A Role for Biology in the Cultural Ecology of · PDF fileHuman Ecology, Vol. 25, No. 2, 1997 A Role for Biology in the Cultural Ecology of Ladakh Andrea S. Wileyl Human ecology research

A Role for Biology in the Cultural Ecology of LadakhAuthor(s): Andrea S. WileySource: Human Ecology, Vol. 25, No. 2 (Jun., 1997), pp. 273-295Published by: SpringerStable URL: http://www.jstor.org/stable/4603239 .

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Human Ecology, Vol. 25, No. 2, 1997

A Role for Biology in the Cultural Ecology of Ladakh

Andrea S. Wileyl

Human ecology research in the high-altitude region of Ladakh (northem India) has tended to focus on the adaptive significance of Ladakhi social institutions given a natural environment characterized by numerous challenges. This research appears to lead to the conclusion that traditionally-living Ladakhis are in a state of well-being and harmonious balance with their environment, as social institutions such as polyandry constrain fertility to keep the population size in check relative to constrained resources. There has been little research on biological adaptation in Ladakh, and the view from biology presents a very different picture of the relationship between Ladakhis and their environment. Data presented here show that the health of reproductive women and infants is compromised by both natural and social factors. Since reproductive health is crucial to the production of future generations, it is argued that mortality plays a major role in constraining population growth in Ladakh, and may be due to the limited biological history that Ladakhis have in this high-altitude region. This may also help us understand Ladakhi pattems in relation to those observed in the Andes. KEY WORDS: Ladakh; high altitude; demography; infant mortality.

INTRODUCTION

Ladakh is a high-altitude desert region that forms the western extension of the Tibetan (trans-Himalayan) plateau in India. The unusual beauty of its stark landscape has attracted the attention of numerous visitors, many of whom comment on how harsh life in Ladakh must be. Its high altitude (Ladakh's capital, Leh, is at 3534 meters) produces hypoxic conditions, high levels of solar radiation, and dramatic seasonality in temperature. Subsis-

'Department of Anthropology, Binghamton University (SUNY), Binghamton, New York 13902-6000.

273

0300-7839/97/0600-0273$12.50/0 ? 1997 Plenum Publishing Corporation



274 Wiley

tence agriculture is possible only through intensive regulation of scarce or inaccessible water resources and high inputs of human labor. Given the constellation of ecological challenges, it comes as no surprise that research questions in Ladakh have focused on how the human population has managed to sustain itself under such conditions. In doing so, it is consistent with a long history of such research by human ecologists on high-altitude environments in general (cf. Baker and Little, 1976; Baker, 1978). What seems to uniquely characterize the very limited literature on Ladakh is a recurring celebration of traditional Ladakhi lifestyles as eminently sustainable and not even particularly arduous, and of a distinctive "joie de vivre" exhibited by Ladakhis themselves (Norberg-Hodge, 1991; Crook and Os- maston, 1994). This has come to be the dominant image of Ladakh, pro- moted in part by a widely-read book by Helena Norberg-Hodge (1991), Ancient Futures,2 and the more scholarly edited volume Himalayan Buddhist Villages (Crook and Osmaston, 1994). Both works construct an image of a carefully managed productive and reproductive system and an expansive social and ritual life based on Tibetan Buddhist precepts. Here, traditional forms of subsistence and social life form a "closely integrated system" that is both highly productive and sustainable (Osmaston, 1994). This system is said to produce a finely-tuned and harmonious equilibrium between population, culture, and environment. In sum, traditional lifeways of the population of Ladakh have been hailed as superbly adapted to a natural environment in which numerous stresses are present.

Within this cultural ecology framework a few core themes are re- peated, the most pervasive of which is the apparent delicate balance between the number of people and clearly defined and limited resources. Social mechanisms regulating population growth have been seen as central to the long-term success of Ladakhi lifestyles, and polyandry, an unusual marital form, has been singled out as a practice that has this function (Car- rasco, 1959; Sumi et al., 1975; Rizvi, 1983; Norberg-Hodge, 1991; Crook and Crook, 1994). Polyandry, in combination with primogeniture, allows for only one reproductive female per generation in each household, thereby reducing overall population growth. Some authors argue that polyandry also accounts for the relatively high status of women in Ladakh (Sumi et al., 1975; Rizvi, 1983; Norberg-Hodge, 1991). Monastic Buddhism also comes into play here as an institution that draws males (and to a much smaller extent, females) into a celibate religious life, thereby further reducing the size of the reproductive pool of adults. Thus, several aspects of

2Norberg-Hodge's book is not intended specifically for an academic or anthropological audi- ence, and her book is very successful as a critique of Western-style development in contexts such as Ladakh. However, the author is widely acknowledged as an authority on Ladakh due to her long term work there (ongoing since the mid-1970s).



Cultural Ecology of Ladakh 275

Ladakhi social life appear to comprise a tidy package of remarkable and seemingly democratic adaptations to a host of constraining environmental conditions.

Despite the wide reliance by researchers working in Ladakh on cultural ecological models, this region has not been a site for theory building about human ecological relationships. The term adaptation retains an ambiguous, and I would argue, naive usage in the literature on Ladakh. It seems most consistent with an early usage in which cultural practices that maintain populations in a stable relationship with their environment through homeostatic or population self-regulation mechanisms were seen as adaptive (Rappaport, 1968). As Robert Netting commented on his own work in an Alpine village in the Alps:

In occasionally referring to the Swiss mountain village of Torbel as an "island in the sky" and describing the intricate economic and social means by which its inhabitants over the centuries struck a balance with their alpine environment I may well have been guilty of . . . an overemphasis on functional integration, stability, and regulatory mechanisms within the community and a relative neglect of disequilibrium, changes emanating from more inclusive political-economic systems, and instances of evolutionary maladaptation. (1990, p 229)

A similar charge could be made against the literature on Ladakh, which is generally vague on the level at which adaptation occurs (Norberg-Hodge, 1991; Osmaston et al., 1994; but see Crook and Crook, 1994, for a more sophisticated discussion). As a consequence it is too easy to conclude that reduced fertility is operating for the good of the group and its goal is population sustainability. Lacking is an analysis of the context for individual behavior and decision-making that would help explain how these group-level phenomena come about. Further, and most importantly, the costs of these behaviors have not been fully explored.

Adaptation will be used here to describe processes by which humans are able to maintain their health under specific environmental conditions, and produce future generations. It does not rely on a notion of homeostatic mechanisms, nor on a notion of adaptive behavior or biology as optimal, but rather as compromise among biological and social systems and the variety of stresses to which people must respond (Thomas et al., 1979; Huss- Ashmore and Thomas, 1988). A biocultural perspective will be adopted that attempts to integrate existing work in cultural ecology that limited its focus to the adaptive significance of social institutions in this environment, and that on high-altitude human biology, which has largely ignored the social context of individual physiology.

This paper will investigate how the ostensible adaptive "fit" between Ladakhi culture and environment looks from the perspective of human biology. Relative to the Andes, little research has been done on the topic of biological adaptation in the Himalaya. The former have been well-described



276 Wiley

with respect to how human bodies respond to habitable high altitudes, and how health and survival are affected by the combination of hypoxia and cold, among other conditions (Baker and Little, 1976; Baker, 1978). Placing Ladakhi adaptations in a comparative perspective provides insight into the relative adaptive status of Ladakhi biology and behavior and moves beyond the particularistic area focus that has dominated Ladakh studies. I will first review the cultural ecology literature on Ladakh, particularly as it relates to population processes, and then discuss how biological factors contribute valuable information on adaptation to an arguably stressful environment. I present data that provide insight into biological adaptation, directly assessed through the reproductive health of women and the survival of their infants. The data suggest that the health and well-being of women and infants are compromised by several aspects of the natural environment and also by some Ladakhi social institutions.

ECOLOGY AND POPULATION PROCESSES IN LADAKH

Ladakh is a region of approximately 100,000 km2, located between 32 and 36 degrees latitude on the northern border of the Indian subcontinent and at the western end of the Himalayan range. (See Fig. 1.) It lies to the north of the great Himalayan range in the transHimalayan plateau, bounded by the Karakorum range to the north and west, and contiguous with Tibet to the east. Within Ladakh are the Ladakh and Zangskar ranges, averaging over 6000 meters in elevation. The entire region is mountainous (with an altitude range of 4000 meters) and arid, with most human settlement between 3000 and 4000 meters above sea level. Only .002% of the total land mass of Ladakh is estimated to be forested (Mann, 1986). Well within the temperate zone, Ladakh's climate is to a limited extent affected by the monsoonal cycle of the subtropical areas to its south and by extratropical weather systems originating from the north in central Asia. Total annual precipitation is less than 10-15 cm, with most precipitation occurring in the summer months of July and August when occasional monsoon clouds drift across the great Hi- malayan range and into Ladakh (Mani, 1981). There is tremendous seasonal variation in temperature, with average temperatures in the capital ranging from -8.4?C in January to 17.6?C in July (Mani, 1981). Temperatures may vary from as low as -300C in the winter to a high of 300C in the summer. Given the mountainous conditions of Ladakh, there are many microclimates that are characterized by different temperatures, precipitation, and solar radiation, but in general, Ladakh is arid, dusty, windy, and cold for much of the year, and the air always hypoxic.

Overall, the population density of Ladakh is just over one person/km2 (total population in the 1981 census was 134,000), making it the least




I T IHIN

| t 4 _ | tS~~~~~~HUTAN 'l

Tropic of Cancer

\Jt IN D I A BURMA|

200 0 200 400

KILOMETERS

Fig. 1. Ladakh in the context of South Asia.

densely populated district of India, but this statistic is essentially meaning- less given the limited habitable terrain. Mann (1986) estimated that only 0.2% of the entire land area of Ladakh is inhabited or under cultivation due to the topography and limited access to water. Most villages and fields are situated on the relatively flat plains of the Indus River valley or in subsidiary valleys along tributary streams. While there are abundant rivers, many have carved out steep canyons in their passage through the moun- tains, rendering access difficult or impossible. Cultivation is possible only up to 4000 meters, above which nomadic or seasonally nomadic populations live with their livestock. The population is mostly rural and loosely organized in over 200 villages.



278 Wiley

Most farmers own the land they cultivate or lease it on a long-term basis. Landholdings average around five acres and economic differences among most villagers are reportedly minimal (Norberg-Hodge, 1991). Each landholding household functions as an autonomous unit, although during busy times in the agricultural cycle, families will share work with relatives or mutual-aid networks (phasphun). Villages are organized democratically, and headmen (goba) are appointed on a rotating basis, functioning mainly to settle disputes. Village life revolves around the agricultural cycle, which begins in April when fields are plowed and fertilized with manure. Barley is the principal crop of Ladakh and requires regular watering through the extensive and complicated network of irrigation channels. Other fields are planted with potatoes or hardy wheat varieties, and most households maintain a large house garden in which a variety of vegetables such as peas, turnips, radishes, onions, and various greens are cultivated (cf. Osmaston, 1994, for a detailed description of agricultural production). Harvesting, the most labor intensive phase of the agricultural cycle, begins in September, and the winter months are spent doing household tasks or in leisure activities. All agricultural tasks are done manually, with the aid of livestock for plowing and threshing.

Human habitation in Ladakh may date back about 4000-5000 years, although knowledge about the antiquity of settlement in the area is largely speculative (Rabgias, 1988). Further east in Tibet archeological remains have been tentatively dated at 25,000 years (Zhiman et al., 1982). Although occupying the same ecological zone in the transHimalayan plateau, these sites are so distant from Ladakh that they are of limited use in determining the antiquity of habitation there. Scholars have suggested that peoples speaking Dardic languages were the first inhabitants of Ladakh, moving south and east into the region from west or central Asia (Rizvi, 1983). Other populations moved north, possibly from the Kulu Valley just south of the Great Himalaya. People of Tibetan and Mongolian origin may have originally come to Ladakh as pastoral nomads, but large-scale immigration from the east most likely did not begin until Tibet gained loose suzerainty over Ladakh between the eighth and tenth centuries (Fisher et aL, 1963; Rizvi, 1983). The dominant language of Ladakh came to be Ladakhi, a dialect of Tibetan, which belongs to the Sino-Tibetan language phylum. La- maist (Tibetan) Buddhism was established in Ladakh at least by the first century AD.

Ladakh emerged as an important way-station on transAsian trade routes as early as the ninth century due to its central location between west Asia, the south Asian subcontinent, and the large empires of east and central Asia (Rizvi, 1983). Despite its forbidding geography and seeming isolation, Ladakh, in particular its mercantile center at Leh (later its capi-




tal), was a fairly cosmopolitan place that linked merchants and traders across Asia, providing opportunities for the mixing of cultures and peoples. Some traders eventually settled in Ladakh, and some later acquired land and became farmers. One result of this is a history and contemporary pattern of cultural and biological variation, particularly in the Indus Valley.

The antiquity and settlement history of the population of Ladakh is essential to understanding current patterns of adaptation. There is evidence from historical census records dating back to the turn of the century that the population of Ladakh has grown very slowly until extremely recently, at an average annual rate of only 0.5% (Government of India, 1961). The question has not been why this low rate of growth has occurred, since this is taken as a self-evident outcome of marginal subsistence conditions, so much as how this very low rate of population growth was achieved (Nor- berg-Hodge, 1981; Sander, 1983). Research has focused on the intense social regulation of reproduction, and its outcome, low average fertility. However, it must be pointed out that there are three routes to demographic homeostasis: low fertility, high mortality, and emigration. There are no historical reports of widespread outmigration from Ladakh. The geomorphol- ogy of the Himalaya most likely precluded large-scale emigration and it seems unlikely that it played a major role in constraining population growth (unlike what Netting (1981) observed as a key component of demographic stability in the Alps).

As mentioned, many researchers have focused on reduced fertility as an important population limiting mechanism. In this case, fraternal polyandry - the marriage of one woman to more than one brother - has been investigated as an important social institution having this function. The significance of this rare marriage pattern has been the subject of much research on Tibetan populations throughout the Himalaya (Goldstein, 1971, 1976, 1981; Aziz, 1978; Sander, 1983; Schuler, 1987; Levine, 1988; Durham, 1991). Polyandry has generally been analyzed as a social institution that constrains overall population growth by restricting the pool of actively re- producing women in the population while simultaneously maintaining a labor force within the household large enough to carry out labor-intensive subsistence agriculture (Carrasco, 1959; Goldstein, 1971, 1976, 1981; Aziz, 1978; Osmaston and Crook, 1994). This is not merely an "etic" explanation for polyandry's existence here; it also has "emic" legitimacy as Ladakhis readily articulate this rationale for its practice.

In combination with an inheritance system of primogeniture, polyandry functioned to maintain landholdings within one household by limiting the number of reproductive women and legitimate heirs to one per generation. Sons not wishing to join a polyandrous union could leave the family, but with no resources or opportunities for nonagricultural work (a situation



280 Wiley

which persisted until 30 years ago, when new opportunities arose in the military and tourism), their livelihood was insecure (Rizvi, 1983). In addi- tion, it was traditional to send the youngest son to a monastery to become a monk at a young age (monks may return and live for a while at home, and often do so to help in agricultural activities). Most often daughters married into other households since residence is usually, though not exclusively, virilocal. In the absence of a male heir, daughters can inherit and husbands come to live in the woman's household. Since polyandrous mar- riages accommodate a small number of women relative to men, this system creates a pool of unmarried females who generally remain in their natal households, often moving into a subsidiary house on the family land with their parents upon the marriage of the heir. Both census records and village surveys indicate that as many of 25% of the adult female population in Ladakh has never been married (Attenborough, 1994a; Elford, 1994; Wiley, 1995). A small fraction of women become nuns, but since nunneries are rare, most remain in their natal homes. Both monks and nuns are supposed to be celibate though there may be a very low level of fertility among them.

Since polyandry generates "surplus" females, one might expect female infanticide to be common, but there is little evidence suggesting this is the case in the Himalaya (Goldstein, 1981; Levine, 1987). Given the need for labor within the household, and the existence of acceptable nonreproductive roles for women, it seems unlikely that female infanticide would be widespread. Indeed, some authors have idealized polyandry as an institution that fosters female empowerment (Rizvi, 1983; Norberg-Hodge, 1991). Relative to women in other parts of South Asia, Buddhist women in Ladakh have a great deal of freedom and engage in valued productive work. They do not veil themselves, and are often seen in the bazaar alone or in groups with other women. They freely engage in interactions with unrelated men, and comprise the majority of vendors at the local vegetable market in the Leh bazaar. The produce they sell is from their household gardens, and the profit from such mercantile activities is theirs to spend as they like, as is the wealth they bring to their marriage. Aside from cultural expectations that men plow and women weed, distinctions between women's work and men's work are unfixed. In general work is cooperative in nature, and both men and women work in the fields at all stages of the agricultural cycle.

From an evolutionary perspective, polyandry and the monomarital principle (i.e., one reproductive union per generation (Goldstein, 1971)) can be considered adaptive in that over generations, land is maintained within a household such that descendants are more numerous and better off than if land were divided among several legitimate heirs (Durham, 1991). In any given generation fissioning and monogamy may temporarily increase the number of descendants, but over several generations this re-




productive strategy may lead to the extinctions of lineages as the amount of land per household diminishes sharply. Thus, while at any given time polyandrous unions do not produce more children than monogamous or polygynous unions (which has led some authors to challenge the adaptive significance of this behavior pattern, cf. Beall and Goldstein, 1981; Sander, 1983), over time it is a more sustainable strategy, but only in the context of a fixed resource base. Under these conditions, polyandry is a viable adaptive strategy, certainly producing a population that is more likely to be sustained than one that periodically crashes and rebounds. It is worth noting that this "low pressure" demographic system mimics that of historical northern Europe, where there was a high rate of celibacy for both men and women and a system of primogeniture among landed households (cf. Hajnal, 1965).

The above scenario suggests an idealized social pattern that generated low fertility through restricted access to marriage (yet guaranteed some measure of respect and access to resources for nonreproductive men and women), social harmony, and ecological sustainability, all in all creating a neat package of functional behaviors. There is however, a darker side to this idyllic construct. Returning to the theme of demographic stability, the other component of the demographic equation is mortality, little explored in the Himalaya relative to fertility. Ethnographic descriptions of Ladakh make scant reference to health except to note how Tibetan medicine and other healing traditions are practiced (Kuhn, 1988). There seems to be a general sentiment that the population -living traditionally -is fairly healthy, and people live long and productive lives, generally uninhibited by serious infectious or degenerative diseases (Meyer, 1981; Norboo and Ya- hya, 1988; Norberg-Hodge, 1991; Ball and Elford, 1994). The limited nutritional research done indicates that Ladakhis subsist on an adequate caloric and protein base, with a diet heavily reliant on barley and supple- mented with seasonally available vegetables and dairy products (Palriwala, 1988; Attenborough et al., 1994). There are references to widespread iron- deficiency anemia, which is particularly problematic under hypoxic conditions because iron mediates the body's capacity to transport oxygen and also to possible shortages of calcium and Vitamins A and B-12 (Meyer, 1981; Stobdan, 1990; Attenborough et al., 1994). Respiratory diseases, ex- acerbated by cold, aridity, hypoxia, and domestic pollution, are the most common forms of infectious disease and affect all segments of the population (Norboo et al., 1991). Recent research on health has focused on the rise of cardiovascular disease as a consequence of changing dietary and activity patterns, especially in and around Leh (Norboo and Yahya, 1988).

The limited data on health and disease thus suggest the relative healthiness of the population and notable lack of chronic debilitating dis-



282 Wiley

eases. But if processes of adaptation are of interest, mortality in the early part of life should be investigated. In terms of shaping population growth, infant and child mortality, in combination with fertility, determines the number of individuals who reach reproductive age and thereby contribute to the size of the next generation. Infant mortality is closely related to maternal health, mediated by the resources that mothers have to channel to the fetus and infant. In keeping with the emphasis on the healthiness of Ladakhis and women's power, it has been repeatedly reported that there is a widespread ideology in Ladakh that women should eat well and rest from heavy agricultural work during pregnancy (Kuhn, 1988; Norberg- Hodge, 1991). Ostensibly then, women's reproductive health is valued and resources are devoted to maintaining it, which should enhance the survival and well-being of women and their infants.

In a paper repudiating an exclusive role for low fertility in constraining population growth among Tibetan populations, Goldstein (1981) argued for increased attention to the role of infant and child mortality. Among Tibet- ans in high-altitude Nepal, he noted that 20% of newborns died in infancy. Women who had completed childbearing reported that, on average, over half of their children had died before reaching the mean age of childbearing. This level of mortality was offset by moderate fertility, brought about by relatively high fertility within marriage combined with a low rate of marriage for women (due to polyandry). Thus high mortality played an important role in reducing potential population growth, although Goldstein did not speculate on its causes. Research based on retrospective data suggests similarly high rates of pre-reproductive mortality in Ladakh. Studies carried out in two villages in Zangskar, a region in southern Ladakh, have indicated that 9-19% of newborns died in infancy, and 20-30% of all births ended in death before reaching reproductive age (Attenborough, 1994a; Elford, 1994). Both of these studies found moderate rates of marital fertility (average children ever born to married women over 45 = 4.2-4.5), which were similar to rates calculated from Ladakh census data (Wiley, 1995).

There are reasons to suspect that high infant mortality in this high-altitude region may be a consequence of hypoxia. Studies in the Andes have consistently shown a strong and consistent negative relationship between birthweight and altitude (Lichty et al., 1957; McClung, 1969; Haas et al.,

1977, 1980; Haas, 1980; Beall, 1981; Conlisk, 1987; Yip, 1987). That is, as altitude increases, birthweight decreases. The mechanism underlying this effect has not been demonstrated, but intrauterine growth retardation is most likely the result of an exaggerated hypoxic intrauterine environment, as the mother attempts to supply a fetus with oxygen when her own oxygen transport system is under stress from living in a hypoxic environment. Most importantly, birthweight is well-established as a strong predictor of infant




mortality, particularly during the neonatal period (0-28 days) (McCormick, 1985). Elford (1994) found that almost half of infant deaths occurred in the neonatal period in a village survey in Zangskar, indicating a strong link to intrauterine events, and there was no evidence of neonatal tetanus, which is usually an important cause of early mortality in developing countries (Ball and Elford, 1994). Hypoxia may thereby act as a significant determi- nant of infant survival, but we also expect maternal characteristics (e.g., nutritional status) to have interactive effects and contribute to intrapopu- lation variation in birthweight and infant mortality risk.

Since thus far there had been no study investigating these effects in the Himalaya as possible contributing factors to high infant mortality and by extension constrained population growth, I undertook to find out if such a proc- ess was acting in Ladakh. The early years of life are risky in any population or environment, and from the perspective of adaptive processes, early death represents natural selection at work. Given that infant health is closely related to maternal health, if the health of women is compromised, there will be negative outcomes among their offspring. In other words, reproductive health is a locus for adaptation and is affected by a combination of social and ecological factors. We can further examine the distribution of stress and variation in mortality within this population to move beyond simple state- ments about the seamless harmony and well-being among the traditional Ladakhi population as evidence of highly functional cultural adaptations. Comparison with other high-altitude populations further allows an assessment of the relative well-being of Ladakhi women and infants.

MATERNAL AND INFANT HEALTH IN LADAKH

This study of the ecology of infancy was carried out from 1990-1991 in Leh, Ladakh and focused on the size of infants at birth and their survival rates from birth through the first month of life and up to 1 year of age. Data generated from this study comprise three distinct but overlapping sets.

1. A prospective study of 145 Ladakhi newborns and their mothers carried out at the Sonam Norbu Memorial Hospital in Leh from April to October, 1990. Mothers and their newborns were opportunistically re- cruited to participate in the study and were each assessed anthropometri- cally (infants: weight, length, circumferences and fatfolds; mothers: weight, height, arm circumference, and triceps skinfold). Detailed data on maternal characteristics were compiled from interviews with mothers and from prenatal records. Further specification of the neonatal assessment and maternal interview protocols can be found in Wiley (1994a,b). Follow-up of these newborns was conducted after 28 days and involved simply noting the survival status of the infant. If the infant had died, the age at death and cause



284 Wiley

of death were recorded. Infants born at the end of the study period who were not able to be censused in 1990 were followed-up during a return field trip in 1991.

2. Follow-up data were available from birth records of all other infants born in the hospital during 1990 (n = 372). This supplementary dataset was used to predict neonatal mortality from a limited number of infant characteristics such as sex and date of birth, and maternal biological (age, parity) and social characteristics (ethnicity, occupation). These birth records also contained reproductive histories of multiparous women who delivered at the hospital in 1990. Information was available on the survival status, age, and in 90% of the records, sex of previous children born to these women. These data were used to estimate cohort neonatal and infant mortality rates. Analy- sis of the determinants of mortality from both retrospective data and the prospective study was done using proportional hazards analysis.

3. The third source of available information on infant and child health was hospital pediatric admissions records, which were reviewed for the period from January 1989 through March 1991. These registers contained data on the pattern and cause of infant and child deaths in the hospital, and admission diagnoses for infants.

Due to the lack of information on infant mortality, obstetric complications, and reproductive histories from the general population, it is difficult to determine if the characteristics of the women and infants in these clinical samples were at significant variance from the overall population of mothers and infants in Ladakh.3 Women using the hospital facilities for giving birth may have been more likely to have experienced previous obstetric problems or death of an offspring, thus overestimating reproductive health problems in the sample population. However, women in sample 1 were better educated on average than women in the general population (Government of India, 1981), and ill newborns and mothers were excluded from this sample. In general, members of all of the samples had better access to health facilities and a wider variety of foods than the overall population. So it is not entirely clear whether biases in the samples would over- or underestimate reproductive problems. Forty-three of the villages of Ladakh are represented in samples 1 and 2, mostly from the Indus Valley, and about 23% of the samples is de- rived from Leh, which is consistent with the proportion residing there in the 1981 census. Sample 1 is comprised of Ladakhis only, while sample 2 contains Ladakhis (87%), Tibetans (5.5%), and migrants (7.5%). In sample 1, 80% of the women were Buddhist and 20% Muslim; in sample 2, 80% were Bud- dhist, 15% were Muslim and 5% were Hindu, which roughly corresponds to

3The fact that these are hospital based samples does not provide problems for comparative analyses, as all of the Andean and Tibetan studies have been conducted in urban hospital contexts.




3600'

3400;*

Tibet (Moore, 1990) Z 3200-- | - 5 *v Tibet (Zamudio et al., 1993)

3000 -

2800-

2600. I I I I I ~~~~~Ladakh *

O 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Altitude (meters)

Fig. 2. The relationship between birthweight and altitude (redrawn from Wiley, 1994b).

census estimates of religious affiliation. Ethnicity and religion are not recorded in the third sample.

Figure 2 summarizes a series of New World studies of altitude and birthweight, and includes the extant data from the Himalaya. The average birthweight in Ladakh (2745 grams) is much lower than the average birthweight of Andean newborns at equivalent altitudes by 300-400 g, and somewhat surprisingly, 500 g lower than Tibetan newborns in Lhasa (Moore, 1990; Zamudio et al., 1993). The median birthweight (2721 g) was just below the mean, indicating that over 50% of newborns weighed less than the mean. Birthweight was a significant predictor of mortality up to 28 and 90 days, but not at 6 months or one year. Newborns weighing less than the mean at birth had dramatically increased probabilities of neonatal mortality-those weighing 2500 g had a 3% probability of dying, while those weighing 2000 g had a 14% chance of dying in the first month of life. Beyond the first month, mortality rates increased only marginally, suggesting that there is a very strong selective effect acting against small infants in the first month of life. Table I shows that Ladakhi newborns have dramatically elevated risks of mortality at all weights below 3500 g (which en- compasses virtually all of the Ladakhi newborns) after 1 week, compared to birthweight-specific mortality rates in the Andes (Beall, 1981; Conlisk, 1987).



286 Wiley

Table I. Neonatal and Infant Mortality in Ladakh Compared to High Altitude Bolivia (Conlisk, 1987) and Peru (Beall, 1981)a

Neonatal mortality Infant mortality

Birthweight Bolivia-7 days Ladakh-7 days Peru-1 yeaer Ladakh-6 months

1500 0.243 0.285 0.150 0.638 1750 0.155 0.090 0.481 2000 0.057 0.080 0.080 0.346 2250 0.041 0.075 0.241 2500 0.001 0.021 0.060 0.164 2750 0.010 0.020 0.110 3000 0.002 0.005 0.030 0.074 3250 0.003 0.030 0.050 3500 0.002 0.001 0.040 0.033 3750 0.001 0.038 0.022

aLadakh data are predicted probabilities; Conlisk and Beall show observed death rates (from Wiley, 1994a).

The probability of neonatal mortality was highest in the winter months, and in 1990, births were also concentrated in the winter. Women indicated that they preferred to give birth in the winter when other demands on their time and energy were minimal. Neonates died most frequently of respiratory complications, most likely resulting from the interactive effects of cold, aridity, domestic pollutants, and hypoxia. Because small infants have fewer biological resources than larger infants, their ability to respond effectively to such challenges to their health appears to be impaired.

Reproductive histories pooled from samples 1 and 2 yielded cohort infant mortality rates of 182/1000, substantially greater than the rate of 121/1000 calculated for children whose sex was also recorded, indicating that if an infant survived, its sex was more likely to have been reported. Neonatal mortality ranged from 98/1000 to 144/1000. What is most striking about these rates is not the magnitude of infant mortality but rather the very high rate of neonatal mortality, which consistently made up between 79% and 86% of infant mortality. This observation is confirmed by the prospective study which showed probabilities of mortality increasing only marginally after the first month. Males and females showed similar rates of both neonatal and infant mortality. Although the level of infant mortality in Ladakh is perhaps not surprising, the pattern is unusual for a developing country context, where mortality risk generally increases over the first year of life. The Ladakhi pattern (but not the magnitude) is much more akin to that found in industrialized countries where most infant mortality occurs during the neonatal period (Wiley, n.d.).

One implication of this unusual age pattern of infant mortality is that very early mortality is closely linked to processes occurring during pregnancy. Early deaths are often termed endogenous, or due to risk factors




manifesting in the prenatal environment, as opposed to the postnatal environment that the infant encounters as it ages (Pressat, 1972). Thus early deaths are more likely tied to maternal health during pregnancy, and in this case, the mother's ability to mediate the effects of hypoxia that the fetus perceives indirectly in utero, and the direct effects of hypoxia in the postnatal world. It would appear that hypoxia is influencing infant mortality mostly through reduced birthweight, but maternal factors modify its effects on the fetus and newborn.

In multivariate regression, maternal weight and newborn gestational age were significant predictors of birthweight, and maternal weight alone accounted for 10% of the observed variation (Wiley, 1994b). In turn, maternal weight is determined in part by current diet and activity patterns, as well as a woman's nutritional history. When women were interviewed about their dietary practices during pregnancy, most admitted to little change in either their dietary or activity patterns. Regression analysis showed that women who worked the same or more than usual during pregnancy had substantially smaller infants than those who worked less, and this effect was significant even when maternal weight was controlled for (Wiley, 1994b). More frequent consumption of protein and energy rich foods was not associated with significant increases in newborn size, although there was a positive relationship between overall food consumption and neonatal size. Most women were found to be anemic during pregnancy (average hemoglobin reading during pregnancy was 10.4 g/dl), despite a cultural prescription encouraging meat consumption by pregnant women. Thus, while there exists a cultural ideology stressing the health of women during this crucial phase of reproduction that most women articulated, in practice women seem to experience little change in their lifestyle, and this impacts poorly on the fetus, and ultimately on the infant. As a caveat, the prospective study took place throughout the most active times in the agricultural cycle (spring through fall), and activity may have had a different effect on birthweight had it been carried out in the winter months.

CONSTRAINTS ON WELL-BEING IN LADAKH

The view from biology presents a different conclusion than the view from cultural ecology. It suggests that high infant mortality exists in Ladakh and plays a role in constraining population growth. The magnitude of infant mortality reported here is similar to that estimated by researchers working in Zangskar (Attenborough, 1994a; Elford, 1994). Almost 20% of infants do not live through their first year of life; almost 15% do not make it past the first month. The causes of high neonatal mortality are multiple, but one important risk factor is size at birth, which is in turn determined by



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H oxia

Soarradition]

arid airl

Neonatal Maternal Health Mortality

Nutrition Mateial workloads

domestic pollution

aridit

cold (seasonality)

Fig. 3. Ecologically-mediated determinants of high infant mortality in Ladakh.

maternal nutritional status and work patterns, and by the more generalized environmental phenomenon of hypoxia (see Fig. 3). Therefore, some threats to infant survival stem from the natural environment, and are in some sense unavoidable. Others stem from the social environment of women's work and diet as well other factors such as prolonged exposure to domestic pollution (from household dung and kerosene fires, especially during the long and cold winters), which are themselves related to aspects of the natural environment (e.g., cold). One might thereby argue that mechanisms by which the Ladakhi population is maintained and Ladakhi lifeways sustained include serious threats to the health of women and children. The "balance" of population and resources comes about by compro- mising the well-being of those primarily responsible for the producing next generation. This may not surprise workers in other cultural contexts, but it is in contrast to the optimistic view of a Ladakhi population regulated mainly by the more benign checks on fertility.

Without sufficient data on the health of other members of the population it is difficult to ascertain whether the health of mothers and infants is especially compromised. Compared to older infants and children, neonates have much higher rates of mortality, again indicating that hypoxia and other stresses in utero are important and affect them disproportion-




ately. This suggests a focusing of risk on pregnant women and young infants. Sustained work, pregnancy itself, hypoxia, and iron deficiency interact to produce serious stress on the biology of reproductive women. Risk is not evenly distributed among these women; those who work less and eat more have larger, healthier babies. However, this pattern does not correlate with simple measures of socioeconomic status. In fact, women who lived in households that owned more land were more likely to work more when they were pregnant than those who owned less land. Women's work - both agricultural and domestic -is crucial to subsistence, while their reproductive "work" is essential to the production of a household labor force. A compromise is thus effected, between production and reproduction under dramatic constraining conditions, and costs are born by women and manifest in the high rates of death among their young offspring.

While several authors have commented on the relative power of Ladakhi women in both domestic and public realms (Sumi et al., 1975; Rizvi, 1983; Norberg-Hodge, 1991), it appears that women's power does not translate directly into women's health. This is not to downplay the significance of the status of women, but rather to point out that this may place stresses on women that have heretofore been ignored. That is, their centrality in domestic production places high demands on their biological resources, such that the health of their newborns is compromised. More- over, the oft-articulated valuation of women's reproductive health, i.e., that they should rest, be excused from heavy work, and eat more preferred foods, is clearly not being carried out, a fact that others have recently acknowledged (Attenborough, 1994b; Attenborough et al., 1994). It further indicates that there may be important constraints on women's ability to make use of these privileges, constraints such as the necessity to work, or the paucity of nutrient rich foods during pregnancy. Clearly more quanti- tative data are needed to determine the importance of each of these factors to reproductive health and ultimately to population regulation. One sug- gestion would be to compare the health, nutrition, and work patterns of reproductive vs. nonreproductive women.

The impaired health of mothers and infants in Ladakh is further illu- minated from a comparative perspective. In relation to Andean women actively involved in reproduction, Ladakhi women are lighter (diff = -6 kg) and have smaller triceps skinfolds (diff = -7.0 mm), although they are substantially taller (diff = +3.6 cm) (McClung, 1969; Haas, 1980; Haas et al., 1980). Differences in maternal weight and fatness suggest that Ladakhis are poorly nourished. While dietary data do not indicate a lack of protein and energy rich foods in the Ladakhi diet, heavy agricultural workloads may exacerbate or precipitate acute undernutrition and contribute to increased fetal stress during pregnancy. Haas et al. (1982) have shown that



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lower weights among older infants at high altitude in Bolivia reflected the persistent effect of their small size at birth. Slowed growth and small adult size are also evident in the Andes (Frisancho, 1993), and variation in nutritional status between socioeconomic groups also plays a central role in shaping reduced growth in highland populations (Leonard, 1989). The small size of Ladakhi infants may persist throughout growth, resulting in smaller adult size, and the variation we observe in birthweight may contribute to variation in size among adult women. That is, hypoxia and undernutrition may have long-tern intergenerational effects.

Compared to Tibetan women in Lhasa, Ladakhi women were 2.7 cm shorter, and their infants were 500 g smaller (Moore, 1990; Zamudio et al., 1993). This is especially revealing when observed in the context of Fig. 2. Compared to the "average" high altitude population, Tibetan newborns appear quite robust; at the same altitude, Ladakhi newborns are remark- ably small, and by extension presumably have higher mortality rates (the Lhasa studies did not report on birthweight-specific infant mortality rates). This suggests two important points. First, descriptions of Ladakhis should not be extrapolated from information (particularly on reproductive health or biology) on Tibetans. Population processes in Tibet are likely to be shaped by very different forces than those acting in Ladakh, despite a sur- face socio-cultural similarity. Second, history matters. Tibet may have been settled long before Ladakh (Moore, 1990), and Tibetans may simply have had longer to adapt genetically to high altitude stresses than have Ladakhis. Until more archeological work is done, this conclusion remains speculative. At the same time, Ladakhis probably represent a genetically heterogeneous population resulting from successive waves of immigration and settlement by peoples from several different regions of different altitudes in Asia.

History also matters, but in a somewhat counterintuitive way, in com- parisons with Andeans. The Andes have indigenous populations with an- tiquities of approximately 10,000 years, apparently less than Tibet, but longer than Ladakh, and these differences help make sense of the birthweight variance. Historically, indigenous populations of the Andes have been subject to colonialism and its effects, namely dislocation from land, wage labor, and general exploitation, and investigation of these processes has been incorporated into the cultural ecological studies in the Andes (Or- love and Guillet, 1985). Differences in health and nutritional status among Andean mothers and children correspond to differences in wealth and other socioeconomic measures (Leonard, 1989). Despite this, measures of average reproductive health status still show Andeans doing better than Ladakhis. Ladakh was not colonized in the way that other parts of South Asia came under direct British control, and remained an autonomous king- dom until the late nineteenth century. Ladakhis have never become an un-




derclass, by and large do not participate in wage labor, and have retained control over their land. But these social factors have not necessarily trans- lated into improved health. Indeed, it would appear that biological history is extremely important when it comes to reproductive health in Ladakh, and the veneer of social equality and harmony does not manifest in good health among mothers and children.

Some might argue that what I have observed in Ladakh is an artifact of the changes that have occurred over the past 20 years, mainly as a result of military expansion, the opening up of Ladakh to tourism, and the Indian government's attempts at development. Women's work may be affected by increasing penetration of a monetary economy, where men increasingly take advantage of nonagricultural economic opportunities (such as the military), which leaves the burden of agricultural and domestic work to women. Or, dietary patterns have changed as a result of meat becoming much more expensive as a consequence of fewer individuals controlling its production relative to the increased demand in Leh and larger villages close to Leh, from which the study populations are largely (though not exclusively) drawn. However, similar dietary and work profiles and infant mortality rates were observed in studies in Zangskar, a more "traditional" region of Ladakh, and hypoxia remains a challenge to be reckoned with.

CONCLUSION

Given that Ladakhis inhabit one of the most marginal landscapes on the earth, a central question of this work has been how to assess the adaptive status of the population of Ladakh relative to the constraints inherent in the environment. In this case, important constraints include low oxygen density (hypoxia), cold, aridity, domestic pollutants, and labor intensive subsistence. In particular, this study addressed the selective forces acting on mothers and infants, insofar as they represent the intersection of fertility and mortality. Size at birth is one manifestation of this intersection, and is a useful index of adaptation since it both reflects the maternal resources marshaled to the fetus in utero, and is an accurate predictor of survival prospects within the first month and year after birth. Average birthweight was very low in this population, and was associated with a very high risk of mortality, particularly in the first month of life. Birthweight was the outcome of maternal nutritional status, diet, and activity patterns as well as hypoxia (although the precise contribution of hypoxia could not be demonstrated due to the noncomparative nature of the study), and the asso- ciation between birthweight and early mortality suggests that these are important determinants of infant survival. In other words, infant survival



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is strongly shaped directly by the natural environment of Ladakh and indirectly by the very social institutions that make subsistence possible.

A central conclusion to this work is that processes of adaptation represent compromises, not "optimal" solutions to a particular set of environmental problems. The "balance" of very slow population growth and available resources is better thought of as a "compromise," which is made possible in part by high mortality rates among neonates. To limit population growth through infant mortality places an immense burden on the energetic and nutrient resources of mothers, which are already marginal, and reproductive women may experience more negative effects of hypoxia due to increased strains on their oxygen carrying systems. And of course infants, especially in the first month of life, suffer disproportionately from stresses endured in utero and in the immediate postnatal world that derive from the natural and social environments. While there is an ideology that pur- ports concern for the reproductive health of women, in practice the burden of labor prevents most women from enjoying these luxuries. It may be that cultural scripts for behavior represent attempts to ameliorate health problems, but they are not effective given other constraints.

Adaptation implies the maintenance of the population over the short and long term, and to investigate this, we can inquire into the extent to which biological and cultural factors exacerbate or mitigate stress, especially in relation to fetal and infant health. The biocultural perspective adopted here builds on previous work in cultural ecology that limited its focus to the adaptive significance of social institutions in this environment, and that on high- altitude human biology which lacked a focus on the social context of physiology. It attempted to look further at the ways that the environment influences biology either directly or as mediated through social institutions, and how stress is distributed within this population. The picture that emerges demonstrates that the "adaptive harmony" between population and resources may be possible only with some costs to well-being, particularly that of women and infants. While analysis of Ladakhi social institutions may produce a picture of harmony and balance, especially relative to high-altitude societies in the Andes, analysis of biological phenomena produces a picture of lives compromised by a variety of ecologically-related factors.

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A Role for Biology in the Cultural Ecology of · PDF fileHuman Ecology, Vol. 25, No. 2, 1997 A Role for Biology in the Cultural Ecology of Ladakh Andrea S. Wileyl Human ecology research