Introduction: Breast milk is the best way to feed all infants. It results in better nutrition for the infant and to reduced rates of chronic disease later in childhood and adulthood. Breastfed babies have lower rates of infectious diseases and will not be exposed to contaminated infant formula, such as the recent experience with melamine in China. The WHO Expert Consultation on Infant Feeding recommended exclusive breastfeeding for six months, with the introduction of complementary foods and continued breastfeeding thereafter. It was also recommended by the WHO that breastfeeding continue beyond six months for up to two years and beyond. Breastmilk can provide the majority of nutrients for the first 12 months of life. Complementary foods were given in the second half year gradually. / However with the rapid economic development, the traditional home based obstetric system in China has changed. Following the change in women’s living styles, traditional infant feeding perceptions and practices have changed. Women now have high rates of returning to work after delivering a baby, especially in the urban areas, and more infants are being given infant formula and other substitutes for breastfeeding. Zhejiang Province is the one of fastest developing economic regions located in the mid Eastern coast of China. The breastfeeding rate has dropped rapidly since the 1970’s. This has significant implications for the child health in this region. A longitudinal study of breastfeeding was needed to provide the data necessary to implement a comprehensive health promotion program. Efforts are needed to promote breastfeeding, which should be one of the highest health promotion priorities. / The aim of this study was to document the prevalence and duration of breastfeeding and exclusive breastfeeding in city, suburban and rural areas in Zhejiang Province; analyze the factors determining the initiation and the duration of breastfeeding; document mothers’ knowledge about the benefits of breastfeeding; identify the prevalence of problems associated with breastfeeding and constraints to exclusive breastfeeding up to six months of life; document the prevalence of prelacteal feeds and finally to describe differences in breastfeeding between city, suburb and rural area. / Method: In order to achieve these objectives a longitudinal cohort study was undertaken of infant feeding practices in three locations in Zhejiang Province which represent city and suburban and rural areas. Mothers who delivered babies during 2004 and 2005 were randomly selected from the obstetric wards while in hospital and invited to voluntarily participate in the study. The mothers were interviewed in hospital and after discharge, were contacted by telephone three more times at 1, 3 and 6 months. The few mothers who could not be reached by telephone were interviewed during the scheduled routine immunisation clinics at their local MCH clinic. On each of these follow up occasions they were interviewed using a structured questionnaire to obtain details of infant feeding practices. A total of 1520 mothers were recruited in 4 hospitals located in city, suburb and rural areas. Almost all mothers (98%) agreed to participate. All data analyses were carried out using the Statistical Package for Social Science (SPSS), release 14.0 (SPSS Inc., Chicago, IL, USA). Descriptive techniques and survival analysis were used to document breastfeeding rates and duration. Cox regression analysis was undertaken to explore factors affecting breastfeeding. / Results: Of the total 1520 mothers were recruited into the study, 628 were from the city, 347 from the suburb and 535 from the rural area. Breastfeeding initiation rates were high in all three locations. Initially more than 95% of the mothers began breastfeeding, but only 50.3% babies averagely in three locations were being exclusively breastfed at discharge. The number of infants being exclusively breastfed prior to discharge was relatively low. Exclusive breastfeeding before discharge was positively related to delivery method, the first feed given to the baby, mother’s place of residence, mother’s age, mothers’ education level and family income. / ‘Any breastfeeding’ rates at discharge and at 1, 3 and 6 months were 96.9%, 96.0%, 89.7% and 76.7% respectively. ‘Exclusive breastfeeding’ rates at discharge, and at 1, 3, 6 months were 50.3%, 55.1%, 45.8% and 3.9% respectively. The average duration of ‘exclusive breastfeeding’ was 44.7 days (95% CI, 41.6-47.9). / Overall about half of mothers gave the babies prelacteal feeds before commencing breastfeeding. This situation was more common in city, compared with the suburban and rural mothers. The prelacteal feeding rates were 62.0%, 36.6% and 39.0% in city, suburb and rural area respectively. / The breastfeeding rates differed by location between the city, suburb and rural areas. ‘Any breastfeeding’ rates in the city, suburb and rural area at discharge were 96.5 %, 96.8 % and 97.4 % respectively, the ‘exclusive breastfeeding’ rates in city, suburb and rural area at discharge were 38.0%, 63.4 % and 61.0 % respectively. The rates of exclusive breastfeeding at six months were only 0.2%, 0.5 % and 7.2 % respectively, well below the Chinese and WHO targets. / The risk factors related to cessation of ‘any breastfeeding’ were ‘mother’s age’, ‘the time the decision to breastfeed was made’, ‘whether the infant was admitted to special care nursery’, ‘mother’s return to work within 6 months’, ‘the early feeding of water and /or other complementary foods, and location of mother’s usual residence. Factors negatively associated with ‘exclusive breastfeeding’ duration were early return to work and to place of residence, with the mothers living in the rural area exclusively breastfeeding for longer. / Delivery method was an important influence on breastfeeding. In this study the highest caesarean section rate was in the city (76%), with a similar rate in the suburbs (74%) and the lowest in the rural area (53%). Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88). / Conclusion: The study has descried the initiation and duration of breastfeeding (to six months) of babies in the different areas of Zhejiang Province. Separate information is provided on the prevalence of ‘any breastfeeding’ and ‘exclusive breastfeeding'. The factors that are associated with the initiation and duration of breastfeeding in Zhejiang Province are documented. Health promotion programs are needed to change some traditional inappropriate breastfeeding perceptions and to promote ‘exclusive breastfeeding’ in the first six months of life in Zhejiang. Education should be given and regulations should be introduced restricting hospital staff from recommending prelacteal and supplementary feeds unless warranted for medical reasons. The research also shows that there would be a benefit to breastfeeding if delivery and lactation leave were extended to six months and if the incidence of caesarean section could be reduced to levels more consistent with WHO expected levels.

À la lumière des perspectives critiques sur les théories et les pratiques comptables, « la comptabilité pour la durabilité » a émergé comme une discipline relativement nouvelle. Par rapport aux différents modèles développés dans le cadre de l’idéologie néolibérale, certains modèles alternatifs avec des stratégies « plus fortes » de conservation des capitaux, notamment la « Triple Ligne d’Amortissement » (TLA) (Richard, 2012; Rambaud et Richard, 2013), semblent avoir beaucoup des potentiels de faire quelques changements fondamentaux. Cette thèse est une enquête sur les conditions nécessaires et les résistances possibles rencontrées par la mise en place du modèle TLA. Le secteur agricole de la République populaire de Chine est choisi comme le terrain de recherche en vue d’étudier le contexte institutionnel et historique. L’enquête sur le contexte chinois est effectuée en référence aux théories de l’économie politique institutionnaliste, inspiré par Karl Polanyi (2002[1944]), Mancur Olson (1965), and Chang Ha-Joon (1994, 2002). / In the light of critical perspectives on accounting theories and practices, sustainability accounting (SA) as a relatively new discipline has emerged. Compared to various SA models developed under the mainstream neoliberal ideology, some alternative models with “stronger” capital conservation strategies, notably the “Triple Deprecation Line” (TDL) (Richard, 2012; Rambaud & Richard, 2013), seem to have a lot of potentials to make some fundamental changes. This dissertation is essentially an investigation of necessary conditions and possible resistances faced by the establishment of the TDL model. The agriculture sector of the People’s Republic of China is chosen as the field of research in order to study the institutional environment and historical context in real-world settings. The investigation on the Chinese context is conducted with reference to theories of institutionalist political economy, inspired by Karl Polanyi (2002[1944]), Mancur Olson (1965), and Chang Ha-Joon (1994, 2002).

In the light of youth unemployment and increased transnational mobility practice oriented vocational education and training get more and more importance in the international cooperation in education. There is a broad consensus among educational experts, that one of the possible measures to reduce youth unemployment in the world is to provide youth skills and competences, which are needed on the labour market. The school based vocational education needs to be updated with practical skills. The fundament of each practice oriented vocational education and training system (VET) lays in the cooperation between the main actors: the enterprises and vocational schools. Dual systems in countries as Germany, Switzerland and Austria offer many good practice examples on the benefits of the engagements of both actors in the vocational education and training system but nevertheless these examples cannot be taken as “one model fits all” which can be implemented in each country. Therefore each country interested in the redesign of their own vocational education and training system needs to identify possible benefits of and challenges in their system, to be able to specify the opportunities and threat for future development. It cannot be presumed that enterprises can be forced to take apprentices and train them in their facilities. It has to be evident for every educational actor willing to cooperate with enterprises, that enterprises first strive for growth in profits upon others to be able to secure their existence and secondly they may support additional, non-economic activities; for example the vocational education and training of future employee. Although to ensuring the quality of future employees may partly be seen as their social responsibility this fact will still depend on their economic situation and their need for skilled labour. However, making profit does not collide with the idea of the engagement of enterprises in the vocational education and training. It only needs an in depth-analysis of potentials and needs of enterprises and vocational schools and an adequate planning as well as development of the educational programs and activities. The following example on the PR China delivers many interesting basic approaches on how cooperation between enterprises and vocational schools can be built up, managed and preserved. Thanks to the over thirty years of multilateral cooperation between der PR China and other European and Asian countries, the PR China already knows what is needed to modernize the vocational education and training system. Further education of teachers, redevelopment of curriculums and the redesign of the infrastructure of the vocational schools are those activities, which enriched the Chinese vocational education and training system in the last thirty years. There is still backwardness in the economically weak part of the country but within the “go-west-strategy” of the government innovative measures are offered for enterprises to foster the development of the western region; for example cut red tape or tax and duty exemptions. In the course of the bureaucracy development of the east-southeast part of the country and through the increased perception of the country in the international business the quality of labour become more relevant also for the PR China. Products with low-value-added and unskilled labour were not sufficient anymore for the competitiveness of the country in the international environment. More and more enterprises realised the shortage of qualified labour because of the rise of progressing technology and of the availability of qualified labour. The commitment to quality in the vocational education and training laid on the market orientation and therefore on the establishment of cooperation between enterprises and vocational schools. The PR China can consequently show good practice examples from cooperation in the vocational education after more than thirty years of learning from other countries. The constructive element of these cooperation was identified by the actors as the consensus about the mutual benefit of cooperative activities. Although there are many good practices in the cooperation, nevertheless, more persuasiveness is still needed for continuous fostering of quality in the vocational education and training. The cooperation is not only influenced by the interest, need and the level of cooperation between enterprises and vocational schools, but the nature of the directives of the government are crucial for the cooperation too. For example, the decentralized implementation of the directives of the government may endanger the uneven development and quality assurance in vocational training. The transfer of responsibility of the state in the hands of the provinces ensures on the one side more freedom for provinces, for instance, it allows them to adapt the vocational education and training to their specific needs and to implement it to local circumstances. This means, to offer labour market oriented vocational education and training. On the other side it needs in the context of quality assurance to archive the knowledge gained through the fragmented implementation. This implies, that already developed teaching and learning materials should not get lost but it should be used as synergies and transfer these to other provinces, schools or enterprises. One of the exemplary efforts made by good situated “model vocational schools” is their willingness to overtake a sponsorship for other less developed vocational schools that are located mostly in the western region. Previously mentioned schools support the improvement of the teaching quality of latter mentioned schools and help them especially in the initial phase of the redevelopment of their teaching and training system. More concrete, “school sponsorships” allow to share knowledge, experience or to share technical equipment. The further education of teachers, the establishment of training facilities, the adaptation of curriculum to the labour market needs leave space for the consideration of local needs on the one side, and the dynamics of market development on the other side. It is only possible to take over responsibility for less developed schools, if there is financial support through the government too. School sponsorship is mostly subject to model schools therefore there is a significant need for recognition and promotion of education activities of these model schools. The high dynamic of the labour market in developing regions may cause challenges in the cooperation between vocational schools and enterprises, especially in the time of recession. If the cooperation with a vocational school gives rise to concern because of the limited time, personal availability or financial support in the enterprises, than the support of enterprises may decrease. Therefore the model schools strive to mobilise all actors, ask for financial and material benefits during the time of economic growth to be able to implement those benefits targeted and lay a solid fundament for the performance of less developed schools. This fundament may consist of well-educated vocational teachers, well-equipped training facilities as well as practice oriented curricula. A solid basis allows vocational schools in a economically weak period to use previous investments and benefits. Additional created supplementary services, as further educational offers for enterprise employees, well-educated vocational teachers as consulters by building up of new production lines or by doing research on the effectiveness of human resources, are examples for reserves to bear itself. The redefinition of the role of vocational schools as “service providers” in a wide sense, allows setting quality standards in relation with the pedagogical requirements and economical needs in the vocational education and training. The school administration and teachers need to be equipped with additional management skills in addition to their educational and professional skills to be able to initiate, build and maintain cooperation systematically and analytically. Enterprises need to be aware of taking responsibility for future skilled labour while cooperating with vocational schools. The openness of enterprises for cooperation allows determining one's potential within vocational education and training and look for benefits for both actors. It is necessary for a successful cooperation to be a "win-win" situation, so the motivation for all parties should be maintained. Finally each cooperation needs competent teachers, well equipped training facilities also strategic planning (AIOC-strategy) in sense of analysis of initial situation and the possibilities for the implementation of practical vocational education and training, optimisation of available capacities and resources, the interdependence of responsibilities and competences of both actors, and the consolidation of pedagogical quality criteria under economic premises. The PR China has tried in the past thirty years to modernize its vocational education and training system; this happened mostly in the technical occupations. The challenge for the future will be to do the same effort for the service occupations. The reform and open-door policy of the Chinese government since the 1970s brings many opportunities not only for the economy, but also for the society. The rapid development in the technically based fields brought the anticipated economic upswing and leads the PR China from a development country to the second biggest economy in the world. Now, the current government aims more to increase the life standard of the Chinese and strengthen the domestic consumption than to focus on industry production. Through the emerging middle class the quality and necessity of services gain higher importance in the society and it is seen as an integral part of increasing their quality of life. Chinas new generation remained from the destructive revolutions of the 1960s and 1970s, which have slowed down the development in the country. It has now in hand to bring together identity of the country with its traditions and modernity not only outwardly in the perception of the world, but to strengthen it also in the Chinese society.

In the light of youth unemployment and increased transnational mobility practice oriented vocational education and training get more and more importance in the international cooperation in education. There is a broad consensus among educational experts, that one of the possible measures to reduce youth unemployment in the world is to provide youth skills and competences, which are needed on the labour market. The school based vocational education needs to be updated with practical skills. The fundament of each practice oriented vocational education and training system (VET) lays in the cooperation between the main actors: the enterprises and vocational schools. Dual systems in countries as Germany, Switzerland and Austria offer many good practice examples on the benefits of the engagements of both actors in the vocational education and training system but nevertheless these examples cannot be taken as “one model fits all” which can be implemented in each country. Therefore each country interested in the redesign of their own vocational education and training system needs to identify possible benefits of and challenges in their system, to be able to specify the opportunities and threat for future development. It cannot be presumed that enterprises can be forced to take apprentices and train them in their facilities. It has to be evident for every educational actor willing to cooperate with enterprises, that enterprises first strive for growth in profits upon others to be able to secure their existence and secondly they may support additional, non-economic activities; for example the vocational education and training of future employee. Although to ensuring the quality of future employees may partly be seen as their social responsibility this fact will still depend on their economic situation and their need for skilled labour. However, making profit does not collide with the idea of the engagement of enterprises in the vocational education and training. It only needs an in depth-analysis of potentials and needs of enterprises and vocational schools and an adequate planning as well as development of the educational programs and activities. The following example on the PR China delivers many interesting basic approaches on how cooperation between enterprises and vocational schools can be built up, managed and preserved. Thanks to the over thirty years of multilateral cooperation between der PR China and other European and Asian countries, the PR China already knows what is needed to modernize the vocational education and training system. Further education of teachers, redevelopment of curriculums and the redesign of the infrastructure of the vocational schools are those activities, which enriched the Chinese vocational education and training system in the last thirty years. There is still backwardness in the economically weak part of the country but within the “go-west-strategy” of the government innovative measures are offered for enterprises to foster the development of the western region; for example cut red tape or tax and duty exemptions. In the course of the bureaucracy development of the east-southeast part of the country and through the increased perception of the country in the international business the quality of labour become more relevant also for the PR China. Products with low-value-added and unskilled labour were not sufficient anymore for the competitiveness of the country in the international environment. More and more enterprises realised the shortage of qualified labour because of the rise of progressing technology and of the availability of qualified labour. The commitment to quality in the vocational education and training laid on the market orientation and therefore on the establishment of cooperation between enterprises and vocational schools. The PR China can consequently show good practice examples from cooperation in the vocational education after more than thirty years of learning from other countries. The constructive element of these cooperation was identified by the actors as the consensus about the mutual benefit of cooperative activities. Although there are many good practices in the cooperation, nevertheless, more persuasiveness is still needed for continuous fostering of quality in the vocational education and training. The cooperation is not only influenced by the interest, need and the level of cooperation between enterprises and vocational schools, but the nature of the directives of the government are crucial for the cooperation too. For example, the decentralized implementation of the directives of the government may endanger the uneven development and quality assurance in vocational training. The transfer of responsibility of the state in the hands of the provinces ensures on the one side more freedom for provinces, for instance, it allows them to adapt the vocational education and training to their specific needs and to implement it to local circumstances. This means, to offer labour market oriented vocational education and training. On the other side it needs in the context of quality assurance to archive the knowledge gained through the fragmented implementation. This implies, that already developed teaching and learning materials should not get lost but it should be used as synergies and transfer these to other provinces, schools or enterprises. One of the exemplary efforts made by good situated “model vocational schools” is their willingness to overtake a sponsorship for other less developed vocational schools that are located mostly in the western region. Previously mentioned schools support the improvement of the teaching quality of latter mentioned schools and help them especially in the initial phase of the redevelopment of their teaching and training system. More concrete, “school sponsorships” allow to share knowledge, experience or to share technical equipment. The further education of teachers, the establishment of training facilities, the adaptation of curriculum to the labour market needs leave space for the consideration of local needs on the one side, and the dynamics of market development on the other side. It is only possible to take over responsibility for less developed schools, if there is financial support through the government too. School sponsorship is mostly subject to model schools therefore there is a significant need for recognition and promotion of education activities of these model schools. The high dynamic of the labour market in developing regions may cause challenges in the cooperation between vocational schools and enterprises, especially in the time of recession. If the cooperation with a vocational school gives rise to concern because of the limited time, personal availability or financial support in the enterprises, than the support of enterprises may decrease. Therefore the model schools strive to mobilise all actors, ask for financial and material benefits during the time of economic growth to be able to implement those benefits targeted and lay a solid fundament for the performance of less developed schools. This fundament may consist of well-educated vocational teachers, well-equipped training facilities as well as practice oriented curricula. A solid basis allows vocational schools in a economically weak period to use previous investments and benefits. Additional created supplementary services, as further educational offers for enterprise employees, well-educated vocational teachers as consulters by building up of new production lines or by doing research on the effectiveness of human resources, are examples for reserves to bear itself. The redefinition of the role of vocational schools as “service providers” in a wide sense, allows setting quality standards in relation with the pedagogical requirements and economical needs in the vocational education and training. The school administration and teachers need to be equipped with additional management skills in addition to their educational and professional skills to be able to initiate, build and maintain cooperation systematically and analytically. Enterprises need to be aware of taking responsibility for future skilled labour while cooperating with vocational schools. The openness of enterprises for cooperation allows determining one's potential within vocational education and training and look for benefits for both actors. It is necessary for a successful cooperation to be a "win-win" situation, so the motivation for all parties should be maintained. Finally each cooperation needs competent teachers, well equipped training facilities also strategic planning (AIOC-strategy) in sense of analysis of initial situation and the possibilities for the implementation of practical vocational education and training, optimisation of available capacities and resources, the interdependence of responsibilities and competences of both actors, and the consolidation of pedagogical quality criteria under economic premises. The PR China has tried in the past thirty years to modernize its vocational education and training system; this happened mostly in the technical occupations. The challenge for the future will be to do the same effort for the service occupations. The reform and open-door policy of the Chinese government since the 1970s brings many opportunities not only for the economy, but also for the society. The rapid development in the technically based fields brought the anticipated economic upswing and leads the PR China from a development country to the second biggest economy in the world. Now, the current government aims more to increase the life standard of the Chinese and strengthen the domestic consumption than to focus on industry production. Through the emerging middle class the quality and necessity of services gain higher importance in the society and it is seen as an integral part of increasing their quality of life. Chinas new generation remained from the destructive revolutions of the 1960s and 1970s, which have slowed down the development in the country. It has now in hand to bring together identity of the country with its traditions and modernity not only outwardly in the perception of the world, but to strengthen it also in the Chinese society.