As universal as the origin of species, the process of childbirth and the rituals, regulations, and social influences that surround it have developed into a collection of beliefs and behaviors as diverse as the cultures in which they are found. Describing these in detail would be far beyond the scope of this chapter; however, several themes emerge in which commonalities can be examined.

The first theme pertains to the strong preference, in some cultures, for male children. This is because of the importance of heredity and the maintenance of the male line in patrilineal societies, a guarantee of the continuity of the family. This will have a bearing on inheritance, including land ownership, and sometimes position and rank in society. Added to this are other financial considerations: in many places, the families of girl children bear the added burden of having to provide a dowry at the time of marriage, which presents a heavy load for many who are at the brink of poverty.

While developments in medical technology have allowed for screening and improving fetal outcomes, this has had the unintended effect of allowing parents to screen for the sex of the fetus. This possibility of choice has resulted in situations where healthy pregnancies may be terminated if the sex is not desirable.
In China, which instituted a one-child policy in the late 1970s to combat overpopulation, pressures on couples to have a male child have greatly increased. As well as “quantity,” China has been interested in “quality” of births, instituting a law in 1995 restricting “imperfect” births, part of a greater government scheme intimately tied to interventions in reproductive health. Dikotter (2) examines these eugenic developments in detail within the historical, political, and economic context of Chinese society, describing the impact of current legislation on the personal lives of both men and women. When women in China are found to have “unauthorized” pregnancies not in compliance with the one-child policy, involuntary abortions or forced sterilization may occur or they risk high fines or the destruction of home or possessions (3).

Around the world, demographers have documented “missing women”—male: female sex ratios that favor men—in India 920 women for every 1,000 men, in China 100 women for every 113.8 men (3). They also cite the Indian government statistic that, out of 8,000 abortions at a clinic in Bombay, India, 7,999 were of female fetuses. Whether due to female infanticide or prenatal screening, the results are the same. This pattern has also been reported in the Middle East, with dramatic ratios as low as 48 women to 100 men in the United Arab Emirates. Economist Amartya Sen has calculated that there are over 100 million “missing” women in the world (3). In an attempt to explain this phenomenon, Sen links the interaction between economic reforms and cultural values that produce situations of gender subordination for women. In this way, development policies such as agricultural reforms, also known as structural adjustment policies, may actually (inadvertently) have a negative impact on women’s health in terms of their nutritional status, levels of stress, and worsening poverty, leading to decreased access to health care.

At the other end of the reproductive spectrum, Hmong immigrants from Laos to the United States are reported to have one of the highest birthrates in the world, 9.5 children per couple, compared to the rate of White Americans, 1.9 children, and Black Americans, 2.2 children (4). This rate is thought to be a result of a combination of early marriage and a suspicious attitude toward Western medicine, including contraception, and is likely to decrease as young Hmong became more acculturated to life in America. In her insightful study of cultural misunderstandings between a Hmong family and the American medical establishment, Fadiman explains that

The last sentence alludes to the concept of early socialization into gendered roles, beginning in the cradle.

There are also numerous traditions and taboos concerning the birth process itself. For example, the Hmong believe that it is important to bury the placenta in the dirt floor of the house, so that after death it can be found by the soul and worn
as a “jacket” on a journey to the land of the ancestors, where one day the soul is reborn as a new baby (4). How this belief, along with so many others, has been transformed in an era of migration, hospital births, and modernized accommodations that lack dirt floors has been a process of ongoing negotiation.

Beliefs about pollution and taboo as means of regulating women’s sexuality before, during, and after childbirth are commonly found around the world. Women are often kept in confinement for a specific period of time, usually weeks, after childbirth before being allowed to reintegrate into marital life and the wider society. Lewis’s study of ritual among the Gnau people of New Guinea describes in intricate detail the ways in which men and women’s lives in this traditional culture are bound by their beliefs. This is demonstrated by their performance of rituals that link them to others in the community, the local environment, and the supernatural world (5).

Another area of study has been the effects of poverty on childbearing and maternal and child health. In a moving and well-researched ethnography on women’s lives in a Brazilian shantytown, anthropologist Nancy Scheper-Hughes (6) studies the links between social class and reproduction and finds that “poverty interacts in many different ways to produce child mortality and to shape reproductive thinking and practice” (p. 326). She describes the ways that scarcity affects maternal thinking, particularly difficulties in coping with extremely high rates of infant mortality, to the extent of bringing about a situation she describes as “the social production of indifference to child death.” This does not imply that women do not experience the loss of their infants, but rather that they have come to differentiate the greater grief associated with the loss of an older child, who is already formed and with whom there is greater attachment, from the infant, in whom little has thus far been invested. Women in this environment have been demoralized to the point of seeing their breast milk as no good, spoiled, or sour and feeling that they have nothing left to give to their children. However, in order to reach their preferred family size, they must often bear two or three times that number of pregnancies, with the physical and psychological burdens this entails, in order to ensure a few surviving offspring. All of this is occurring in an environment of oppression with minimal government support for the very poor and with strong Catholic beliefs, which, among other things, forbid the use of contraception. Despite all the hardships, Scheper-Hughes is able to document survival skills and resilience among these women that provide hope for the future.

Childhood is a time of rapid growth and learning in many spheres: physical, psychological, and cognitive, including mastery of language and a wide variety of interactions with the wider world. Culture is woven into the consciousness of a child during family activities—including daily chores, play, games, food, social occasions, religion and festivals, and contact with siblings, parents, grandparents, and the extended family and beyond. While the psychiatric and psychological literature offers many theories of child development, less has been written about the impact of culture on this critical period or how culture is learned.

In a chapter on gender, development, and psychopathology, Notman and Nadelson (7) write that “the role of particular cultural practices, including gender differences in child rearing, are manifest from infancy. Differences in parental behavior, especially those related to concepts of male and female roles, are
powerful forces contributing to differences in male and female development” (p. 2). Examples of these differences—the ways that culturally constructed gender roles are passed from one generation to the next—taken from a variety of ethnographic studies and other sources are presented below.

In the memoir Wild Swans (8), which describes the lives of four generations of Chinese women during decades of massive political upheaval and social change during the nineteenth and twentieth centuries, Jung Chang describes how her great-grandmother, typical of millions of her era, was born to a working-class family without intellectual background or official post, and because she was a girl, was not given a proper name. She was simply called “Number Two Girl” (er-ya-tou). She had been promised by her family, at age 6, to the newborn son of a friend when he became of age, and the wedding took place when he turned 14 years old. Chang explains that, in this time of arranged marriages, it was considered one of the duties of a wife “to help bring up her husband.” Girls were taught that “a virtuous woman should suppress her emotions and not desire anything beyond her duty to her husband” (p. 34). Notably, when Number Two Girl had a daughter of her own, the baby was given a real name. However, despite this nod to encouragement of her own identity, the baby girl (Chang’s grandmother) was not able to escape the practice of binding feet. At age 2, her feet were tightly bound with cloth, breaking the bones in her arches and causing lifelong excruciating pain, all done to satisfy men’s idea of feminine beauty.

Psychological anthropologist Jean Briggs’s description of the emotional education of a 3-year-old Inuit girl in Canada’s Arctic brings us to how culture is learned, the process of creating children “who think and feel like Inuit” (9). Through detailed ethnographic analysis of family “dramas” or social interactions, she outlines the process of Inuit education, whose goal of “increasing thought” in children is hidden in playful questions asked by adults. These repeated interactions, as encapsulated in the case study of one child’s development, make visible the wider processes of socialization. However, because each of these interactions and new understandings is negotiated and renegotiated on an individual level, Briggs concludes that children cannot acquire a “fixed set of understandings” or a “total culture” through this very active learning process.

In another Inuit example, the ethnography of the Netsilik Eskimo of the central Canadian Arctic describes another important feature of the socialization of children, the learning of male and female roles (10). This traditional hunting society had a clear division of labor between the sexes, with a focus on husband and wife as collaborative partners in the subsistence of the nuclear family, although the husband held a superior position as head of the household. While the men hunted and fished, the women worked at home preparing food and animal skin clothing, which were equally essential to the survival of the family. Learning occurred through observation and imitation, with boys and girls each following their same-sex parents from a very young age. Balikci describes how spending almost all their time in the company of their parents within the confines of the igloo and its surroundings, and growing up in close association with the adult world, children quickly adopted the roles of the same-sex parent. This closeness is true of many traditional societies, where families live at much closer quarters, both spatially and psychologically, than in more modernized societies.

In the mainstream North American setting, In a Different Voice, Gilligan’s influential psychological study of women’s development begins in childhood and
goes on through various stages of development through interviews with different age groups (11). Written in the early 1970s, this study was one of the first to explore differences between the sexes in terms of conceptions of self and morality and tries to understand the roots of women’s position in society, what Gilligan terms “woman’s place in man’s life cycle.” One of the well-known findings from this study is that even from a very young age, female children value interpersonal relationships and begin to order their worldview according to this principle of human connectedness. In contrast, boys often take a more logical and hierarchical approach to solving dilemmas. This leads to a tension between women and men, based on their use of different models of human relations: connectedness versus hierarchy. Both connectedness and hierarchy co-exist in the parent-child relationship and continue to be negotiated from that point onward as the child makes his or her way out into the world.

Formal learning—school-based education and literacy—is another of the tasks of childhood. Much has been written about the link between lack of education and the disparities in the economic, political, and health status of women around the world (3). When resources are scarce, girls in many countries often stay home while school fees are dedicated for their brothers. Families may not be aware of the importance of this decision to their daughters’ futures.

Sexual maturation occurs in several steps, beginning as a girl approaches the age of puberty. Hormonal and physical changes, the development of secondary sexual characteristics, and finally, the onset of menarche, signal a shift in psychological identity that may take several years to fully integrate. The understanding that menarche has a potential for pregnancy and thus leads to the next stage in the life cycle of an adult woman is often viewed as a source of anxiety and risk (7). Peer groups generally become more important at this time, as girls begin to move beyond the immediate family as a source of role modeling and support, and issues of self-esteem, self-confidence, and physical attractiveness come to the forefront.

Puberty rites are common in many cultures to mark this time of change. These may be in the form of public rites, religious ceremonies, or social gatherings. Lewis (5) presents a detailed analysis of the intricate puberty rituals performed among the Gnau of New Guinea. For both female and male initiates, this is a major event of public recognition, involving elaborate decoration, feasting on ritual foods, and the reinforcement of social linkages within the family. For boys, the ritual includes a form of “symbolic menstruation” as they are made to bleed from their penises. Although, when asked by Lewis whether this male bloodletting was meant to resemble menstruation, the Gnau denied this idea, the behavior also occurs among other groups in New Guinea, and is described in this way in other anthropologic literature.

Female circumcision, also known as female genital mutilation (FGM), is another cultural tradition that occurs in many parts of the world, particularly in Africa and the Middle East, at the time of puberty or before, often in girls as young as 6-10 years of age. This procedure, the aim of which is to guarantee women’s virginity and diminish their sexual pleasure, has an enormous impact on the development of female and sexual identity in the countries where it is practiced. In addition to these psychological effects, medical morbidity, infection, and chronic pain, occurring both at the time of the circumcision and possibly for
years after, at the time of first sexual contact or childbirth, may have longstanding, even life-threatening, repercussions. The women are at greater risk of HIV transmission because damage to the urinary tract and vagina may lead to fistulas and other possibilities of infection (3).

A firsthand account of this difficult and painful experience is provided by Aman, a Somali woman, in her memoirs (12). To place this experience in perspective, anthropologist Janice Boddy describes female circumcision in the social context of Somali culture, a Muslim, male-dominated, pastoralist society. Although Islam does not specifically sanction this practice, or gender inequality in general, it is customary in Somalia to view women’s status as inferior to that of men and for women to be bound by male authority. Concepts of honor, reputation, and independence are the foundations of Somali social organization. However, it is precisely these values, which are seen by Somalis to be unachievable by women because of their sexuality, that keep them in a morally inferior position. Boddy writes:

Boddy cautions for the need to understand this practice in context, as it is generally older women and mothers who ensure its continuation. Peer pressure and a fear that, without it, marriage might be difficult or impossible keep it going. There are some changes currently being made among more educated women, with less radical operations being performed; some have been reduced to a symbolic pinprick.

Immigration has led to greater awareness of this issue because FGM procedures are being performed or requested in Europe and North America. Groups such as Amnesty International have brought this issue to world attention in calling for an annual “International Zero Tolerance to FGM Day” and lobbying African governments to sign a declaration “to protect African women from cultural and traditional belief systems that are inimical to the sexual and reproductive rights of women in the continent” (13). However, many women still see this practice as central to their social identity. Aman herself describes her infibulated body as “clean, closed and smooth” with its own aesthetic value (12). Desjarlais et al. (3, p. 139) present the case example of West African immigrant women in France, who face a difficult bind between risking legal charges and public trials (to have their daughters circumcised) and risking ostracism from the West African community. Without more local support to negotiate these cultural conflicts, it will be difficult to find meaningful solutions that will allow for a fuller inclusion of these young women in a changing society.

Body image and reproduction are intimately linked as attention to physical attractiveness grows more important during adolescent years (7). Eating disorders have been particularly studied in this regard, and comparisons made across cultures where physical preferences vary considerably. Anorexia is generally
thought to be a particularly Western disorder, perhaps even considered as a culture-bound syndrome of Western Europe and North America (14). Much has been written about the impact and immediacy of Western media favoring thinner and thinner models and actresses, who predominate as role models for generations of impressionable young women. But how is this related to the development of an eating disorder? Eating disorders, including anorexia and bulimia, have been described in many places around the world. However, prevalence rates vary considerably, and they may be quite rare outside of a Westernized context. A careful analysis of questionnaires is needed to avoid misinterpreting culturally consistent responses. For example, in India answering positively about “engaging in dieting behavior” could mean observing religious Hindu fasts, or in China “cutting food into small pieces” is appropriate for eating with chopsticks (14). In these countries, eating disorders are rarely found. In other parts of Asia, some atypical eating disorders are described that do not include the phobia of fatness, central to the definition of the disorder given in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Anne Becker (15) was in the fortunate position of being able to conduct a study of eating disorders among adolescent girls in Fiji, a remote group of islands in the South Pacific, just as television was making its first appearance. There had been no previously published studies on the effects of the introduction of television on the eating habits of a media-naive population. The study began in 1995, just as television went on the air in Fiji, and a follow-up was done three years later. Becker’s group found a significant increase in scores, indicating disordered eating, following television exposure. Although no subjects met criteria for anorexia, self-induced vomiting to control weight had gone from 0% in 1995 before television to 11.3% only three years later (15). There was an increase in body dissatisfaction during this time as girls expressed wanting to emulate characters they saw on television. Most interestingly, this rapid change took place in a setting where traditional Fijian culture saw a more robust physique as the ideal body shape and encouraged large appetites at feasts and family gatherings. Thus, the introduction of Western media imagery can be directly linked to the internalization of a new cultural ideal of thinness and the development of body dissatisfaction, leading in some cases to disordered eating.