Smoking During Pregnancy Health Concern

Smoking During Pregnancy Health Concern Erin Chaplin – Term Project Assignment #1 Topic: Tobacco Use  State: Iowa Objective: TU-6 -TU-6 Increase smoking cessation during pregnancy Increase smoking cessation during pregnancy Introduction Maternal smoking during pregnancy is a key public health concern in the United States. There are few instances in which environment has such a large effect on development as during pregnancy, which is considered a critical period.2 Prenatal factors have a large influence on a baby’s growth and development, and can lead to health consequences that affect them for their whole lives.2 Many women still smoke during pregnancy, despite it being well known that it puts the baby at risk of many health problems. There is a significant amount of scientific research proving the adverse effects of smoking during pregnancy, and pregnant women are discouraged from smoking while pregnant.2 However, it is reported that as many as 14% of pregnant women in the US continue smoking during pregnancy.1 Smoking during pregnancy remains the most common cause of infant illness and death, even though effective cessation methods exist.3 Public health is working toward trying to decrease the prevalence of smoking during pregnancy, but historical progress has been slow.3 Implications The period of infant development during pregnancy has arguably the most profound influence on a person’s long term health and quality of life.2 Smoking during pregnancy can negatively influence growth and development to such an extent as to determine future health and behavior of the child.2 There is plenty of evidence proving that the effects of smoking during pregnancy increases the risk of pregnancy complications such as fetal death (spontaneous abortion), fetal growth restriction (reduced birth weight), placental complications, and premature delivery.1,2,3 Smoking also increases the risk of sudden infant death syndrome (SIDS) after birth.3 â€Å"In 2002, 5%–8% of preterm deliveries, 13%–19% of term infants with growth restriction, 5%–7% of preterm-related deaths, and 23%–34% of deaths from sudden infant death syndrome (SIDS) were attributable to prenatal smoking in the United States.† 3 Children of mothers who smoked during pregnancy also have increased risk for disease, health problems, and behavioral/ psychological issues later in life.2 There is evidence of a dose-response relationship, that increasing amount of cigarette usage is related to increased risk of defects and complications.1,2 It has been shown that nicotine crosses the placenta, and concentrations of nicotine in the baby can be as much as 15% higher than concentrations in the mother.2 There is also evidence that women who smoke during pregnancy have an increased risk of having a baby with two or more defects.1 There are a surprisingly large number of different physical birth defects that have been associated with significantly higher risk in women that smoke during pregnancy. There is a 9% increased risk associated with cardiovascular/heart birth defects.1 There is a 16% increased risk associated with musculoskeletal defects, such a limb reductions/underdevelopment.1 There is a 19% increased risk of facial defects, especially oral/facial clefts, with eye defects alone being greater than 25% increased risk.1 There is also increased risk of gastrointestinal defects and hernias.1 The most significant effects of smoking are seen in the occurrence and increased risk of limb reductions, club foot, oral clefts, eye defects, and hernias.1 There is not sufficient evidence to show an association between maternal smoking and defects of the genitourinary, respiratory, or central nervous systems, though it is possible that smoking may have some effect.1 (See Appendix B for Figure showing associations of specific defects with smoking) In the US there are approximately 120,000 babies born each year with a birth defect, which is 3% incidence per year.1 Smoking while pregnant has been proven to be associated with significantly increased risk for a variety of defects including cardiovascular, musculoskeletal, gastrointestinal, facial, and more.1 Many of these birth defects are quite serious, result in physical and psychological illness, require several painful and expensive surgical treatments throughout the infant’s lifetime, and may still result in a disability.1 In the US the estimated total expenditures for treating birth defects was approximately $2.1 billion in 2003.1 In 2004 approximately $122 million in healthcare costs for infants were attributed to maternal smoking.3 Thus it is a significant cost on the healthcare system for women to smoke while pregnant. Other studies have found behavioral and psychological associations between smoking during pregnancy and the child’s abilities later in life.2 One study suggests that maternal smoking negatively affects a child’s speech and language development.2 Another study found an association with decreased intelligence in the child at age 4.2 There are also several studies that suggest an association with increased externalizing disorders, such as conduct disorder and attention deficit/hyperactivity disorders (ADD/ADHD).2 Cognitive function has been shown to be adversely affected in through decreased attention span, response inhibition, memory, impulsivity, receptive language, verbal learning and design memory, problem solving, speech and language, school performance, and auditory processing.2 It is important to also keep in mind that secondhand smoke after birth also increases a baby or child’s risk for respiratory disease and infections, immune system problems like asthma and allergies, ear infections, sudden infant death syndrome (SIDS), and cancer later in life.2,3 Trends Maternal smoking remains a common problem.2 It is reported that as many as 14% of pregnant women in the US continue smoking during pregnancy.1 For most states the prevalence of smoking hasn’t changed much over time; however from 2000 to 2010 smoking prevalence actually decreased in parts of the US.3 In a subgroup of ten states the prevalence of smoking during pregnancy decreased from 13.3% to 12.3%, and smoking after birth decreased from 18.6% to 17.2% over the 11 year period.3 Sites that showed a significant decrease in maternal smoking from 2000 to 2010 include Colorado, Illinois, Minnesota, New Jersey, New Mexico, New York, New York City, Utah, Washington, Wisconsin and Wyoming.3 New York City achieved the highest annual percentage decrease.3 Unfortunately in Louisiana, Maine, Mississippi, and West Virginia the prevalence of smoking during and after pregnancy actually increased over the time period.3 (See Figures on next page showing maternal smoking prevalence in US by time and location) In 2010 prevalence of smoking before pregnancy ranged from 9.2% in New York City to 46.2% in West Virginia, with an average of 23.2% of women that reported smoking during the 3 months before pregnancy.3 At the time only New York City and Utah had achieved the Healthy People 2020 goal of reducing prevalence of smoking during the 3 months before pregnancy to 14%. 3 Figure 1 from Source 3 Figure 2 from Source 3 In 2010 prevalence of smoking during pregnancy ranged from 2.3% in New York City to 30.5% in West Virginia, with an average of 10.7% of women that reported smoking during the last 3 months of pregnancy.3 At the time none of sites had yet achieved the Healthy People 2020 goal of reducing prenatal smoking prevalence to 1.4%.3 In 2010 the percentage of women that had smoked but quit before the last trimester had increased significantly, especially in Illinois, Massachusetts, Michigan, and New Jersey.3 Unfortunately in Louisiana the number of women quitting smoking while pregnant actually decreased.3 In 2010 the percentage of women that quit smoking while pregnant ranged from 34.3% in West Virginia to 74.6% in New York City, with an average of 54.3% of women that reported quitting smoking during pregnancy.3 All sites with data available had achieved the Healthy People 2020 goal of increasing smoking cessation during pregnancy to 30%.3 In 2010 the prevalence of smoking after birth had decreased significantly, it ranged from 4.1% in New York City to 37.5% in West Virginia, with an average of 15.9% of women that reported smoking 4 months after delivery.3 In Iowa, from 2007 to 2012 the trend overall has been an average of a 15% decrease in women that have smoked before and during pregnancy.4 Unfortunately, despite this downward trend, there still remain 15% of women in Iowa that smoke during their first trimester, and 12% of women that smoke throughout their entire pregnancy.4 Awareness is helping, and there is now 41% of women in Iowa that smoked before pregnancy but quit while pregnant.4 Disparities Prevalence of smoking during pregnancy varies widely depending on maternal age, ethnicity, education, and health insurance coverage.1,2,3 Priorities can be highlighted based on this demographic information. In the US on average 20% of women less than 25 years old smoke while pregnant, compared with only 9% of women 35 years or older.1 Also 22% of women with less than 12 years of education smoke while pregnant, compared with only 6.5% of women with greater than 12 years of education.1 Some studies have even suggested that the percentage of women under age 20 that are smoking while pregnant has increased.2 Based on the demographic information presented in the Table in Appendix A, groups that need the most assistance are identified. It is easy to see a trend that women age 20-24, that are American Indian/Alaska Native, had 12 or less years of education, and had Medicaid coverage (low income) were more likely to smoke before, during, and after pregnancy.3 Women that were less than 20 years old, Asian/Pacific Islander, had greater than 12 years of education, and had private insurance coverage were all more likely to quit during pregnancy.3 (See Appendix A for Table showing maternal characteristics in prevalence of prenatal smoking) Conclusion Smoking during pregnancy has been a continued problem within the US. Maternal smoking has been proven to increase risk for many birth defects.1 Educational information encouraging women to quit smoking before or during pregnancy needs to be stressed.1 Educational and policy efforts also need to be targeted especially toward women under age 24, with 12 or less years of school, in lower socioeconomic groups, because they are more likely to smoke while pregnant.1,3 Efforts to reduce prevalence have only been mildly successful.3 In 2010 none of the states with data available had achieved the goal of reducing prevalence of prenatal smoking to 1.4%.3 If trends continue at the current slow rate then it could take another 100 years to reach that goal.3 Current tobacco control efforts in most states are probably not adequate to be able to reach national goals in reducing the prevalence of smoking during pregnancy.3 Appendix A Table 2 from Source 3 Appendix B Figure 1 from Source 1- â€Å"Summary of the meta-analyses for maternal smoking in pregnancy and birth defects. The pooled ORs are shown for each body system and specific defects (total number of malformed cases in brackets). CI: confidence interval† 1 References Hackshaw A, Rodeck C, Boniface S. (2011) Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Human Reproduction Update 2011; 17:589–604. doi: 10.1093/humupd/dmr022; URL: http://humupd.oxfordjournals.org/content/early/2011/07/09/humupd.dmr022.full Knopik VS, Maccani MA, Francazio S, McGeary JE. (2012). The epigenetics of maternal cigarette smoking during pregnancy and effects on child development. Development and Psychopathology 2012; 24(4):1377-1390. doi: http://dx.doi.org.proxy.lib.uiowa.edu/10.1017/S0954579412000776. Tong VT, Dietz PM, Morrow B, D’Angelo DV, Farr SL, Rockhill KM, England LJ. (2013). Trends in Smoking Before, During, and After Pregnancy – Pregnancy Risk Assessment Monitoring System, United States, 40 Sites, 2000–2010. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries 2013; 62(6):1-19. URL: http://www.cdc.gov/mmwr/pdf/ss/ss6206.pdf Muldoon, J. (2013) Percent of newborns exposed to maternal smoking, by county. IA Dept. Public Health: Vital Records and Bureau of Family Health, Div. Tobacco Use Prevention Control, IDPH; 2013. URL: http://www.idph.state.ia.us/IDPHChannelsService/file.ashx?file=787F5953-4D70-4563-A885-FCB2C9D3C185

Passage to India Part One Essay

Summary: Chapter IV Mr. Turton invites several Indian gentlemen to the proposed Bridge Party at the club. The Indians are surprised by the invitation. Mahmoud Ali suspects that the lieutenant general has ordered Turton to hold the party. The Nawab Bahadur, one of the most important Indian landowners in the area, announces that he appreciates the invitation and will attend. Some accuse the Nawab Bahadur of cheapening himself, but most Indians highly respect him and decide to attend also. The narrator describes the room in which the Indian gentlemen meet. Outside remain the lowlier Indians who received no invitation. The narrator describes Mr. Grayford and Mr. Sorley, missionaries on the outskirts of the city. Mr. Sorley feels that all men go to heaven, but not lowly wasps, bacteria, or mud, because something must be excluded to leave enough for those who are included. Mr. Sorley’s Hindu friends disagree, however, as they feel that God includes every living thing. Summary: Chapter V At the Bridge Party, the Indian guests stand idly at one side of the tennis lawn while the English stand at the other. The clear segregation dismays Adela Quested and Mrs. Moore. Ronny and Mrs.  Turton disdainfully discuss the Indians’ clothing, which mixes Eastern and Western styles. Several Englishwomen arrive and discuss the earlier production of Cousin Kate. Mrs. Moore is surprised to note how intolerant and conventional Ronny’s opinions have become. Mr. Turton arrives, cynically noting to himself that each guest has come for a self-serving reason. Reluctantly, Mrs. Turton takes Adela and Mrs. Moore to visit a group of Indian ladies. Mrs. Turton addresses the Indian women in crude Urdu, and then asks Mrs. Moore and Adela if they are satisfied. One of the Indian women speaks, and Mrs.  Turton is surprised to learn that the women know English. Mrs. Moore and Adela unsuccessfully try to draw the Indian women out into more substantial conversation. Mrs. Moore asks one of them, Mrs. Bhattacharya, if she and Adela can visit her at home. Mrs. Bhattacharya agrees to host the Englishwomen the upcoming Thursday, and her husband promises to send his carriage for them. Mr. Fielding, who is also at the party, socializes freely with the Indians and even eats on the Indian side of the lawn. He is pleased to learn that Adela and Mrs. Moore have been friendly to the Indians. Fielding locates Adela and invites her nd Mrs. Moore to tea. Adela complains about how rude the English are acting toward their guests, but Fielding suspects her complaints are intellectual, not emotional. Adela mentions Dr. Aziz, and Fielding promises to invite the doctor to tea as well. That evening, Adela and Ronny dine with the McBrydes and Miss Derek. The dinner consists of standard English fare. During the meal, Adela begins to dread the prospect of a drab married life among the insensitive English. She fears she will never get to know the true spirit of India. After Adela goes to bed, Ronny asks his mother about Adela. Mrs.  Moore explains that Adela feels that the English are unpleasant to the Indians. Ronny is dismissive, explaining that the English are in India to keep the peace, not to be pleasant. Mrs. Moore disagrees, saying it is the duty of the English to be pleasant to Indians, as God demands love for all men. Mrs. Moore instantly regrets mentioning God; ever since she has arrived in India, her God has seemed less powerful than ever before. Summary: Chapter VI The morning after Aziz’s encounter with Mrs. Moore, Major Callendar scolds the doctor for failing to report promptly to his summons, and he does not ask for Aziz’s side of the story. Aziz and a colleague, Dr. Panna Lal, decide to attend the Bridge Party together. However, the party falls on the anniversary of Aziz’s wife’s death, so he decides not to attend. Aziz mourns his loving wife for part of the day and then borrows Hamidullah’s pony to practice polo on the town green. An English soldier is also practicing polo, and he and Aziz play together briefly as comrades. Dr. Lal, returning from the Bridge Party, runs into Aziz. Lal reports that Aziz’s absence was noticed, and he insists on knowing why Aziz did not attend. Aziz, considering Lal ill mannered to ask such a question, reacts defiantly. By the time Aziz reaches home, though, he has begun to worry that the English will punish him for not attending. His mood improves when he opens Fielding’s invitation to tea. Aziz is pleased that Fielding has politely ignored the fact that Aziz forgot to respond to an invitation to tea at Fielding’s last month. Analysis: Chapters IV–VI The wildly unsuccessful Bridge Party stands as the clear focus of this portion of the novel. Though the event is meant to be a time of orchestrated interaction, a â€Å"bridge† between the two cultures, the only result is heightened suspicion on both sides. Indians such as Mahmoud Ali suspect that Turton is throwing the party not in good faith, but on orders from a superior. Turton himself suspects that the Indians attend only for self-serving reasons. The party remains segregated, with the English hosts regarding their guests as one large group that can be split down only into Indian â€Å"types,† not into individuals. Though the Bridge Party clearly furthers our idea that the English as a whole act condescendingly toward the Indians, Forster also uses the party to examine the minute differences among English attitudes. Mrs.  Turton, for instance, represents the attitude of most Englishwomen in India: she is flatly bigoted and rude, regarding herself as superior to all Indians in seemingly every respect. The Englishmen at the party, however, appear less malicious in their attitudes. Mr. Turton and Ronny Heaslop are representative of this type: through their work they have come to know some Indians as individuals, and though somewhat condescending, they are far less overtly malicious than the Englishwomen. Cyril Fielding, who made a brief appearance in Chapter III, appears here to be the model of successful interaction between the English and Indians. Unlike the other English, Fielding does not recognize racial distinctions between himself and the native population. Instead, he interacts with Indians on an individual-to-individual basis. Moreover, he senses that he has found like-minded souls in Adela Quested and Mrs. Moore. Of the two, Fielding is more closely akin to Mrs. Moore than Adela: Fielding and Mrs. Moore are unself-conscious in their friendship with Indians, whereas Adela consciously and actively seeks out this cross-cultural friendship as an interesting and enriching experience. Forster fleshes out the character of Adela Quested significantly in these chapters. As part of this effort, the author uses Fielding as a sort of moral barometer, a character whose judgments we can trust. In this regard, we can see Fielding’s judgment of Adela—that she appears to object to the English treatment of the Indians on an intellectual, rather than emotional level—as Forster’s own judgment. Adela, perhaps because of this intellectual, unemotional curiosity about Indian culture, conducts her interactions in India in a negative sense rather than a positive one—attempting to not act like the other English rather than attempting to actively identify with Indians. Adela always acts s an individual, rejecting the herd mentality of the other couples at the English club. While the other English try to re-create England in India through meals of sardines and plays like Cousin Kate, Adela hopes to experience the â€Å"real India,† the â€Å"spirit† of India. Yet we sense that Adela’s idea of this â€Å"real India† is vague and somewhat romanticized, especially when compared to Mrs. Moore’s genuine interaction with Aziz or Fielding’s enthusiastic willingness to partake in Indian culture. The primary Indian protagonist, Aziz, develops in these chapters as significantly distinct from English expectations of Indian character. While the English pride themselves on dividing the Indian character into â€Å"types† with identifiable characteristics, Aziz appears to be a man of indefinable flux. Forster distinguishes Aziz’s various guises—outcast, poet, medical student, religious worshiper—and his ability to slip easily among them without warning. Aziz’s whims fluctuate in a way similar to his overall character. In Chapter VI we see Aziz shift from mood to mood in the space of minutes: first he wants to attend the Bridge Party, then he is disgusted with the party, then he despairingly mourns his dead wife, then he seeks companionship and exercise. Ironically, one of Aziz’s only constant qualities is a characteristically English quality: an insistence upon good breeding and polite manners. This quality makes Aziz slightly prejudiced—it leads him to reject his friendship with Dr. Lal—yet it also allows him to disregard racial boundaries, as when he feels automatically affectionate toward Fielding because of the Englishman’s politeness. Furthermore, Forster uses these chapters to begin to develop one of the major ideas he explores in A Passage to India—the inclusiveness of the Hindu religion, especially as compared to Christianity. Forster portrays Hinduism as a religion that encompasses all, that sees God in everything, even the smallest bacterium. He specifically aligns Mrs. Moore with Hinduism in the earlier scene from Chapter III in which she treats a small wasp kindly. The image of the wasp reappears in Chapter IV as the wasp that the Hindus assume will be part of heaven—a point on which the Christian missionaries Mr. Grayford and Mr. Sorley disagree. Mrs. Moore is a Christian, but in Chapter VI we see that she has begun to call her Christianity into question during her stay in India. Whereas God earlier was the greatest thought in Mrs.  Moore’s head, now the woman appears to sense something beyond that thought, perhaps the more inclusive and all-encompassing worldview of Hinduism. Summary: Chapter VII In every remark [Aziz] found a meaning, but not always the true meaning, and his life though vivid was largely a dream. (See 0pl,) Fielding’s many worldly experiences keep him from being insensitive toward Indians like the rest of the English are. The English mildly distrust Fielding, partly out of suspicion of his efforts to educate Indians as individuals. Fielding also makes offhand comments that distress the English, such as his remark that â€Å"whites† are actually â€Å"pinko-grey. Still, Fielding manages to remain friendly with the men at the English club while also socializing with Indians. Aziz arrives at Fielding’s for tea as Fielding is dressing. Though the two men have never met, they treat each other informally, which delights Aziz. Fielding breaks the collar stud for his shirt, but Aziz quickly removes his own and gives it to Fielding. The relations between the two men sour only briefly when Aziz misinterprets Fielding’s dismissive comment about a new school of painting to be dismissive of Aziz himself. Aziz is disappointed when Mrs.  Moore and Adela arrive, as their presence upsets the intimacy of his conversation with Fielding. The party continues to be informal, though, even with the women present. Aziz feels comfortable addressing the women as he would address men, as Mrs. Moore is so elderly and Adela so plain looking. The ladies are disappointed and confused because the Bhattacharyas never sent their carriage this morning as promised. Adela pronounces it a â€Å"mystery,† but Mrs. Moore disagrees—mysteries she likes, but this is a â€Å"muddle. † Fielding pronounces all India a muddle. Aziz denounces the rudeness of the Hindu Bhattacharyas and invites the women to his own house. To Aziz’s horror, Adela takes his invitation literally and asks for his address. Aziz is ashamed of his shabby residence and distracts Adela with commentary on Indian architecture. Fielding knows that Aziz has some historical facts wrong, but Fielding does not correct Aziz as other Englishmen would have. At the moment Fielding recognizes â€Å"truth of mood† over truth of fact. The last of Fielding’s guests, the Hindu professor Godbole, arrives. Aziz asks Adela if she plans to settle in India, to which Adela spontaneously responds that she cannot. Adela then realizes that, in making this admission, she has essentially told strangers that she will not marry Ronny before she has even told Ronny so herself. Adela’s words fluster Mrs. Moore. Fielding then takes Mrs. Moore on a tour of the college grounds. Adela again mentions the prospect of visiting Aziz’s house, but Aziz invites her to the Marabar Caves instead. Aziz attempts to describe the caves, but it becomes clear that Aziz has never seen them. Godbole has been to the caves, but he does not adequately describe why they are extraordinary; in fact, Aziz senses that Godbole is holding back information. Suddenly, Ronny arrives to take Adela and his mother to a polo match at the club. Ronny ignores the Indians. Aziz becomes excitable and overly intimate in reaction to Ronny’s rude interruption. Fielding reappears, and Ronny privately scolds him for leaving Adela alone with Indians. Before the ladies leave, Godbole sings an odd-sounding Hindu song in which the singer asks God to come to her, but God refuses. In her ignorance, [Adela] regarded [Aziz] as â€Å"India,† and never surmised that his outlook was limited and his method inaccurate, and that no one is India. (See Important Quotations Explained) Summary: Chapter VIII Driving away from Fielding’s, Adela expresses annoyance at Ronny’s rudeness. Adela mentions Aziz’s invitation to the Marabar Caves, but Ronny immediately forbids the women to go. Ronny mentions Aziz’s unpinned collar as an example of Indians’ general inattention to detail. Mrs. Moore, tired of bickering, asks to be dropped off at home. Adela feels suddenly ashamed of telling those at the tea party of her intention to leave India. After the polo match at the club, Adela quietly tells Ronny that she has decided not to marry him. Ronny is disappointed, but he agrees to remain friends with her. Adela sees a green bird and asks Ronny what type of bird it is. Ronny does not know, which confirms Adela’s feeling that nothing in India is identifiable. Ronny and Adela begin to feel lonely and useless in their surroundings; they suddenly feel they share more similarities than differences. The Nawab Bahadur happens by and offers Ronny and Adela a ride in his automobile. Riding in the back seat, the two feel dwarfed by the dark night and expansive landscape surrounding them. Their hands accidentally touch, and they feel an animalistic thrill. The car mysteriously breaks down on a road outside the city. They all climb out and determine that the car must have hit something, probably a hyena. After a short while, Miss Derek drives past them offers them a ride back to Chandrapore. Driving back to Chandrapore, Miss Derek jokes about her employer, an Indian noblewoman. Ronny and Adela feel drawn together by their shared distaste for Miss Derek’s crass manner and for the Nawab’s polite but long-winded speeches. When Adela and Ronny arrive back at the bungalow, Adela says that she would like to marry Ronny after all. He agrees. Adela, however, immediately feels a sense of disappointment, believing she will now be labeled the same as all the other married Englishwomen in India. They go inside and tell Mrs. Moore of their plans. Adela begins to feel more pleasant, joining Ronny in poking fun at the Nawab Bahadur. When Ronny and Adela tell Mrs.  Moore of the strange car accident, the older woman shivers and claims that the car must have hit a â€Å"ghost. † Meanwhile, down in the city of Chandrapore, the Nawab Bahadur describes the accident to others. He explains that it took place near the site where he ran over and killed a drunken man nine years ago. The Nawab Bahadur insists that the dead man caused the accident that occurred this evening. Aziz is skeptical, however, and feels that Indians should not be so superstitious. Analysis: Chapters VII–VIII Though Fielding himself disregards racial boundaries, his tea party does not quite develop into a successful version of the Bridge Party. Aziz and Adela both appear overexcited during the tea, while Mrs. Moore and Professor Godbole remain withdrawn from the others’ chatter. The sudden cultural interaction carries Adela away and convinces her, almost subconsciously, that she cannot remain in India and become a wife at the club—prompting the spontaneous admission that upsets Mrs. Moore. The tea sours when Ronny arrives, though his rudeness appears only to bring out tensions that already existed. Aziz becomes grotesquely overfamiliar, Adela blames herself and Ronny, Fielding becomes annoyed, and Mrs. Moore becomes spiritually drained by Godbole’s Hindu song. The tea party is further disturbed by a disparity between what Forster calls â€Å"truth of fact† and â€Å"truth of mood. † Thus far in A Passage to India, we have seen that the Indian characters often tend to say one thing when they mean another. Forster presents this tendency as problematic only for the English, among whom words are taken at face value. Indians appear skilled at identifying the undertones—the unspoken elements—of a conversation. Indeed, we see that Aziz recognizes from tone, rather than words, that Godbole is withholding information from his description of the Marabar Caves. Moreover, when Aziz invites Mrs. Moore and Adela to his house, the â€Å"mood† of his question—his sincere feeling of goodwill and hospitality to the Englishwomen—is all that Aziz means to convey. Adela, however, takes the invitation literally and asks for Aziz’s address. The misunderstanding makes Aziz uncomfortable, as he is in fact embarrassed about the appearance of his home. Fielding, too, reacts negatively to Adela’s literal-mindedness. This disconnect between cultural uses of language is an important division between the English and Indians in the novel. Forster explores another divide between the English and Indian cultures through the idea of naming or labeling. If the English in the novel always say exactly what they mean, they also are quick to attach names or labels to objects and people around them. When Adela and Ronny sit together at the club, Adela wonders aloud what kind of bird sits on the tree above them. Ronny does not know, which depresses Adela even more; meanwhile, the narrator notes that nothing is identifiable in India, as things disappear or change before one can name them. The British in India realize that with the ability to name or label things comes power. It is for this reason that Fielding’s remark that â€Å"whites† are really â€Å"pinko-grey† upsets the men at the club: by deflating labels like â€Å"white† and â€Å"brown,† Fielding implicitly challenges the assertive naming and labeling power of the English in India. If â€Å"white† really only refers to skin tone—rather than also connoting superiority, advanced religion, technology, and morality—then â€Å"whites† have no inherent right to rule India. Adela’s conflicted view of naming or labeling constitutes a major tension within her character. On the one hand, Adela recognizes that the ability to label gives one power—or, as she might say, a purpose or place in the world. India’s resistance to identification, symbolized by the nameless green bird, challenges Adela’s sense of individuality. On the other hand, Adela realizes that being on the receiving end of a label can leave one powerless. It is for this reason that she remains resistant to marrying Ronny, knowing that she will be labeled an Englishwoman in India—a club wife—and that her behavior will be restricted accordingly. When Adela feels her individuality challenged by India’s resistance to identification, she seems more likely to turn to Ronny for marriage; yet, when she recognizes the tyranny of labels like â€Å"Englishwoman in India,† she feels reluctant to marry Ronny. We see in these chapters that the natural environment of India has a direct effect on Ronny and Adela’s engagement. As soon as Adela tells Ronny she does not want to become engaged, their surroundings begin to overwhelm them, making them feel like lonely, sensual beings who share more similarities than differences. In particular, they feel that the night sky swallows them during their ride with the Nawab Bahadur. The sky makes Ronny and Adela feel indistinct as individuals, suddenly part of a larger mass that is somehow fundamentally united. Therefore, when their hands touch accidentally in the car, both Ronny and Adela are attuned to the animalistic thrill of sensuality. Their experience under the engulfing Indian sky draws Ronny and Adela together, forcing them to assert themselves as important, distinct individuals through a commitment to each other. Furthermore, the social environment of India—the Indians who surround Ronny and Adela—contributes to this shift in perspective in the couple’s relationship, their new feeling that they are more alike than different. Specifically, Ronny and Adela feel a bond through their shared distaste for Miss Derek and the Nawab Bahadur—a bond that leads Adela to suddenly reverse her decision and renew her engagement to Ronny. In this regard, Forster implies that the union of marriage requires a third presence, against which husband and wife can define themselves as similar. Indeed, after announcing their renewed engagement, Adela shows her openness to her future with Ronny through her willingness to make fun of the Nawab Bahadur with him. While Ronny and Adela feel a sense of unity against the muddle that is India, we see Mrs. Moore grow even more spiritually attuned to the minds of Indians. First Mrs. Moore appears to be most aligned with the religious figure of Professor Godbole. Godbole’s song, in which God is called but does not come, profoundly affects Mrs. Moore, deepening her sense of separation from her Christian God. Then, when Ronny and Adela tell Mrs.  Moore of their car accident with Nawab Bahadur, the elder woman strongly feels that a ghost caused the accident. Though Ronny and Adela ignore Mrs. Moore, we learn a short while later that the Nawab Bahadur, too, suspects that a ghost caused the accident—the ghost of the drunken man that he ran over nine years ago near the same spot. While Ronny and Adela begin to segregate themselves from the social and natural landscape that surrounds them, Mrs. Moore surrenders to the overwhelming presence and mysticism she feels in India, attuning herself to a sort of collective psyche of the land she is visiting.

The Street Hawker

Street hawkers are very common in India. They can be found here, there and everywhere. There is hardly any village, town or a city without street hawkers. They have been there for countries. They go from one town to another town and street for selling their various articles. A street hawker comes with his basket full of fruits, vegetables, sweets, and articles of general use. He may come with a big bundle of clothes or shawls on his back. He is very useful. He brings the bazaar to our door-steps and makes life easy and convenient. He is welcomed by all, particularly by ladies, old men and children. He has no fixed hours. If he is there in this colony in the morning, he will be in the next street in the evening. He has his own way of selling goods and calling the customers. The things he hawks are cheaper. On seeing him come children and ladies flock him to purchase things of daily need. He can also liked by schools during recess time. His eatables are liked by school children as they are cheap and tasty. There is a lot of haggling. Sometimes a hawker has to come to terms with his old customers and sell things on reduced rates. Sometimes hawkers cause nuisance by distributing the peace of the locality by their loud cells. They often throw wrappers, fruit-skins and leaf-plates here and there. Many a time a hawker may indulge in theft or stealing. An anti-social element may also be there in the guise of a street hawker. It is not safe to purchase things from unknown hawkers. Hawkers should be registered and licenced to check cheating and mal-practices. They may cheat small children and supply cheap and harmful eatables. Sometimes a hawker may turnout a child-lifter. Thousands and thousands of poor people earn their daily bread by hawking. It is a very useful self-employment which can be started with a very small amount of money. There is no harm in earning one's bread and butter by hawking. Government should try to help them by giving loans on cheap rates of interest. Their lot should be improved as citizens of the country. As hawkers, they render a useful service. Instead of becoming a burden on the society, they support themselves and their families by adopting this profession. So far no social group or government agency has done anything to organise them.

The Effects Of Childhood Sexual Abuse On Women s Sexual...

This paper will examine the impact of childhood sexual abuse (CSA) on women’s sexual behavior in adulthood. Childhood sexual abuse has been associated with a plethora of physical and emotional symptoms in women. It has been noted that there is a significant relationship between this maltreatment and the development of abnormal sexual behavior. Some women who have been abused as children are suffering from lack of sexual desire, emotional distress, sexual dysfunction, or engage in risky sexual behavior as they become adults. This paper has two purposes: (1) to provide a broad overview of the research on long-term effects of childhood sexual abuse on mental and physical health and (2) encourage counselors and therapists alike to seek knowledge of this issue and in turn provide victims of CSA with effective methods to overcome and deal with any long-term issues of childhood sexual abuse. Keywords: childhood sexual abuse, sexual dysfunction, abnormal sexual behavior Child Sexual Abuse and Its Impact on Adult Sexuality in Women As time progresses on, more reports of child sexual abuse (CSA) have been documented. According to Colangelo and Cooperman, CSA is defined as â€Å"the use of a child under 18 years of age as an object of gratification for adult sexual needs and desires.† Another definition of CSA is â€Å"sexual abuse [that] occurs whenever one person dominates and exploits another by means of sexual activity or suggestion.† (Hall, M., Hall, J., 2011) it is difficult toShow MoreRelatedThe Effects Of Childhood Sexual Abuse On Adults Sexual Behavior1521 Words   |  7 Pagesimpact of Childhood Sexual Abuse on Adults Sexual Behavior Jamila Kamara Dr. Lauren Vansluytman Morgan State University Sexual abuse leaves many scars, creating feelings of guilt, anger, and fear that haunt survivors throughout their lives. 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