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Al INDI. GENCUS TH.RI.APEUTIC STYL AND ITS
CONSSQUENCES FOR NATALITY
ANITA SPRING
Prepared for: Culture, Natality, and F?-.i1v
Plannnina, John Marshall and Steven poiqar eds.
''r f
INTRODUCTION
Prevailing views of indigenous medicinal therapies stress that,
whatever the techniques, curing is generally beneficial to the
individual and group by providing catharsis,scrutinizing social
tensions,and manifesting social solidarity. The beneficent
magical techniques do not harm the individual,although his condi-
tion may deteriorate naturally.
I suggest that therapies (medicines,midwifery,rituals) are not only
socially supportive but also may be physically detrimental to the
individual and contribute to low natality. Among the Luvale there
are definite positive social benefits (e.g.,social supportiveness,
lineal continuity,tension-reduction) which undoubtedly keep the
system going. In terms of reproduction,however,the indigenous
medicinal therapies may inadvertantly (1) cause sepsis resulting
in infertility and (2) increase stillbirths and neo-natal deaths
because of faulty midwifery, thereby lowering natality.
The Luvale are a low natality population in Zambia. Before com-
mencing field research I was cognizant of the low natality from
reports on the region, and I questioned whether social practices
influenced natality. Could anthropological research provide infor-
mation on this problem? Existing literature (White 1949,1953,1959,
1961,1962; White,Chinjavata and Mukwato 1958; and Turner 1967,1968,
1969) and my recent field work (1971-72) show numerous rituals con-
cerned with reproduction and child rearing as well as a developed
"ethno-gynaecology". This report,therefore,focuses on the inter-
2
relationships between medicinal/ritual 'participation and natality
(i.e.,achieved and volitional control of reproduction).
.(1'968)
According to Romani:t the normal fertility standard for Africa
is a birth rate of 50-60 per 1,000 and a "natural sterility"
of -- about 5 per cent among women of
completed natality. The Luvale population shows a birth rate of
38 and childlessness of about 30 per cent in the present study.
Ohadike (1969:41), who analyzed the 1963 Zambian Census, states
that the national fertility ratio of 7ambia is 759. .This is
closer to the fertility of developing nations (e.g., Puerto Rico -
725 in 1940; India 775 in 1930) than to the fertility of
developed nations (e.g., France 319 in 1936; U.S.A. 417
in 1950). The lowest fertility area in Zambia was Northwestern
Province 'with 563 in 1963. TheChavuma Luvale figure is.536
for 1972, and earlier writers (Tables 1 and 2) show figures
.or the Luvale that are comparable to developed countries
(e.g., Kabompo and Balovale 217 and 304 in 1954; Kabompo -
269 in 1958).
The Luvale are a matrilineal people practicing virilocal residence
at marriage. They are hoe cultivators (settled in the location
studied here) with a predominately manioc diet. They have a rela-
tively low male out-migration' for ZamAbia.with an adult sex ratio
presented here
of 70 males per 100 females. The research was conducted
in Chavuma, Zambezi District, Northwest Province. Kabompo,
another Luvale area referred to in the text, is adjacent to
Zambezi in the same province.
LT UVALS NATALz TY ITn -APLT.' ST"UD" 1
Low fertility among the Luvale and neighboring peoples (the Luchazi
and Chokwe) has been noted since the beginning of this century.
A 1904 census and an explorer (Springer 1909) both noted the
small number of children in the villages. Hudson, a district
officer, postulated promiscuity and extensive use of abortifacients
as the causal factors. He believed that "children are not wanted
because men have no further use for a pregnant woman" (1935:243).
The first reliable comparative survey was carried out in the early
1950s by Hitchell (1965) on an urban sample which contained people
Northern
from all the major/Rhodesian (Zambian) groups. He was struck by.
the significantly differential fertility of tribal groups.
Checking into regional variation in disease and diet, he'found
that venereal disease, malaria, and cassava could not account for
the variations observed, since these factors were .apparent both
in areas of high and low fertility. The three most significant
variables were, respectively: tribal membership, religion
(Christianity), and the degree of commitment to urban life.
The most significant by far was tribal membership. In his rankings,
the Lwena group (Luvale, Luchazi, and Chokwe) ranked the lowest
with "Very low fertility". Below in Table 1 are some of his
figures, including all those f.or Northwestern Province. He also
averaged
showed that the Luvale group A the fewest births per year per
adult woman and the highest rate of childlessness 47.8 per cent
of women over 30 were childless. Mitchell concluded that the
differences were neither modern phenomena nor easy to explain.
TA3LS I AGE S :TAN Ar ZD CH ILD/WOMAN FERTILITY RA TIOT.
(From Mlitchell 1965; 9-11)
Mitchell's
Province Placee jor Tribe C/W Ratio Catecrorv
N. Province Luwingu Mambwe 1043 High
N. Province Chinsali Bemba 962 High
N. Province Kasam;a Bemba 887 High
N.W, Province Solwezi Lamba 683 Moderate
Central Lusaka Nyanja 639 Moderate
Barotse Barotse Lozi 545 Moderate
N. W. Province Mwinilunaa Ndembu 478 Low
N.W. Province Balovale Luvale 304 Very Low
(Zambezi)
N.W. Province Kabomoo Luvale 217 Very Low
In reference to the Luvale, Mitchell cited communications from
Graves and Gilges, two medical officers who had worked in the
rural tribal area (Balovale District). Graves said that most of
the barren women he examined had various forms of pelvic sepsis
and salpingitis, resulting in infertility. In his opinion
these infections were caused by a number of practices such as
childhood intercourse, early marriage resulting in difficult
.labor and consequent vaginal manipulation by village midwives,
frequent abortions, herbal remedies, and gonorrhea (personal
communication quoted in Mitchell, 1965:23).
Gilges- said he could not clinically or serologically diagnose
gonorrhea or syphilis in many cases. Although he listed irritating
and toxic herbs that were used intravaginally, he could not detect
the after-effects with the inadequate laboratory facilities at
5
his disposal in the district. Gilges became convinced that a
genetic factor was responsible (personal communication quoted
in Mitchell, 1965:23).
A demographic study in a predominantly Luvale area (Kabompo) was
carried out by '. white later in the 1950s (see Table 2); this was
the area of lowest fertility in Mitchell's study. White argued
that "the basic structure of the low birth rate appears to be low
fertility with a high proportion of women who are infertile,
*and a declining fertility among those who are fertile" (White,
1959:55). (Using his figures I calculated the rate of childlessness
tended -to
to be 33.8 per cent.) He suggested that womenwait until they
are in stable unions before producing, and he posited extensive
use of contraceptives and abortifacients.
The general fertility statistics for Zambia in the 1960s provide
a mnoe current perspective for the1971-72 Chavuma data (see Table
2). The two Zambian national censuses of 1963 (Ohadike 1969)
and 1969 (unofficial census figures) show Northwestern Province
having the lowest natality of any province, and Zambezi District
being lower than the provincial mean. Two trends are clear
from these censuses and the earlier studies: (1)-the fertility
of Zambia and its Northwestern Province is increasing, and
(2) even though there is a'general increase, the fertility in
Northwestern Province started out lower and has remained lower
than the national mean.
NATALITY IN C-AVlUA 1971-72
The conclusions reached in this paper are mainly based on some
measures of natality in Chavuma area of Zambezi District (formerly
Balovale District). Statistics are based on a-sample census (N=1860) of
approximately 15 per cent of the total Chavuma population of
12,325 (1969 national census). A section of this sample, the
805 people grouped under one .political headman",
was more intensively
surveyed. Eost of my interviewing was conducted within this
section, and the section was resurveyed after one year to estimate
annual rates. The child/woman fertility ratios, crude birth
rate, percentage of village versus hospital deliveries, and
monogamy/polygyny ratio were all computed from this section.
Fertility and ritual profile histories were collected for two
samples of women: (1) Village Women, i.e., those women who had
delivered their last (and generally all) babies in the villages,
assisted by indigenous midwives; and.(2) Hospital Women, i.e.,
those women who delivered babies at the nearby mission hospital
during the research period, although any of their previous
babies may have been born in the villages or hospital. Investi-
gations of indigenous medicinal practices and rituals were made
by participant observation and in-depth interviewing over an eighteen
month period.
The Chavuma child/woman fertility ratio was higher than that
of the district and provincial mean (Table 2). This is undoubtedly
a reflection of the easy access to medical facilities enjoyed by
Chavuma w.omon since 50.5 per cent of the babies born in 1971
in Chavumia were delivered in the mission hospital. The child/woman
fertility ratio calculated for only Village Women was below the
district ratio and may, with reservations, be used to estimate
current fertility ratios obtaining in other Luvale areas where
hospital facilities are not readily available.
TABLE 2.
CHILD/WOiANT FERTILITY .RATIOS.
Childreno-5
Women 15-
15-so
Children0-5
WIomen1550
15-50
White (1959 : 54)
Kabompo
no figure
1963 Na-ional Census
(Chadi-ke 196 9:39)
Total Za-mbia
Northwest Province
1969 National Census
(unofficial figures)
Total Zarmbia
Northwest Province
Zambezi District
Sorin.g 1972
Chavuma village and
hospital sample
Chavuma village sample
769
563
867
615
560
625
536
no' figure
no figure
798
603
482
536
467
269
During 1971 30 live births were born to the women in the sample,
giving a crude birth rate of 38. By comparison, Ohadike (1969:37)
gives the 1963 Zambian crude birth rate as 52. The wide discre-
S- I of 52 and the local rate of 3
pancy in these two figures (the national rate, may be more of a
reflection of the age-sex distribution of the Chavuma sample than
of the Chavuma natalitv. Critics of the crude birth rate
point to how easily this measure, designed to show the gross rate
at which the population is reproducing itself, is influenced by
age-sex distributions. whereas only 9 per cent of the total
Zambian population (1969 unofficial figures) is over 50 years old,
28 per cent of the Chavuma sample is over 50.
69.6 per cent of the Chavuma female population is married. Of
the remaining women, most are unmarriageable, being generally too
incapacitated
61d or (22.7 per cent of total), and the remainder are
between marriages (7.8 per cent of total). Of the married women,
74 per cent are in monogamous unions, and only 26 per cent are
in polygynous unions.
Table 3 shows that the women with completed natality (45 years
old and older) have the lowest rate of live births, and the younger
women' have higher rates. This probably reflects low fertility
conditions in the past and an increasing present fertility.
The e::ected. relationship, in a period when the fertility conditions
are not changing as drastically, is one in which the older women
Shave higher rates. This relationship appears in ,White's data,
the higher rate for older women reflecting the longer period of
time that they have been exposed to conception.
TABLE 3. RATE OF LIVE 2Z3?THS
25-29 30-44 45+ vears
Village* (=?=127) 2.47 2.58 1.95
Hospital (1i=88) 2.17 4.74 -
White** (N=216) .945 1.56 2.74
* Includes neo-natal deaths.
f* Calculated from White's data (1959:55).
Comparing Village Women with Hospital W';omen in the same age
category, 30-44 years, it is evident that, even with a general
increase in fertility, the rate of increase may be substantially
greater among those who avail themselves of the hospital facilities
that are available. The apparent inconsistency in the table,
Village Women in the 15-29 year category having a higher rate
than their hospital contemporaries, is explained by -a closer
examination of the Hospital Women in this category. Most of them
are young girls in their teens having their first baby, unlike
the village sample who were generally in their 20s.
The rate of childlessness for Village women of completed natality
(45 years and over) is 23.7 per cent (M=59). Another four women
in this age category only had one pregnancy each, and that
pregnancy resulted in a child who only lived a few hours. This
early death. (within 28 days) of a live birth is herein called
a neo-natal death. After that first pregnancy none of these
four women had another pregnancy. If these women were included
10
within the childless category the rate rises to 30.5 per cent
childlessness. Either of these two rates is a definite decrease
from the rates recorded by M4itchell and White. The change
probably reflects both increasing fertility, a nationwide trend,
and my careful checking of all women who claimed they were
childless. This check often revealed that the woman had had
a child who died immediately after birth or within the .first two
years.
TABLE A. NTUBER OF LIVE BIRTHS (INCLUDING N EO-NATAL DEATHS)
Neo-Natal
Number of Births 0 1 2 3 4 5 6 7 8 10 Deaths
Village '4omen 23 35 22 19 11 10 4 1 1 2 32
(N--12 7)
Hospital Women 0 21 21 13 7 12 8 6 4 0 6
(N=88)
Total Chavuma
Women 23 56 43 32 18 22 12 7 5 2 38
(N=215)
Not corrected for age distribution of the two populations.
Some other characteristics of hospital deliveries are interesting.
Using hospital records for the five-year period, 1967-1971,
I found that, of the 1059 total deliveries, 2.77 per cent were
stillborn, and another 4.7 per cent died within the first week,
*while the mother and child were still at the hospital in post-
partum confinement. 12.6 per cent of all live births were
considered premature, i.e., weighing under five pounds. Table 5
records the-percentage of miscarriages, stillbirths, and neo-natal
deaths for the total pregnancies experienced bv the women in these
two samples. This table is, therefore, a record of reproductive
wastage.
TABLE 5. PERCENTAGES OF REPRODUCTIVES STAGEG.
(N is total pregnancies.)
Neo-Natal
Miscar"riaqces Stillbirths -Deaths Total
Pregnancies of
Village Uomen 12.8 7.5 8.9 29.2
(N=359)
Pregnancies of
hospital l ':omen 3.5 7.3* 1.9** 12.7
(N=;315)
This high percentage is misleading as applied to the hospital
environment because 46 per cent of these stillbirths were the first
pregnancy and were delivered in the village.
** The same qualification extends here; even though this is a
very low percentage, 50 per cent of these neo-natal deaths were
for first pregnancies delivered in the village.
Significantly, about half of the stillbirth and neo-natal death
wastage noted.in previous deliveries experienced by the. hospital
sample is traceable to deliveries in the villages. Below I shall
argue that traditional :idwifery techniques may account for much
of the high rate of stillbirth and neo-natal reproductive wastage.
Table 6.presents some preliminary and partial figures on infant
mortality during the first year of life; these absolute numbers
are taken from the fertility histories I collected. I-ore complete
figures and percentages will be available after more extensive
analysis of thedata. Mortality estimates from the hospital sample
are misleading unless it is taken into account that the most
recent birth for each woman in this sample was less than two
'weeks old at the time of interview.
TABLE 6.
CHILD I:ORTALITY DURING TH FIRST YEAR OF LIF.
Total Pregnancies
Failed Preunancies*
Live Births
iJeo-ilatal Deaths
Deaths 1 month to 1 yr.
Remainder alive of
total pregnancies
Failed Pregnancies
Failed Live Births
Failed Prcgnancies and
Live Births
Pregnancies of
Village e W.lo:be n
359
(-) 73
286
(-) 32
(-) 45
20O
21. 5%
28.6%0
41.7%Z
Pregnancies of
Hospital :'.lomrlen
315
(-) 34
281
(-) 6
(-) 20*"
255
10.8%
9.3%
19.0%
* Failed pregnancies are miscarriages and stillbirths.
l" Mortality estimates from Hospital 'omen are incomplete as
the most recent birth for each woman was less than two weeks
old at the time of interview.
POSTULATED CA.US.ES ? LO'; FATALITY
Several possible causes for low natality among the Luvale have
been suggested by previous studies: (1) venereal disease,
(2) ethnic or tribal group membership, (3) genetic factors,
(4) indigenous medical practices, (5) malaria, (6) diet (manioc),
(7) contraception and abortion, and (8) marriage patterns and
promiscuity.. Ascertaining the influence of any of these factors
for any specific population is.difficul.t without an e::tensive
medical survey that includes physical and laboratory examinations.
Another method of estimating the general importance of these
factors is correlating their presence and intensity and the
existence of regional pockets of low natality in tropical Africa.
These correlations have established the lack of a significant
and stable relationship between natality and any of the last
four factors mentioned.
The first two factors, venereal disease and tribal membership,
have shown consistently high correlations 'with differential
natality, and ERomaniuk (1968), a demographer who has studied
infertility in Zaire, argues that sterility is "physiological
and not voluntary" and is caused by venereal disease. The third-
and fourth factors, genetic factors and indigenous medical
practices, have received less attention and proven more difficult
to specify and measure. Regarding indigenous medical practices,
although induced abortions with their resulting complications
. and post-coital prophylactic infusions affect fertility,
," Romaniuk qualified their i-.portance by noting that they must be
in general and systematic use before their existence would have
a significant effect.
LUVALE THRA?UT'C STYL Z AN:D 'D.CAL CO S ::QUC' S
Whereas I cannot, as a social anthropologist, judge the influence
of venereal disease and genetic factors on Luvale natality,
my field research did establish that low natality among the Luvale
is partially a result of their therapeutic style. This style
lowers natality by adversely affecting fecundity and fetal-
mortality. Medicinal treatments cause sepsis, salpingitis,
and consequent infertility, and midwifery techniques increase
reproductive wastage during gestation and parturition. The most
significant aspect of Luvale medicinal treatments for women is
the frequency of intravaginal application. Intravaginal
therapies, interwoven with public performance of rituals,
are the. most popular mode of treatment for a great variety of
female conditions and ailments.
During the puberty ceremony the labiaminora are elongated and
cosmetically blackened. Pre-coital infusions are applied to
enhance the erotic for normal intercourse. Medicines are given
intravaginally for both gynecological diseases and conditions
(venereal disease, "vaginal frigidity", menstruation, gestation,
and parturition) and non-gynecological diseases (heart palpitations,
backache, hysteria, loss of weight, and worms). In contrast,
Turner's discussion of Lunda medicinal techniques mentions
drinking potions and ooultices as the treatments for the same
illnesses that Luvale women treat intravaginally (Turner, 1964).
A more somber e::pression of the Luvale emphasis on this style
of medicinal application is that the most common mode of female
suicide is 'b intravaginal insertion of the crushed cambium of
a certain root.
This therapeutic style of treatments and techniques may adversely
affect fecundity and fetal mortality in three ways. First,
intravaginal applications of medicines and hands may cause non-
specific infections, perhaps resulting in tubal scarring,
a physician,
permanent sepsis and sterility. Felicia King,. informs me
that pelvic infections may be caused by venereal disease or may
be non-specific and caused by any of a variety of bacteria.
The former is linked to a nale se:: partner and the latter to
intavaginal application. Non-soecific pelvic infections can
cause menstrual disturbances, severe abdominal pains, and also
pains during intercourse--all of which correspond to a variety
of illnesses that the Luvale treat as part of the ritual sequence
for women. E after recovery from this febrile illness'the woman
is infertile and has vague symptoms; more rituals will be
carried out. Zn sum, the fever, abdominal pains, and tenderness
that many of these Luvale women report correspond to pelvic
sepsis and infertility (?.S. King, personal communication).
Timing of intravaginal applications is important since infections
I
are more likely to develop and be more damaging at specific
vulnerable periods in.the woman's life cycle when the uterus is
healing, for example during menstruation, abortion (spontaneous
or induced), parturition and the post-partum period. During
gestation and parturition, several herbal medicines are frequently
applied intrvaginally to "open the way", ensure an easy delivery,
and quic-ken the labor. Difficult labor or delivery or a retained
placenta call for continual intravaginal therapies, and post-
partum pains require yet other medicines. Finally, the vagina
must be contracted by pouring in hot acidic douches so it will be
"tight" for future intercourse. As one English-speaking infor-
mant put it, "we must slink the vagina".
Frequency of application is important because the possibility
that a woman will become infected is greater the more she is
treated. Many illnesses and difficulties in conceiving and
bearing live offspring require that mny medicines and a greater
number of practitioners be called in for the case. Few or no
difficulties require less use of medicines, fewer rituals and
practitioners--and the medicines are applied to a healthy
individual.
Second, specific medicines may affect the woman because of their
chemical components and pharmaceutical properties. Pre-coital
infusions may prevent conception by changing the pR of the vagina.
Some abortifacients are real poisons, and sometimes the pregnant
woman dies with the fetus. Autopsies of women who committed
suicide have shown vaginal deterioration as one of the results
of the intravaginal medicine (.;att and 3reyer-3randwijk 1962:856-7).
Third, midw.ifery techniques consisting of intravaginal examinations
and medicinal application during parturition contribute to compli-
cations, especially in cases of difficult labor and placental
expulsion, and may increase stillbirths and neo-natal deaths--
as well as causing pelvic infections. The midwife performs
numerous vaginal examinations and digital manipulations and
applies a series of herbals to "open the way". She and the other
older women present require early and arduous "pushing" by the
pregnant woman that is not necessarily restricted to when the
woman has contractions. Often the woman becomes exhausted and is
unable to "bear down" during contractions when she is finally
dilated. Due to the frequent examinations and applications the
vagina often becomes swollen and the progress of labor is
further imneded. Sometimes the infant is born with extensive
head moulding and may be stillborn or die shortly thereafter.
As examples of this sequence, I refer to two cases I attended
in the villages when the pregnant woman was required to commence'
pushing when her contractions were very weak and about 30 hours
before she .was fully dilated. There were numerous vaginal
examinations. Finally in each case, after arguments between the
husband and the natrilineal kin of the woman who thought
hospital deliveries more prestigious each woman was taken
to the nearby mission hospital where a live baby was delivered
with the aid of the vacuum extractor. in each case the vagina
had swollen, and the mother had become too tired to push. Both
babies had extensive moulding of the head and required intensive
care during the immediate post-natal period. In both cases, the
nurses remarked that the babies were "distressed" and would
probably have been stillborn or have died within hours after
delivery if the birth had continued in the village. The nurses
supported their remarks by mentioning other similar cases.
Data presented earlier (Tables 5 and 6) -how. that Village W.omen
had significantly higher incidences of stillbirths and neo-.natal
deaths than Hospital .'omen, and that much of the reproductive
wastage recorded for the Hosoital '.Iomen had actually occurred
in previous village deliveries.
THiE -ITUAL cCi:TI::T C? C'J",R"G
Stages in the reproductive process (menstruation, conception,
pregnancy, labor and delivery) and reproductive disorders are all
considered musonco sicknessss. Recourse to traditional curing
practices, therefore, is required and essential to carry the
woman from conception to motherhood. Certain erotic and cosmetic
practices (such as contracting the vagina) are also viewed as
curative. Ill health and.disease are believed to be caused by
the sufferer's transgression or forgetfulness of the ancestors.
Even menstruation and delivery are not considered completely natural,
'since the ancestors control reproduction throughout all its stages.
A married woman normally lives virilocally, there is a
/ danger that she will forget her obligations to her matrilineage.
spirits
, fLuvale ancestral ...'Usually afflict their uterine descendants,
the woman who forgets her matrilineal ancestors is "in peril of
having her procreative powers 'tied-up' by the offended shade"
(Turner 1969:12).
At the same timethe sufferer gains ritual power and personal
prestige once she goes through the necessary rituals of propitia-
tion. She is now in direct communication with her matrilineal
ancestors in terms of their spirit manifestations. She can learn
the medicines, song.s'and proper ritual, and, as she begins to
cure others, her power and prestige increase, both among women and
men. It may be a unique situation that, in a matrilineal society,
women may'gain access to ritual power through their.own ancestors,
who were themselves women. Both male and female ancestors afflict
both men and women, but there is a tendency for men to afflict men
and women to afflict women. Certain matrilineages are noteorthy
for their ritual e::perts and the fact that most of their female
members are initiated.
If a woman has trouble in conceiving, if she miscarries, has a
stillbirth, or if her children sicken or die, it is possible to
seek an explanation in terms of general illnesses. But women's
reproductive and child-rearing problems have a oriori the
ancestral shades as their probable cause. Although a minor
illness may be self-diagnosed and treated, any acute or long-
lasting illness needs proper diagnosis obtained through consulting
a diviner.
A woman never attends personally such a divination; her relatives
are responsible for consulting the diviner and carrying out the
prescribed treatments. Sometimes relatives go to several diviners
to obtain a consensus and verify the diagnosis. The diviner
would by
acts as, an ethnographer, obtaining a ritual and health (fertility)
"profile" of the sufferer. Then the diviner identifies the
afflicting ancestral shades and the modes by which they are
manifesting themselves and directs the patient's relatives to
the kind of specialists) needed. Diviners are most likely to
recommend medicinal curing in connection with mahamba as the
therapeutic treatment. The term mahamba (singular, lihamba)
refers to: (1) spirits through which the ancestors manifest
themselves and possess their descendants, (2) the ritual of
e::orcising one or more spirits, and (3) the cult of those people
who have been possessed by a specific spirit.
Luvale recognize two kinds of mahamba pbssession'--the traditional
ones from the ancestral shades and -the"new"ones believed to come
from the air. The former treat reproduction difficulties,
general illness, madness and hunting misfortunes. The latter
deal only with general illness and infection. The newer cults
still survive today, although they are less popular than they
i~ere in the 1930s and 1940s when they were extremely popular in the area
(White 1949). In examining over 100 cases of spirit possession
rituals, I found that these newer rituals almost never overlap
with the more traditional ones for reproduction.
Women go through the traditional rituals'for reproduction when
the women are married, living virilocally, and in their repro-
ductive period. As a woman grows older and is no longer in her
reproductive period, her illnesses are treated in a more general
way, and post-M.enopausal women who are often unmarried and living
in their own matrilineal village may have both kinds of mahamba
performed for them.
As this separation of ritual jurisdiction suggests, rituals
do not occur randomly nor do they occur only in response to
individual sickness. Rituals are coordinated with life and
reproductive cycles. The fertility and ritual profiles of women
that I collected show that certain medicines and rituals are
performed for certain categories of women at specific times in
21
their reproductive cycle. The onset of menarche sets the stage
for ensuring a woman's fertility, and the type of puberty ritual
performed influences the commencement of sexual life and marriage.
Throughout gestation and parturition the woman is ritually and
medically guarded from disaster--spirits that could cause
miscarriage, a stillbirth, or death to the infant. A difficult
pregnancy and birth requires special medicines, recourse to
divination, and rituals. During the'post-partum period, the
only by
interdiction on intercourse is guidedsritual proscriptions.
Private and public medications are administered for women'.s
diseases, including venereal disease. More and different mahamba
are performed for a variety of illnesses during the reproductive
period. If the woman has difficulties in menstruation or fails
to conceive, she will require numerous private medicinal
treatments and diagnosis by divination, starting a cycle of
minor rituals and spirit possessions to appease her ancestors.
A performance of Tuta will be required for the woman who bears
a stillborn or a, mutilatedd" baby, or whose infant dies shortly
after birth.
If an infant or child sickens, various alternative cures may be
used. depending on the child's symptoms and the mother's repro-
ductive history. The cure will more likely include an elaborate
ritual with a long quarantine period for the child if the mother
has experienced medicines and mahamba for barrenness, illness
livry, or has a record of infnt d
and delivery, or has a record of stillbirths'an.d infant deaths.
22
A successful mother is..likely ,to receive only medicines or have
a minor ritual without spirit possession. Outside factors of
wealth, marriage, and modernity influence all choices, but there
is ,a tendency to repeat the child-rearing rituals performed by
a woman's matrilineal kinswomen (living and dead) if they had
these rituals and were subsequently successful in bearing and
rearing children.
Rituals may be analyzed as indications of female reproductive
crises. The rituals are public statements, the expression of
*
private individual problems and illness. Although informants
may .n6t recall all of their past illnesses, they do remember
all of the rituals that were performed for them. Since each
minor ritual and lihamba is accompanied by its own set of
medicines, ritual performances are, therefore, clues to the
curing therapies and specific medicines that a woman has experienced.
Because' o this, the elicitation of a woman's ritual history
is essential in order to ascertain her medical history.. As
Rappaport has pointed out, "The occurrence of.the ritual may be
a. simple qualitative representation of complex quantitative
information" (1960:235). In this way, it is possible to deduce
the specific medicines a.woman has received, and their modes
and times of application.
Rituals not only record the medicines a woman has received and
her passage through life, but rituals also directly affect the
therapeutic style and, consequently, the performance of ritual
a, f
n purposiv.
and its A p structure (T, urner 1968:.-3) provide the mechanism
that regulates and sanctions medicinal use and medical behavior.
Therapeutic responses to individual crises, as well as the
temporal phasing of medicines within a curing sequence, are
influenced both by the structure of specific rituals and ritual
cycles,and by the necessity to sponsor the accompanying ritual
phases. Sponsorship requires the accumulation of the obligatory
'eer and capital, and this requirement takes time. As I-
mentioned before, each ritual is accompanied by its specific
set of medicines. Although substitutions of medicines do occur,
as individual herbalists and diviners vary in their practices,
the range and frequency of changes are inhibited because the
medicines are part of a set connected to specific rituals.
Similarly this ritual connection sanctions recourse to indigenous
medicine by threatening the fertility and health of those who
might deny its use and by rewarding with prestige and power
those who continue the traditional therapies.
Medicinal therapies and ritual occur both in response to illnesses
and the diagnosed displeasure of the ancestors and in order to
validate and commemorate each stage of the reproductive cycle
and the larger life cycle. Although there does exist a question
about the latent functions of a therapeutic style that acts to
inhibit natality, there e::ists no evidence at present to indicate
S that this limitation of population growth is an advantageous
or adaptive reaction to environmental conditions. From this
therapeutic style in its ritual context flow positive benefits
for individuals and for matrilineal solidarity, as well as negative
consequences for the fecundity and mortality of the group.
TH~ LI. CYCLE O? WOMSN--REPODUCTION A:IN.D RITUAL
Luvale believe
all women are born with a snake-like creature (chisumi) in the
uterus. Before a woman matures, the chisumi is dormant, but it
is aroused by menarch'ey feeding on the blood, and.is only
permanently dormant again after the menopause. Chisumi is,
therefore, always present in a woman. Menstruation is itself
considered an illness (musonqo) caused by the chisumi.
At menarch'-ethe matrikin are responsible for performing the
standard girl's puberty ritual (wali) which ensures fertility
and prepares a girl for sexual life. During the actual seclusion
(lasting from three months to two.years) instruction is given
in dancing, medicines, and coital techniques. The girl elongates
her labia minora, learns pre-coital medicines for producing a
"v:arm, dry vagina" so as to avoid "vaginal frigidity"., and learns
procedures and medicines for menstruation. Whether married or
not, the girl must have her first intercourse at the conclusion
of the coming out phase as this action is considered part of
the ritual and essential for her subsequent fertility.
There are two variations of the standard ritual. In the more
lengthy'one, pre-pubescent girls enter seclusion to await
menstruation. The vagina may be "opened", i.e., the hymen
broken and vagina enlarged. The other is a shortened ritual
in which the girl is only secluded during her actual menstruation
which is followed sometime later by a coming out party.
In the latter many of the mystical aspects of the longer rituals
are omitted, but the labia are, elongated and medicines for
"warmth" and menstruation are still given. These variations are
justified by noting that a mother or sister had these rituals
and were fertile, or conversely, that they had the traditional
ritual and were not. The girl should then try a different
ritual or she will similarly have no children.
The shortened ritual is more popular among school girls who
simply obtain some medicines from Luvale school matrons.
Because there is a correlation between education and hospital
deliveries, more of the. Hospital Women have had the shortened
ritual although younger women in general are leaning in this
direction.
TABLE 7. PARTICIPATION 1Nc GIRL'S PU3ERTY RITUALS.
(In percentages.)
Villace Women HosDital W.omen Total
15-29 30-44 45+ 15-29 30-44
Standard Ritual 80.0 84.3 87.7 52.9 65.6 74.0
Pre-menarch:- Ritual 5.7 9.1 8.8 0 0 4.8
Shortened Ritual 14.3 6.1 3.6 47.1 34.4 21.2
Most Village Women married before they matured and the rest
married as part of the coming out ritual. In the hospital sample,
more women married some time after the ritual (whether long or
shortened) had been concluded. There is a trend among the
younger women in both samples to be married later. In terms of
puberty and marriage as well as education, the hospital sample
represents modern influences.
MEN TR UATIO-C
During subsequent menstruations when there are severe pains or
bleeding, it is considered that the chisumi has become too "hot"
and must be "cooled" with medicines. The theory of procreation
stresses the relationship between menstruation and procreation,
and menstruation that is unduly prolonged or accompanied by
severe abdominal pain is believed by the Luvale to interfere
with the woman's fecundity. If there are menstrual and repro-
ductive problems, chisumi is first suspected and appropriate
treatment started.
Every woman knows some of the medicines (which include intra-
vaginal applications as well as infusions to be drunk) for she
learned them in her puberty camp when she first matured. Her
female relatives and neighbors will contribute their suggestions,
some.being mentioned free of charge, others being purchased
for a price. The point is that, .
S" treatments are commonly available
commeope
and are women's concern, They 2o wmrn self-administered
medicines and continue with women herbalist experts who
require payment.
treatments
If these fail, then perhaps an ancestral spirit is.directing
Sthe chisumi.
A diviner is then consulted who may advise one or several of
the many treatments available, normally commencing with medicines
in which
Ato wash the entire body (applied with a live, white chic-ken),
the wearing of red beads, and the building of a small shrine
behind the woman's house, etc. If the problem continues,
various rituals may be performed to exorcise the afflicting
shades. The most notable of these possible rituals is a
performance of Kula (one of the mahamba), either by itself for
serious cases or, if the patient is a young woman in her
reproductive years, in combination with many other mahamba
that have been diagnosed as "tying up" her fertility.
An examination of ry data on long and heavy menstruation
correlated with ritual performances shows the following.
Among Village Women, there is a higher incidence of traditional
ritual participation than among Hospital Women. 40 per cent of
the Village Women over 45 years of age mentioned having been
troubled by long monthly periods. All of those women sought
medicinal and ritual help; all erected a shrine; all had a
mahamba performance that included Kula; and 28 per cent of them
had a performance limited exclusively to Kula. Younger Village
Women tended to have minor rituals and then mahamba performances
that included Kula. Among the women in the hospital sample,
although many reported having the same problems with menstruation,
no one had the minor rituals or a ritual exclusively for Kula
and only some had a mahamba ritual including Kula.
CONCEPTION THROUGH PARTURITION1
Most women conceive within two years after maturing. Although
younger women are tending to delay marriage, they continue
28
this tendency toward early conception, often being impregnated
by boyfriends shortly after maturing. In the hospital sample,
26 per cent of those who were delivering their first pregnancy
were unmarried. The following table shows the length of time
from physical maturity until first conception among the women
of completed natality.
TABLE 8. YE-AS FRO:IM MATUYRTY TO ZFRST CONCEPTION.
(Not percentages.)
Miscarriage/
Live Birth Neo-Natal Death Stillbirth
1-2 Years 22 4 3
3-4 Years 7 -
5-6 Years 3 2
6+ Years -
No Information 5 3
No Pregnancy 8 -
Most women begin bearing children in their first marriage.
S a
.Gme continue in their second marriage, and few continue in any
subsequent marriages, as shown by women over 45 years.
Concomitantly, by the.second marriage, the majority have
finished with reproduction, and more than one third were
(10.2 per cent)
consistently childless. Only six women/were infertile in their
first marriage and fertile in subsequent unions; all other
women showed their highest-.natality in their first union.
The younger women (15-44 years) of incomplete natality,
especially the hospital sample, show the same trend of initially
highest natality declining in subsequent unions. But the.
generally higher level of natality among the younger women means
29
that their reproduction span is longer and they maintain their
fertility through subsequent marriages.
TABLE 9. FERTILITY I'N MARRIAGES (ONLY ':OMEN OV5E 45).
(Not percentages.)
Iarria ges
1st 2nd 3rd 4th 5th
Live births 37 14 3 1 -
(Neo-Natal Deaths) (5) -
Miscarriages/Stillbirths 4 5 3 1 -
No Pregnancy 17 33 19 11 3
No Information 1 1 1 -
N=59
White's contention that women wait for stable marriages before
conceiving is not borne out by my data, nor does his related
point that women begin bearing children relatively late receive
any substantiation. Iany pregnancies occur in early unions,
even those that are very unstable and brief.
Once a woman conceives, she is guarded through her pregnancy
by a variety of medicines and rituals. For the first pregnancy,
all women have medicines to cool the chisumi so that it will
quickly release the placenta. If the woman becomes ill while.
she is pregnant, other medicines and rituals may be used,
usually those in which offerings are made to the woman's
ancestors. During gestation, the woman is medicated vaginally
("to open the path") and anally ("to cleanse the mother's stomach").
The application of these medicines starts. about
the 7th month and does not require a medical or ritual specialist.
When labor pains begin, the specialist midwife is called. The
midwife immediately begins vaginal examinations to report on the
progress of the labor. Any woman who is older than the expectant
mother is allowed to attend the birth,'and everyone present
demands that the mother push, push, push, frequently when she
has not vet even dilated. Famous midwives are often barren
.themselves.
The greatest fear during childbirth is that all or part of the
*placenta will be retained. In fact, midwives do not wait very
long before starting intravaginal medicines for kusalaho (to be
left out or left over, i.e., the placenta). Medicines are
hastily prepared. The other women present try their techniques,
then the midwife uses her special medicines. Again and again
the placental membranes are pulled and pulled. Other more
distant midwives are brought into difficult cases. Hygiene
8 p
is very low at this time. For giving these "kusalaho medicines"
the midwife may demand a larger fee. If simply cooling the
chisumi with medicines does not make the placenta come completely
out, then it is believed that an ancestral spirit is causing
the problem, and a diviner is consulted, and a series of rituals
are carried out.
Post-partum maternal care is concerned with medicines for
chisumi, for cleansing the birth canal and uterus, and for
tightening the vagina. The latter tw.o involve extensive douching
with hot, very acidic (test brews gave readings of pH 1-3).
herbal prezarations. Some women report high fever and abdominal
pains after delivery, and the ones who are ill in this way
and go to the hospital for treatment are placed on antibiotics.
The Chavuma Mission Hospital specializes in maternity care and
delivery. As an alternative to delivering in the village, it
is widely used, and 15 out of-the 27 (55.5e sarce! census women
who delivered babies in 1971,,had their babies in the hospital.
Some village midwives send their patients to the hospital for
ante-natal clinic, although the women then deliver in the village.
Half of the women who attend ante-natal clinic actually do
deliver at the hospital. When the women in the hospital sample
were interviewed, they were asked a simple open-ended question,
"Why have you come to the hospital to deliver your baby?"
Their reasons as stated are given below.
LE 10. REASONS FOR. DLIV'TRING A TH, HOSPITAL
(N=88 Hosoital v.omen.)
Escape high payment to midwives.
"Fear of retained placenta", i.e., poor techniques
in village.
Both of the above, i.e., "you will pay much if
medicine is aiven for retained placenta".
Nurses have good medicine/referred through
ante-natal clinic.
Previous difficulties in village deliveries.
Previous child died..
."Educated women should go to hospital."
"Too many fingers in the vagina make .it swollen."
If baby dies in womb in village, they do not know
how to get it out.
"They, make you push too hard."
"You may have to go for divination."
"I1o one to care for me in the village."
No Response
women
women
women
women
women
women
womne n
women.
women
women
women
women
women
TAB:
A.
B.
C.
D.
E.
G.
H.
I.
J.
K.
L.
Lt.
CONTRACEPTION1 AN D ABOTICO
The post-partum taboo should ideally be kept by the parents
until the child walks. This interdiction appears to be broken
by many women unless they and their children are the subject of
special child-rearing rituals. Contraceptive medicines allow
the parents to resume se;:ual relations and still ensure that
their child will walk properly, a great concern to all parents.
(Luvale believe that the parents' sexual behavior can kill a
newborn, prevent walking, and cause malnutrition.) These
medicines are usually prepared and placed in beads that are
strung around the baby's waist and there is private magical
ritual for the parents. The "good father" should also practice
coitus interrupts until the baby walks. More traditional
parents sometimes wait 6-8 months before having this medicine
done and resuming intercourse, but modern parents wait only
2-3 months. With so many herbal medi.'- r that are inserted
vaginally, it is noteworthy that no medicines intended as contraceptives,
are administered in this mode.
Current cases of women who use abortifacients are those who have
broken the post-partum taboo and who are pregnant too soon,
or unmarried school girls. Fior -mob ortifacients. it is
known that if the fetus is in the second or third
trimester, the medicines will kill the woman. Although many
abortifacients are effective as poisons, but they were not
apparently in frequent or widespread use. I did witness
one case in which a woman died while attempting an abortion
33
by drinking medicines and inserting medicines intravaginally.
Perhaps the fear of thus accidentally committing suicide
diminishes the frequency. Stories of women who have died are
frequently told in cautioning young women. By interviewing
some herbalists, I found that some'medicines used to treat
venereal diseases and stomach pains were also used for inducing
abortions. These medicines are not supposed to be given to
pregnant w.-omen, but sometimes a woman being treated for another
disease is also in the early, unsuspected first trimester,
as was the case in an involuntary'abortion I witnessed.
!3.ARR .' ..
To cure barrenness (kusakisa) the curing treatment beginning
with private medicines must be sought by a woman's husband.
This medicine is given by an herbal specialist after a diviner
has been consulted. There are two parts to the medicine:
first, a potion to drink that is designed to "cool" the chisumi,
and second, intra.vaginal medicines to open the uterus (lichimbi).
These latter medicines are known to be very irritating, and a
patient may have to be restrained from pulling out the medicines
once they are inserted. 'oThen the doctor finally does remove
the medicines, a voluminous discharge comes out of the vagina,
according to informants. The following table shows how frequently
women in both samples have recourse to "kusakisa medicines";
the practice was more popular in the past. Hospital ; omen do
have better natality histories than Village '.omen, undoubtedly
reflecting their use of a variety of medical facilities,
including ante-natal clinics.
34
TABLE 11.. O:-: 03~ .I:::.S TRADITIONAL MEDICINES TO CURE
(In percenai.cges.)
Village omen Hosnita! T',omen
15-29 30-44 45+ 15-29 30-44
Obtained medicines 13 31 36 15 32
.Of those,
Remaining Barren 25 50 60 -
Subsequently
Conceiving 75 50 40 100 100
.If the woman conceives after the treatment a public spirit
possession ritual featuring mahamba for reproduction is performed.
If the woman has had previous stillbirths or neo-natal deaths,
a performance of the terrible and much feared lihamba, Tuta,
may be carried out. This lihamba is not caused by an ancestral
shade but by a rat that lives in the forest. It is believed
that the woman unknowingly stepped near the hole of this rat,
which is .why she is now afflicted, and the public performance
is carried out near such a hole.
VENEREAL DISEASE
Many women interviewed reported they had kalwena, "gonorrhea",
or pus in the urine, and, less frequently, unono, "syphilis",
or genital lesions. Some claim these diseases have interfered
with reproduction; others blamed chisumi and other illnesses.
There are so many different diseaseswhich Luvale recognize by
genital and urinary symptoms that without proper laboratory
diagnosis, it is difficult to know what they refer to. It is also
35
difficult to know whether venereal diseases are more prevalent
1.0
among the Luvale than among other Zambian tribes.
Younger women in both samples report fewer cases of self-diagnosed
venereal diseases; Hospital Women have lower incidences than
.their contemporaries in the village sample. These differences
may well reflect access and use of medical facilities and anti-
biotics as well as changes in disease categories.
TABLE 12. .OMr0OR O,,! TOT1 'VENEREiL~ DISEASE'.
(In percentages.)
Village Jromen Hosnital *'Jomen
15-29 30-44 45+ 15-29 30-44
8.6 48.5 59.3 3.8 14.3
CH-LD :MORTZALTY AD ITS RITUALS
Child rearing is closely connected with reproduction, and Luvale
women class together a fetal and infant death. Miscarriage,
stillbirth's, and infant'deaths up to one year are called kupihisa
(to be bad). The ancestors :nay cause disaster and sickness
at any stage from gestation through childhood. If the mother
has "a good reproduction record" and her young baby sickens,
perhaps the ancestors are not responsible and only medicinal
treatments will be suggested. However, if there have been
previous problems in either bearing or rearing children,
both rituals and medicines are required.
Seclusion in chicano. (fence) is the most elaborate ritual for
reproduction and rearing. Depending on past fertility and child
mortality (the various patterns are given below), it may be
divined that the woman should be secluded either before
parturition or with her newborn child. She enters seclusion
in a dramatic ceremony. During seclusion all kinds of medicines
and minor rituals are given, and many food/sex taboos are
prescribed. The woman may stay in the fence for a few months
or up to a year and a half (if she were secluded during
.pregnancy). When the child is ready to crawl or walk out of the
fence by itself, then there is another and more elaborate
coming out ceremony for mother and child. A minor variation
(chi.anao cha malala) is less restrictive for mother and child.
There is only partial seclusion, a tiny fence, and no spirit
1lj possession.
For all child-rearing rituals attention is suddenly focused
on mother and child. The woman gets voluminous amounts of
information o. child care by others who have had the rituals.
-Furthermore, the strict and partial seclusion act as quarantines
for the child. Few adults may handle the child, who is also
separated from other children.
In terms of fertility and child mortality, the noteworthy aspect
of these performances, especially the chipaneo series, is that
the woman's "luck" at reproducing and rearing seems to improve.
Many children have personal names that record their having been
37
through the ceremonies as a sm~ll child, and parents proudly
recall how, because they have had these rituals, they now have
children.
Factors other than the past fertility history of the woman
.involved that influence the choice of performance/ceremony are:
the economic and marital status of the woman and husband,
previous fertility and ritual history of close relatives of
both w.:oman and husband, and degree of modernity of the couple.
'Divorced women with young children never have the full seclusion
of chipango, but usually only erect,a shrine. Poorer people
may choose to have one of the minor ritual sequences. As with
the choices between various puberty ceremonies mentioned above,
the choice of these ceremonies partially depends on the kinds
of rituals her female relatives have e:zoerienced and their
fertility performance.
Typical chioanco patterns are: (1) a woman had 1-3 miscarriages
or children who died, and at her next pregnancy she is put to
chiDanco. (In the past she might enter during her pregnancy
and deliver there. The modern pattern is to deliver at the
hospital and then enter.); (2)following E performance of Tuta
during pregnancy she enters before or after delivery; (3) the
woman has failed to conceive for several years, is given
kusakisa medicine, becomes pregnant and enters.
L-.,
Typical chioanqo cha malala patterns are: (1) a woman had no
problems conceiving/bearing and her young child becomes sick;
(2) the sick child is older than a year, when it can crawl out
of the big chinanoo, and less than three years, when it would
be off its mother's back and the mother simply could dance
mahamba for it; (3) when certain circumstances, such as poorness,
immigrant or husbandless status, prevent women'with poor fertility
histories from having full seclusion; and (4) when the parents
think seclusion is old-fashioned.
Table 13 below gives an idea of the degree to which women in
the village and hospital samples have various mahamba, both of
the more traditional and the newer types, and chinanco ceremonies,
both the full and the abbreviated cha malala, for producing and
rearing children.
TABLE 13.
PARTJ.zP'1~Th -....- B !1~~ "r`U,`L.S ?OR REPRODUCTION
D LI
Village '.,omren
15-29 30-44 45+
Mahamba for Reproduction 15
Other Traditional Hahamba
(madness, death of
husband, illness) 1
New Mahamba 5
Total iahamba '21
No Mahamba 17
Mahamba for child rearing
Chipango 10
(Entered during
pregnancy) (4)
Chicanco cha m.alala 5
iahamba for sic;: child 1
Total 1-ahamba for
child rearing 16
No. women in category 35
* Note that a :woman may have more
21 41
3
8
32
9
10
(4).
13
1
33
than
Hospital ':oren
15-29 30-44
12 15
12 3 11
(5) (2) (4)
7 7 5
5 2 1
30 12 16
59 52 .35
one kind of mnh;irn.
CONCk-T USOT T~-O
been
In this paper it has shorn that natality" among the Luvale was
very low in the past and has been increasing in line with the
general Zambian-wide increase. Scme writers have explained
the low natality in terrs of malarial and venereal diseases,
diet, genetic factors, and the postulated use of abortifacients.
As a social anthropologist I cannot analyze the first three, but
I have 'examined certain medicinal and ritual customs 'in detail-
and argue that these are partially responsible for the low natality.
The therapeutic style of intravaginal application and midwifery
techniques contribute to sepsis and subsequent infertility
and increase stillbirths and neo-natal deaths.
Rituals work in combination with the medicinal treatments and
serve as reCulating mechanisms which temporally order the treat-
ments. Without rituals various treatments might be haphazard
or dispensed with altogether. Rituals also serve as a methodo-
logical aid to the anthropologist because they are public knowledge
and indicate when various medicinal therapies occurred and in
relation to what illnesses, whereas private women's therapies
are guarded.
A series of .medicinal treatments connected with reproduction
and se::ual life are interwoven with ritual performances.
Concern for fertility and child mortality, is shown in the multi-
tude of rituals, commencing with the girls' puberty ceremony
40
and continuing through the reproductive years with manamba
performances, with the chiango ritual being the most elaborate
and the most popular. Patterns of natality and child mortality
are reflected in the diagnosis and choice of rituals.
Samples of Village Women and Hospital ','omen have been used to
monitor natality, ritual participation, and modernity. The older
Village ':omen have the lowest natality and the highest reproductive
wastage. They have high childlessness and the most venereal and
other diseases. These women have the most rituals and the more
elaborate ones performed for them, and these women have undergone
most of the traditional therapeutic techniques for illness and
delivery. Younger Village '.iomen continue many of these charac-
teristics. They have moderate natality, high wastage, and fewer
diseases;. and they have undergone almost as many rituals and
therapeutic techniques, although they avoided some of the elabora-
tions.
The Hospital '?;omen have highest natality, least reproductiv-
wastage, and fewest diseases. They. have been educated, perform
few and less elaborate rituals, use traditional therapies rarely,
and use the hospital for illness and maternity. Younger Hosoital
Women tend to marry later but continue to conceive between one
-and two years after puberty, the traditional pattern. Among
women still in their reproductive years, natality may be considered
moderate and reflects greater access to modern maternity and general
medical facilities. Natality is expected to increase and approach
the national average with a continuation of these trends.
.* 41
OC 0:(7** t _0-).'"- .
1. I would lie to thank Art Hanson, Dr. Felicia Savage King,
Donald D2eGlopper and Mary Farmer for their critical reading of an
earlier version of this paper. I would like to express my
appreciation to the staff of the Chavuma Mission Hosoital.
Although I collected hospital records and case histories of
patients, no medical or laboratory studies were conducted.
Mr. D. B. Fanshawe of the Division of Field Research, Kitwe
identified the botanical specimens.
Field research .w-as carried out between 1970 and 1972 under
a grant from .IH Tr aining Program in A.nthropology-, (NIG M13-1256)
and the Department of Anthropology, Cornell University.
2. The simple fertility ratio (Child/'."om.an Ratio) relates the
number of young children in the population to the number of .;omen
in th- reproductive age croup. bhadike (1969:37-33) notes that
this ratio does not necessarily measure maternity because of
differential under-enumaration, childhood migration, and infant
and ear-ly childhood mortality. This ratio looks at fertility
in the -recent past, i.e., the last five years. It is used here
because comparative figures are available.
3. Unless an investigator is very careful, neo-natal deaths and
even deaths of chi ldren under tw.o years w'-l be recorded as
miscarriages, and the mother subsequently registered as "childless".
I intc-r e'.-ved many "childless" women :.ho, upon intensive cuestion-
ning, revealed that they had produced living children who had died
while young.
4. There are no Hospital l.'omen .who are over 45 years old as
maternity care co.mmenced in the area in the early 1950s. All
women inter-v'ewed in the hospital'sanle) had a successful delivery.
Women who de-livered a stillbirth or whose child died while still
in the hospital were not interviewed b"n my Luvale research
assistant but are included in the overall hospital statistics.
5. A list of Luvale female pharmacopoeia which includes, the
chemical components is in progress. Ph determinations ,were made
in the field.
6. Securidaca lon inedunculata. Death occurs within 12-24 hours,
although some women died as late as 14 days after application.
Post-mortems on women who committed suicide intravaginalIl showed
vaginal, liver and gum deterioration (Jatt and Brever-Brandwijk
1962:356-7).
7. The Hospital '.Jomen provide a partial test of this hypothesis;
they have much fewer and less elaborate rituals and medicinal
treatments, and their natality is double that of the traditional
Village ,.omen in the 30--144 .ears group.
8. A common basin of water is used to moisten the vagina and
placental membranes, and in one deliver,, the midlife washed her
feet in it as well$
42
9. Older ..or.n report tht thse cirlz are the very ones who use
abortifaci nts to rid th:. l~. es of unw.antoe prcgnanc s. B ut,
as stated above, 2-5 rer cent of the younger Hospital "';o:.on ar
unmarried and :nmany 'wre school irls.
10. Interestingly the Luvale ter: for gonorrhea, ka.lwena, is a
derogatory term for (:a)Luvale -eople.
43
REFERENCES
Davis, K., and J. Blake 1956. Social structure and fertility:
An analytical framework. Economic Development and Cultural
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