Reproduction follows many patterns in different societies with varying consequences for health. In this column I'll explore some of the recent anthropological research on optimal reproductive strategies from this cross cultural and evolutionary perspective. This review draws upon the important work of Anderson (1996). The major topics I will cover are:
* Abuse, Trauma and Infanticide
* Sexuality, Menarche, Clitoridectomies, Hysterectomies, and Genital Surgery
* Marriage, Reproduction, Childbirth, and Body Image
By exploring the anthropology of these variables I hope to show the foundations of modern day return to "alternative" reproductive health practices such as midwifery, physical therapies, and traditional nutrition including phytomedicines.
Abuse, Trauma and High Tech Infanticide
The first point I want to make is the way in which physical abuse and neglect of children have changed across cultures and time. When one thinks of simpler societies, a lifestyle of physical abuse to children, high risk of trauma and the practice of infanticide, is often imagined. But is this really accurate? To what extent is the modern industrial lifestyle really an improvement in these variables for child and female health? Anthropologists have looked at these questions and found that in reality, modern societies have simply made the process of physical abuse and offspring selection more subtle, masking it with technology In simpler societies children are subject to traumatic, mechanical and violent health threats that we consider primitive and severe. However, in modern industrial societies children are subject to more subtle, cognitive and metabolic abuses that are just as damaging to health.
Children in simple societies are more often subject to physical trauma and direct offspring selection than those in modern societies. For example, Naroll (1983: 245) reviewed 40 societies in the Human Area Relations Files (BRAF), a specialized cross-cultural database, and found that in half of them children were subject to corporal punishment. Children in small-scale societies often suffer from trauma. In a mountain village in Nepal one study found that one child in a hundred aged fourteen or less was suffering from an orthopedic problem; 86% had fallen out of trees which were climbed daily to harvest leaves to feed livestock. Postnatal infanticide and negligent homicide are common in many societies and invariably target girls. Using the BRAF Harris and Divale determined that societies characterized by warfare are particularly prone to terminate girls (1976.) For children under the age of 15 the ratio of boys to girls is 127 to 100 in societies that attribute high status to warriors. One would expect only 106 boys to 100 girls if each sex were given equal opportunity to survive. (More boys are conceived because the fertilization process slightly favors the male conceptus.)
In contrast, today in modern societies technological, cognitive, and metabolic abuse and offspring selection have replaced direct, physical methods. Guns, knives, and other weapons are now available to children and greatly extend the power and morbid potential of violent behaviors. TV and video games support violence and sedentary habits, creating self-destructive cognitive schemas in children and adults. (Kottak 1990) Now instead of falling out of trees or wrestling, children shoot each other. In the US we have instituted safety programs including automobile restraints, playground and water safety, school, violence and gun control that attempt to reduce these risks for children. Yet these problems continue to increase dramatically. One great solution, often suggested by those interested in public health and preventive medicine, is to get inner city kids involved in outdoor recreation. This can connect them with nature and get them away from the technology and urbanism which fosters such violent and destructi ve lifestyles. I've written in the past about wilderness therapy and such organizations as Outward Bound which are doing this work right now.
Similarly, infanticide hasn't gone away at all, but simply takes on a technological edge that makes it harder to detect and much more pervasive. With ultrasound it is now possible to determine the sex of the embryo towards the end of the first trimester of pregnancy. Parents may elect to abort. In one city in the People's Republic of China where ultrasound was used, only 25% of all births in 1992 were girls. Nearly half of 2316 pregnancies were aborted in another city that same year because the parents did not want girls.
Menarche, Clitoridectomies, Hysterectomies, and Genital Surgery
Another common misconception is that simple societies feature high rates of physical mutilation of women's sexual organs. However, in reality such forms of mutilation are relatively superficial when compared to the medical/surgical mutilation inflicted on women in modern, industrial societies in the name of reproductive medicine.
Many forms of body mutilation serve artistic and spiritual purposes in simpler societies (such as piercing, adornment and tattoos) while in modern societies they often serve political functions for controlling individuals and marking them as property. For example, some of the most degrading and harmful genital mutilation is not a characteristic feature of "primitive societies" at all but rather exploded in modern, complex cultures where it was used to control certain classes and genders. Clitoridectomies flourished in Victorian England as a way to stop masturbation which was thought to cause a common culture-bound Victorian disorder known as hysteria. It became most popular after 1850 when it was popularized and practiced by Isaac Baker Brown, an English gynecological surgeon (Cutner 1985). In some cases girls were also infibulated (pierced) at the prepuce, again to prevent masturbation. Extremists added surgical excision of the ovaries, castrating thousands of girls before the practice was abandoned around 1 880. Clitoridectomy was more durable since it was thought to prevent a range of mental and physical disorders. Sexuality of young women was thought to reside outside the sex organs and orgasm was thought to be an ailment, so removal of erectile organs like the clitoris was a necessity. A number of doctors resorted to excision for treating epilepsy, catalepsy, hysteria, melancholy, and even kleptomania. It was performed in mental hospitals until 1935. (Lightfoot-Klein 1989: 180.) Excision of the clitoris was also performed by some surgeons in the 1930s and even into the 1940s as a cure for masturbation as well as to prevent what were perceived as lesbian tendencies.
Clitoridectomies are no longer authorized as a standard of practice in the United States. Some women choose to undergo piercing and infibulation of body parts, including the sexual genitalia. Yet genital alteration has not been abandoned: hysterectomies (with or without removal of the ovaries) have almost become a stage in the contemporary woman's life cycle. By 60 years of age more than one in three American women will have had their uterus removed. (Carson, Nichols, and Schiff 1993) The justification is supposedly based upon sound medical reasoning. In most cases however the surgeries are performed to relieve unpleasant symptoms or to improve the quality of life, for example, as a cure for pelvic pain. The uterus is seen as a useless organ after the reproductive years that can only cause trouble by permitting an unwanted pregnancy or becoming a seedbed of cancer. In the U.S more than 40% of hysterectomies and oophorectomies have involved removal of normal organs. Of 148 procedures reviewed, 64 or 43% were d eemed justified. (Seaman and Seaman 1977: 308.)
