# 10.3: Reproduction

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Reproduction is a basic function of every organism on Earth and passes on the building blocks of life from one generation to another. Every culture in the world has traditions, rules, and ceremonies which preside around reproduction. These may range from sexual practices of Hawaiian nobility to the Supreme Court of the United States in legal disputes such as Roe v. Wade. Reproduction is an ever present variable in anthropology and a prevalent force shaping the world.

Almost all cultures have norms governing sex and reproduction; these range from cultural universals such as the incest taboo to legal concepts such as child support. However, even these taboos are not found to be entirely universal. In many early cultures, such as the Hawaiians, royalty could only be passed down to the child of two royal family members, usually a brother and sister. Different cultures each have individual expectations of women regarding when they begin having children, how many they have, and what age they usually stop having children. For example, women in more male-dominated societies have less or no say in their reproductive processes and health. Reproduction is the biological process by which new individual organisms are produced. Reproduction is a fundamental feature of all known life;

## Reproduction: An Anthropological Definition & Focus

According to the Encyclopedia of Anthropology, human reproduction refers to "the process by which new social members are produced- specifically, the physiological process of conception, pregnancy, birth, and child raising". From a larger perspective, reproduction is what allows a whole society to continue thriving into the future and avoid extinction. Political power has come to be the central concern of reproductive studies since those who have power have control over reproduction of large populations, which ultimately leads to power over that population. This is why, since the 1990's, anthropological studies of reproduction have mainly focused on new reproductive technologies. These technologies have been designed to help guide human reproduction. Examples of "new reproductive technologies" include intrauterine devices, birth control pills, artificial insemination, in-vitro fertilization, and many others which are able to manipulate reproduction. Birth control is a form of contraceptive to limit the chances of pregnancy.

### Childbirth

Childbirth methods vary for women in all different cultures. More industrialized societies, such as the United States, treat pregnancy as a medical problem to be very carefully handled, as opposed to many other cultures that handle it in a completely different manner. For example, people in Agricultural societies usually handle childbirth with midwives [11], and foraging cultures give birth individually. When a woman living in America goes into childbirth, she is immediately taken to a sanitary environment where there are doctors and nurses present and specifically trained to help the woman through the process. Though in a sterile environment, the newborn infant is not entirely safe from disease. After all, most western cultures consider it normal to give birth in the same building that houses all of society's sick. Complications do happen on a regular basis, but because of the high-tech environments, the complications can usually be resolved. With the Ache from Paraguay the women that go into labor are taken to more secluded areas. They are meant to squat, proceed to deliver their child by themselves, bite off the umbilical cord, put the newborn to breast, clean themselves and their baby, and go back to their people. This practice parallels the concept that nature is the Mother in foraging communities. Nature provides a shelter for birthing and is a place where life is given. Because complications are much more common in this situation with risk of infection, excessive bleeding, and overall lack of medical attention, many cultures use midwives to assist the mother. For example, midwives in America are still popular despite the cultural norm of birthing your child in a hospital with an OB/GYN present. Mothers and their families choose this route either because of religious reasons, cultural purposes, or possibly even lack of financial adequacy to pay hospital bills.[12] In the case of the Orang Lom of Bangka, West Indonesia, women have seemingly similar pregnancies to that of American women, but there are some radical differences between the two cultures. For instance, the Lom women don't necessarily have "restrictions" to their pregnancies, but one exception is a prohibition on certain behaviors—the behavior being that pregnant women are to not sit in doorways. To the Lom culture, sitting in a doorway as a pregnant woman is said to cause a prolonged and painful pregnancy. However, once the woman has given birth to their son or daughter, there is an array of rules and regulations that must be followed. Some of the rules include a period of taboo, or prohibition (pantang) that sets in after birth. This period, called repas (which also means 'brittle', 'fragile') lasts for a duration of 44 to 45 days. It is characterized by the sole seclusion of the new mother in her home, with the addition of daily herbal baths with heated water prepared for her by her husband, sexual abstention, and a prohibition against eating certain foods as well as against productive/economic efforts. [13] In addition to complications concerning the physical birthing location, the social environment in which a child is born can also be an issue. For example, depression in a mother after childbirth, called postpartum depression, can result from a poor social support system among other things. This can potentially result in far more problematic conditions such as postpartum psychosis in which the depression becomes chronic and can effect the mothers physical health and ability to bond with her child.

Adoption is the action of adopting or being adopted. If a mother were to give up her baby or child, that child would be available to anybody who was looking to start a family. The birth mother may give the child away for many reasons, such as not being able to provide for it, being too young to have a child, or simply because she may not want a child at all. In America, that child would go through the foster care system until they are chosen by prospective parents. There is a slight social stigma associated with adopting or being adopted, but for many, it's simply another way to build a family.

### Abortion

Abortion is the action of terminating a pregnancy or is the premature exit of products of conception. To do this in an induced abortion, one must remove the embryo or fetus from a woman's uterus after conception. There are several different ways to perform an abortion. Induced abortions are different from spontaneous abortions (also defined as a miscarriage) because an induced abortion is usually done on purpose, whereas a spontaneous abortion is usually unexpected.

##### Induced abortion

There are a variety of ways to perform an induced abortion, some relatively safe and others extremely dangerous. In more developed countries the use of medical or surgical abortion is used.

##### Medical abortion

Medical abortion is performed with the use of pharmaceutical drugs, which are only useful in the first trimester of a pregnancy. Surgical abortion (also known as a vacuum abortion) is the most common method used.

###### Surgical abortion

To perform a surgical abortion one removes the fetus or embryo, membranes, and placenta using a suction method with a syringe (this is called manual vacuum aspiration or MVA). Another way to perform a surgical abortion is through the use of an electric pump (this is called electric vacuum aspiration or EVA). Surgical abortion is usually performed from the fifteenth week of pregnancy to the twenty-sixth.

##### Other types of abortion

There are also other types of abortion that are not performed medically or surgically. These methods include the use of herbs and special diets as discussed above in the section control of pregnancy. There are also other ways that are not as safe. One method of abortion is attempted from abdomen trauma or putting pressure on the uterus externally. The amount of force upon the abdomen is extreme and does not always succeed in a miscarriage. This form of abortion can result in internal bruising and can be harmful to the mother of the child. The most unsafe methods of abortion are almost always self-induced through the insertion of non-medical tools into the uterus. These tools can include wire clothing hangers or even knitting needles. Self-induced abortions are most dangerous because they can result in infection and lacerations of the uterus which could eventually result in death if not properly treated. Overall, the pain of a surgical abortion is between that of a dull toothache and a headache or a mild backache.

For example, women in Nigeria have been known to mix dry gin with 'Alabukun' powder to induce abortion. Alabukun Powder contains the salts Acetylsalicylic Acid and caffeine as active ingredients. This method of abortion is usually performed by young Nigerian women, who do not have the proper funds to receive an abortion done by a doctor. This mixture is deadly and will surely kill the fetus. [14]

#### Abortion in the United States

Abortion in the United States is a very controversial issue. There is quite a bit of political and ethical debate that underlies whether or not it should be legal. In a legal sense in the United States, the term, "abortion" refers to induced abortion as opposed to spontaneous, because it is purposeful. The first abortion laws in the U.S. appeared in the 1820's which outlawed abortions after the fourth month of pregnancy. By the 1900's most abortions had been deemed illegal, and in 1965 all states had banned abortions.[14] Currently, in the United States, abortion is legal but can be restricted by any state to varying degrees, as a result of the highly controversial 1973 case Roe v. Wade. These restrictions include: prohibiting abortion after a specific amount of time during the pregnancy (i.e. after the second trimester), required parent notifications for minors, parental consent for minors, and the permission to perform the abortion after informing the patient of the risks prior to the procedure. Before Roe vs. Wade, abortion was illegal in over half of the U.S., and otherwise legal only in the case of rape or to protect a woman’s health. It was legal upon request in only four states. In deciding the outcome of Roe vs. Wade, the Supreme Court ruled that forbidding abortion except when necessary for a woman’s health was unconstitutional and that the issue of abortion fell under the constitutional right to privacy. Today’s view on whether or not abortion should be legal is largely divided between those who are "pro-choice" which is those who believe a woman should have the choice for a safe and healthy abortion, and those who are "pro-life" who support anti-abortion. Opinions are based on religion, gender, political party, region, and can vary depending on specific reasons for a woman having an abortion.

#### Abortion in East Africa

Abortion is illegal in Eritrea unless it is medically necessary for the health of the mother. When a young girl unexpectedly gets pregnant, she cannot legally acquire an abortion unless given permission by a medical professional. “The reality is that a woman will seek an abortion—legal or otherwise—almost instinctively and in self-defense.” Rules do not stop these young girls from aborting and they will do it illegally if they wish to get rid of their pregnancy.

#### Abortion in Colombia

Colombia has stricter laws regarding abortion than America. Colombia, along with El Salvador and Chile, where the 3 countries in Latin America which completely prohibited any kind of abortion by law.

On May 10, 2006, Colombia’s Constitutional Court ruled abortion legal only when pregnancy endangers the life or health of the mother or results from rape or incest, or if the fetus is unlikely to survive. This ruling caused a large controversy between the Catholic Church and the doctors who perform the surgeries as well as the women who chose to have the abortion.

In the United States, the right to choose an abortion is based on the women’s right to privacy. In contrast, Colombia’s ruling for abortion is based on the women’s right to heath, life, and equality. In Colombia, it is estimated that on average women have more than one illegal abortion throughout their life.[15]

### Positive Puberty Ritual

#### Navajo culture

An ethnographic example of a positive puberty ritual can be found in Navajo culture. When a Navajo girl reaches puberty, she undergoes a four-day ceremony called ceremony which signifies her transformation from childhood into womanhood. The ceremony is centered around the Navajo myth of Changing Woman, the first woman on Earth who was able to bear children. The myth says that Changing Woman performed the first Kinaalda and that the ceremony gave her the ability to have children. Because of this, all Navajo girls must also undergo the ceremony so that they will grow into strong women who can also have children.

#### Hispanic culture

Many Hispanic cultures celebrate a woman's coming of age with the Quinceañera (from the Spanish word "quince" meaning 15). When a girl turns 15, it is traditional for her to celebrate both religiously and often socially with friends and family, showing that she has overcome puberty, reached adulthood, and is eligible for marriage, or more commonly today is ready to begin dating. The celebration begins with a Thanksgiving Mass, or "Misa de acción de gracias," which is attended by the close family, godparents, as well as up to seven damas (maids of honor) and 7 chamberlanes (chamberlains). After the mass, many families choose to continue the celebration with an extravagant party, including fancy dresses, food, decorations, and often a live band and dancing. Some girls choose to go on a trip instead of having a party, but still enjoy time with family and close friends to celebrate the transition from childhood to womanhood.[16]

#### Judaism

In Judaism, a traditional the traditional coming of age ceremony takes place at the age of thirteen. For a boy, this is called a Bar Mitzvah and for a girl, it's called a Bat Mitzvah. This tradition includes both a religious portion of the individual's life (reading a portion of the religious text the Torah) and a lively party. For the individual, it is one of the most important traditions in Judaism, rivaled only by marriage.

#### Filipino culture

In the Philippines, puberty for boys is based on circumcision. Filipino people consider a boy becoming a man when he gets circumcised, and the age range boys usually get circumcised is around 7-11. Children in the Philippines are taught that they are a man when you get circumcised so they get excited to get circumcised but also they may feel terrified because the process of circumcision in the Philippines isn't modern for some individuals since they can not afford to get circumcised in an actual hospital; they just go to small clinics.

### Birthing Practices

There are four main types of birth:

1. Complete birth - entire separation of the infant from the maternal body (after cutting of the umbilical cord)
2. Multiple births - the birth of two or more offspring produced in the same gestation period
3. Post-term birth - birth of an infant at or after 42 completed weeks (294 days) of gestation
4. Premature birth - birth of an infant before 37 completed weeks (259 days) of gestation

The best position for the baby to be born is head first. The head first position poses the least amount of danger for both baby and mother. When a baby is breached (feet or buttocks first) it can cause many complications for both the baby and the mother.

It should also be noted that there are three main methods of giving birth:

1. Vaginal birth- the natural emergence of the baby from the mother's birth canal. This is the preferred method of birth for most women. This process starts with the onset of labor which consists of uterine contractions which start the natural “pushing” of the baby down in the vagina for delivery. The natural pushing is the painful part of birth but it can be controlled with breathing exercises. The birthing process is also practiced in many different types of pain management. While pain management is often medical, there are types of natural birth that give women the choice to have a birth in a controlled and comfortable environment without the distraction or stress of the hospital.

• There are 3 phases of vaginal birth:
• 1st phase: The opening of the cervix or dilation. This is when the doctor will perform internal examinations to check the orientation and health of the baby
• 2nd phase: The cervix is fully dilated at approximately 10 cm. The mother helps the delivery by pushing. This phase can last up to 2 hours. The baby is delivered at the conclusion of this stage.
• 3rd phase: Also known as the afterbirth. The placenta is delivered and the mother emotionally connects with her baby.
• Types of Natural Birth:
• Hypno Birthing

In hypnobirthing, the mother undergoes self-hypnosis as a method of pain control. Hypnosis is defined as, "a naturally induced state of concentration, a place where mind and body can communicate with the subconscious mind." When in this state, communicating with the subconscious can help to control pain. According to HypnoBirthing of Colorado [15] the state of self-hypnosis while delivering can put the woman in a completely relaxed and day-dreamy attitude. The woman, however, will still feel in complete control and be able to sense her surges (also called contractions). In hypnobirthing, one of the goals is to let the body's natural painkillers, endorphins, to take over the pain instead of letting stress enhance the pain.

• Water Birth

Another popular form of natural childbirth is water birth. Water birth is the process of giving birth in a tub of warm water. This can be done at home or in a birthing center, but it is usually recommended that a Douala, midwife, or medical professional be present. Usually, the woman will enter the water after being about 5 cm. dilated. It is thought that the relaxing environment will help the mother push more effectively and be a pleasant, non-stressful environment for the baby to enter the world into. Water births have been gaining popularity since the 1980's. There are some possibilities for danger to occur in this situation, such as the baby inhaling water when underwater. Usually, this will not occur; however, because the baby still receives oxygen through the umbilical cord and breathes in the womb out of instinct.

2. Assisted birth- the use of medical technologies, such as forceps to assist in delivering the baby from the mother's birth canal.

3. Caesarean birth- Is a method that uses a surgical incision made in the mother’s abdomen and uterus for the delivery of an infant. This method is often referred to as a C-Section. Although a vaginal birth is the most preferred, a Caesarean birth may be necessary if there are complications in the pregnancy, for example, if the baby is not receiving enough oxygen (emergency c-section) or if the mother chooses the option (elective c-section). The elective C-Section is performed a week or two before the actual due date. If the expectant mother is HIV-positive and blood tests done near the end of pregnancy show that you have a high viral load, then a planned c-section would be the recommended birth plan by the doctor. It is equally important to have a planned c-section if the baby is expected to be extremely large and difficult to pass through the vaginal opening, (a condition is known as macrosomia). This is particularly true if the expectant mother is diabetic or has had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.[17] Most maternity units in the UK deliver between 10 and 20 percent of babies by Caesarean section. [16]

• Multiple Births - If the woman were to have multiple births then it is possible she would have to get a C-Section to prevent permanent damage to herself during the birthing process.
• Labor Stops – Over one-third of all C-Sections performed are a result of labor stopping. Prodromal labor is when a woman begins contracting like she would in labor, but the contractions do not lead to birth. The contractions can begin and then fizzle out for days before leading to labor and then finally birth.
• Concern for the Baby – Complications concerning the baby such as the umbilical cord being pinched or the baby not receiving proper blood flow might result in the necessity of a C-Section.
• Medical Conditions – Preexisting medical conditions in the mother such as diabetes or high blood pressure may also cause a need for a caesarean section.

### Differences in Birthing Practices

#### Foraging Societies:

In many foraging (hunting/gathering) cultures, the woman will walk away from the group to give birth on her own. This can result in an increase in complications and danger to the mother and child due to the lack of medication, assistance, and natural predators.

#### Agricultural Societies:

In agricultural societies, midwives usually assist women giving birth. Midwives are specially trained to deliver babies.

#### Industrial Societies:

In many industrial societies, women in labor are given medication to help with the pain. Also, Caesarean births (C-Sections) are common. In parts of the U.S. and Brazil, 50% or more of births are C-Section births.

#### Causes of Maternal Death:

Indirect Causes: 20%

Severe Bleeding: 24%

Infection: 15%

Unsafe Abortion: 13%

Eclampsia (unstable blood pressure): 12%

Obstructed Labor: 8%

Other Direct Causes: 8%

### Cultural Meaning of Birthing Practices

Birthing practices vary greatly across the world. In several different cultures, such as the Yucatán, Holland, and Sweden, a midwife is enlisted to help in the birthing process. All births in Sweden take place in hospitals with the help of trained midwives. However, in the US, 95% of births take place in a hospital, where the mother and child are treated as patients. This contrasts sharply from the Maasi of Kenya where the "mother gives birth in her own hut, and she remains there until her strength is recovered and she feels well again. During that time she is attended by the women of the village or kraal.[18]" Countries have also been seeing an increased rate of Caesarian sections performed in recent years. [17] Not only have medical technologies improved to make this practice more safe for the mother and child, but the industrial and post-industrial societies that make up developed countries today require individual participants to schedule everything into exact slots of time. Through this surgery, women are able to schedule the exact moment they give birth and can thus plan their return to society ahead of time.

Nevertheless, the different birthing practices all hold a cultural similarity in that they affect all aspects of social life in a culture. Childbirth affects the mothers because of all the potential differences in the meaning of childbirth and can allow the woman to become closer to herself, her significant other, and her family. In no culture does childbirth go unnoticed, and the different birthing practices help establish the different cultural meanings of the birth.

For example:

• In Japan, mothers are encouraged to eat traditional foods that will nourish the mother and baby during the labor. Mochi and eggs are high in protein and carbohydrates which give the Japanese mothers strength and energy in the birthing process. Traditionally, the feelings of pain expressed through noises and verbal expression were considered acceptable but such extreme expressions were considered shameful. Mothers are expected to remain stoic throughout the delivery process. These traditional beliefs are still widely held in Japanese culture concerning birth.
• Tradition also states that fathers would not be present during the birth. Midwives and female relatives were however allowed to be in the room with the mother in labor. [18]

### Child Birth in Kenya

Many African hospitals are expensive for the average family to afford to deliver their baby with medical attention. A Kenyan woman named Wanjiru shares her story “I remember going to the hospital in 2001. I was in pain, like most of the other women, but we were made to sit on a wooden bench and were not allowed to go into the labour ward without paying.” Because majority African hospitals are so overwhelmed by the number of pregnant women that need help delivering their baby, they are usually not very polite. Wanjiru was told, “You are asked to spread your legs ‘like you did for your husband.” According to a report, Failure to deliver, prepared by the Federation of Women Lawyers in Kenya and the Center for Reproductive Rights (CRR), there are numerous challenges facing women in Kenya’s health facilities, including suffering abuse and neglect before and during delivery. (http://kenvironews.wordpress.com/2007/10/04/kenya-mothers-agony-of-giving-birth-in-public-clinics/)

### Postpartum Depression

During the period of time following childbirth, it is common that young mothers experience what is known as postpartum depression. This is a period of time where the mother feels gloomy and sad rather than happy about her new child. Postpartum depression occurs in about 13% of pregnancies within the first 12 weeks and will continue in about 8% of pregnancies.[19] In extreme cases postpartum depression can continue long enough to be considered postpartum psychosis. There are multiple risk factors that will increase a women's chances of having postpartum depression after birth. These include a history of anxiety or depression, obstetric and neonatal complications, increased amount of stress, and a small social group of friends. There are many doctors and researchers worldwide conducting studies on how to intervene during the pregnancy and after the pregnancy to see if there are changes.

Asian cultures tend to have higher rates of depression postpartum but in Pakistan and Nepal it's more prevalent and has an increased rate, 28-63%.[20] Researchers believe this has to do with the mother's environment and culture. For instance, there's an increased amount of physiological violence from their male partners, illiteracy of both parents, and serious neonatal complications. All these issues bring lots of stress and low self-esteem on the mother and even baby putting the mother at higher risk for depression postpartum. Women in lower socio-economic areas need more medical and mental health assistance during their pregnancy to ensure mental stability and a safe delivery.

### Breast Feeding

Breast Feeding practices vary between cultures. A child should be breastfed for at least six months and is recommended to be continued until two to four years of age. Breast milk carries many nutritional benefits to the child. Vitamins and antibodies that the mother carries are passed on to the baby to help build the immune system and developing body. Breastfeeding is also critical for mother and child bonding. Hormones are exchanged in the breast milk and well as in the mother to promote nurturing feelings. During the breastfeeding months, lactational amennorrhea occurs which prevents the mother from conceiving again. In some cultures, this is a method for birth control and is classified as natural family planning.

In the United States and other industrial societies, breastfeeding practices may look different from foraging or agricultural societies. A mother may cut her time of breastfeeding short in order to return to a career or job. Many mothers will pump their breast milk to feed the child when she may not be there or is out in public. Using artificial formula is also common, although the baby may suffer nutritionally and socially. In societies, such as The United States, breastfeeding may also be cut short due to a socially constructed attitude of individuals being independent. A mother may be socially ridiculed for breastfeeding her child too long and not promoting them to become nutritionally independent. Mothers breastfeeding in public are often sexualized and, for that, a negative social stigma surrounding breastfeeding has developed over the years. Society has conditioned women to feel ashamed for a natural and necessary bodily function, which is a product of the over-sexualization and objectification of women's bodies.

A 1999 research project done in Munich, Germany at the Institute for Social Pediatrics and Adolescent Medicine did a study on the effects of breastfeeding and its relationship to childhood obesity. This study was comprised of 9,357 German children between the ages of 5 to 6. The study found that children who were breastfed for 3 to 5 months had a 35% reduced risk of being obese upon their entry into school. Breastfeeding has also been linked to an increase in cognitive intelligence.[21]

#### Nationwide Insurance Company Court Case

In 2015, a former employee of Nationwide Insurance Company Angela Ames sued her employer for not allowing time for her to pump breast milk for her child. When she approached him, he sent her home to "be with her babies;" however, during that time he wrote her a letter of resignation and she was promptly fired the next day. The U.S. Supreme Court sided with Nationwide and the Eighth Circuit Court, denying Ames’ petition for a review of her case’s dismissal. The trial court’s decision — which the Circuit Court upheld — said that for Nationwide’s firing of Ames for taking the time to express milk at work could not have been sexist because, under certain circumstances, some men can lactate, too. The court’s reasoning, in this case, echoes old Supreme Court pronouncements that discriminating against pregnant women at work isn't sex discrimination because both men and women can be non-pregnant. Congress long ago rejected this ridiculous reasoning when it passed the Pregnancy Discrimination Act.[22]

### Formula Feeding of Infants

Although the American Academy of Pediatrics and the American Academy of Family Physicians recommends breast milk feeding as the best method for feeding infants, many parents still choose formula as an acceptable alternative. There are several reasons for this. Some medical conditions are best treated with the use of formulas. These include congenital lactase deficiency, galactosemia, atopic disease and milk protein allergies. Another reason people opt for formula feeding over breastfeeding is convenience. Working or traveling mothers may find formula feeding an easier alternative over the physical demands of breastfeeding. Obviously, it enables others, besides the mother, to feed the infant. Mothers experiencing postpartum depression may find it difficult to breastfeed their babies and thus they may opt for formula feedings. In this way postpartum depression impacts a mothers bonding with her child through the absence of hormone transfer through breastmilk. Some parents choose to give their infants formula in bottles as a method of helping the baby sleep rather than providing it with nutrition. This is not recommended due to risk of suffocation, choking or tooth decay.[23]

There are different types of formula available today. They are classified according to three basic criteria: caloric density, carbohydrate source, and protein composition. Most infants intaking formula need one with iron. For congenital lactase deficiency and galactosemia, soy formulas are recommended. Hypoallergenic formulas with hydrolyzed protein are best for infants with atopic disease and milk protein allergies. None of these formulas are effective in the treatment of colic in infants. There are antireflux formulas that decrease the incidence of emesis and regurgitation, but since they do not help growth or development and therefore, are not often recommended.[24]

The American Pediatrics Association does advocate breastfeeding over formula feeding for infants in the first six months of their life if they do not have any of these complicating medical conditions. Breastfeeding provides infants with natural antibodies and is typically more easily digested than formula.[25]

In the early years of the 20th-century breastfeeding was the most common form of infant feeding in the United States. But with the advent of better sanitation and refrigeration, milk could be more safely stored. As well, the use of evaporated milk for formula preparation decreased bacterial contamination and curd tension of infant formulas. From 1930 through the 1960s, breastfeeding declined and cow’s milk and formula (called beikost) were introduced into the diet at earlier and earlier ages. Mothers with middle to upper income could afford refrigeration and get pasteurized milk and thus were more inclined, if so desired, to use cow’s milk and formula. Lower income mothers or mothers living in areas without electricity were less inclined to do so. This would include mothers from ghetto areas in large cities and those from remote rural areas.[26]

#### Formula Feeding in Somalia:

Getting proper nutrition is an ongoing problem in Somalia for many residents there, particularly those in the mid to lower economic bracket. Consequently, plump babies are considered healthy babies. Such mothers in Somalia often supplement breastfeeding of their infants with formula or just switch to total formula feeding to ensure a plump baby. This often starts early in the child’s life as mothers believe that breast milk and its important ingredient, colostrum, are often no good for more than three hours – and thus non-nutritional upon the birth of the child. For Somali immigrants, many do not have adequate family support to allow for the mother enough rest and are not familiar with pumping and storage as an option to provide breast milk. This is why many of them choose formula feeding for their infants.[27]

### Reproductive Technologies

Reproductive technologies are devices or materials that are used to interact with natural human or animal reproduction. The circumstances in which the use of reproductive technologies is utilized or even accepted varies in many areas of the world. While many people across the globe use technologies such as condoms or other contraception methods, it is not universally accepted by all, especially during different times in history. The reason for this can include an individual's or society's religious practices, prominent in pre-twentieth century Catholic belief systems. Another more advanced use of reproductive technologies is demonstrated in the procreation between same-sex couples. These technologies help couples who are unable to procreate naturally to birth children with genetic materials from both parents. Technologies similar to that can be utilized with opposite-sex partners as well. If one or both individuals is unable to procreate naturally, genetic material can be combined and implanted into a surrogate female who will then carry the child to term for the parents.

#### Artificial Insemination

Artificial insemination (AI) is the deliberate introduction of sperm into a female's uterus, fallopian tubes or cervix for the purpose of achieving a pregnancy through in vitro fertilization by means other than sexual intercourse.[28] The procedure can be used for many kinds of fertility problems. For men, it is often used when men have very low sperm count or have sperm that is not strong enough to swim through the cervix and up into the fallopian tubes. For women, AI is utilized in situations of endometriosis, abnormal reproductive organ, and unreceptive cervical mucus. Oftentimes doctors will suggest AI when they are unsure of the reason for a couple's infertility. There are four types of AI including intrauterine Insemination, intrauterine tuboperitoneal insemination, intracervical insemination, and intratubal insemination.

Success rates for this procedure vary. In the U.S., success rates of AI are observed at 10 to 15 percent among women aged 41 to 42 and 5 percent in women over 42.[29] Some contributing factors for unsuccessful pregnancies using AI are medical issues of the woman (severe case of endometriosis, severe damage or blockage of fallopian tubes), poor egg or sperm quality and the older age of the woman. [30]

Artificial insemination, coupled with a fertility treatment such as gonadotrophin, renders a greater chance of having twins or triplets. Since the average cost of artificial insemination is from $1500 to$4,000 per pregnancy, it may be more financially beneficial for a couple to have more than one child per procedure.

Faiths that place a strong emphasis on the procreation of the family, such as Mormons, may opt for artificial insemination before adoption or AI from an outside sperm donor. In this way, couples increase the chances of carrying on their own lineage. The Mormon church does not approve of single women using AI. It also discourages AI of married women using semen from anyone but their husband. The Church does, however, note that children conceived by artificial insemination where the sperm is donated by the husband are sealed in the temple and are considered lineage of the couple. [31]

#### Surrogacy

Surrogacy is another form of reproductive technology that has enhanced reproduction in Western societies. For families that are unable or unwilling to conceive, they can choose surrogacy. Surrogacy is achieved by entering into a legal contract with a willing participate who will carry the baby to full term and deliver it for the family. A medical professional will manufacture a fetus out of the parents' fertilized sperm and egg, and then implant it into the carrier. This process is called In Vitro Fertilization (IVF). The carrier agrees to be paid a certain sum of money as well as typically health care and sometimes rent, groceries and amenities. In the United States, it is typical to pay someone between $100,000 to$150,000 US Dollars.

However, if this is too much money or the family does not want to know the carrier, they can choose to have a surrogate in another country. In India, surrogates are typically paid between $6,000 -$8,000 which is much more than they would be paid working a typical job. They are given a room to sleep in, regular doctors appointments, food and anything they could need. This is often a much better choice for women in India than to work in a factory. They consider their womb to be like a room that they rent out periodically.[32] It should be noted that these surrogate mothers, while given counseling, do sometimes experience postpartum depression due to the absence of the child after birth.

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