It’s World HIV/AIDS Parent’s guide to HIV/AIDS Prevention. By Lukonge Achilees.

Excerpted from his book Make me understand parenting, family and health.

What is HIV/AIDS?
It has been observed here in uganda and worldwide parents these days fear to talk with their children about HIV/AIDs leaving huge task to teachers, social workers, health workers like doctors etc and activist. lets explore, give us your ears

HIV stands for Human Immune deficiency Virus. • The “H” is for “Human” because it survives only in human beings. • The “I” is for “Immune deficiency”because it attacks the immune system. • The “V” is for “Virus.” A virus needs a host cell to reproduce. • HIV attacks a specific type of human white blood cell, the T-cell. • A person can be infected with HIV and
not know it. People who are infected with HIV often have no symptoms and feel healthy.

How parents and caregivers talk with their children about HIV/AIDS
HIV/AIDS is a worldwide epidemic. Countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East are some places where the numbers of young people infected with HIV are rising. Ask apparent or caregiver to spend some time with you researching how HIV/AIDS impacts the rest of the world, and then compare the information to the UGANDA.
You can visit your local public library or use the Internet to gather information. Perhaps you’ll be able to find out:
How poverty contributes to the spread of HIV/AIDS
Any laws that protect people who are HIV positive
If people who are HIV positive have access to necessary treatments and medications
What life is like for someone who is HIV positive Pick a country and talk about what you would do to help with the HIV/AIDS epidemic? How could you help make a difference in that country even though you live in UGANDA?
Then, find ways to make a difference in your community. Perhaps you can volunteer by donating your time to an organization that helps people that are HIV positive, raising money by participating in a fundraiser like AIDS Walk, or working with your school or public library to organize an event for World AIDS Day (December 1).

Then let’s go to the point, how you can share information about HIV/AIDS in your home.You may think that children are too young to learn about HIV/ AIDS, but young people hear many messages about it from the media, friends, or other family members. Perhaps they even know someone who is HIV positive.The truth of the matter is that the only way to help prevent HIV/AIDS among young people is to share accurate,age-appropriate information so that they can protect themselves.ThisissueofFamilies Are Talking includes basic facts about HIV/AIDS, information and messages to share with your children and teens,activities to raise HIV/AIDS awareness, as well as organizations and Web sites for more information.
Tips to help parents and caregivers talk with their children about HIV/AIDS?
Do not wait until your children ask questions
Know and practice the messages that you want to share
Seek “teachable moments” —daily opportunities that occur when you are with your children — that make it easy to share your messages and values
Let your children know that you are open to talking with them about sexuality issues
Provide pamphlets, books, and other age-appropriate, medically accurate materials
If you don’t know how to answer your children’s questions, offer to find the answers or look them up together
Find out what your children’s schools are teaching about HIV/AIDS
How does someone get HIV? Someone who is HIV positive can pass the virus to another person through certain body fluids. The sources are:
Vaginal Secretions
Breast Milk
Other Body Fluids containing blood

Certain behaviors can put people at risk for HIV infection. The most common means of transmission are:
Having sexual intercourse (oral, vaginal, or anal) with someone who is HIV positive.
Sharing needles with someone who is HIV positive — for drug or steroid use, to pierce the ears and body, and to tattoo the body rom an HIV-positive mother to her baby before or during birth, or after birth through breastfeeding

Talking with infants and toddlers (0-2years), talking with preschool children (3-4years), talking with young children (5-8 years), talking with preteens (9-12years) talking with teens (13-19 years)
Of course, infants and toddlers are too young to comprehend HIV/AIDS. But, as their main teachers, it’s important for parents and caregivers to help them develop a healthy attitude toward sexuality. You can begin by naming all the parts of their bodies, teaching them that their entire body is natural and healthy. (“This is your arm. This is your elbow.This is your vulva/penis.This is your knee.”) Byreacting calmly when they touch their genitals, you are teaching them that sexual feelings are normal and healthy. By holding them, hugging them, talking with them, and responding to their needs, you are laying the groundwork for trust and open discussions as they grow up.
TALKING WITH PRE-SCHOOL CHILDREN (three to four years) Children at this age are learning about their bodies.They learn about their world through play.They begin to ask questions about where babies come from. They can understand simple answers.They do not understand abstract
ideas or adult sexual behaviors.They can learn simple things about health, such as bathing, washing their hands, brushing their teeth, eating nutritiously, and napping.They can begin to accept the need for privacy. The best thing a parent can do at this stage is to create an environment where children will feel comfortable asking questions about their bodies, health, and sexuality. Children will then learn that sexuality is something that you are comfortable discussing in your home.
TALKING WITH YOUNG CHILDREN (five to eight years) Children at this age understand more complex issues about health, disease, and sexuality.They are interested in birth, families, and death.They have probably heard about HIV/AIDS from television, friends, or adults. They may have questions or fears about HIV/AIDS.They may have heard that people get HIV/AIDS because they are bad.They understand answers to questions based upon concrete examples from their lives. For example, if your children cut their fingers and blood appears, you have an excellent opportunity to explain how germs (things that make you sick) can get into the blood system from cuts in the body. If they are in a school with a child who is infected with HIV, they need to know that they cannot get HIV/ AIDS from playing, studying,eating with, or talking with that child.
SHARING WITH SPECIFIC MESSAGE WITH YOUNG CHILDREN ABOUT HIV/AIDS Today, children grow up in a world where they are surrounded by messages about HIV/AIDS.To be sure that your young children know about HIV/AIDS infection and prevention, share the facts in simple, clear, age-appropriate language.Thefollowing are questions kids ask and messages that you can share with them.
What is HIV? HIV is caused by a small germ in a person’s blood that is so little it can’t be seen with the eyes. Some people with HIV feel and look healthy. Other people feel and look sick.
How do people get HIV? HIV can only live inside the body. There are very specific ways that HIV goes from the inside of one person’s body to the inside of another person’s body. You can mention that during sex, someone who has HIV can pass the germ from their body to the other person’s through certain body fluids.
Can kids get HIV? Very few children get HIV. If a woman who has HIV is pregnant, sometimes her baby is born with HIV. Some kids don’t have enough good cells in their blood and may need more by having a transfusion. That’s when they go to the hospital and receive a treatment that gives them another person’s blood to make their blood stronger. It’s rare, but sometimes the blood that they received at the hospital may have had HIV.
How can kids protect themselves from HIV? •If someone is bleeding, don’t touch their blood. Find an adult to help. •If you find a needle in the playground, street, or anywhere else, don’t touch it. Find an adult to help.
Can kids be friends with people who have HIV? •A person cannot become infected with HIV by being around someone who has HIVor AIDS. •People with HIV or AIDS are just like other people, but their bodies may work harder to keep them healthy.
Talking with young children about hiv/aids Since young children learn best by example, it is helpful to give them the information that they need by sharing stories or reading books together that address HIV/AIDS.
TALKING WITH PRETEENs (nine to 12 years) Because of the strong social pressures that start at this age, it is important that you talk about HIV/AIDS regardless of what you know about your children’s sexual or drug experiences. As a concerned parent or caregiver,you must make certain your children know about prevention now .During the changes of puberty, preteens are very curious about sex and need basic, accurate information. They need to know that sex has consequences, including pregnancy, diseases, and HIV infection. They need to know why sexual intercourse — oral, vaginal, and anal — is an adult behavior and why it is a good idea for young people to wait to have sex. They need to know how HIV is transmitted, how it is not transmitted, and how to prevent transmission, including talking about condoms. This may seem like a difficult task, but it will give you a chance to teach your children the values that you hope they will adopt in their lives. It is also the time to remind your children that they can come to you with questions about HIV/AIDS or sexuality.
TALKING WITH TEENS (13 to 19 years) Social pressure to try sex and drugs are often very strong for teens. In fact, almost 50 percent of young people In grades nine through 12 have had sexual intercourse. Whether your child is among the 50 percent who have had sex or the 50 percent who have not, it’s important to share your values with your children. Let your teenagers and preteens know that the best way to prevent HIV infection is by not engaging in any behavior that puts them at risk for infection, including having any type of sexual intercourse or using any type of drugs. At the same time, explain that if they are going to be sexually active, they must protect themselves against pregnancy and sexually transmitted diseases (STDs), including HIV. This is also a time when you might consider talking with your teens about the full range of sexual behaviors that people find pleasurable but do not involve any exchange of body fluids and therefore lessen the risk of HIV/STD infection and pregnancy.
Sharing specific message with young people
Social pressures to have sex and use drugs are often very real issue all young people must there4 know that;
Not having sexual intercourse (abstinence) is the best method for preventing HIV infection. It is also the best method for preventing other STDs and pregnancy.
Lifelong monogamy with an uninfected and honest partner is as effective in preventing HIV infection as abstinence.
Teenagers who have intercourse must use latex condoms for each and every act of intercourse, including oral,vaginal, and anal sex.
Teenagers should avoid all drugs including alcohol. Drugs and alcohol impair good decision making and may suppress the immune system.
Sharing needles of any kind puts people at risk for HIV and other infections.This includes sharing needles for injecting drugs, injecting steroids, piercing the ears and body, and tattooing.
An activity for young people to communicate with parents and care givers. Hiv/aids is a worldwide epidemic.Countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East are some places where the numbers of young people infected with HIV are rising. Ask aparent or caregiver to spend some time with you researching how HIV/AIDS impacts the rest of the world, and then compare the information to the UGANDA. You can visit your local public libraryor use the Internet to gather information. Perhaps you’ll be able to find out: How poverty contributes to the spread of HIV/AIDS Any laws that protect people who are HIV positive
HIV/AIDS & STDS awareness in Family If people who are HIV positive have access to necessary treatments and medications what life is like for someone who is HIV positive Pick a country and talk about what you would do to help with the HIV/AIDS epidemic. How could you help make a difference in that country even though you live in UGANDA?
Then, find ways to make a difference in your community. Perhaps you can volunteer by donating your time to an organization that helps people that are HIV positive, raising money by participating in a fundraiser like AIDS Walk, or working with your school or public library to organize an event for World AIDS Day (December 1).


Questions and answers
What are the different types of STDs?
STDs are often divided into two categories—viral and bacterial—based on the type of microorganism that causes the specific disease.
Those STDs caused by bacteria—such as Gonorrhea, Syphilis, and Chlamydia—are curable with antibiotics. Those STDs caused by viruses are not. These include Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes, and Hepatitis B. Medical treatment can, however, alleviate the symptoms of these STDs.
Some STDs are also caused by protozoa (Trichomoniasis) and other organisms (crabs/pubic lice and scabies). These STDs are curable with antibiotics or topical creams/lotions.
What are the symptoms of STDs?
STDs have a range of symptoms, but it’s often hard for people who are infected to determine if they have an STD. Many STDs have no symptoms, have symptoms that are easily confused with common illnesses, or have latent symptoms that take weeks or years to show up.
Symptoms of STDs like Chlamydia and gonorrhea can include itching or burning during urination. Herpes and HPV symptoms sometimes don’t occur for weeks, months, or years and can include sores or a rash (for Herpes) or whitish, raised growths (for HPV). And HIV-positive individuals usually don’t have any symptoms for years until they begin to experience the opportunistic infections that characterize AIDS.
There is no way to tell if another person has an STD just by looking at them. The only way to know for sure is to visit a healthcare provider and get tested. What is involved in testing for STDs?
There are many different ways health care providers screen for STDs. These can include visually examining sores or lesions, collecting fluid from the urethra or cervix with a cotton swab, testing urine or blood, or conducting a biopsy.
Individuals should seek diagnosis and treatment at the first sign of symptoms to avoid serious complications. Because many STDs have no symptoms, individuals should also talk to their health care providers about having a routine STD screening as part of their annual physical or gynecological. Women need to understand that STD screenings are not necessarily part of their annual gynecological exam and that Pap smears do not screen for STDs other than HPV.
Individuals can find an STD clinic in their area .
Are condoms effective in preventing STDs?
Condoms provide different levels of risk reduction for different STDs because infections are spread differently—some STDs are spread by contact with bodily fluids while others are spread by skin to skin contact. In general, research shows that condoms are most effective in preventing those STDs that are spread by bodily fluids, such as HIV. Condoms can reduce the risk of contracting diseases spread by skin-to-skin contact, such as Herpes, as well. However, they may be less effective because contagious sores and lesions can occur outside of the area covered by the condom.
These are prevention messages recently developed by the CDC:
Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latexcondoms can reduce the risk of other STDs. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of Gonorrhea, Chlamydia, and Trichomoniasis. Latex condoms, when used consistently
and correctly, can reduce the risk of Genital Herpes, Syphilis, and HPV only when the infected areas are covered or protected by the condom.
What is Chlamydia?
Chlamydia, which is caused by the bacteria chlamydia trachomatis, targets the cells of mucous membranes including the surfaces of the urethra (male and female), vagina, cervix, and endometrium (the lining of the uterus) as well as the anus and rectum. Although possible, it rarely targets the mouth or throat. If left untreated in women, it can spread to the fallopian tubes and lead to Pelvic Inflammatory Disease (PID), a serious medical condition that can cause infertility.
Chlamydia is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.
Chlamydia is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, sitting on public toilets, or touching door knobs.
Chlamydia is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to avoid passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Chlmydia?
Over 1,030,911 Chlamydia infections were reported to the CDC. The reported rate of Chlamydia among women (515.8 cases per 100,000 females) was almost three times as high as the reported rate among men (173.0 per 100,000 males). Young women ages 15–19 had the highest reported rates of Chlamydia (2,862.7 per 100,000). Chlamydia infections increased from 50.8 to 347.8 per 100,000 between 1987 and 2006.
What is Gonorrhea?
Gonorrhea, once known as “the clap,” is caused by bacteria called Neisseria gonorrhoea that grow in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and the urethra in both women and men. The bacteria can also grow in the mouth, throat, and anus.
Gonorrhea is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.
Gonorrhea is not transmitted through such casual contact as hugging, shaking
hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
Gonorrhea is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Gonorrhea?
Over 358,366 cases of Gonorrhea were reported in the United States. For the sixth consecutive year, gonorrhea rates among women (124.3 per 100,000) were slightly higher than among men (116.8 per 100,000). Among women, those ages 15–19 had the highest reported rate of Gonorrhea (647.9 per 100,000). Among men, those ages 20–24 years of age had the highest reported rate of Gonorrhea (454.1 per 100,000).

What is Hepatitis B?
Hepatitis B is a virus that causes chronic infection, cirrhosis (scarring), and cancer of the liver. The virus is present in blood, semen, vaginal secretions, and breast milk.
Hepatitis B is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes; or from an infected mother to her newborn during childbirth or breast-feeding.
Hepatitis B is one of the only STDs for which a vaccine is available. Individuals must take all three doses of the vaccine to protect themselves against infection. They can obtain the vaccine from their health care provider.
Hepatitis B is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure for Hepatitis B. Treatment varies depending on whether the infection is acute (newly acquired) or chronic (persistent). How Common is Hepatitis B?
The number of new Hepatitis B infections per year has declined from an average of 260,000 in the 1980s to approximately 60,000 in 2004. Of an estimated 1.25 million Americans chronically infected with Hepatitis B, 20 to 30 percent were infected during childhood.
What is Herpes?
Herpes is a recurrent skin condition characterized by sores on the mouth or genitals. It is caused by the herpes simplex viruses called HSV-1 and HSV-2. Although HSV-1 most commonly causes “cold sores” or “fever blisters” on the mouth or face and HSV-2 most commonly causes sores on the penis or vulva, the viruses are identical under a microscope and either type can infect the mouth or genitals.
Herpes is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person or through kissing. This is possible even when no sores are present.
Herpes is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure for Herpes. Antiviral medications can reduce the frequency of outbreaks and speed the healing of the outbreaks
How Common is Herpes?
Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had a genital Herpes infection. Infection with HSV-2 is more common in women (approximately one out of four) than in men (almost one out of five). This may be due to the fact that male-to-female transmission is more efficient than female-to-male transmission.
What Is Human Immunodeficiency Virus (HIV)?
The Human Immunodeficiency Virus (HIV) causes an individual’s immune system to weaken and lose its ability to fight off infections and cancers. After developing a number of these infections or reaching a certain blood count level, an HIV-positive person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS).
HIV is present in blood, semen, vaginal secretions, and breast milk. It is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes used to inject drugs; or from an infected mother to her newborn during childbirth or breast-feeding.
HIV is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure or vaccine for HIV or AIDS. There are, however, a number of drugs and combinations of drugs that allow people with HIV or AIDS to stay healthy for longer periods oftime.
How common is HIV?
At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS. CDC has estimated that approximately 40,000 persons in the United States
become infected with HIV each year. In 2005, almost three quarters (74%) of HIV/AIDS diagnoses were for male adolescents and adults. In 2005, blacks (including African Americans), who make up approximately 13% of the US population, accounted for almost half (49%) of the estimated number of HIV/AIDS cases diagnosed. An estimated 4,883 young people received a diagnosis of HIV infection or AIDS in 2004, representing about 13% of the persons given a diagnosis during that year.
What is Human Papillomavirus (HPV)?
There are over 100 strains of the Human Papillomavirus (HPV). Approximately a third of these strains are sexually transmitted and cause genital HPV. Some types of genital HPV may cause warts that can grow on the cervix, vagina, vulva, penis, scrotum, urethra, and anus. Other strains of genital HPV can cause abnormal cells to grow on the cervix and can lead to cervical cancer.
Researchers at the pharmaceutical companies Merck and GlaxoSmithKline have developed vaccines that target particular strains of HPV. Merck’s vaccine, Gardasil, targets HPV types 16 and 18, which are associated with 70% of all cervical cancer and types 6 and 11 which are associated with 90% of all genital warts. GlaxoSmithKline’s vaccine only targets HPV types 16 and 18. Both vaccines have been shown to be nearly 100% effective in preventing infection with the HPV strains they target. Merck’s vaccine, Gardasil, was approved by the Food and Drug Administration (FDA) for females ages 9–26 and was recommended for routine use with females ages 11–12. Individuals can obtain the vaccine from their health care provider. GlaxoSmithKline’s has not yet been approved by the FDA.
HPV is transmitted by direct skin-to-skin contact with an infected individual. It can also be transmitted when warts are not present. It is sometimes transmitted from mother to infant during childbirth.
There is no cure for HPV. Many HPV infections will resolve on their own without causing any long-term harm. Others may require treatments to remove warts or abnormal cells.
How common is HPV?
Approximately 6.2 million new cases of HPV infection are reported every year, and, at least 20 million Americans are already infected.Among those individuals ages 15–49, only one in four Americans has not had a genital HPV infection. Approximately 14,000 women are diagnosed with cervical cancer in the United States each year; over 5,000 die from this disease each year.
What is Syphilis?
Syphilis, which is caused by bacteria called spirochetes, causes sores (chancres) to appear mainly on the external genitals, vagina, anus, or in the rectum. They can also appear on the lips and in the mouth.
There are three stages of syphilis. During the primary stage, which usually occurs within 10 to 90 days after exposure, a sore may appear. During the secondary phase, which usually occurs within 17 days to six-and-a-half months after exposure, a rash may appear on various parts of the body. If left untreated, Syphilis can proceed to the latent stage during which it may have no visible symptoms but can cause irreversible damage to internal organs.
Syphilis is transmitted through direct contact with sores during unprotected anal, oral, or vaginal sex with an infected person. Syphilis can also be transmitted from mother to newborn during childbirth.
Syphilis is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
Syphilis is curable with antibiotics prescribed by a health care provider. Damage to internal organs during the latent stage is irreversible. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.
How common is syphilis?
Over 9,756 cases of primary and secondary Syphilis cases were reported to the CDC in 2006. The reported rate of primary and secondary Syphilis increased 11.8 percent among men (from 5.1 cases to 5.7 cases per 100,000) between 2005 and 2006. During this time, the rate also increased 11.1 percent among women (from 0.9 to 1.0 cases per 100,000).
What is Trichomoniasis?
Trichomoniasis, or “trich,” is a genital inflammation caused by the protozoa trichomonasvaginalis.
Trichomoniasis is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person.
Trichomoniasis is curable with antibiotics prescribed by a health care provider. Both partners must undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Trichomoniasis ?
Trichomoniasis is the most common curable STD in young, sexually active women.
An estimated 7.4 million new cases occur each year in women and men.
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.
Parents are encouraged to read as much as possible about circumcision. They should make themselves aware of the complexities of the circumcision procedure itself. Speak to your doctor about the step-by-step procedure. If possible, ask to observe a circumcision at your hospital, so that you will know fully what is involved.
The International Coalition for Genital Integrity has classified circumcision as a type I genital mutilation. Pictures and video of a circumcision are available on the Circumcision Information and Resource Pages (CIRP) website.
What is the foreskin there for?
The foreskin serves three functions: protective, sensory, and sexual.
In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.
Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control The inner foreskin (mucosa) is the skin directly against the glans. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin). The frenulum is a particularly sensitive narrow membrane that runs down the ventral groove of the glans and attaches to the inner foreskin. The ridged band is the interface between the inner foreskin (mucosa) and the shaft skin. It often “puckers” past the tip of the glans. The band contains whorled smooth muscle fibers, giving it pronounced elastic properties that allow the foreskin to be retracted. The ridged band has a tactile sensitivity equivalent to that of the lips.
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in
sexual activity. What are some reasons that circumcision is performed?
Circumcision is primarily performed for cultural or religious reasons.
Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.
It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.
Medical grounds for circumcision that are most commonly cited are: Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners; reduced risk of sexually transmitted disease (STD).
There is contradictory evidence in the research literature as to whether circumcision reduces UTI but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics. The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI.
Penile cancer is an extremely rare form of cancer. It occurs mostly in older men, and most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men: The Maden study (an ongoing study of penile cancer at Fred Hutchinson Cancer Research Center in Seattle) observed that 37% of penile cancer cases occurred in circumcised men.
The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven [12]. The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases was disproved by a new study [22]. The question of HIV warrants further study [20], [7]. Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors.
The only known effective means of preventing HIV infection are fidelity, condom use and abstinence. Hygiene
The foreskin is easy to care for and the intact penis is easy to keep clean. The foreskin usually does not fully retract for several years and should never be forced. When the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin every day.
Gently rinsing the genital area while bathing is sufficient. Harsh soap and excessive washing can irritate the penis, which can lead to inflammation of the glans (balanitis).
Smegma is a white waxy substance, consisting of natural secretions and shed skin cells, that may occur around the folds of the genitalia in both males and females. In the past it was feared that smegma might be carcinogenic (and this fear was used as a justification for circumcision), but this fear has been disproven. Good general hygiene and common sense are key to preventing infection. If my son isn’t circumcised, won’t it have to be done later?
Abnormalities or diseases of the foreskin can be treated conservatively, if and when they occur, on a case-by-case basis.
Probably the most common abnormality of the penis is “phimosis”, or tight foreskin. (This is not the same as the natural attachment of the foreskin to the glans in very young children, which is completely normal.) The foreskin can normally be retracted by adolescence.
If retraction is not possible, a number of newer treatments are available which do not involve circumcision: Steroid creams, stretching, and preputioplasty. [18] Some of these treatments have only been published recently, and not all doctors are aware of them.
If your son has a serious problem with his foreskin, such as a severe infection (balanitisxeroticaobliterans) or gangrene, perhaps related to diabetes, removal of the affected area may be a medically advisable option. If my son isn’t circumcised, won’t he be teased?
Children can be cruel, and will find things to pick on another child about, whether it be his chubbiness, glasses, or freckles. Some parents think that their son should be circumcised so that he will “match” his father, brothers, or friends. As parents, we can help our children to feel good about their bodies and to respect individual differences.
Parents often express a fear that their son will “feel different in the locker room” if he is intact. There is good evidence that proper education is the answer. Boys who are taught from an early age that they are normal, whole and healthy will have a lesser chance of suffering embarrassment in the locker room, especially if some of the other boys are also intact.
Nonreligious infant circumcision is not an issue in European, Asian or South American countries. In Canada the average rate of infant circumcision for boys is roughly 25%, with large regional variations. The rate in the United States has dropped to less than 60%, and will drop below 50% in a few years if present trends continue. This is already true in the Western US (35% in 1993).
What are some reasons not to have my son circumcised?
Your son’s foreskin is a healthy, natural part of his body. Any part of the body may develop problems. It is possible, though very unlikely, that the foreskin will develop problems. However, most foreskin problems are easily treatable.
When your son becomes an adult, he may choose circumcision for himself. However, there is a good chance he will prefer not to be circumcised. Leaving your baby’s foreskin alone preserves his right to a whole and intact body.
Circumcision will be painful for the baby
The medical evidence in favor of routine circumcision of healthy babies is not persuasive. If your son has a problem with his foreskin, such as a severe infection (balanitisxeroticaobliterans) or gangrene, perhaps related to diabetes, your doctor may recommend partial or complete circumcision or removal of the affected area. Phimosis (nonretractable foreskin, if it persists much longer than normal) can usually be treated by gentle stretching and/or steroid creams. The vast majority of boys will never have any foreskin problems that necessitate surgery.
Is circumcision painful?
The often repeated statement that babies can’t feel pain is not true. It is documented in the medical literature that babies are as sensitive to pain as anyone else, and perhaps more so. [13,14]
Most circumcisions are performed without anaesthetic, because there are risks involved with using anaesthetics on babies. Sometimes local injections are used, but this does not eliminate pain. Most babies will show signs of pain during the procedure and in the week or ten days following circumcision. Recent studies have shown that the pain is remembered long beyond the time of the procedure itself. [23]
While pain may help parents decide against circumcision, parents should look at the long term effects of their decision first, not only during infanthood, but all the way to adulthood. Your decision will affect your son for the duration of his life.
Does infant circumcision have risks?
Circumcision is surgery, and like all surgery it has risks. These include: Excessive bleedingInjury to the glansInfection (raw wound is exposed to feces and urine in diaper) Complications from anaesthesia, if used Surgical error, including removal of too much skin In rare cases, complications can be life-threatening.
Up to 20% of circumcised males will suffer from one or more of the following complications, to some degree: Meatal stenosis (narrowing of the urethral opening due to infection and subsequent scarring, that occurs almost exclusively in circumcised boys) [15] extensive scarring of the penile shaft skin tags and skin bridges bleeding of the circumcision scar curvature of the penis tight, painful erections psychological and psychosexual problems [21]
The surface of the glans becomes dry if not protected by the foreskin. It is believed that dryness and abrasion may cause progressive loss of sensation in the glans, especially in later life. Circumcised men on the whole do enjoy sex and are able to orgasm.
What if we want to have our son circumcised?
Circumcision does not need to be done right away. There is no need to feel pressured by your doctor. Take your time.
If you intend to ask your doctor to have your son circumcised, ensure that the procedure is carried out by an experienced surgeon. Sometimes circumcision is considered “minor surgery” and inexperienced residents are given the task of performing it. This leads to a higher rate of serious errors and complications.
You may desire that your son will retain some inner foreskin, and especially the frenulum, to preserve as much sexual sensitivity and function as possible. Another method is the dorsal slit. This method does not involve the removal of tissue, but allows the glans to be exposed.
Your doctor can help you decide how much skin will be removed and how much of the glans should remain covered if desired. However, in most cases, once your signature is on the consent form, the physician has absolute license to execute the circumcision as he/she sees fit. You must ensure that your intentions are in writing before the operation occurs.
To lessen the pain, speak to your doctor about the use of an anaesthetic for your baby. Note that some doctors who use anesthetic may not allow sufficient time for the anesthetic to take effect: It is important to ensure that this does not happen. When and why was routine neonatal circumcision introduced in English-speaking Western countries?
Doctors in the English-speaking countries started circumcising babies in the mid-1800s to prevent masturbation, which some doctors claimed caused many diseases, including epilepsy, tuberculosis and insanity. Of course, these arguments are not accepted today.

Live a dream and Life to inspire others. By Lukonge Achilees

Many people dream about how they will end up in the future; in a huge house, a fancy car, an apartment surrounded by city lights in a big city dream, or in a mansion alongside the beach with beautiful white sand.

They dream about success in a cliche-kinda-way, they measure success by an exact amount; by something just in the surface without any hidden values underneath.

But not in my case. To live in the middle of millennials generation makes me want to dream bigger and think harder than that; artificial things are too shallow, I want depth, a huge depth more than just something that could be counted.

I want to plant a brilliant seed in people’s mind, I want to invest values inside them; all I want to do in my youth is to inspire.

I want to dedicate my energy to lit up the flames within somebody to grow; to realize that each of us has something inside that needs to be woken up.
I want to be that person who sees passion within everybody’s souls; I want to see the passion they had reflected in their eyes as they speak about the things they love to do.

I want to lit up the fire inside somebody’s dim inner self; I want to be somebody whose positive energy is contagious to each corner of the room.

I want to be the reason someone’s insight; the realization that s/he is actually could be as valuable as gold.
I want to give my time to ignite somebody’s soul; they need to know that they impact their surroundings.

I want to be somebody who will honestly tell the truth; that failures are unavoidable, but it’s not the reason we should stop.
I want to make them immortal; to always pick themselves up if the world tears them down to the ground. I want to be somebody’s caffeine; to insight them that hard work pays off in the end, that everything they did will actually give them result, sooner or later.

I want to be the reason behind somebody’s statement of “I have finally did it.”
I want to be the golden sun rays to the people’s gloomy days. I want to bring the wind that gives them ease as they make their eyes kaleidoscopic with tears.
I want to be their fireflies in the darkness so they know which way to go; I want to be their path just to survive.

I want to make them see the galaxies within themselves; that actually they have the constellation of stars inside them which could lead to a magnificent supernova.

I want to be the person who simply is happy just to see someone’s night sky filled by a glorious shooting star.
I want to dedicate myself to speak the truths through my actions; to make people get what they truly deserve.

I want to be somebody who turns on the light bulb inside someone’s head; to be the source of their ideas, to be the spirit which gives them enthusiasm to implement their bright ideas to come true.

I want to synchronize my own heartbeats to the people; to make them feel how to be, to make them embrace each emotion that they feel, to always make them true to themselves, to always be honest within ourselves.

I want to be that someone who brings somebody’s wall down; to make them brave enough just to open themselves up, to make them vulnerable yet they know how to be stronger.

To be somebody’s place to rest their messed up minds but as well as to be their reminder to begin their race so they can arrive to the finish line.

I want to be their music in their life; so that they can dance towards this battlefield called life; I want to be somebody’s favorite song, to be their mood booster and an escape towards a bad day that they’ve gotten into.

I want to give a message in everything that I do; behind each word that I speak, behind every spaces and lines in my writings. I want to have an impact through the arts that I’ve created; through each moves, smiles, quirks, and the giggles during hard times.

I want to be everybody’s reminder that we are actually never alone. In this confusing life in our 20s, we are in this together and we will surely survive.

I don’t want to be seen as something shallow, I want depth; huge depth which artificial things are not there to be seen. In my 20s, I don’t want artificial things; all I want is to inspire.

That’s the End of the Murrum road, turn left to Tarmac one.

Its 3:56 in the morning. I have been awake since two, because I am tired of sleeping. I am tired of being in deep sleep of my own life, while suns rise and set each day, and the hours of my life quietly drone on as I sit around waiting and praying that the way will reveal itself. I am waiting to accumulate evidence to support my haphazard belief that I am actually capable of being happy. Some divine switch that will go off one day, letting me know that all my hours of waiting and patience have paid off because I took the smart and responsible path, and sacrificed a lifetime of immediate happiness for long-term comfort.

I am tired of that passive bullshit.

I am tired of being in my own life; I am tired of smart and responsible.

Today I will do everything I am told I shouldn’t; I will quit a full-time job with benefits. I will quit a job with a promising and lucrative future. I will quit a job that others have convinced me is worth it. I will quit this job because when I look at the lives that the others lead, I feel suffocated. And all I see is darkness.

I do not want the life that the others lead. So why am I making the effort to mimic and mirror their path? Why do I stay and allow myself to feel small, worthless, disrespected, and hopeless? Why am I wasting another minute pursuing a dream with a ceiling? A dream imposed on me by parents, standards, society, peers and my father Richard Mutawe. Why am I continue to let many opportunities come my way to fade, because of strong desire to work, serve, and stay with people who don’t value our work? A self-imposed dreams because I am too afraid that I am not worthy or bigger and better.

I cannot be small anymore, I cannot play small, I cannot remain in such situation because someone else using my soft heart to treat me like a bullshit. I cannot be hated by my brothers and sisters, to remain alone in the world as if I am orphan. I can feel the exterior of myself-imposed shell cracking at every major joint in my body. I can feel the physical cage of my soul begging to fall apart,  I can hear voices from Parents Nakayemba Rose and Kaggwa Deogracious, Brothers and sisters Matovu Tony, Mutawe Julius, and Doreen, calling me to find new hope. This transformation may look like destruction, because of years I spent here at PTMOF, long lasting friends I got. It may look and feel like a breakdown, because I am quitting without any plan where to go. A train catapulting too fast down rusty tracks with lighter fluid pooling to either side, daring me to grab a match.

Taunting me, saying

“Who do you think you are? To think the rules don’t apply to you?”

 Anxiety, Fear, Shame.

Feeling like I am ready to crash and burn. I am ready to rise… God always is with me since I was born; I have been moving with him throughout primary at Kibale Primary, to secondary. St Mary’s s.s, Kabale ss, to University (MRU).

I am ready to be awake.

I will not sit on the sidelines of my life anymore, waiting to check boxes on my resume that should equate to meaning, longing, purpose, and self-love, (My transcript must be respected). Like I will reach the end of a maze and discover a golden box of worth that I will cling to for dear life because the prize was won after navigating through sacrifice and walls.

 I am blowing up the maze; I am climbing over the walls. I am not wasting another moment asleep at the wheel because it’s the safe thing to do.

I am tired of waiting to figure out who I am ready I am. There is no time to wait and to waste. I cannot be passive or docile. I am not comfortable with small; I am not going to wait for my savings to accumulate and my credit card bills to be paid before I begin to lay the groundwork of the life I actually want. I will love the foundation and I am ready to serve it outside, I will love people working at the foundation who treated me like a baby, I will miss everyone who loved me, treated me well, Alice you has been too good to me, my career mother, my mentor, my everything. You deserve my respect. Mariam, you has been good to me, loved me with all your heart, your soul, you has been my advisor, my counselor indeed, I will love you till the dawn of the light. Winnie, you have been inspiration to everyone, what a soul mate young mother!  Loving, bright, beautiful angel, born with smart cognition, you will be remembered. Salma, what a God’s treasure, what a bright future ahead! I treasure you like no one else, keep the candle burning, let light shine and bright to your family and the community you will serve. Director Salome, thank you for your

International Women’s Day! My special Day goes to a teenage Mother at work place. Namatovu Zam

Think equal, build smart, innovate for change

International Women’s Day is a time to reflect on progress made, to call for change and to celebrate acts of courage and determination by ordinary women who have played an extraordinary role in the history of their countries and communities.

The 2019 theme “Think equal,build smart, innovate for change” focuses on innovative ways in which we can advance gender equality and the empowerment of women, particularly in the areas of social protection systems, access to public services and sustainable infrastructure.

The achievement of the ambitious Sustainable Development Goals requires transformative shifts, integrated approaches and new solutions, particularly when it comes to advancing gender equality and the empowerment of all women and girls.

Innovation and technology provide unprecedented opportunities, yet trends indicate a growing gender digital divide and women are under-represented in the field of science, technology, engineering, mathematics and design. It prevents them from developing and influencing gender-responsive innovations to achieve transformative gains for society. From mobile banking to artificial intelligence and the internet of things, it is vital that women’s ideas and experiences equally influence the design and implementation of the innovations that shape our future societies.

Echoing the priority theme of the sixty-third session of the Commission on the Status of Women , in 2019 we look to industry leaders, game-changing start-ups, social entrepreneurs, gender equality activists, and women innovators to examine the ways in which innovation can remove barriers and accelerate progress for gender equality, encourage investment in gender-responsive social systems, and build services and infrastructure that meet the needs of women and girls.

On 8 March 2019, join us as we celebrate a future in which innovation and technology creates unprecedented opportunities for women and girls to play an active role in building more inclusive systems, efficient services and sustainable infrastructure to accelerate the achievement of the SDGs and gender equality.

Gender equality and the Sustainable Development Goals

International Women’s Day is also an opportunity to consider how to accelerate the building momentum for the effective implementation of the Sustainable Development Goals, especially goal number 5: Achieve gender equality and empower all women and girls; and number 4: Ensure inclusive and quality education for all and promote lifelong learning.

Think Equal - Build Smart: Innovate for Change

Some key targets of the 2030 Agenda

  • By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and Goal-4 effective learning outcomes.
  • By 2030, ensure that all girls and boys have access to quality early childhood development, care and preprimary education so that they are ready for primary education.
  • End all forms of discrimination against all women and girls everywhere.
  • Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
  • Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.

Story shared by parent of a teenage mother called Namatovu Zam, who gave birth to twins at 16 years. after almost survived death. MY Mothers’s day goes to her and many young women at the center.

In the start of 2017, her father died, the elder sisters suggested that everyone was to start living on their own. Being the last born at the age of 18, she decided to come to kampala to look for some work to do. She later got a job as a maid; she only managed to work for few months since she was always suffering from a severe headache and brutality from her obsesses. She later went back to village where she met a young man aged 23 who promised to take good care of her. She came to town with a young man and they stayed together for one week. She later went to look for another job. After some few weeks she realized that, she had missed her periods now she is pregnant, she went back to a young man’s place to tell her about her news. The young man denied the pregnancy and told her never to come back looking for him.

She had no jobs, and lost focus and hope, she started living on streets and in churches. When the pregnancy was around six months, she went to the village. Her elder sisters got mad about the pregnancy and they quickly advised her to abort. But fortunately, she resisted, not to kill the innocent baby, and she did not abort and was chased away angrily from home, she felt that everything was over, no hope, no money, no any assistance, she cried loud, thinking what she can do but all remained in vain, she was motivated to remain strong, that now it is the right time to stand firm no matter what.

She was given 5000 UGX by a Good Samaritan, she went back to Kampala but no where to stay, she started living in churches like Christian life church of pastor Jackson Ssenyonga in Bwaise, and Miracle center cathedral of Pastor Robert Kayanja  Lubaga where she was receiving some help from the volunteers.

At Christian life church, it is where, she met a girl by names of Nakulima Winnie they interacted for minutes, she was good and told her that there is an organization called Pelletier teenage mothers foundation where she can get assistance, she directed her, she went to PTMOF, but God is good, her prayers were answered, she found good humanitarian people there, they counseled her, and gave her hope, they even allowed to assist her, since she was homeless, they gave her where to stay, she stayed there one day, but they connected her to her sister in Kajjansi, but, she remained there three days only, because the elder sisters directed her sister where she was living to chase her away, failure to do so, they are to come and chase her out, she escaped quietly, and went back to Christian life church, but still, the order came from pastor Sserwadda to chase all pregnant girls, those with children and elders.

Life became hard again, at Pelletier teenage mothers foundation there was no space where she can live with her pregnancy, her sisters chased her from all corners where she can get help, so, the matter worsens, she went back to streets, sleeping on veranders, and tree shades for couple of weeks, she met a woman called Musawo Jane in Bwaise, she gave her tea and what to eat, she told a bodaboda rider to take her to Lubaga miracle center cathedral of Pastor Robert Kayanja, she spent their 2 weeks since they was still chased because it is prohibited to deliver from church, she went again back on streets by then the pregnancy was around seven months.

She walked with her baby inside right from Lubaga heading where she don’t know, some times the sunshine and heavy rain barely hit her, she stopped on the church called worship house of pastor Wilson Bugembe, she slept there one day, and heading to a health center called Kawempe Mulago where she stayed 5 days getting medicine and other post natal care for free, because she explained her story to doctor, he was touched and decided to assist her for free.

From there, she continued her Journey, walking while sleeping on peoples retail shops, petrol stations, verandas, and streets, she went back to Christian life church, by then she was 8 moths pregnant, from there, she prayed to Lord for couple of weeks cried to him, to save me from this situation, to deliver well. I went to Kawempe Mulago for check up and to get medicine, that’s where she gave birth to her two little ones Twins (boys)

“I don’t know what to say, but it’s a blessing from God, the holly spirit that Made those mothers and fathers from Pelletier teenage mothers foundation, madam Alice, Mr. Lukonge Achilees and Madam Solome Nanvule, when you have bee rejected by your relatives, chased everywhere, but you found hope from people you don’t know!!! May lord grant them all the blessings?” I am Learning (hairdressing) at (PTMOF) i hope to start my own business after completing the course.

Preparing and delivering Twins: The last days story of a single mother who lived on street, and give birth to Miracle and Favour.

And the moment that I have been anticipating for days, months, and years even has come. I took a deep breath and pushed down my baby with own power while I followed my body. Before my breath finished, my first baby came sliding out of me and the next follows. While I exhaled, I quietly said that they are born. They put my twin into my arms even before cutting their umbilical cord. They were warm, wet, soft, and smelled sweet. They screamed joyfully, and I thanked them repeatedly for giving me this wonderful experience. The doctors and nurses were looking on at that remarkable moment when our twin joined my family, confused, happy, and teary eyed. They stared at us with questioning expressions because they had just watched a birth so vastly different from the fearful births they had witnessed in the past—fearfulness that resulted from the negative birth stories that have been handed down to women for years especially women who passed through difficult life and have eroded their confidence and power regarding birth. How had it come to this?

Forty weeks and 5 days into the pregnancy, my Twins and I were still together. In life I don’t wished anyone to live in, I felt their movements less now—they were smaller than they had been but stronger. My friends on streets, at least 20 people checking on me every day where I used to sleep on cement to ask when I will give birth and scaring me by saying things like, ―What if something’s wrong with the baby?‖ no one among my brothers and sisters wanted to know about my life, My mother and Father up in the sky/heaven may be were watching and praying for me, and waiting impatiently for their first grandson, constantly saying, ―It’s high time the baby made an appearance.‖ Because they used to say that when they are still alive, they loved me so much. I became so fed up, especially in the last 10 days of my pregnancy. I suggested to the close friends-to-be that they not tell anyone the approximate birth date to avoid similar experiences.

I made myself believe that my Twins would be born in the night, having heard somewhere that animals that sleep in the daytime birth in the night and vice versa (which seemed to show that privacy and protection are important in nature.) In the weeks and days leading up to my due date, I tried my best to go to sleep in people’s houses, or people’s veranders early every day so as not to be tired when I finally went into labor. I would fall asleep rubbing my abdomen and thinking, ―Maybe I’ll smell you tonight babies.‖ But when morning came, I would wake to find my babies was still saying, ―Good morning, mommy!‖ from my womb. It was another such morning when I went to the toilet of one of good Samaritan and saw the first thrilling sign that the birth was finally going to happen. I had to go to nearby church to pray, There came a lady dressed well, totally in the same age group, she was from Pelletier teenage mothers foundation (PTMOF) it was the first sign that Miracle exists, and God is always there for the poor, she told me about the services they are offering, at first I was in fear of strangers but finally I trusted her since we met at the church.

She leads me to where she stay, I found older woman at home, to find that she was the mother of that lady I met, but I told them everything I passed through, they gave me an emergence shelter, when the contractions became more frequent. I put my hand on my abdomen and could feel uterine contractions, but they were not bothering me at all. We had a nice family breakfast, took a walk with those around for 2 hours, and went to the market, and then I cleaned my house in a squatting position. (Knowing that squatting is one of the most appropriate positions during labor because it enables the baby to move more easily in the birth canal [ Balaskas, 1992 ], I was seeking any excuse to squat.) That evening, I was feeling quite energetic and dynamic. At around 9:00 p.m., while we were all watching TV together as family, I fell asleep on the living room sofa. At 11 p.m., The mother of Winnie woke me up to tell me to go to my bed, but by then I felt wide awake, so she went to bed herself—a relief to me because I was sure she would treat me like an invalid if she thought the birth was imminent.

My new sisters at the centre was not sleepy either, so we decided to watch a documentary about dolphins giving birth. I told them that my babies would come to the world that day, but one called Mariam just laughed and said, ―The dolphin might be giving birth today, but you won’t.‖ Then they all decided to go to bed. I was having contractions, but I would not have even noticed them had I not put my hand on my abdomen. I was also feeling some pressure on my perineum, but the contractions I had felt during the pregnancy had disturbed me more. I decided to take a shower, and the warm water combined with the smell of the shampoo made me feel great. All was available, I never used them in my life, and the good life I got at the last days of my pregnancy I never thought of living in such life after the death of my mother and father at an early age. I blow dried my hair, put on some nail polish, prepared the clothes I would wear to go to the hospital, and ate an apple. Then, I finally went to bed. At around 2:00 a.m., I put my hand on my abdomen and tried to time my contractions, which by now were frequent and long lasting. Because of the stories of labor pains that I still had in my mind, however, I didn’t think they could be birth contractions.

While I was relaxing my whole body, I suddenly felt nauseous and vomited. The Mother of Winnie called Mrs Alice and Winnie both woke up, and Winnie said to me, ―It cannot be time for birth, but perhaps something is wrong. We should go to the hospital.‖ We grabbed the already-packed bags, got in the car, and turned on an enjoyable praise song to listen to during the drive. On the way, I continued with my breathing and relaxation exercises. I could sense an amazing cocktail of hormones flowing through my body. I had never felt so happy, energetic, and motivated. These were the last moments of my babies inside me, and we were enjoying it! Everybody was calm as we headed to the delivery room.

It was 2:50 a.m. The team on night duty was sitting around eating a pizza. I told them, ―Don’t trouble yourselves, it’s not time for the birth. We just came in for a checkup.‖ They loved the way I was jocking around! All laughed loud! The on-duty doctor put a hand on my abdomen and said, ―The contractions are severe. I think I should examine you.‖ I lay on the examination couch and he made a vaginal examination. The doctor told me that they are Twins! I said what!? At that point, I collected myself and asked the personnel to make the head of the bed as upright as possible. Suddenly, just as I was about to stand up, I felt severe pressure on my perineum. At the same time, I felt like I would explode with excitement. Odent (2003) notes that with births where there is no intervention or fear, a sudden adrenaline rush can occur just before the fetal ejection reflex.

This is exactly what happened in my birth. Overcome by a sensation like the thrill you get at the moment you parachute off a mountainside and shout out with joy at the top of your voice, I screamed uncontrollably. Realizing that the doctor, Mrs Alice, and the nurse were all staring at me in amazement, I told them, ―Everything’s okay, don’t worry. There is no pain, just a sudden adrenaline rush.‖ Odent (2003) notes that, with births where there is no intervention or fear, a sudden adrenaline rush can occur just before the fetal ejection reflex. This is what happened in my birth. I settled myself back onto the bed and felt the urge to push. My body position was as straight as possible. I took a deep breath and pushed my first baby downward with all my power. ―Push slowly,‖ my birth doctor warned me. ―The baby’s coming too fast. After few minutes, I pushed the second baby! Doctor told me! Again ―Push slowly,‖ I’ll have to do an episiotomy.‖ But I just could not slow myself down, and the episiotomy was done at the last moment. In my terms, it was a natural birth throughout, without any intervention other than the episiotomy. Is it still possible, therefore, to call this a natural birth? I think it is. It was completely natural because the intervention happened only when necessary.

Two or 3 weeks later, when I had the chance to make some time for myself and think about the birth, I wondered whether the episiotomy might have been unnecessary. After all, I had given myself regular perineal massages every day after the 30th week of my pregnancy specifically to avoid perineal laceration or an episiotomy, just as suggested by evidence-based practice (Berghella, Baxter, & Chauhan, 2008). I thought my perineum was ready for the birth. Why did they have to do an episiotomy? I had been in a squatting position, which is the most appropriate position for birth, and had pushed the babies by grasping and pulling my knees up toward me. The babies came out of my vagina very quickly both because I pushed my babies uncontrollably fast, and because of the fetal ejection reflex combined with an adrenaline rush. Perhaps if I had been in the ―polar bear‖ position Mongan (2005) suggested for quick delivery, I would have been able to give birth without the need for an episiotomy.

I was in a state of shock after the delivery, unable to believe my Twins was now in my arms. It was 3:15 a.m. Just 25 minutes had passed since I had gone into the delivery room. The birth was not the way some people had described it. It was totally painless, joyful, exciting, and quick. My Twins was so good, Looking healthy. At first, They greeted the world with loud screams, presumably because of the effects of the hormone cocktail, but they calmed down after they was cradled in my arms and heard me say, ―Welcome, my Twins. I have been waiting for you for so long. I love you so much, do not cry.‖ They began looking around curiously with their eyes wide open. One named Wasswa Miracle and the other named Kato Favour. I am Zam Namatovu

MRU Psychology/Behavioural

Operant Conditioning

A look at operant conditioning as a process of learning, and how Skinner’s box experiments demonstrated the effect of reinforcements on behavior.

Operant Conditioning

Operant conditioning is a theory of learning in behavioral psychology which emphasises the role of reinforcement in conditioning. It emphasises the effect that rewards and punishments for specific behaviors can have on a person’s future actions. The theory was developed by the American psychologist B. F. Skinner following experiments beginning in the 1930s, which involved the use of an operant conditioning chamber. Operant and classical conditioning remain important theories in our understanding of how humans and other animals learn new forms of behavior. 

Early Developments in Conditioning: Pavlov’s Dogs

Early research into conditioning was conducted by the Russian physiologist Ivan Pavlov. During studies of digestion in dogs, he noticed that his subjects would salivate when a researcher fed them. After the researcher had opened a door, entered the room and fed the dogs a few times, the animals began to associate the door opening with food, and would begin to salivate whenever they heard the door. Through associative learning, the dogs had linked an neutral stimulus (the door opening) with an unconditioned stimulus (food). Repeated classical conditioning had led to the door becoming a conditioned stimulus, which prompted the dogs to salivate.


Pavlov conducted additional research, known as the ‘Pavlov’s dog’ experiments, in which he further investigating classical conditioning as a form of learning.

Exposing dogs to a variety of stimuli before feeding them, he discovered that the animals could be conditioned to salivate in response to different types of event, such as the ringing of a buzzer or the sounding of a metronome

Thorndike’s Law of Effect

In 1905, American psychologist Edward Thorndike proposed a ‘law of effect’, which formed the basis of our modern understanding of operant conditioning. Thorndike’s research focussed on learning processes and he conducted experiments to discover how cats learn new forms of behavior.

He would place a cat in a puzzle box, where the animal would be remain until they learnt to press a lever. Initially, they would be trapped in the box for a long period of time, roaming it before inadvertently pressing the lever, and a door opened for the cat to escape. However, once the cats learnt to associate operating the lever with a positive outcome – being able to leave the box – they wasted less and less time before using it to escape. Through instrumental learning, the cats had learnt to associate pressing the lever with the reward of freedom

Thorndike drew on these findings when developing his law of effect. He argued that the effect of one’s action – whether it is rewarded or punished – influences whether an individual will be likely to repeat such behavior in the future.

B. F. Skinner

Burrhus Frederic Skinner (1904-1990) was an influential American psychologist, writer and inventor. Born in Susquehanna, Pennsylvania, he studied at Hamilton College in New York, where he graduated in 1926 with plans to pursue a career in writing. However, a lack of success as an author, and his discovery of the theories of Ivan Pavlov, prompted an interest in psychology. He enrolled at Harvard University, where he completed his masters and in 1931, a doctorate. Skinner remained in a teaching position at Harvard whilst continuing his research. In 1938, he outlined a theory of learning involving operant conditioning.

Aside from his work in psychology, Skinner was also a keen inventor. During the Second World War, he took part in Project Pigeon, a failed attempt to create a missile controlled by pigeons. Amongst his more successful inventions was the air crib, a temperature-controlled environment for babies, which he used with one of his own children.

Skinner retired from Harvard University in 1974. He died from leukemia in 1990.

Operant Conditioning Chamber

When B. F. Skinner began studying psychology, it was the theories and ideas of the behaviorist school dominated the discipline. Many psychologists agreed with the proposals made by John B. Watson (1878-1958). In 1913, he published “Psychology as the Behaviorist Views It”, an article now cited as the “behaviorist manifesto”. Watson argued that the human mind could be most effectively understood by looking at a person’s observable behavior, rather than his or her cognitive processes, which he believed were more difficult to observe and quantify.

As a fellow behaviorist, Skinner believed that conditioning played a significant role in the learning process. He studied Thorndike’s law of effectusing a piece of experimental apparatus now known as an operant conditioning chamber, or ‘Skinner box’. An animal is placed in a box, which contains a reward mechanism such as a hopper to dispense food pellets. A researcher can observe the animal whilst administering rewards. Punishments can also be imposed using the electrified base of the box to deliver electric shocks. A light and a speaker built into the side of the chamber allow for a signal to be communicated to the subject, whilst the animals are given with a lever to press.

In 1938, Skinner published The Behavior of Organisms, in which he described the functions of operant conditioning. Whilst experimenting with an operant conditioning chamber, he had found that animals behaving in a particular manner would either repeat or avoid that behavior depending on whether they were subsequently rewarded or punished.

In one experiment, )observed the behavior of pigeons in the box. The birds were free to move around the box, turning full circle and moving their heads. Meanwhile, the hopper fed the subjects at regular timed intervals, regardless of the their behavior. Skinner found that when a bird’s particular movement was coincidentally but repeatedly followed by food, the pigeons would interpret the behavior as having caused the hopper to offer a reward. A variety of superstitious behaviors, including twists and full-circle turns, were adopted by the birds in the expectation that food would follow. 

Skinner explained the pigeons’ behavior in terms of operant conditioning. The food served as a positive reward for the birds’ behavior, leading them to repeat a particular movement more often when they found that it was subsequently rewarded.

The reinforcements and punishments which influence behavior take a number of forms. A positive reward or punishment describes the imposition of a stimuli in a situation. Depending on the stimuli, this may either promote or discourage an individual’s behavior. Conversely, negative rewards and punishments involve the removal of a particular benefit or punishment. Again, these reinforcements may influence a person’s future actions.

Positive Reinforcement

positive reinforcement is the provision of a reward or other benefit following a desirable action. This encourages a person or animal to repeat a particular behavior in future, in the hope that the reinforcement will be repeated.

Examples of positive reinforcements include:

  • A dentist gives a boy a sticker after he remains calm throughout a dental check-up. The child will be encouraged to behave well at the dentist’s practice in future, expecting that he will receive more stickers. 
  • Rewarding a dog with a treat after it has successfully completed a training maneuver when rehearsing for a dog show.
  • In some food courts, electronically-operated waste bins contain a sensor and a speaker. When the bin senses a person emptying waste into the receptacle, the speaker emits a recorded voice which thanks the user for using the bin, instead of choosing to leave their litter. This appreciation may lead the user to seek gratification again by using the waste bin in the future.

Negative Reinforcement

Negative reinforcements are the removal of an undesirable or uncomfortable stimuli from a situation. Such reinforcements may involve the ceasing of punishment when a person’s behavior conform to a demand. In order to avoid future punishment, an individual may change his or her behavior. For example:

  • A girl who regularly fights with her sister is told by her parents that she is to be grounded on the days that she misbehaves. On days when the girl changes her behavior, the punishment is lifted, and she learns act more amicable towards her sister.
  • A person climbing into a hot bath is burnt and quickly climbs out of the water. Subsequently, they learn to wait for the bath to cool before entering the water in order to avoid being burnt again.
  • A man attends a music concert. The band is uncomfortably loud and he leaves the concert hall to find a quieter environment. In future, he declines invitations to watch bands in order to avoid the loud music, which operated as a negative reinforcement.

Positive Punishment

positive punishment is a stimuli imposed on a person when they behave in a particular way. Over time, the person learns to avoid the positive punishment by altering their behavior.

Examples of positive punishment:

  • A child is sent to his room when he is impolite to his mother. The boy, who wants to play with his toys downstairs, begins to be more polite to his parents. 
  • An internet service provider limits users’ usage to a set amount of data, after which the user’s internet speed is severely reduced for the remainder of the month. Users learn to avoid slow download speeds by using less of their data allowance.
  • A convict flouts the rules of a prison. He is placed in solitary confinement as a form of positive punishment, and eventually chooses to follow the rules to avoid further isolation. 

Negative Punishment

Negative punishment is the removal of a benefit or privilege in response to undesirable behavior. A person wants to retain the benefits that they previously enjoyed, and avoids behavior which may lead to their rights being revoked.

Negative punishment examples include:

  • A child is prevented from attending a football game after failing to clean their room. The threat of further punishment leads them to complete their assigned chores.
  • A dog owner shouts at their pet after it runs away in a park. The dog, wanting to avoid being shouted at, learns to stay close to its owner whilst in the park.
  • A man strains his eyes after reading without his glasses. Although he dislikes wearing spectacles, he wears them to avoid straining his eyes.

As with its classical counterpart, operant conditioning depends on the repetition of a stimulus in order to maintain the association between behavior and a reinforcement. Initial conditioning is repeated in order to create an association, and must then be periodically repeated so that the link between the two is not lost. If, after initial conditioning, the reinforcement is removed (e.g. a treat is no longer given when a dog behaves), the subject will eventually ‘unlearn’ the association. Extinction can result in the person or animal resuming their original behavior.

Schedules of Reinforcement

Skinner was curious to find out what variables affected the effectiveness of operant conditioning. He conducted research into the effect of timing on conditioning with Charles B. Ferster, a fellow behavioral psychologist who worked at the Yerkes Laboratories of Primate Biology in Florida. 1found that schedules of reinforcement – the rate at which a reinforcement is repeated – can greatly influence operant conditioning.

A number of types of schedules of reinforcement have been proposed by Skinner, Ferster and others, including:

Continuous Reinforcement Schedules (CRF)

A reward or punishment is provided every time an individual exhibits a particular mode of behavior. Through continuous reinforcement, the subject learns that the result of their actions will always be the same. However, the dependability of continuous reinforcement can lead to it becoming too predictable. A subject may learn that a reward will always be provided for a type of behavior, and only carry out the desired action when they need the reward. For instance, a rat may learn that pushing a lever will always lead to food being provided. Given the security that this schedule of reinforcement provides, the rat may decide to save energy by only pressing the lever when it is sufficiently hungry.

Partial Reinforcement Schedules (PR)

Instead of responding every time a person behaves in a particular way, partial reinforcementinvolves rewarding behavior only on some occasions. A subject must then work harder to receive a reinforcement and may take longer to learn using this type of operant conditioning.

Partial reinforcement can be used following a period of initial continuous reinforcement to prolong the effects of operant conditioning. For example, an animal trainer might give a treat to a dog every time it sits on command. Once the animal has learnt that a reward provided for obeying the trainer, partial reinforcement may be used. The dog may receive a treat only every 5 times it obeys a command, but the conditioned behavior continues to be reinforced and extinction is avoided.

Partial reinforcement modifies the ratio between the conditioned response and reinforcement, or the intervalbetween reinforcements:

  • Fixed-interval schedules
    A reinforcement is only given at a set interval. For instance, an employer rewards company employees with an annual bonus to reward their work. The interval of one year is fixed, and the employees anticipate a reinforcement annually.
  • Variable-interval schedules
  • Reinforcements are provided at intervals which the subject is unaware of. Instead of paying an annual bonus, an employer might pay smaller bonuses, sometimes monthly, other times every 2, 3 or 4 months. The employee is unaware when the reinforcement will be given and is encouraged to work harder with the knowledge that bonuses could be decided at any time.
  • Fixed-ratio schedules
    Fixed-ratio schedules require a subject to provide the conditioned response a predetermined number of times before a reinforcement is given. An example of a fixed-ratio schedule is an amusement arcade game which rewards the player with a toy on every 10th attempt. 
  • Variable-ratio schedules
    A variable-ratio schedule reinforces behavior depending on the number of responses made, but this ratio changes constantly. The amusement game described above might instead reward the 2nd, 6th, 20th and 21st attempts. 

Differences from Classical Conditioning

Although classical and operant conditioning share similarities in the way that they influence behavior and assist in the learning process, there are important differences between the two types of conditioning.

During classical conditioning, a person learns by observation, associating two stimuli with each other. A neutral stimuli is presented in conjunction with another, unconditioned, stimulus. Through repetition, the person learns to associate the first seemingly unrelated stimuli with the second.

In contrast, operant conditioning involves learning through the consequences of one’s actions. It is the reinforcement that follows behavior which informs a person’s future actions. A person behaves in a particular manner and is subsequently rewarded or punished. They eventually learn to associate their original behavior with the reinforcement, and either increase, maintain or avoid their behavior in future in order to achieve the most desirable outcome.


Skinner’s theory of operant conditioning played a key role in helping psychologists to understand how behavior is learnt. It explains why reinforcements can be used so effectively in the learning process, and how schedules of reinforcement can affect the outcome of conditioning. Skinner’s research also addressed the use of behavioral shaping, whereby successive approximations of an expected response are also reinforced, leading a subject gradually towards the desired type of behavior.

An advantage of operant conditioning is its ability to explain learning in real-life situations. From an early age, parents nurture their children’s behavior using rewards. Praise following an achievement (e.g. crawling or taking a first step) reinforce such behavior. When a child misbehaves, punishments in the form of verbal discouragement or the removal of privileges are used to dissuade them from repeating their actions.

Operant conditioning can also be observed in its applications across a range of learning environments. Teachers reward students’ achievements with high grades, words of encouragement and star-shaped stickers on homework – all examples of positive reinforcement. Positive punishments – detention, exclusion or parents grounding their children until their behavior changes – serve to further influence behavior using the principles of operant conditioning. And its uses are not limited to influencing human behavior: dog trainers use reinforcements to shape behavior in animals and to encourage obedience.

Skinner’s theory has, however, been criticised for its oversimplification of the complex nature of human behavior. Operant conditioning is based on the idea that behavior is ‘learnt’ simply through the process of reinforcement. However, it neglects individual differences and the cognitive processes that influence behavior. This has led critics to label Skinner’s ideas as deterministic: operant conditioning assumes that environmental factors beyond a person’s control are responsible for their behavior. It fails to account for people’s ability to reason and to decide their actions according to their own free will.


MRU Psychology

Mary Ainsworth Attachment Theory

Mary Ainsworth’s (1971, 1978) observational study of individual differences in attachment is described below

Strange Situation Procedure

The security of attachment in one- to two-year-olds were investigated using the strange situation paradigm, in order to determine the nature of attachment behaviors and styles of attachment.

Ainsworth developed an experimental procedure in order to observe the variety of attachment forms exhibited between mothers and infants.

The experiment is set up in a small room with one way glass so the behavior of the infant can be observed covertly. Infants were aged between 12 and 18 months. The sample comprised of 100 middle-class American families.

The procedure, known as the ‘Strange Situation,’ was conducted by observing the behavior of the infant in a series of eight episodes lasting approximately 3 minutes each:

Mary Ainworth

(1) Mother, baby, and experimenter (lasts less than one minute).

(2) Mother and baby alone.

(3) A stranger joins the mother and infant.

(4) Mother leaves baby and stranger alone.

(5) Mother returns and stranger leaves.

(6) Mother leaves; infant left completely alone.

(7) Stranger returns.

(8) Mother returns and stranger leaves.



Strange Situation classifications (i.e., attachment styles) are based primarily on four interaction behaviors directed toward the mother in the two reunion episodes (Ep. 5 & Ep. 8).

  1. Proximity and contacting seeking
  2. Contact maintaining
  3. Avoidance of proximity and contact
  4. Resistance to contact and comforting

The observer notes down the behavior displayed during 15-second intervals and scores the behavior for intensity on a scale of 1 to 7.

strange situation scoring

Other behaviors observed included:

  • Exploratory Behaviors e.g., moving around the room, playing with toys, looking around the room.
  • Search Behaviors, e.g., following mother to the door, banging on the door, orienting to the door, looking at the door, going to mother’s empty chair, looking at mother’s empty chair.
  • Affect Displays negative, e.g., crying, smiling.

Results – Attachment Styles

Ainsworth (1970) identified three main attachment styles, secure (type B), insecure avoidant (type A) and insecure ambivalent/resistant (type C). She concluded that these attachment styles were the result of early interactions with the mother.

A forth attachment style known as disorganized was later identified (Main, & Solomon, 1990).

Separation AnxietyDistressed when mother leavesIntense distress when the mother leavesNo sign of distress when the the mother leaves
Stranger AnxietyAvoidant of stranger when alone, but friendly when the mother is presentThe infant avoids the stranger – shows fear of the strangerThe infant is okay with the stranger and plays normally when the stranger is present
Reunion BehaviorPositive and happy when mother returnsThe infant approaches the mother, but resists contact, may even push her awayThe Infant shows little interest when the mother returns
OtherUses the mother as a safe base to explore their environmentThe infant cries more and explores less than the other two typesThe mother and stranger are able to comfort the infant equally well
% of infants70%15%15%

B: Secure Attachment

Securely attached children comprised the majority of the sample in Ainsworth’s (1971, 1978) studies.

Such children feel confident that the attachment figure will be available to meet their needs. They use the attachment figure as a safe base to explore the environment and seek the attachment figure in times of distress (Main, & Cassidy, 1988).

Securely attached infants are easily soothed by the attachment figure when upset. Infants develop a secure attachment when the caregiver is sensitive to their signals, and responds appropriately to their needs.

According to Bowlby (1980), an individual who has experienced a secure attachment ‘is likely to possess a representational model of attachment figures(s) as being available, responsive, and helpful‘ (Bowlby, 1980, p. 242).

A: Insecure Avoidant

Insecure avoidant children do not orientate to their attachment figure while investigating the environment.

They are very independent of the attachment figure both physically and emotionally (Behrens, Hesse, & Main, 2007).

They do not seek contact with the attachment figure when distressed. Such children are likely to have a caregiver who is insensitive and rejecting of their needs (Ainsworth, 1979). The attachment figure may withdraw from helping during difficult tasks (Stevenson-Hinde, & Verschueren, 2002) and is often unavailable during times of emotional distress.

C: Insecure Ambivalent / Resistant

The third attachment style identified by Ainsworth (1970) was insecure ambivalent (also called insecure resistant).

Here children adopt an ambivalent behavioral style towards the attachment figure. The child will commonly exhibit clingy and dependent behavior, but will be rejecting of the attachment figure when they engage in interaction.

The child fails to develop any feelings of security from the attachment figure. Accordingly, they exhibit difficulty moving away from the attachment figure to explore novel surroundings. When distressed they are difficult to soothe and are not comforted by interaction with the attachment figure. This behavior results from an inconsistent level of response to their needs from the primary caregiver.

Strange Situation Conclusion

Ainsworth (1978) suggested the ‘caregiver sensitivity hypothesis’ as an explanation for different attachment types. Ainsworth’s maternal sensitivity hypothesis argues that a child’s attachment style is dependent on the behavior their mother shows towards them.

  • ‘Sensitive’ mothers are responsive to the child’s needs and respond to their moods and feelings correctly. Sensitive mothers are more likely to have securely attached children.
  • In contrast, mothers who are less sensitive towards their child, for example, those who respond to the child’s needs incorrectly or who are impatient or ignore the child, are likely to have insecurely attached children.

For example, securely attached infant are associated with sensitive & responsive primary care. Insecure ambivalent attached infants are associated with inconsistent primary care. Sometimes the child’s needs and met, and sometimes they are ignored by the mother / father. Insecure-avoidant infants are associated with unresponsive primary care. The child comes to believe that communication of needs has no influence on the mother/father.

Ainsworth’s (1971, 1978) findings provided the first empirical evidence for Bowlby attachment theory

For example, securely attached children develop a positive working model of themselves and have mental representations of others as being helpful while viewing themselves as worthy of respect (Jacobsen, & Hoffman, 1997). Avoidant children think themselves unworthy and unacceptable, caused by a rejecting primary caregiver (Larose, & Bernier, 2001). Ambivalent children have a negative self-image and exaggerate their emotional responses as a way to gain attention (Kobak et al., 1993). 

Accordingly, insecure attachment styles are associated with an increased risk of social and emotional behavioral problems via the internal working model.

attachment styles

Theoretical Evaluation

This caregiver sensitivity theory is supported by research from, Wolff and Van Ijzendoorn (1997) who conducted a Meta-analysis (a review) of research into attachment types. They found that there is a relatively weak correlation of 0.24 between parental sensitivity and attachment type – generally more sensitive parents had securely attached children.

However, in evaluation, critics of this theory argue that the correlation between parental sensitivity and the child’s attachment type is only weak. This suggests that there are other reasons which may better explain why children develop different attachment types and that the maternal sensitivity theory places too much emphasis on the mother. Focusing just on maternal sensitivity when trying to explain why children have different attachment types is, therefore, a reductionist approach.

An alternative theory proposed by Kagan (1984) suggests that the temperament of the child is actually what leads to the different attachment types. Children with different innate (inborn) temperaments will have different attachment types.

This theory is supported by research from Fox (1989) who found that babies with an ‘Easy’ temperament (those who eat and sleep regularly, and accept new experiences) are likely to develop secure attachments. Babies with a ‘slow to warm up’ temperament (those who took a while to get used to new experiences) are likely to have insecure-avoidant attachments. Babies with a ‘Difficult’ temperament (those who eat and sleep irregularly and who reject new experiences) are likely to have insecure-ambivalent attachments.

In conclusion, the most complete explanation of why children develop different attachment types would be an interactionist theory. This would argue that a child’s attachment type is a result of a combination of factors – both the child’s innate temperament and their parent’s sensitivity towards their needs.

Belsky and Rovine (1987) propose an interesting interactionist theory to explain the different attachment types. They argue that the child’s attachment type is a result of both the child’s innate temperament and also how the parent responds to them (i.e., the parents’ sensitivity level).

Additionally, the child’s innate temperament may, in fact, influence the way their parent responds to them (i.e, the infants’ temperament influences the parental sensitivity shown to them). To develop a secure attachment, a ‘difficult’ child would need a caregiver who is sensitive and patient for a secure attachment to develop.

Methodological Evaluation

The strange situation classification has been found to have good reliability.  This means that it achieves consistent results.  For example, a study conducted in Germany found 78% of the children were classified in the same way at ages 1 and 6 years (Wartner et al., 1994).

Although, as Melhuish (1993) suggests, the Strange Situation is the most widely used method for assessing infant attachment to a caregiver, Lamb et al. (1985) have criticized it for being highly artificial and therefore lacking ecological validity. The child is placed in a strange and artificial environment, and the procedure of the mother and stranger entering and leaving the room follows a predetermined script.

Mary Ainsworth concluded that the strange situation could be used to identify the child’s type of attachment has been criticized on the grounds that it identifies only the type of attachment to the mother. The child may have a different type of attachment to the father or grandmother, for example (Lamb, 1977). This means that it lacks validity, as it does not measure a general attachment style, but instead an attachment style specific to the mother.

In addition, some research has shown that the same child may show different attachment behaviors on different occasions. Children’s attachments may change, perhaps because of changes in the child’s circumstances, so a securely attached child may appear insecurely attached if the mother becomes ill or the family circumstances change.

The strange situation has also been criticized on ethical grounds. Because the child is put under stress (separation and stranger anxiety), the study has broken the ethical guidelines protection of participants.

However, in its defense, the separation episodes were curtailed prematurely if the child became too stressed. Also, according to Marrone (1998), although the Strange Situation has been criticized for being stressful, it is simulating everyday experiences, as mothers do leave their babies for brief periods of time in different settings and often with unfamiliar people such as babysitters.

Finally, the study’s sample is biased – comprising 100 middle-class American families. Therefore, it is difficult to generalize the findings outside of America and to working-class families.


Ainsworth, M. D. (1964). Patterns of attachment behavior shown by the infant in interaction with his mother. Merrill-Palmer Quarterly of Behavior and Development,51-58.

Ainsworth, M. D. S. (1967). Infancy in Uganda: Infant care and the growth of love.

Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.

Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. (1971) Individual differences in strange- situation behavior of one-year-olds. In H. R. Schaffer (Ed.) The origins of human social relations. London and New York: Academic Press. Pp. 17-58.

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

Ainsworth, M. D. S., & Wittig, B. A. (1969). Attachment and exploratory behavior of one-year-olds in a strange situation. In B. M. Foss(Ed. ), Determinants of infant behavior (Vol. 4,pp. 111-136). London: Methuen.

Behrens, K. Y., Hesse, E., & Main, M. (2007). Mothers’ attachment status as determined by the Adult Attachment Interview predicts their 6-year-olds’ reunion responses: A study conducted in Japan. Developmental Psychology, 43(6), 1553.

Belsky, J., & Rovine, M. (1987). Temperament and attachment security in the strange situation: An empirical rapprochement. Child development, 787-795.

Bowlby, J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic Books.

Bowlby, J. (1980). Loss: Sadness & depression. Attachment and loss (vol. 3); (International psycho-analytical library no.109). London: Hogarth Press.

Fox, N. A. (1989). Infant temperament and security of attachment: a new look. International Society for Behavioral Development, J yviiskylii, Finland.

Jacobsen, T., & Hoffman, V. (1997). Children’s attachment representations: Longitudinal relations to school behavior and academic competency in middle childhood and adolescence. Developmental Psychology, 33, 703-710.

Kagan, J., Reznick, J. S., Clarke, C., Snidman, N., & Garcia-Coll, C. (1984). Behavioral inhibition to the unfamiliar. Child development, 2212-2225.

Kobak, R. R., Cole, H. E., Ferenz-Gillies, R., Flemming, W. S., & Gamble, W. (1993). Attachment and emotional regulation during mother-teen problem-solving. A control theory analysis. Child Development, 64, 231-245.

Lamb, M. E. (1977). The development of mother-infant and father-infant attachments in the second year of life. Developmental Psychology, 13, 637-48.

Larose, S., & Bernier, A. (2001). Social support processes: Mediators of attachment state of mind and adjustment in later late adolescence. Attachment and Human Development, 3, 96-120.

Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M.T. Greenberg, D. Cicchetti & E.M. Cummings (Eds.), Attachment in the Preschool Years (pp. 121–160). Chicago, University of Chicago Press.

Marrone, M. (1998). Attachment and interaction. Jessica Kingsley Publishers.

Melhuish, E. C. (1993). A measure of love? An overview of the assessment of attachment. ACPP Review & Newsletter, 15, 269-275.

Schaffer, H. R., & Emerson, P. E. (1964) The development of social attachments in infancy. Monographs of the Society for Research in Child Development, 29(3), serial number 94.

Stevenson-Hinde, J., & Verschueren, K. (2002). Attachment in childhood. status: published.

Thompson, R. A., Gardner, W., & Charnov, E. L. (1985). Infant-mother attachment: The origins and developmental significance of individual differences in Strange Situation behavior. LEA.

Wartner, U. G., Grossman, K., Fremmer-Bombik, I., & Guess, G. L. (1994). Attachment patterns in south Germany. Child Development, 65, 1014-27.

Wolff, M. S., & Ijzendoorn, M. H. (1997).

MRU Psychology

Decision Making: Definition, Factors, Limitations, Ethics of Decision Making

Decision making can refer to either a specific act or a general process.

A decision is the conclusion of a process by which one decision is chosen among available alternative courses of action for the purpose of attaining a goal(s). Decision making is defined as the selection of a course of action from among alternatives.

strategies in decision making

According to Stoner, Freeman & Gilbert, “Decision making is the process of identifying to deal with a specific problem or take advantage of an opportunity.”

R. Terry defines decision making as the “Selection of one behavior alternative from two or more possible alternatives”.

According to Weihrich & Koontz, “All management work is accomplished by decision making”.

According to Trewartha and Newport, “Decision making involves the selection of a course of action from among two or more possible alternatives in order to arrive at a solution for a given problem”.

So, decision making means “to cut off” or in practical terms, to come to a conclusion of something. It is a course of action, which is consciously chosen for achieving the desired result.

In terms of managerial decision-making, it is an act of choice, wherein a manager selects a particular course of action from the available alternatives in a given situation. It is done to achieve a specific objective or to solve a specific problem.

How are Decisions Actually Made?

decision making process

For novice decision makers with little experience, decision makers faced with simple problems that have few alternative courses of action, or when the cost of searching out and evaluating alternatives is low, the rational model provides a fairly accurate description of the decision process.

But in reality, people do not follow the rational decision-making process. As one expert in decision making said, “Most significant decisions are made by judges, rather than by a defined prescriptive model” (Bazerman, ms).

The following reviews will provide a more accurate description of how most decisions in organizations are actually made:

Bounded Rationality

Rationality of individuals is limited by the information they have, the cognitive limitations of their minds, and the finite amount of time they have to make a decision. Individuals are limited by the information they have in order to make a decision in the decision-making process due to the limitation of the rationality of individuals.

Bounded rationality is the idea that when individuals make decisions, their rationality is limited by the available information.

Actually, the capacity of the human mind for formulating and solving complex problems is far too small to meet the requirements for full rationality. Actually here the decision makers construct simplified models that extract the essential features from problems without capturing all their complexity.

Herbert A. Simon proposed bounded rationality as an alternative basis for the mathematical modeling of decision-making, as used in economics, political science, and related disciplines. It complements “rationality as optimization”, which views decision ­making as a fully rational process of finding an optimal choice given the information available.

Many economic models assume that people are on average rational, and can in large enough quantities be approximated to act according to their preferences. The term is thought to have been coined by Herbert A. Simon.

In Models of Man, Simon points out that most people are only partly rational, and are irrational in the remaining part of their actions. These include:

  1. Limiting the types of utility functions
  2. Recognizing the costs of gathering and processing information
  3. The possibility of having a “vector” or “multi-valued” utility function.


The word “intuition” comes from Latin verb Intueri translated as consider or from late Middle English word intuit, “to contemplate”. Intuition is a phenomenon of the mind, describes the ability to acquire knowledge without inference or the use of reason.

Intuition has been subject of discussion from ancient philosophy to modem psychology, also a topic of interest in various religions as well as a common subject of writings and is often misunderstood and misinterpreted as instinct, truth, belief, meaning and other subjects.

Some scientists have contended that intuition is associated with innovation in scientific discovery. Experts no longer automatically assume that using intuition to make decisions is irrational or ineffective.

There is growing recognition that rational analysis has been over emphasized and that, in certain instances, relying on intuition can improve decision making. Eight conditions have been identified when people most likely to use intuitive decision-making.

These are-

  1. when a high level of uncertainty exists;
  2. when there is a little precedent to draw on;
  3. when variables are less significantly predictable;
  4. when facts are limited; ‘
  5. when facts don’t clearly point the way;
  6. when analytical data are of little use;
  7. when there are several possible alternative situations from which to choose, with good arguments for each; and
  8. when the time is limited and there is pressure to come up with the right decision.

Problem Identification

Problems that are visible tend to have a higher probability of being selected than ones that are important. There are two reasons behind it.

First, visible problems are more likely to catch a decision maker’s attention.

Second, remember we are concerned with decision making in organizations. Decision makers want to appear competent and “on the top of problems.”

This motivates them to focus attention on problems that are visible to others. If a decision maker faces a conflict between selecting a problem that is important to the organization and one that is important to the decision maker, self-interest tend to win out.

It is usually in a decision maker’s best interest to attack high-profile problems. Moreover, when the

decision maker’s performance is evaluated, the elevator is more likely to give a high rating to someone who has been aggressively attacking visible problems.

Alternative Development

At. this stage managers decide how to move from their current position towards their decided future position. More complex search behavior, which includes the development of creative alternatives, will be resorted to only when a simple search fails to discover a satisfactory alternative.

Finding alternatives are not the problem normally. Reducing the number of alternatives in order to analyze and find out the best one is the problem.

Making Choices

After evaluating all of the possible alternatives, the decision maker will make the final decision. The decision makers rely on heuristics or judgmental shortcuts in decision making. There are two common categories of heuristics- availability and representativeness.

Availability heuristics is the tendency for people to base their judgments on information that is readily available to them. Representative heuristics tend to assess the likelihood of an occurrence by trying to match it with a preexisting category.

Another bias that creeps into decisions in practice is a tendency to escalate commitment when a decision stream represents a series of decisions.

Escalation of commitment refers to staying with a decision even when there is clear evidence that it is wrong. It has obvious implications for managerial decisions.

Many organizations have suffered large losses because a manager was determined to prove his or her original decision was right. In actuality, effective managers are those who are able to differentiate between situations in which persistence will pay off and situations in which it will not.

Factors Influencing Decision Making

Decision making and problem solving are ongoing processes of evaluating situations or problems, considering alternatives, making choices, and following them up with the necessary actions.

Sometimes the decision-making process es extremely short, and mental reflection is essentially instantaneous. In other situations, the process can drag on for weeks or even months.

The entire decision-making process es dependent upon some factors which are considered by the manager at the time of decision making.

The factors are;

  • Coalition.
  • Intuition.
  • Escalation of Commitment.
  • Risk Propensity.
  • Ethics.


Coalition is one of the major elements of decision making. A coalition is an informal alliance of individuals or groups to achieve a common goal.

This common goal is often a preferred decision alternative.

For example, coalition of stockholders is frequently band together to force a board of directors to make a certain decision. The impact of coalitions can be positive or negative.

Managers must recognize when to use coalitions, how to assess whether coalitions are acting in the best interests of the organization, arid how to constrain their dysfunctional effects.


Intuition is an innate belief about something without conscious consideration. Managers sometimes decide to do something because they think it is right.

This feeling is usually not arbitrary rather it is based on years of experience and practice in making decisions in similar situations.

An inner sense may help managers make an occasional decision without going through a full-blown rational sequence of steps.

Escalation of Commitment

Another important behavioral process that influences decision making is escalation of commitment to a chosen course of action. In particular, decision makers sometimes make decisions and then become so committed to the course of action suggested by that decision.

Risk Propensity

Risk propensity is to which a decision maker is willing to gamble when making decision. Some managers are cautious about every decision they make.

They try to adhere to the rational model and are extremely conservative in what they do.

Such managers are more likely to avoid risk, and they infrequently make decisions that lead to big losses. Other managers are extremely aggressive in making decisions and are willing to take risks.


Individual ethics are personal beliefs about right or wrong behavior. A manager should make decisions that maximize the enterprise benefits, even at the cost of his/her personal benefits.

Basically these factors influence the decision making process. At the time of taking decisions managers have to consider so many things. They have to analyze the advantages and disadvantages of all the available alternatives.

When they consider the things and analyze the alternatives the above factors influence their decision making process.

Limitations of Decision Making

Though decision making is a basic and essential function for any organization, there are several limitations of it.

Some of them inherit in the process of decision making like rigidity and other arise due to shortcoming of the techniques of decision making and in the decision maker themselves.

Limitations of decision making are;

  • Time Consuming.
  • Compromised Decisions.
  • Subjective Decisions.
  • Biased Decisions.
  • Limited Analysis.
  • i Uncontrollable Environmental Factors.
  • Uncertain Future.
  • Responsibility is Diluted.

Time Consuming

A lot of precious time is consumed for decision making. Individual decisions take a lot of time because the manager has to study the merits and demerits of all the alternatives.

He also has to take advice from many people before making a decision.

All this consumes a lot of time. Group decisions are also time consuming. This is because it involves many meetings and each member has to give his opinion.

This results in delayed decisions or no decisions.

Compromised Decisions

In group decisions, there is a difference of opinion. This results in a compromised decision.

A compromised decision is made to please all the members. It may not be a correct and bold decision. The quality of this decision is inferior.

So it will not give good results on implementation.

Subjective Decisions

Individual decisions are not objective. They are subjective because the decisions depend on the knowledge, education, experience, perception, beliefs, moral, attitude, etc., of the manager. Subjective decisions are not good decisions.

Biased Decisions

Sometimes decisions are biased. That is, the manager makes decisions, which is only beneficial for himself and his group. These decisions Have a bad effect on the workers, consumers or the society.

Limited Analysis

Before making a decision the manager must analyze all the alternatives. He must study the merits and demerits of each alternative.

However, most managers do.not do this because they do not get an accurate date, and they have limited time. Inexperienced researchers and wrong sampling also result in a limited analysis.

This limited analysis results in bad decisions.

Uncontrollable Environmental Factors

Environmental factors include political, social, organizational, technological and other factors. These factors are dynamic in nature and keeps on changing every day.

The manager has no control over external factors. If these factors change in the wrong direction, his decisions will also divert and go wrong.

Uncertain Future

Decisions are made for the future. However, the future is very uncertain. Therefore, it is very difficult to take decisions for the future.

Responsibility is Diluted

In aft individual decision, only one manager is responsible for the decision. However, in a group decision, all managers are responsible for the decision.

That is, everybody’s responsibility is nobody’s responsibility. So, the responsibility is diluted.

For the above reasons sometimes decision making losses its importance, even it becomes impossible to achieve the organizational goals.  For this reasons, at the time of decision making the managers should be aware about the above limitations.

Ethics in Decision Making

Ethics are the set of moral principles that guide a person’s behavior These morals are shaped by social norms, cultural practices, and religious influences.

Ethics reflect beliefs about what is right, what is wrong, what is just, what is unjust, what is good, and what is bad in terms of human behavior. Ethical decision-making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles.

In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternative.

An individual can use three different criteria in making ethical choices. The first is the utilitarian criterion, in which decisions are made solely on the basis of their outcomes or consequences.

The goal of utilitarianism is to provide the greatest good for the greatest number. The view tends to dominate business decision making. It is consistent with goals like efficiency, productivity, and high profits. Another ethical criterion is to focus on rights.

An emphasis on rights in decision making means respecting and protecting the basic rights of individuals, such as the right to privacy, to free speech, and to due process.

A third criterion is to focus on justice. This requires individuals to impose and enforce rules fairly and impartially so that there is ah equitable distribution of benefits and costs.

Each of these criteria has advantages and liabilities. A focus on utilitarianism promotes efficiency and productivity, but it can result in ignoring the rights of some individuals, particularly those with minority representation in the organization.

The use of rights as a criterion protects individuals from injury and is consistent with freedom and privacy, but it can create an overly legalistic work environment that hinders productivity and efficiency.

A focus on justice protects the interests of the underrepresented and less powerful, but it can encourage a sense of entitlement that reduces risk taking, innovation, and productivity.

Thanks from MRU achive steps that can help you to make decision