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Lecture 7

Lecture 7

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Dan Sellen

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ANT208 Lecture 7 March 14, 2013 • Female reproductive health ◦ proximate determinants of fertility + health risks ◦ modernity and change in women's life history ◦ menopause: evolution and lived experience • Human nutrition ecology and disease ◦ human dietary transitions and human health ◦ contemporary diet related disease ◦ basics of human nutrition ◦ evolutionary medical anthropological perspectives • Two major transitions shaping our diet: ◦ 1. Transition to agriculture ◦ 2. Transition to globalized, industrialized food production system ◦ associated with diabetes, CVD: "diet-related diseases" • FEMALE REPRODUCTIVE HEALTH ◦ Ovarian function ▪ Medicalization: Premenstrual syndrome (PMS) ▪ Infertility: primary vs secondary sterility, NRT (New Reproductive Technology) ▪ cultural issue: can be stigmatized and medicalized, leading to technological + reproductive intervention ▪ primary sterility: inability to conceive/carry conception due to physiological dysfunction that may or may not be curable (males and females) ▪ secondary sterility: sterility associated with STDs and STIs ◦ Sexually transmitted disease, STD ▪ Pelvic inflammatory disease, PID ▪ reproductive health issues are not only biological but also social: lived experience and difficulties in mental health, social relations ◦ Birthing and lactation ▪ Maternal mortality vs safe motherhood, fistula ▪ Maternal benefits of breastfeeding ▪ benefits of breastfeeding, birthing without anaesthesia? ▪ breastfeeding following birth improves weight loss, prevention of postpartum bleeding, and later life cancers (ovarian and breast); ANT208 Lecture 7 March 14, 2013 therefore it is not just an infant nutritional issue - "evolved package" ◦ Reproductive cancers ▪ Causes, increases, access to screening + treatment ▪ increase in cancer rates around the world due to increase in sexually risky behaviour, environmental toxins, decrease in other diseases that used to affect morbidity rates in women ▪ screening and treatment widely available in only certain populations ◦ Violence (structural, proximal and "cultural") ▪ abuse and rape; female genital cutting (FGC) ▪ structural violence: lack of access to cancer screening, treatment, safe motherhood, trained attendance - affects people who are poor + have less political power ▪ situations of warfare + political instability leads to violence against women (social issues affecting health issues) ▪ FGC: cultural issue • PROXIMATE DETERMINANTS OF FERTILITY (POPULATIONS) • *class input ◦ age of menarche ▪ "adolescent subfecundity" ▪ earlier the onset, the earlier conception may occur ◦ age of menopause ▪ * test question: which is more flexible? menarche: varies among populations, affected by prior childhood environment ▪ whereas menopause is FIXED at around 50 yrs, doesn't seem to be modified by same environmental factors that affect age of menarche ▪ strong evolutionary selection on menopause - not an adaptation that responds to early life cues ▪ whereas menarche is variable, is an adaptation in that it is flexible and responds to environmental conditions ◦ access to proper nutrition ▪ fat affects onset of ovulation and maintenance of ovulation cycles - was thought to be simple 30 yrs ago ▪ now more complex: there is no specific level of body ANT208 Lecture 7 March 14, 2013 fat that determines fertility; therefore a myth ▪ calorie intake vs calorie expenditure - starvation leads to reduction in ovulation ◦ endemic diseases (HIV, TB, etc.) ▪ may lead to scarring of reproductive tissue, elevated risk during pregnancy: spontaneous abortions, autoimmune attacks on implanted zygote ◦ access to reproductive technology/family planning (contraception) ▪ global health: unmet demand of family planning - women not having access to family planning even though they want it, leading to unwanted pregnancies ▪ higher birth rates due to lack of access to family planning, rather than being a cultural byproduct ▪ hormonal birth control affects progesterone + estrogen levels, also introduces high levels of exogenous estrogen --> changes overall exposure, may cause endometriosis and cysts, which later may affect fertility ◦ social issues ▪ coital rates: labour migration affecting birth rates ▪ negotiation of sexual relations and family planning, gender imbalances ◦ *in lecture slide ◦ Possibility ▪ age at menarche + menopause ▪ marriage, migration, and sexuality ▪ marriage less helpful marker of birth rates and conception due to shifting social attitudes ▪ couples (homosexual and heterosexual) more likely to consider having a family ◦ Probability ▪ 1. coital frequency + timing ▪ 2. ovarian cycling: length, ovulation ▪ dysmenorrhea ▪ breastfeeding ▪ releases prolactin in brain, which maintains production of milk and reduces chances of ovulation ▪ this effect can be powerful in the first three months of pregnancy: "natural family planning method" (adaptive value: allows greater ANT208 Lecture 7 March 14, 2013 investment in current child) ▪ can nurse and ovulate at same time (strange to Westerners) ▪ optimal birthing interval in hunter-gatherer communities ▪ general pattern: three yrs ▪ breastfeeding is suggested for two years (makes sense knowing ^) ▪ 3. nursing ("lactational infecundability") ▪ 4. pathological sterility (STDs) ▪ some factors more important in determining fertility: ex. how patients are treated; nursing may be considered factor that improves fertility ▪ 5. pregnancy loss (spontaneous abortion, fetal death) ▪ 6. use of contraception ▪ 7. use of abortion ▪ legalization of abortion prevents unsafe abortions from occurring - most vulnerable
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