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Ancient Bodies, Modern Lives: How Evolution Has Shaped Women's Health
Winner of the 2011 W.W. Howells Book Award of the American Anthropological Association
How has bipedalism impacted human childbirth? Do PMS and postpartum depression have specific, maybe even beneficial, functions? These are only two of the many questions that specialists in evolutionary medicine seek to answer, and that anthropologist Wenda Trevathan addresses in Ancient Bodies, Modern Lives .
Exploring a range of women's health issues that may be viewed through an evolutionary lens, specifically focusing on reproduction, Trevathan delves into issues such as the medical consequences of early puberty in girls, the impact of migration, culture change, and poverty on reproductive health, and how fetal growth retardation affects health in later life. Hypothesizing that many of the health challenges faced by women today result from a mismatch between how their bodies have evolved and the contemporary environments in which modern humans live, Trevathan sheds light on the power and potential of examining the human life cycle from an evolutionary perspective, and how this could improve our understanding of women's health and our ability to confront health challenges in more creative, effective ways.
How has bipedalism impacted human childbirth? Do PMS and postpartum depression have specific, maybe even beneficial, functions? These are only two of the many questions that specialists in evolutionary medicine seek to answer, and that anthropologist Wenda Trevathan addresses in Ancient Bodies, Modern Lives .
Exploring a range of women's health issues that may be viewed through an evolutionary lens, specifically focusing on reproduction, Trevathan delves into issues such as the medical consequences of early puberty in girls, the impact of migration, culture change, and poverty on reproductive health, and how fetal growth retardation affects health in later life. Hypothesizing that many of the health challenges faced by women today result from a mismatch between how their bodies have evolved and the contemporary environments in which modern humans live, Trevathan sheds light on the power and potential of examining the human life cycle from an evolutionary perspective, and how this could improve our understanding of women's health and our ability to confront health challenges in more creative, effective ways.
272 pages, Hardcover
First published May 26, 2010
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But fortunately, our long lives provide us with a group of people who have everything to gain from providing care for young children and almost nothing to lose: grandmothers. Some scholars have even argued that helpful grandmothers are the key to the success of the human species.
---
In recent years there have been a lot of interest in the impact of social, psychological, and familial circumstances on the timing of menarche. The mammalian literature is replete with evidence that exposure to adult females can delay puberty and exposure to adult males can accelerate it. The proposed mechanism is pheromonal. One of the effects of pheromones is that changing social circumstances that lead to more woman working outside the home can explain the downward trend in age of menarche in the past few decades. The idea is that similar to what has been described for other mammals, when women of reproductive age are in daily and frequent contact with prepubescent girls, their presence (their pheromones) delay the onset of ovarian function in the girls, but now that most mothers work outside the home, their pheromones are not having the same effect.
---
Psychologist Michele Surbey offered support of this hypothesis in a study of more than 1,200 girls, among whom those who experienced father absence matured earlier than those who were raised by both parents. Furthermore, the younger the girl when her father left, the earlier her menarche, and if she subsequently lived with a stepfather, menarche was even earlier. In other words, long-term exposure to related males seems to delay menarche, whereas exposure to unrelated males appears to accelerate it. If indeed early menarche is associated with an increased risk of breast cancer, it could be argued that being raised by two parents is protective for a number of health risks. This may be a stretch, however, because the both-parents-raising-children model that we have in the United States is far from universal across cultures.
---
The reported variation in ovarian hormones also encourages closer evaluation of oral contraceptives for women who have different hormonal profiles from those of American and Western European women, on whom most of the research and testing of birth control pills are doe. Vitzhum suggests that this can account for the frequently reported difficulties women in health-poor populations have with oral contraceptives. Gillian Bently, nothing that women are adapted for a specific level of steroid hormones to which they were exposed during fetal development, argues that those adapted to low levels have more difficulty metabolizing the hormones in contraceptives designed for women in health-rich populations who experience higher endogenous levels...
---
Evidence that the effectiveness of mammograms is enhanced if done during the follicular phase and that surgery for breast cancer may contribute to better survival when done during the follicular phase lends support to the idea that hormonal variation during the menstrual cycle affects aspects of health other than reproduction.
---
Many aspects of a woman's physiology are altered when she becomes pregnant. One of the most important is that she metabolizes food more efficiently and gets more nutrients from the food she consumes than she does when she is not pregnant. This leads to weight gain even when food intake does not increase or when it decreases.
---
If a woman mates with a man whose histocompatibility genes are similar to hers, the resulting embryo will also be genetically similar to her. In this situation, she may not recognize the embryo when it begins to implant and may not depress her immune system to prevent rejection. One suggestion is that this is an "anti-inbreeding" mechanism and it may also explain why women who have trouble conceiving with one man are easily able to get pregnant when they have a different partner. The mechanism may be particularly important in small populations where genetic diversity would otherwise be low, a phenomenon that probably characterized most of human evolutionary history.
---
A particularly tragic example of the problems that arise when drugs pass to the fetus through the placenta was the use of thalidomide in the 1950s and 1960s as a drug to suppress nausea of pregnancy. When the drug was tested on galagos, primates with thick-barrier placentas, it had no apparent effect on the developing fetus. But when the drug was used by humans, serious limb malformations occurred in the fetus, crippling thousands of European children (fortunately, due to a particularly vigilant member of the U.S. FDA, Frances Oldham Kelsey, the drug was prohibited in the United States).
---
The chemical is closely related to those that cause bitter taste of the cabbage family such as broccoli and brussels sprouts. Tasters (those with the homozygous dominant or heterozygous combination of allels) detect the bitter substance and tend to avoid eating such foods or eat them in small quantities. Nontasters (those with two recessive alleles) are not as aware of the bitter taste and tend to eat the foods in larger quantities. Interestingly, these foods are known as "goitrogens" in that they inhibit the uptake of iodine, which is a problem in populations that consume foods grown in iodine-deficient soils. Before the iodonization of salt, women who avoided eating these bitter foods (because they were tasters) would have been better able to utilize the iodine available and less likely to have children with cretinism. Nontasters may have been more likely to have children with cretinism. Nontasters may have been more likely to eat the foods, and thus their iodine uptake may have been compromised, resulting perhaps in major health problems in their children. So if brussels sprouts are not among your favorite foods, you may be able to thank your aversion to their bitter taste for keeping your ancestors healthy. Furthermore, if the cabbage family vegetables were particularly likely to cuase morning sickness in your mother (as will be discussed next), you may have been protected from developing thyroid problems or even cretinism. Cabbage-family vegetables are among those most frequently cited as causing morning sickness.
--
Clearly, any way that one can reduce stress and exposure to stressors during pregnancy is likely to be beneficial. Considering the dense social networks which our ancestors experienced during pregnancy, it is not surprising that social support enhances the health of both mother and fetus. As we will see in the next chapter, having social support at the time of the birth may have made the difference between life and death for many mothers and babies in the past.
---
The great amount of brain growth that occurs after birth means different things for the infant and the parents. For the mother, energetic investment is greater postnatally than prenatally (pregnancy "costs" an extra 300 calories per day, while lactation "costs" an extra 500 per day beyond her normal needs). And the only way that more dependent infants could survive would be for mothers and fathers to invest more heavily in them in the first several months after birth while the neurological systems necessary for independent function develop.
---
Another reason we may see more evidence of obstructed labor in health-rich populations has to do with the posture that a woman typically assumes during delivery in most hospital births: flat on her back in a position known as lithotomy. It is not hard to see that this is probably the least optimal position for birth in comparison with squatting, sitting upright, or even standing. For one, gravity is working against the fetus when the mother is lying flat on her back. Perhaps this position is best for birth attendants, but it does not appear to be in the best interest of mothers and babies. The most common position for delivery reported in the anthropological literature is seated or semi-reclining, although squatting, kneeling, and standing are also frequent. The flat-on-the-back position is rarely used in other cultures or in nonhospital births in health-rich nations.
---
A recent study of the effect of position on pelvic flexibility has confirmed that the birth canal widens in several dimensions in the standing or squatting positions in comparison with the flat-on-the-back position. Unfortunately, for women who hope to deliver in the squatting position, it is often extremely difficult if they have not spent a lot of time in that position in their everyday lives. In cultures where women routinely squat in delivery, they also squat around cooking fires, for elimination, and in social interactions, so they have the muscle development to support their weight during delivery. If someone is available to support her, however, even a woman who does not routinely squat can deliver in that, potentially more optimal, position.
---
The most common cause of maternal mortality related to birth is postpartum bleeding. When the placenta detaches from the uterine wall, it leaves behind a "wound" of open blood vessels that will continue to bleed if they are not closed. One of the functions of postpartum uterine contractions is to help the uterus "shut down" and close the open blood vessels. This usally proceeds without complications, unless there is a portion of the placenta or other membranes retained in the uterus to get in the way of closure. In hospital deliveries today injections of oxytocin are routinely given to inhibit postpartum hemorrhage, but in the past, what did women and their companions do to prevent excessive blood loss? Just as the mother and her birth companions do a lot of enhance the health and survival of the infant immediately after birth, it appears that the infant has ways of enhancing the health and survival of its mother. Within a few minutes after birth, an infant will begin to lick, nuzzle, or even suckle the mother's breast. These forms of nipple contact stimulate the release of oxytocin into her bloodstream, which results in uterine contractions, expulsion of the placenta, and closure of the open wound left behind by the placenta. If the infant is not able to move towards the mother's breast, stimulation of the nipple by any method available accomplishes the same thing, but it is compelling to think that the infant can save its mother's life by preventing postpartum hemorrhage in a very low-tech way.
---
There are a number of ways in which a mother maintains her infant's health throughout the prenatal and postnatal period that strengthen the notion that the 15-21 months following conception are a continuum of fetal-like development.
---
The World Health Organization recommends that bathing infants should be delayed until a few hours after birth to minimize heat loss, and certainly other important functions of vernix would be compromised by bathing. The anti-infective properties of vernix are equally important in hospital births where it may protect babies from hospital-acquired infections.
---
Mothers all over the world use their voices to soothe their infants and even have a special language known as "motherese." Vocal interactions between mothers and infants of most animal species also serve to maintain proximity and facilitate individual recognition and nursing. Often the maternal vocalizations are high-pitched, complementing the fact that infants are more able to perceive sounds in pitched, complementing the fact that infants are more able to perceive sounds in the higher ranges. Pediatrician Berry Brazelton suggests that the human neonatal nervous system is better able to respond to the higher pitched female voice. Other observers note that mothers seem to "instinctively" elevate the pitch of their voices when talking to their infants, often switching pitch mid-sentence when they move from looking at adults at their infants.
---
If those of us who work in the field of evolutionary medicine made recommendations, here is what we might say mothers should do to reduce the chances of developing more serious mood disorders of the postpartum period: (1) prepare for childbirth so that its physical and emotional stressfulness is reduced, especially by having a supportive companion with the mother at delivery; (2) eat plenty of omega-3 fatty acids through pregnancy and postpartum; (3) breastfeed the infant for at least a year; (4) get as much sleep as possible, even if it means sleeping with the infant (in a safe manner) so as to minimize the disruption caused by breastfeeding; (5) reduce stress from as many sources as possible, even if it means some form of (nondrug) therapy to deal with ones that cannot be controlled; (6) get plenty of exercise, because it counteracts both inflammation and stress (but do not start doing vigorous exercise in pregnancy if exercise has not been routine); (7) keep potentially stressful infant crying to a minimum by breastfeeding frequently and responding to cries as quickly as possible. Even if none of these works to prevent baby blues, they enhance overall health of mothers and infants, so I have no hesitation in proffering them.
---
An evolutionary perspective has a number of things to say about infant crying, most of which suggest that routine, prolonged crying by infants was probably rare in the past. Babies cry for three good reasons: when they are in pain, hungry, or alone. A mother who kept her infant with her all the time and provided opportunities for breastfeeding "on demand" probably did not have an infant who cried for hunger or loneliness, so pain would have been the only reason that a baby cried, and response to that cry of pain was likely immediate. Also notable is that nohuman primate infants rarely cry, and they are also rarely away from their mothers.
---
A number of studies have reported that rocking movements serve to quiet a crying baby, as long as they are above 60 cycles per minute. This occurs at a slow walking speed for humans, suggesting that the positive response to this speed may results from millions of years of being carried on the mother's hip or in a sling around her neck as she foraged for food. One suggestion is that infant development proceeds best when babies are carried and exposed to rhythmic movements of walking. Today's parents try to approximate that speed by placing an infant in a mechanical rocker or swing. As another example, some frustrated parents who want to quiet their colicky infants place them "on top of the washing machine during the agitation cycle."
---
Beyond its importance in securing reproductive success, breastfeeding has numerous health benefits for the mother. Endorphins and oxytocin are released into her system when she breastfeeds - these feel-good opioids and hormones contribute to positive interactions with and feelings about the infant, which enhance the attachment process. They also help to speed her own recovery from labor and delivery and seem to have antistress effects. Miriam Lobbok, a physician has called breastfeeding a "preventative health measure for women" and the "final stage of labor." As I have noted, breastfeeding soon after delivery is one of the best "natural" ways to protect against postpartum hemorrhage, and continuing to breastfeed helps the uterus returns to its pre-pregnant state and the mother to her pre-pregnant weight. In the birth with which I was involved, the midwives always encouraged infant contact with the nipple because other tools for preventing postpartum hemorrhage were not usually available to them.
---
Ideally the pro-family values touted in the United States in recent years would include pro-gamily work conditions that enable, rather than interfere with, breastfeeding.
---
Without takign the commendation to extremes (no birth control, self-imposed under nutrition), it seems possible that by increasing exercise, reducing fat intake, and minimizing exposure to industrial biochemicals, women would experience fewer problems at menopause. In this way, adopting the behaviors and diets of our ancestors may go a long way towards not only reducing the stresses of menopause but prolonging healthy lives as well.
---
If you remember nothing else about an evolutionary approach to women's health, remember that natural selection has favored adaptability and flexibility, and as such we have a lot of control over our health and the health of our descendents. Perhaps somewhere between our evolved bodies and our 21st century bodies is a sort of "happy medium" that represents a "good enough" way of living. Where on that arc a given person finds a place to light is variable and depends on individual as well as sociocultural factors. But some of the information in this book may help in finding that resting spot.
---
Vegetarian diets, particularly when intake is high, are associated with lower levels of estrogen. Low overall caloric intake is also associated with lower estrogen. In contrast, high-fat diets are associated with higher levels. These dietary patterns are related to evolved reproductive strategy in that they signal energy scarcity (vegetarian, high fiber, restricted calories) or plenty (high fat). Fiber, in particular, seems to have an effect on estrogen levels, perhaps due to the phytoestrogens that are common constituents, some of which serve to lower estrogen levels. Quantity of fiber seems to matter. At low levels, phytoestrogens stimulate estrogen production but as high levels, they inhibit it. Additionally, fiber and phytoestrogens consumed by a woman during pregnancy can have the effect of increasing or decreasing cancer risks in her daughters. Fiber intake is notoriously low in many Western diets.
---
From the old aphorism "the life you save may be your own" (apologies to Flannery O-Conner) we now have "the lives you may save may be those of your children, grandchildren, and great grandchildren."
But fortunately, our long lives provide us with a group of people who have everything to gain from providing care for young children and almost nothing to lose: grandmothers. Some scholars have even argued that helpful grandmothers are the key to the success of the human species.
---
In recent years there have been a lot of interest in the impact of social, psychological, and familial circumstances on the timing of menarche. The mammalian literature is replete with evidence that exposure to adult females can delay puberty and exposure to adult males can accelerate it. The proposed mechanism is pheromonal. One of the effects of pheromones is that changing social circumstances that lead to more woman working outside the home can explain the downward trend in age of menarche in the past few decades. The idea is that similar to what has been described for other mammals, when women of reproductive age are in daily and frequent contact with prepubescent girls, their presence (their pheromones) delay the onset of ovarian function in the girls, but now that most mothers work outside the home, their pheromones are not having the same effect.
---
Psychologist Michele Surbey offered support of this hypothesis in a study of more than 1,200 girls, among whom those who experienced father absence matured earlier than those who were raised by both parents. Furthermore, the younger the girl when her father left, the earlier her menarche, and if she subsequently lived with a stepfather, menarche was even earlier. In other words, long-term exposure to related males seems to delay menarche, whereas exposure to unrelated males appears to accelerate it. If indeed early menarche is associated with an increased risk of breast cancer, it could be argued that being raised by two parents is protective for a number of health risks. This may be a stretch, however, because the both-parents-raising-children model that we have in the United States is far from universal across cultures.
---
The reported variation in ovarian hormones also encourages closer evaluation of oral contraceptives for women who have different hormonal profiles from those of American and Western European women, on whom most of the research and testing of birth control pills are doe. Vitzhum suggests that this can account for the frequently reported difficulties women in health-poor populations have with oral contraceptives. Gillian Bently, nothing that women are adapted for a specific level of steroid hormones to which they were exposed during fetal development, argues that those adapted to low levels have more difficulty metabolizing the hormones in contraceptives designed for women in health-rich populations who experience higher endogenous levels...
---
Evidence that the effectiveness of mammograms is enhanced if done during the follicular phase and that surgery for breast cancer may contribute to better survival when done during the follicular phase lends support to the idea that hormonal variation during the menstrual cycle affects aspects of health other than reproduction.
---
Many aspects of a woman's physiology are altered when she becomes pregnant. One of the most important is that she metabolizes food more efficiently and gets more nutrients from the food she consumes than she does when she is not pregnant. This leads to weight gain even when food intake does not increase or when it decreases.
---
If a woman mates with a man whose histocompatibility genes are similar to hers, the resulting embryo will also be genetically similar to her. In this situation, she may not recognize the embryo when it begins to implant and may not depress her immune system to prevent rejection. One suggestion is that this is an "anti-inbreeding" mechanism and it may also explain why women who have trouble conceiving with one man are easily able to get pregnant when they have a different partner. The mechanism may be particularly important in small populations where genetic diversity would otherwise be low, a phenomenon that probably characterized most of human evolutionary history.
---
A particularly tragic example of the problems that arise when drugs pass to the fetus through the placenta was the use of thalidomide in the 1950s and 1960s as a drug to suppress nausea of pregnancy. When the drug was tested on galagos, primates with thick-barrier placentas, it had no apparent effect on the developing fetus. But when the drug was used by humans, serious limb malformations occurred in the fetus, crippling thousands of European children (fortunately, due to a particularly vigilant member of the U.S. FDA, Frances Oldham Kelsey, the drug was prohibited in the United States).
---
The chemical is closely related to those that cause bitter taste of the cabbage family such as broccoli and brussels sprouts. Tasters (those with the homozygous dominant or heterozygous combination of allels) detect the bitter substance and tend to avoid eating such foods or eat them in small quantities. Nontasters (those with two recessive alleles) are not as aware of the bitter taste and tend to eat the foods in larger quantities. Interestingly, these foods are known as "goitrogens" in that they inhibit the uptake of iodine, which is a problem in populations that consume foods grown in iodine-deficient soils. Before the iodonization of salt, women who avoided eating these bitter foods (because they were tasters) would have been better able to utilize the iodine available and less likely to have children with cretinism. Nontasters may have been more likely to have children with cretinism. Nontasters may have been more likely to eat the foods, and thus their iodine uptake may have been compromised, resulting perhaps in major health problems in their children. So if brussels sprouts are not among your favorite foods, you may be able to thank your aversion to their bitter taste for keeping your ancestors healthy. Furthermore, if the cabbage family vegetables were particularly likely to cuase morning sickness in your mother (as will be discussed next), you may have been protected from developing thyroid problems or even cretinism. Cabbage-family vegetables are among those most frequently cited as causing morning sickness.
--
Clearly, any way that one can reduce stress and exposure to stressors during pregnancy is likely to be beneficial. Considering the dense social networks which our ancestors experienced during pregnancy, it is not surprising that social support enhances the health of both mother and fetus. As we will see in the next chapter, having social support at the time of the birth may have made the difference between life and death for many mothers and babies in the past.
---
The great amount of brain growth that occurs after birth means different things for the infant and the parents. For the mother, energetic investment is greater postnatally than prenatally (pregnancy "costs" an extra 300 calories per day, while lactation "costs" an extra 500 per day beyond her normal needs). And the only way that more dependent infants could survive would be for mothers and fathers to invest more heavily in them in the first several months after birth while the neurological systems necessary for independent function develop.
---
Another reason we may see more evidence of obstructed labor in health-rich populations has to do with the posture that a woman typically assumes during delivery in most hospital births: flat on her back in a position known as lithotomy. It is not hard to see that this is probably the least optimal position for birth in comparison with squatting, sitting upright, or even standing. For one, gravity is working against the fetus when the mother is lying flat on her back. Perhaps this position is best for birth attendants, but it does not appear to be in the best interest of mothers and babies. The most common position for delivery reported in the anthropological literature is seated or semi-reclining, although squatting, kneeling, and standing are also frequent. The flat-on-the-back position is rarely used in other cultures or in nonhospital births in health-rich nations.
---
A recent study of the effect of position on pelvic flexibility has confirmed that the birth canal widens in several dimensions in the standing or squatting positions in comparison with the flat-on-the-back position. Unfortunately, for women who hope to deliver in the squatting position, it is often extremely difficult if they have not spent a lot of time in that position in their everyday lives. In cultures where women routinely squat in delivery, they also squat around cooking fires, for elimination, and in social interactions, so they have the muscle development to support their weight during delivery. If someone is available to support her, however, even a woman who does not routinely squat can deliver in that, potentially more optimal, position.
---
The most common cause of maternal mortality related to birth is postpartum bleeding. When the placenta detaches from the uterine wall, it leaves behind a "wound" of open blood vessels that will continue to bleed if they are not closed. One of the functions of postpartum uterine contractions is to help the uterus "shut down" and close the open blood vessels. This usally proceeds without complications, unless there is a portion of the placenta or other membranes retained in the uterus to get in the way of closure. In hospital deliveries today injections of oxytocin are routinely given to inhibit postpartum hemorrhage, but in the past, what did women and their companions do to prevent excessive blood loss? Just as the mother and her birth companions do a lot of enhance the health and survival of the infant immediately after birth, it appears that the infant has ways of enhancing the health and survival of its mother. Within a few minutes after birth, an infant will begin to lick, nuzzle, or even suckle the mother's breast. These forms of nipple contact stimulate the release of oxytocin into her bloodstream, which results in uterine contractions, expulsion of the placenta, and closure of the open wound left behind by the placenta. If the infant is not able to move towards the mother's breast, stimulation of the nipple by any method available accomplishes the same thing, but it is compelling to think that the infant can save its mother's life by preventing postpartum hemorrhage in a very low-tech way.
---
There are a number of ways in which a mother maintains her infant's health throughout the prenatal and postnatal period that strengthen the notion that the 15-21 months following conception are a continuum of fetal-like development.
---
The World Health Organization recommends that bathing infants should be delayed until a few hours after birth to minimize heat loss, and certainly other important functions of vernix would be compromised by bathing. The anti-infective properties of vernix are equally important in hospital births where it may protect babies from hospital-acquired infections.
---
Mothers all over the world use their voices to soothe their infants and even have a special language known as "motherese." Vocal interactions between mothers and infants of most animal species also serve to maintain proximity and facilitate individual recognition and nursing. Often the maternal vocalizations are high-pitched, complementing the fact that infants are more able to perceive sounds in pitched, complementing the fact that infants are more able to perceive sounds in the higher ranges. Pediatrician Berry Brazelton suggests that the human neonatal nervous system is better able to respond to the higher pitched female voice. Other observers note that mothers seem to "instinctively" elevate the pitch of their voices when talking to their infants, often switching pitch mid-sentence when they move from looking at adults at their infants.
---
If those of us who work in the field of evolutionary medicine made recommendations, here is what we might say mothers should do to reduce the chances of developing more serious mood disorders of the postpartum period: (1) prepare for childbirth so that its physical and emotional stressfulness is reduced, especially by having a supportive companion with the mother at delivery; (2) eat plenty of omega-3 fatty acids through pregnancy and postpartum; (3) breastfeed the infant for at least a year; (4) get as much sleep as possible, even if it means sleeping with the infant (in a safe manner) so as to minimize the disruption caused by breastfeeding; (5) reduce stress from as many sources as possible, even if it means some form of (nondrug) therapy to deal with ones that cannot be controlled; (6) get plenty of exercise, because it counteracts both inflammation and stress (but do not start doing vigorous exercise in pregnancy if exercise has not been routine); (7) keep potentially stressful infant crying to a minimum by breastfeeding frequently and responding to cries as quickly as possible. Even if none of these works to prevent baby blues, they enhance overall health of mothers and infants, so I have no hesitation in proffering them.
---
An evolutionary perspective has a number of things to say about infant crying, most of which suggest that routine, prolonged crying by infants was probably rare in the past. Babies cry for three good reasons: when they are in pain, hungry, or alone. A mother who kept her infant with her all the time and provided opportunities for breastfeeding "on demand" probably did not have an infant who cried for hunger or loneliness, so pain would have been the only reason that a baby cried, and response to that cry of pain was likely immediate. Also notable is that nohuman primate infants rarely cry, and they are also rarely away from their mothers.
---
A number of studies have reported that rocking movements serve to quiet a crying baby, as long as they are above 60 cycles per minute. This occurs at a slow walking speed for humans, suggesting that the positive response to this speed may results from millions of years of being carried on the mother's hip or in a sling around her neck as she foraged for food. One suggestion is that infant development proceeds best when babies are carried and exposed to rhythmic movements of walking. Today's parents try to approximate that speed by placing an infant in a mechanical rocker or swing. As another example, some frustrated parents who want to quiet their colicky infants place them "on top of the washing machine during the agitation cycle."
---
Beyond its importance in securing reproductive success, breastfeeding has numerous health benefits for the mother. Endorphins and oxytocin are released into her system when she breastfeeds - these feel-good opioids and hormones contribute to positive interactions with and feelings about the infant, which enhance the attachment process. They also help to speed her own recovery from labor and delivery and seem to have antistress effects. Miriam Lobbok, a physician has called breastfeeding a "preventative health measure for women" and the "final stage of labor." As I have noted, breastfeeding soon after delivery is one of the best "natural" ways to protect against postpartum hemorrhage, and continuing to breastfeed helps the uterus returns to its pre-pregnant state and the mother to her pre-pregnant weight. In the birth with which I was involved, the midwives always encouraged infant contact with the nipple because other tools for preventing postpartum hemorrhage were not usually available to them.
---
Ideally the pro-family values touted in the United States in recent years would include pro-gamily work conditions that enable, rather than interfere with, breastfeeding.
---
Without takign the commendation to extremes (no birth control, self-imposed under nutrition), it seems possible that by increasing exercise, reducing fat intake, and minimizing exposure to industrial biochemicals, women would experience fewer problems at menopause. In this way, adopting the behaviors and diets of our ancestors may go a long way towards not only reducing the stresses of menopause but prolonging healthy lives as well.
---
If you remember nothing else about an evolutionary approach to women's health, remember that natural selection has favored adaptability and flexibility, and as such we have a lot of control over our health and the health of our descendents. Perhaps somewhere between our evolved bodies and our 21st century bodies is a sort of "happy medium" that represents a "good enough" way of living. Where on that arc a given person finds a place to light is variable and depends on individual as well as sociocultural factors. But some of the information in this book may help in finding that resting spot.
---
Vegetarian diets, particularly when intake is high, are associated with lower levels of estrogen. Low overall caloric intake is also associated with lower estrogen. In contrast, high-fat diets are associated with higher levels. These dietary patterns are related to evolved reproductive strategy in that they signal energy scarcity (vegetarian, high fiber, restricted calories) or plenty (high fat). Fiber, in particular, seems to have an effect on estrogen levels, perhaps due to the phytoestrogens that are common constituents, some of which serve to lower estrogen levels. Quantity of fiber seems to matter. At low levels, phytoestrogens stimulate estrogen production but as high levels, they inhibit it. Additionally, fiber and phytoestrogens consumed by a woman during pregnancy can have the effect of increasing or decreasing cancer risks in her daughters. Fiber intake is notoriously low in many Western diets.
---
From the old aphorism "the life you save may be your own" (apologies to Flannery O-Conner) we now have "the lives you may save may be those of your children, grandchildren, and great grandchildren."
April 6, 2012
Laid out very well and plainly - and especially topical for me at the moment (in week 31 of pregnancy).
Really I think the book deserves an A, but I'm withholding that grade in favor of a B because I don't think it's quite as accessible to a non-specialist audience as the book was hoping to be. I'd definitely, definitely use it for a class or a book group, though!
Really I think the book deserves an A, but I'm withholding that grade in favor of a B because I don't think it's quite as accessible to a non-specialist audience as the book was hoping to be. I'd definitely, definitely use it for a class or a book group, though!
August 27, 2018
To be fair, I skin read this & it may be better then my initial impression. My impression is that I'm glad to see these topics being brought up but I still see a lot of theory & male perspective used as examples on this book, almost as if the writer doesn't realize it herself. This is how engrained a male perspective has been in our western medical history. I am looking forward to a time where we have evolved to really understand & treat our female bodies as they deserve. There is too much pain & not enough understanding or relief.
June 27, 2018
Excellent read. Everyone should read this book, but of course women especially. It really makes you think about your body differently in contrast to what Western medicine often deems as “problematic.” The actual text is really only 196 pages while the rest of the book consists of notes and refernences.
October 4, 2024
4.5 *
Love this book! It is a bit dated but the learnings are salient and relevant even today!
Love this book! It is a bit dated but the learnings are salient and relevant even today!
April 18, 2014
The dominant metaphor in medicine these days is that the body is a machine. When it breaks, you look at the blueprints, or go to someone who has the blueprints (a doctor) and try to fix it. A useful metaphor to an extent, but when you consider the body as an evolved form that has been shaped by forces favoring reproduction for millions of years, it is more helpful to look at the body as a bundle of compromises. Compromises that have favored reproduction (that's how natural selection works), maybe even at the cost of long-term health and longevity.
An evolutionary approach to health addresses the mismatch between our evolved bodies and our physical lifestyles. Because cultural evolution has outpaced biological evolution (think of game-changers like agriculture, birth control, modern medicine, etc.), the way we live doesn't always match up with how our bodies have evolved to work.
This well-researched book covers all the major phases in a woman's life with regard to her one evolved purpose: reproduction. This is not to argue that reproduction in the most important function of a woman's identity, but that her health cannot be understood outside of the way her body has evolved.
This book also inadvertently helped me understand the evolutionary approach to the paleo diet as well (though the anthropologist author does not address this in the book). The idea is not so much to mimic paleolithic living as it is to recognize that we are already living in paleolithic bodies! The argument is not one of complete biological determism (of which I am a staunch opponent) because it's very premise is that we live in a unique environment created by culture, and this is what creates a challenge for our health. Adding Trevathan's view of the body as a bundle of compromises shaped for reproduction is an often-missing piece to the dietary puzzle, and I have much more exploring to do!
An evolutionary approach to health addresses the mismatch between our evolved bodies and our physical lifestyles. Because cultural evolution has outpaced biological evolution (think of game-changers like agriculture, birth control, modern medicine, etc.), the way we live doesn't always match up with how our bodies have evolved to work.
This well-researched book covers all the major phases in a woman's life with regard to her one evolved purpose: reproduction. This is not to argue that reproduction in the most important function of a woman's identity, but that her health cannot be understood outside of the way her body has evolved.
This book also inadvertently helped me understand the evolutionary approach to the paleo diet as well (though the anthropologist author does not address this in the book). The idea is not so much to mimic paleolithic living as it is to recognize that we are already living in paleolithic bodies! The argument is not one of complete biological determism (of which I am a staunch opponent) because it's very premise is that we live in a unique environment created by culture, and this is what creates a challenge for our health. Adding Trevathan's view of the body as a bundle of compromises shaped for reproduction is an often-missing piece to the dietary puzzle, and I have much more exploring to do!
August 15, 2013
Really a 2.5, this was initially quite interesting as the author discussed evolution and its effect on women's health today. However, much of the book - which was quite academic - was devoted to pushing her agenda on breastfeeding and co-sleeping. She did not discuss studies or results that didn't agree with her hypotheses (for instance: if a higher number of ovulatory cycles - due to fewer pregnancies and less breastfeeding - leads to increased rates in breast and ovarian cancers, then why did the chart in the book show that China - with its one child policy - has the lowest rates of those surveyed?).
January 2, 2011
Excellent book.
Read
May 14, 2012Facts and theories abound! So great! Made for every woman to read!!!!
December 7, 2021
The part about cholesterol and animals foods is more agenda, than science, but for the most part it is a good book. 4/5
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