Highlighting the roles of ecology, culture, history, and political economy, this book considers how the unique mountain ecology and socio-cultural patterns of the Himalayan region of Ladakh contribute to a peculiar pattern of infant mortality. It stresses the burdens of women's work in this region as crucial to birth outcome. An example of a new genre of anthropological work called "ethnographic human biology," this study utilizes the methodology of human biology but strongly emphasizes the ethnographic context that provides meaning for human biological measures.
Author(s): Andrea S. Wiley
Series: Cambridge Studies in Medical Anthropology 12
Publisher: Cambridge University Press
Year: 2004
Language: English
Pages: 270
Cover......Page 1
Half-title......Page 3
Series-title......Page 5
Title......Page 7
Copyright......Page 8
Dedication......Page 9
Contents......Page 11
Photographs......Page 12
Tables......Page 13
Acknowledgments......Page 15
Abbreviations......Page 21
Glossary of Ladakhi Words......Page 23
1 Introduction......Page 27
A Biocultural Perspective on Health......Page 33
The Population and the Body......Page 34
Health......Page 37
The Environment......Page 38
Adaptation......Page 39
Biocultural Synthesis: High-Altitude Examples......Page 41
A Biocultural Perspective on Reproductive Health in Ladakh......Page 42
Ethnographic Human Biology......Page 45
2 Challenges of High-Altitude Living......Page 51
High Altitude: Laboratory for Human Adaptability......Page 52
Hypoxia and Fetal Growth......Page 53
Hypoxia and Child Health......Page 56
High Altitude and Infant Mortality......Page 58
High Altitude and Fertility......Page 61
Other Ecological Stresses of High Altitude......Page 63
3 Contextualizing Reproductive Health Research in Ladakh......Page 65
Geography......Page 66
Early Historical Context......Page 71
Political, Demographic, and Social Changes......Page 72
Household Subsistence......Page 75
Household Dynamics......Page 76
Gender Dynamics......Page 79
Diet......Page 81
Health Care Institutions......Page 83
Reflexivity in Human Biology Research......Page 87
Background to Fieldwork......Page 88
Routines of Fieldwork......Page 90
4 Big Mountains, Small Babies......Page 97
Pregnancy and Birthweight......Page 98
Measuring Mothers and Newborns......Page 99
Sample Characteristics......Page 103
Potential Sample Biases in Health Parameters......Page 107
Descriptive Anthropometry......Page 108
Maternal Nutritional Status and Birth Outcome......Page 112
Diet during Pregnancy......Page 114
Workloads during Pregnancy......Page 117
Ethnicity and Birth Outcome......Page 122
Buddhist-Muslim Differences in Birth Outcome......Page 124
The Institutional Management of Pregnancy and Birth......Page 126
The Role of Tibetan Medicine in Pregnancy Management......Page 127
Other Healers......Page 129
Summary......Page 130
5 An Ecology of Infancy in Ladakh......Page 131
Determinants of Infant Mortality......Page 132
Follow-up of Infants in This Study......Page 134
Neonatal Characteristics and Infant Mortality......Page 136
Hospital Birth and Pediatric Admissions Records......Page 141
Pattern and Level of Infant Mortality......Page 142
Hospital Deaths......Page 144
Patterns of Morbidity......Page 147
The Ecology of Infant Health and Death......Page 150
Neonatal Ecology......Page 151
Ecology of Infant Health......Page 160
Summary......Page 170
Neonatal Characteristics......Page 172
Neonatal and Infant Mortality......Page 177
Summary: Ladakh and the Andes Compared......Page 181
Ladakh in the Himalayan Context......Page 182
Birthweight......Page 183
Neonatal and Infant Mortality......Page 187
Ladakh in the Context of South Asia......Page 192
Birthweight......Page 193
Neonatal and Infant Mortality......Page 197
Summary: Ladakh in the Indian Context......Page 200
Conclusions......Page 203
7 Toward Relevant Research: Adaptation and Policy Perspectives on Maternal-Infant Health in Ladakh......Page 204
The Proximate Determinants of Infant Mortality in Ladakh......Page 205
Birthweight......Page 206
Neonatal Mortality......Page 208
Postneonatal Mortality......Page 209
Adaptive Status: Ladakhi Mothers and Infants......Page 210
The Household: Compromise and Adaptation......Page 212
Impact of Social and Economic Change on the Household......Page 215
Adaptation and Reproductive Health: Concluding Remarks......Page 218
Intervention......Page 219
Infant Mortality Statistics in Global Perspective......Page 221
Targeting Birthweight......Page 223
Infectious Disease......Page 226
The Future of Reproductive Health in Ladakh......Page 227
CHAPTER 3......Page 231
CHAPTER 4......Page 232
CHAPTER 5......Page 233
CHAPTER 7......Page 234
References......Page 235
Index......Page 253
