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Family Planning, Amazon Style Publication info: Natural History ; New York  Vol. 101, Iss. 12,  (Dec 1992): 30.

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ABSTRACT (ABSTRACT)  

Amid the cultural changes confronting the Shipibo Indians of the Peruvian Amazon, high fertility is imposing new

hardships. The fertility problems of the Shipibo, a matter that is political and not scientific, are detailed.

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Amid cultural change, high fertility imposes new hardships on an Indian people

"When you come back, don't forget to bring tootimarau," Chomoshico called to me. I was leaving the Shipibo Indian

village of Manco Capac, on the banks of the Pisqui River in the Peruvian Amazon, where I had been doing medical

research. Chomoshico was nearing the end of her eleventh pregnancy. She already had seven living children.

Neither she nor her husband wants more. "Enough. Clothes cost," they told me. "I'm tired of having children," she

said. "I almost died with the last one." Her husband has tuberculosis.

Tootimarau means "medicine to keep from being pregnant"--birth control. I knew I could promise Chomoshico

worm medicine for her children's parasites, and I might be able to bring her vitamins and iron for her pregnancy,

even medicine for tuberculosis. But while I could informally provide other kinds of medical care, I could not arrange

to bring her birth control without risking reprisals from politicians who are against it. The Shipibo have been asking

me for tootimarau for more than twenty-five years, but I haven't been able to arrange any yet. I can only refer them

to a Peruvian doctor in Pucallpa, many days away by canoe. Most can never get there. The men even pull me aside

to ask if I know about an operation to "fix" men--vasectomy--and, again, I tell them the name of my medical

colleague in Pucallpa.

In the same village, a few weeks before, a young girl had died on her thirteenth birthday trying to give birth to twins.

And in that girl's natal village, just up the river, I had just seen my first case of flank starvation among the Shipibo

Indians, with whom I had worked as a physician and scientist since 1964. The starving man had tuberculosis. His

family, which would normally have taken care of someone so ill, was away working for a logging company.

Chomoshico's desperate request for birth control, the death of the thirteen-year-old girl, and the plight of the

starving man are all related. The Shipibo's own high fertility, uncontrolled by any effective means, is compounding

the problem of the population pressure created by an influx of outsiders, who are moving into Shipibo territory and

destroying the natural resources.

The Shipibo Indians who live along the Ucayali River and its tributaries, such as the Pisqui, notice that the fish are

getting smaller and harder to find, and that the game animals they rely on during the rainy season--when fish are

almost impossible to catch--are more elusive than in the past. Palm leaves for thatching roofs seem scarcer, and

people have to trek long distances, sometimes a mile or more, to gather firewood, once available a few steps away.

People are aware that their own village is growing, that they do not know all its inhabitants, that the village school

is crowded. Sometimes they have to go all day without eating fish. The Shipibo word for fish, piti, is also their word

for food: a Shipibo without fish is truly poor.

In this crisis, the Shipibo are not alone. The Peruvian government has urged desperate people from the crowded

coastal cities and Andean communities to settle and live in the jungle "paradise." They have. Pucallpa, the major

port on the Ucayali, the "highway" river that becomes the Amazon, was probably an aboriginal Shipibo settlement

(its Shipibo name means "red earth"). In the 1940s, just before the trans-Andes highway was put through to

Pucallpa from Lima, the settlement's population was about 2,500. When I first visited Pucallpa in 1964, the

population had grown to about 25,000. It was a raw, dusty, frontier town with dirt streets and Saturday night

gunfights. More than 250,000 people live there now--a hundredfold increase in fifty years.

With the local waters already depleted, fishing boats from Pucallpa speed downstream more than 150 miles, where

they take all fish more than two inches long with drift nets, pack the fish in ice, and start back up the river. The

smaller fish are discarded to rot. There is not much left for the Shipibo, for the mestizo colonists from elsewhere in

Peru, for the large fish, for the alligators, or for the wading birds that used to line the shores of the Ucayali. Areas

around Pucallpa that were covered by canopy rain forest in 1964 now look like Oklahoma. The hundreds of bird

species that enlivened the forest have been replaced by emaciated cows. Swamps filled with fish are replaced by

causeways carrying buses and motorcycles. Twenty years ago, a traveler camped on the beach of the Ucayali

River could not sleep for the sounds of fish splashing and alligators hunting them. There aren't enough fish to keep

one awake now; the traveler is kept awake by the whine of fishermen's outboard motors.

Instead of living by subsistence fishing and horticulture, as the Shipibo principally do, their new neighbors exploit

the environment to make money. First come the timber cutters, followed by cattle ranchers, commercial fishermen,

and the farmers of bananas, rice, and other cash crops. The resultant deforestation and flooding have eliminated

some crops and game animals that were sources of food for the Shipibo in the rainy season. The Shipibo

themselves are drawn into the money economy and sometimes sell products from scarce animals (such as water

turtle eggs) in order to get cash.

The Shipibo painfully admit that, although they work much harder than before, they don't have enough money for

clothes (which they used to make by hand from woven cloth) and schoolbooks for their children (not a factor thirty

years ago). They now have to buy food at times, even though it was previously plentiful.

The Shipibo (and the closely related Conibo) are the dominant indigenous people of the upper Peruvian Amazon.

They have survived there for about a thousand years, but only by battling fiercely with other tribes and exhibiting a

pragmatic tenacity in the face of colonization. Before the European conquest, they may have numbered more than

50,000. By the early twentieth century, fewer than 3,000 remained. Somehow they escaped the further decimation

or complete extinction that befell many other Amazon tribes exposed to European diseases, enslavement,

intertribal warfare sponsored by rubber tappers, and other openly genocidal attempts to rid the Amazon of its

native inhabitants. Their population is now about 30,000 and growing.

The last smallpox epidemic was in 1964. But now, in addition to the modern plagues of tuberculosis and cholera,

the Shipibo have a new health problem: high fertility, which places pressure on resources and takes a heavy toll

among Shipibo women.

In the past the Shipibo controlled their birth rate and population growth in a variety of ways: by sexual abstinence,

by abortion (using pressure on the uterus), by infanticide, and by the use of herbal contraceptives. Knowledge of

these contraceptives was passed down through the generations from mother to daughter, from grandmother to

granddaughter. But several things happened to interrupt this tradition. The horrifying epidemics that wiped out

whole villages following European contact prompted shamans in related tribes to forbid the practices of infanticide

and abortion. The Shipibo shamans may also have taken this step, but more likely, Christian missionaries played a

role in disrupting the cultural traditions that controlled fertility. In 1697, the Shipibo massacred a group of

Franciscans who were insisting that the Shipibo give up polygyny (multiple wives). Today, the custom remains

strong in some parts of the Shipibo culture area but is declining in villages close to centers of Western influence.

Even though polygyny allows some men to have more offspring than others, it permits women to have fewer

children with longer intervals between births. This arrangement has several important effects: it allows women to

recover from each pregnancy; it allows children to gain maturity before being weaned and placed on a diet of all

solid foods; and it reduces the total number of children borne by individual women. The result for the group is that

women have a better chance of recovering from pregnancy and therefore of living longer, and child survival is

better.

These advantages of polygyny are often cited by members of traditional societies, whose strategy is, not to have

as many children as possible, but to have as many as possible that survive to adulthood. A final result of polygyny,

paradoxically, is that community fertility could be restrained.

My acquaintance with Shipibo methods of controlling fertility began in 1964, when I was a third-year medical

student from the University of Colorado. I had just finished working intensively for several months at the Hospital

Amazonico "Albert Schweitzer" near Pucallpa, and had traveled to the Shipibo village of Paococha to learn about

native ideas concerning the nature, treatment, and control of disease. A Shipibo friend who was helping me,

Ambrosio, came to me one day to tell me that his wife was bleeding to death: she had just had a baby. Ambrosio

asked me to see her, and I treated his wife for retained membranes and postpartum uterine atony (relaxation of the

uterus). She recovered, and he asked me what he could do for me. I told him I would like to learn about medicines

that women use to control pregnancy. His aunt Julia was the local expert.

From Julia I learned that Shipibo women have several such herbal preparations. One of the most common is called

tootimahuaste (tooti means "pregnancy," ma means "not," and huaste means "herb"). Taken as a tea during three

successive menstrual periods, it is supposed to cause sterility.

In 1969, for my master of public health thesis, I returned to the village to conduct a more formal census and collect

the inhabitants' reproductive histories. I asked the Shipibo women in my survey if they knew about these

medicines and if they used them. They roared with laughter at the idea of a male gringo asking these intimate

questions in their language. Then they usually told me that they knew about them; many had used them. Some of

the women had seriously harmed themselves by using highly toxic natural substances in a desperate attempt to

control fertility.

At first I was puzzled to find that women who had used the herbal contraceptives had more children, on the

average, than those who hadn't. This turned out to be because older women, who had already had many children,

were more likely to have used the herbal contraceptives. But my doubts about the effectiveness of the traditional

contraceptives were renewed when I analyzed the results of my two population studies in 1964 and 1969. The

Shipibo in Paococha turned out to have the highest fertility ever recorded for a human group, with a woman having

an average of ten births during her reproductive life.

Moreover, their rate of population growth was nearly 4.9 percent per year, with the population doubling every 14.5

years. Such a population explosion had to be fairly recent, for if such a rate had been in effect for very long the

population would have been huge. The phenomenon could not be completely explained by better medical care

(some of which I had provided) and a declining death rate. Either the herbal contraceptives didn't work, or I wasn't

getting all the information.

There were two other factors. By 1969, a large extended family from down the Ucayali river, at the periphery of the

Shipibo territory, moved into Paococha. Several of the men had multiple wives. (The local, "downtown" Shipibo

assured me that, unlike themselves, the new family was composed of salvajes--savages--and that they practiced

the old ways, including polygyny.) Because missionaries and schoolteachers discouraged it, this family structure

was becoming rare.

The second factor was suggested to me when I remembered that the Shipibo always observed certain taboos,

including "dieting," when taking medications of any kind. I asked the women what they did when they took

tootimahuaste. They replied that one cannot eat salt, honey from the forest or other sweets, ripe bananas, and

certain kinds of fish. And a woman taking tootimahuaste may not have sex. This would mean an abstinence of

three months or more. Right away, I suspected what epidemiologists call a "secondary noncausal association"

between the use of herbal contraceptives and fewer pregnancies.

Postpartum sexual abstinence is often linked with polygyny in tribal societies. The woman who has just given birth

may not sleep with her husband for a period of time, which may be from three months to three years. During that

time her husband sleeps with one of the other wives. In Shipibo tradition, it is not uncommon for a man to have

two or three wives. Because women in polygynous marriages might be better able to observe the sexual

abstinence associated with herbal contraceptives, and because this might help these women have longer birth

intervals, I speculated that a decline in the practice of polygyny could be contributing to the community's high

fertility.

To be sure of this, I had to determine that, on average, the birth intervals were indeed longer for women in

polygynous marriages than for women in monogamous manages and that fertility was actually lower for the

former than for the latter. Further, I wanted to determine if the rates of polygyny differed among the villages, and if

so, whether less polygyny is associated with lower or higher community fertility. By studying Shipibo villages that

were separated by long distances and had different levels of cultural contact with Western society, I could

compare the relationship between polygyny and fertility.

Up on the Pisqui River, Shipibo lives are more traditional than in the Shipibo villages lining the Ucayali. The Pisqui

is much smaller and fluctuates more quickly than the Ucayali. It contains fewer fish and other edible wildlife. The

Pisqui Shipibo live more by hunting and gathering than their Ucayali brethren. They are more isolated from outside

influences, and have been since at least early colonial times.

In 1983 and 1984, I studied eight Shipibo villages in different states of cultural transition. Six of the villages were

as much as sixty miles up the Pisqui. The results of the study showed that polygyny is generally more common on

the Pisqui, and that longer birth intervals occur in the polygynous unions there. In some Pisqui villages, 45 percent

of the women were in polygynous marriages, whereas in Paoyhan, a new Shipibo village on the Ucayali, only about

5 percent of the women were in this kind of union.

Comparing the birth interval lengths and fertility of all women, regardless of their villages, I found that, on average,

the birth intervals for women in polygynous marriages were thirty-four months--four months longer than those of

women in monogamous marriages. And most significant, women in monogamous marriages had 1.3 more children

during their reproductive lives than women in polygynous marriages. Accordingly, in villages where polygyny was

more common, the average intervals between births were longer and community fertility rates were lower.

The most acute health problem for the Shipibo, as both they and I see it, is epidemic disease--tuberculosis, cholera,

and influenza, to mention a few. These diseases carry off the older people who know the cultural traditions, and

they carry off many children. But the long-term problem is high fertility, which is placing pressure on the

diminishing resources. Weakened by increasingly poor nutrition, the Shipibo are more vulnerable to epidemics. In

their case, population growth means poverty and disease.

For Shipibo women, high fertility means sickness and death. They have an extremely high rate of cervical cancer,

which is probably related, among other things, to early childbearing and many pregnancies. I estimate that the

maternal mortality ratio--the proportion of women who die from pregnancy and childbirth--is roughly one for every

hundred live births, one hundred times higher than in the United States.

A larger question raised by studies such as mine is whether we really understand how fast the world's population

is growing and will grow in the future. The Shipibo are essentially not counted in the Peruvian census, and neither

are their mestizo and other Shipibo neighbors. Numbers sent to the government offices are highly inaccurate (but

then I, for one, never received a U.S. census form in 1990).

From my experiences in Latin America, I would speculate that official census counts are missing at least one in ten

people and perhaps every fourth person. Some of those groups excluded appear to have population growth rates

of more than 3.5 percent. If this is true--and if it is similarly true in other parts of the developing world--world

population growth rates may not only be higher than official estimates but may also grow higher as traditional

societies like the Shipibo experience rapid cultural change.

Human population growth is not new. But there was a time, long past, when it took 100,000 years for world

population to double. Soon after agriculture was invented, the doubling time dropped to 700 years. Now our

population is doubling every 35 to 40 years. What happened?

While there are many answers, one emerges from this study and others like it: many human societies that

controlled their fertility in the past have lost the tradition of doing so in the frenzy of modern cultural change. The

old methods that reduced births have not yet been replaced by the new technologies of fertility control. The result

is chaos, suffering, more cultural change, and in some cases, even more rapid population growth. Where will it

stop?

For the Shipibo it stops when the beloved yoshanshico (grandmother) dies of tuberculosis and takes with her the

ancient Amazon traditions of pottery making and weaving and knowledge of the plants and seasons. It stops with

the loss of half the village's children to a measles epidemic. It stops with the death of a beautiful thirteen-year-old

girl in childbirth. It stops when the village chief, a vigorous and intelligent young man, dies of cholera. It stops

when the legendary hunter of piache, a giant fish once commonly found in Amazon lakes, returns after three days

in the bush with his canoe empty and his harpoon unused. His family gets by on another meal of banana porridge.

It stops when the bright but superfluous young men and women of the village leave for the city, where they can get

low-level jobs and survive. Their village education, which kept them from the forest and from learning their

environment and own culture, has given them only minimal skills for life in town, where they sometimes conceal

their cultural identity to get jobs.

It stopped for Ambrosio's wife when she died, exhausted, trying to give birth the next time, at the end of her twelfth

pregnancy. The previous child proved to be mentally retarded, probably the result of a two-day labor and difficult

delivery. For Ambrosio, a friendly man with a mischievous smile and quick wit, it stopped when he died from

tetanus two years later. For Julia, who became one of my dearest friends in life, a woman who had outlived two

husbands and thrown out several others, who was fiercely independent and could hunt and fish with the men, who

was a skilled artist and walking library of Shipibo culture, it stopped when she started coughing blood and bled to

death in a few minutes in front of her horrified family. The Shipibo are being forced to choose between buying

tuberculosis medicine for people like Julia and building schools for their children.

For me, there are few things as delightful as the sound of Shipibo children laughing. The Shipibo love their children,

and it shows. But what is ahead for people like Chomoshico and her husband and children? The inexorable

arithmetic of population growth is upon them, and the consequences for their environment and families are plain

to see. As a public health physician, I cannot help noticing that the Shipibo's fertility problems are inseparable from

their other health problems and the changes going on around them. I also cannot help noticing that each family,

with few exceptions, wants to limit its fertility but has no safe, effective means of doing so. That is not a scientific

issue, but a political problem that neither I nor the Shipibo can solve.

DETAILS

Subject: Social conditions &trends; Fertility; Birth control; Native peoples

Location: Amazon Basin

Company / organization: Name: Shipibo Tribe; NAICS: 921150

Publication title: Natural History; New York

Volume: 101

Issue: 12

Pages: 30

Number of pages: 8

Publication year: 1992

Publication date: Dec 1992

Publisher: Natural History Magazine, Inc.

Place of publication: New York

Country of publication: United States, New York

Publication subject: Mines And Mining Industry, Earth Sciences--Geology, Museums And Art Galleries,

Biology--Entomology, Metallurgy, Archaeology, Sciences: Comprehensive Works,

Astronomy

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