II). 3.6.3 Self Administered Questionnaire (SAQ) Self Administered Questionnaire will be used to determine the medical personal knowledge as shown in Appendix III / Lampiran III. 3.7 Sampling methodology Sampling refers to the process of selecting a portion of the population to represent the entire population (Polit Hungler, 1999). In this study only 30 participants will be selected among the antenatal and postnatal mothers in HTAN from January till March in the year of study. The study was done with pilot test 10 antenatal and postnatal mother and the cronbachs alpha= 0.732 3.7.1 Statistical analysis The result of this study was based on the responses from 30 of the antenatal and postnatal mothers. The independent variables identified namely were designation. The data was analyzed and presented in percentage. 3.7.2 Research tools Data was collected by using structured questionnaire. See Appendix III and Appendix IV. 3.8 Expected results Antenatal mothers have the knowledge and understanding of the importance in exclusive breastfeeding. Antenatal mothers will be making decisions on exclusive breastfeeding before delivery. CHAPTER 4 RESEARCH RESULTS 4.0 Introduction In this chapter the collected data is analysed from the questionnaires given to the respondents. The demographic factors usually tested as it is often used as the inference study as it is easy to get and easily analysed the effect (Jack Fiorito et el 2007) . The first part is a demographic data about the respondents for example race, age , education level and their exclusive breastfeeding knowledge. 4.1 Characteristics of demographic respondents Section A Table 1 : Ethnic :- Antenatal mothers Antenatal mothers Post natal mothers Ethnic Number of respondents Percentage Number of respondents Percentage Total number Malay 11 73.3 % 13 86.7 % 24 Chinese 1 6.7 % 0% 1 Indian 3 20.0 % 2 13.3% 5 Referring to the table above, majority of the respondents are from the Malay ethnic which gives 73.3% for the antenatal mothers while the postnatal respondents gives 86.7%. The second higher percentage of ethnic comes from the Indians that give 20 %for the antenatal mothers and the postnatal mothers contributes 13.3 %. The least is the Chinese that gives only 6.7% that is only one respondent for the antenatal but none for the postnatal mothers.. As usual majority of the respondents are the Malays as most of them preferred to give birth in government hospitals comparing to the Chinese who prefer going to the private hospitals. Table 2 : Age of the respondents Age range Number of respondents for both ante and postnatal mothers Percentage 20 -25 years old 9 30.0% 26 30 years old 12 40.0 % 31 35 years old 6 20.0 % 36 40 years old 3 10.0% The age range for this study is done to get a better view to the majority of the ante and postnatal mothers involved. As shown in the table above the age range between 26 to 30 years of the antenatal and postnatal mothers gives the majority which contributes 40.0 %. The least comes from the age range of 36 to 40 years that gives only 10% which only 3 respondents involved. Table 3 ; Education Level Academic level Number of respondents Percentage Non- schooling 1 3.3 % Primary school 2 6.7% Secondary school 17 56.7% College/ University 10 33.3% As shown in the above table, the majority of the educational level comes from the secondary school level which contributes 56.7 % from all the respondents. This shows that this group of respondents have the great trust in the government hospital so does the college/ university level respondents that gives 33.3% of all. Table 4 : Occupation Occupation Number of respondents Percentage Housewife 17 56.7 % Self employed 4 13.3 % Government servant 5 16.7% Private sector 4 13.3% Referring to the above table, the housewife is the majority respondents in this study that carries 56.7% which is more than half of the respondents involved. The government servants contributes 16.7% while the self employed and the private sectors employees give the same percentage of 13.3% each. Table 5. : Exclusive breastfeeding prior knowledge YES NO Number Of respondents 25 5 Percentage 83.3% 16.7 % Referring to Table 5, 83.3% of the respondents have the prior knowledge of exclusive breastfeeding which means that they had the experience and knowledge to breastfeeding. Five respondents, contributing 16.7% had no knowledge of exclusive breastfeeding. Table 6 : Number of child Number of child (conceiving/ give birth) Number of respondents Percentage 2 12 40% 3 11 36.7% 4 3 10% 5 2 6.6% 6 2 6.6% As shown in the table above , 12 respondents conceiving or giving birth to their second child that gives 40% of the study. 36.7% conceive or give birth to their third child, 10% or 3 respondents conceive or give birth to their 4th child and 6.6% contributed by respondents who conceive or give birth to their 5th and 6th child. SECTION B Knowledge on exclusive breastfeeding Question number 1

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Week 4 Quiz

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