FROM ISOLATION TO MODERNITY: DEMOGRAPHIC TRANSITION AND PUBLIC HEALTH CHANGES IN TENGANAN PAGERINGSINGAN (BALI PDF

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FROM ISOLATION TO MODERNITY: DEMOGRAPHIC TRANSITION AND PUBLIC HEALTH CHANGES IN TENGANAN PAGERINGSINGAN (BALI) OVER TWO DECADES: 1976-1995. Georges BREGUET, bio-anthropologist (Geneva) and Roland NEY, medical doctor (Lausanne). SUMMARY Before the 1970's, the community of Tenganan Pageringsingan...

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FROM ISOLATION TO MODERNITY: DEMOGRAPHIC TRANSITION AND PUBLIC HEALTH CHANGES IN TENGANAN PAGERINGSINGAN (BALI) OVER TWO DECADES: 1976-1995. Georges BREGUET, bio-anthropologist (Geneva) and Roland NEY, medical doctor (Lausanne).

SUMMARY Before the 1970's, the community of Tenganan Pageringsingan, which is located in the eastern part of Bali, was known by anthropologists to be one of the most secluded societies of the archipelago. Its population, which has been decreasing in size since the beginning of the 20th century and is currently amounting about 300 people, practised unique and very complex religious rites which were related to strict endogamic rules. Morbidity associated with a strong infant mortality were classical tropical features. Traditional sanitary practices and traditional healing were the most common treatments. Rapid changes have occurred in the village since the 70's:, such as the development of local communications by the central government, the opening up to tourism, the breaking of the endogamic rules, a spectacular decrease in infant mortality and in general morbidity, and an improvement in sanitary practices. All these changes have been observed, analysed, and quantified by both a bio-anthropologist (G.B.) and a medical doctor (R.N.) who, between 1976 until 1995 during numerous missions, recorded genealogy, family history, medical history and medical examination of all the individuals of the above-mentioned community.

Paper presented at the Third International Bali Studies Workshop, The University of Sydney, 3-7 July 1995, at the Annual International Meeting of the Society for Balinese Studies, Denpasar - Bali, 13-15 July 1995, and at the Annual Meeting of the Swiss Academy of Sciences (Société Suisse d'Anthropologie), St Gall, 8 September 1995.

Address for correspondence and reprints: Georges BREGUET 7, rue Jean-Calvin 7 CH-1204 Geneva - Switzerland e-mail: [email protected]

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1. INTRODUCTION The village of Tenganan Pageringsingan (115˚33'E/8˚29'S) is located in the south eastern part of the Indonesian province of Bali, kebupaten Karangasem, kecamatan Manggis; 3 km distant from the sea at an altitude of 40 meters. The village is located in a small valley surrounded by hills which form an arc of a circle around it (Figure 1). Figure 1. View of Tenganan Pageringsingan from the south kelod.

The territory which is connected to the community (1'105 ha.) mainly consists of dry grounds (tegalan 600 ha.), irrigated rice-fields (sawah 280 ha.) and secondary forests. It is very important to underline that the members of the community due not themselves work in the fields, this duty being left to close by villages which will supply the sharecroppers. The main agricultural production is the rice in the sawah, the tubers and corn in the tegalan, coconuts, fruits, sugar and palm wine in the forests. Breeding is restricted to the water-buffalo (ritual function only), to the Balinese cow (outside the village), to the black pig (at the rear the houses) and to the fighting cock (ritual function only). Since the seventies, the village has become an important center of cultural tourism in Bali. Thanks to the building of hotels in Candi Dasa, the nearest beach, in the eighties, and the important promotion of tourism by the government in the nineties, the number of tourists has appreciably increased. In order to fulfil this tourist demand, some residents have changed their activities and therefore increased their income, this leading paradoxically to a more or less important increase of their banking debt. Tenganan Pageringsingan could be descripted as an "old-Balinese" community of which the social organisation is based on communal land tenure, gerontocratic political control and a lack of high caste (triwangsa) families. It is also renowned for its unique double-ikat clothes production and its extreme cultural conservatism. Amongst the more significant anthropological studies which have been carried out on this subject, let us mention the studies made by Korn (1933), Ramseyer (1984) and Français (1989). What

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most strikes the visitor, is the architectural unity of the village, which forms a large quadrilateral 500 meters long by 250 meters wide (Figure 2). This quadrilateral is divided by three large parallel streets which are bordered with houses (in the west is the banjar kauh, in the middle the banjar tengah, in the east the banjar pande), oriented in the sacred direction running from the sea (kelod) to the volcano Agung (kaja). Figure 2. Map of TENGANAN & BANJAR PANDE.

The members of the Tenganan Pageringsingan's religious community are obliged to live in the first (banjar kauh) or second street (banjar tengah). An habitation parcel which is located in one of these two streets will be allotted to each married couple. People living in this part of the village will be designated as TENGANAN. The rows of houses lining the third street (banjar pande) form a particular social entity. While the northern side (banjar pande kaja) is inhabited by former members who have been rejected from the religious community and their descendants, the southern side (banjar pande kelod) is inhabited by

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immigrants from other villages, and also by two large important families: the Pande and the Pasek. These people will be designated as BANJAR PANDE. In 1979, more than 350 people were living in gardens located outside the village. The following villages are also included with Tenganan Pageringsingan within the Desa Dinas Tenganan, the local administrative unit: Dauh Tukad, Gumung, Bukit Kauh and Bukit Kangin. In 1979, this unit contained a total of 3,170 residents. In this article, we will only focus on the demographic and bio-medical analysis of Tenganan Pageringsingan (TENGANAN + BANJAR PANDE). This study which took place between 1976 to 1995, will focus on the 16 year period from 1979 until 1994 with reference to one of our former publications (Breguet 1983) in which the same data were analysed over another 16 year period (1963-1978). Globally the main differences between TENGANAN and BANJAR PANDE can be summarised as follows: - a difference of social status and prestige: the members of TENGANAN are the elected ones. The BANJAR PANDE does not benefit from a real autonomy, as its social existence is completely related to TENGANAN. - a difference of social obligations: TENGANAN's members are bound by many ritual obligations, which is not the case for BANJAR PANDE's members. Nowadays and especially with regard to young people, these obligations may constitute a handicap toward modernisation, professional development and love life. - a difference of fortune and income: due to the organisation of their property estates, their management of the income from tourism and their importance in fabric production, TENGANAN members are significantly wealthier and their income is higher than that of BANJAR PANDE's members. However, there are some exceptions to this definition as, for instance, the rich Pasek family in BANJAR PANDE or some very poor families in TENGANAN. - a difference in nutritional supply: with social differences leading to biological differences. The nutritional input is therefore more important and varied in TENGANAN, with an emphasis on animal proteins due to their numerous ritual sacrifices. Finally, living conditions and health have improved more in TENGANAN than in BANJAR PANDE. However, this difference is tempered since the Indonesian administration is bound by law to the equal treatment of the members of booth communities.

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2. MARRIAGE Marriage structure In TENGANAN, a wedding between an uncle and his niece as well as a marriage between first cousins will be considered as incestuous and will therefore be strictly prohibited. But this rule seems not to be in force elsewhere in Bali, including BANJAR PANDE. In TENGANAN, the ideal type of marriage seems to be the union between second cousins. In 1978, the percentage of this kind of marriage amounted to 12%, to which we can add 4% for marriages between first cousins once removed; however this last kind of marriage was not recommended as taking place between two different generations. In 1978, on the basis of 37 couples (46% of the total number of living couples) whose marriages were arranged by their families, 90% of the cases showed a family relationship within the married couple. This proportion decreased to 50% in another group which was analysed (54% of the total number of couples) where wife and husband chose each other. It seems that, during these past 16 years, marriages arranged by the families have become an exception. Endogamy As specified by the constitution (awig awig), endogamy is a strict obligation within the community. Actually, if someone is willing to become a member of the Council (kerama desa) he is strictly bound by this rule. From 1876 until 1925, only two women came from outside, that is to say an exogamy rate of 1%. Since 1925, we have noted a slight increase of exogamic marriages, due to a modification of the constitution wherein authorised unions have been precisely codified: the wife must either originate from the neighbouring village of Ngis, or be the issue of a Pasek, Bendesa or Pande's family or be fescended from a high caste (triwangsa). A marriage between a woman originally from TENGANAN with a man foreign to the village will irrevocably lead to their rejection from the community. The same conclusion applies to a marriage occurring between a man from TENGANAN and a woman coming from outside, this kind of marriage not being admitted by the rules and generally the deportees will be directed towards BANJAR PANDE. Polygamy is forbidden to those individuals who are willing to remain members of the kerama desa. Contrarily to widows, widowers are authorised to remarry. Literally speaking, divorce does not exist when it is possible to live separated. Extra-marital relationships may happen but are risky. People who will infringe these regulations will not only be fined but could also be deported to BANJAR PANDE (see Korn 1933 for some examples). From 1925 until 1978, we have counted 11 exogamic marriages in TENGAGAN, this means 8% of total marriages. In recent yaers we have noted an important modification since, of the 35 weddings which were celebrated between 1979 and 1994, 11 were exogamic ones; that is to say 31%, which represents during these 16 years the same numbers of wives from outside as during the previous 50 years. The most current explanation we can give about this wave of exogamic marriage which breaks the traditional custom and impedes a man to enter into the village's council, is that modern education gives young students the chance to meet young girls from other villages. Moreover, if it occurs that one of these young girls becomes pregnant following pre-marital relationships, the young man will be obliged to marry her

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quickly. On the other hand, these young people could not consider that loosing a seat in the village's council will represent an important failure for them. In the contrary, it will even be an opportunity for those young people who are willing to lead a career outside the village, as they will not be handicapped any longer by the ritual obligations resulting from a seat in the council during their professional life. The consequence of these marital choices is that the council is deprived of a part of the best educated young people. It also interesting to note that in TENGANAN the inbreeding coefficient (calculated according to genetics methods) between two second cousins is the same, due to the long term endogamy, as the one between two first cousins in an exogamic population like the one of BANJAR PANDE (Breguet 1983). As a matter of fact, in BANJAR PANDE there is no obligation for marriage to meet the village's endogamic requirements (43% of exogamic marriages between 1901 and 1978). However, this rate must be lowered due to a "family" (dadia) endogamy which has been more particularly recorded in the Pasek and Pande families. Compared to TENGANAN, BANJAR PANDE's marriage structure is more opened and less consanguine. Polygamy is allowed, divorces and remarriages do happen frequently. Finally, it seems that generally speaking the forming of couples and the expression of sexuality are more liberated there than in TENGANAN (Breguet 1983). Of the 43 marriages which have been celebrated in BANJAR PANDE between 1979 and 1994, 24 (56%) were, geographically speaking, exogamic ones. We can therefore state that actually the majority of marriages in BANJAR PANDE are included in this scheme. 3. DEMOGRAPHY Size of the populations Korn (1933) estimated that TENGANAN's population in 1926 was 415 residents, and quoted as follows: "As far as I can go back in times, population is decreasing". According to an oral information, we have been told that around 1885, a TENGANAN resident who just got married was obliged to move to BANJAR PANDE as the 133 housing parcels of TENGANAN were already occupied. In our opinion and following this information, we estimate that demography has been reaching its highest level (approximately 450 residents) around this date (1885). Since December 31st, 1962, strengths are known very precisely (Table 1 and Figure 3), the decrease (-138 individuals) in TENGANAN's population from 1926 until 1963 (36 years) amounts to 33%. Hence, the populations shows a relative stability from 1963 until 1978 (16 years) with an increase from 277 residents to 291 (+14 individuals, +5%), and this in spite of an important smallpox epidemic which killed 16 individuals in 1966. During the last 16 years (19791994), we have noticed a slow but regular increase of the population: from 291 to 317 residents, representing a growth of 26 individuals (+9%).

BANJAR PANDE tendencies are totally different. Its population which was estimated by Korn (1933) to be of 188 residents in 1926, was of 229 residents at the end of 1962; that is to say a growth (+41 individuals) of BANJAR PANDE's population from 1926 until 1963 (36 years) of 22%. Hence the

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number is continuing to increase despite 29 persons who emigrated (transmigrasi) in 1966 to the province of Lampung (Sumatra). We should point out that about 15 of these people came back to BANJAR PANDE some years later. Growth occurs from 229 to 262 (+33 individuals, +14%) from 1963 until 1978 (16 years) as well from 262 to 329 (+67 individuals, +26%) from 1979 to 1994 (16 years). The graphic (Figure 3) clearly shows the relative evolution of these two populations; since 1990 BANJAR PANDE's population has overtaken that of TENGANAN.

Table 1. Populations of TENGANAN and BANJAR PANDE (1963-1994). Date 31/12/62 31/12/63 31/12/64 31/12/65 31/12/66 31/12/67 31/12/68 31/12/69 31/12/70 31/12/71 31/12/72 31/12/73 31/12/74 31/12/75 31/12/76 31/12/77 31/12/78 31/12/79 31/12/80 31/12/81 31/12/82 31/12/83 31/12/84 31/12/85 31/12/86 31/12/87 31/12/88 31/12/89 31/12/90 31/12/91 31/12/92 31/12/93 31/12/94

M. 132 132 138 136 131 133 126 129 131 132 132 137 138 138 137 137 138 137 142 137 141 142 144 150 149 149 152 157 158 157 160 161 163

F. 145 145 149 146 141 144 143 142 138 140 142 145 147 150 154 150 153 152 148 148 152 150 149 152 154 153 150 151 152 155 155 155 154

TENGANAN Total 277 277 287 282 272 277 269 271 269 272 274 282 285 288 291 287 291 289 290 285 293 292 293 302 303 302 302 308 310 312 315 316 317

M. 110 112 97 97 97 96 98 99 103 105 107 108 115 122 121 124 126 132 130 129 132 134 137 138 140 141 142 142 143 145 147 149 150

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F. 109 115 99 99 102 101 100 106 112 116 119 120 122 127 131 135 136 139 138 139 141 147 147 154 154 154 158 165 170 172 175 176 179

BANJAR PANDE Total 219 227 196 196 199 197 198 205 215 221 226 228 237 249 252 259 262 271 268 268 273 281 284 292 294 295 300 307 313 317 322 325 329

Structure and dynamic of the populations The distribution by ages shown in the demographic pyramids (Figure 4) illustrates the structural differences which exist between BANJAR PANDE and TENGANAN. The mean age is 31.1 years in BANJAR PANDE, while it is 34.4 years in TENGANAN. These rates are high, compared to the mean age of the Balinese population, which averages 25 years. Figure 3 DEMOGRAPHIC EVOLUTION 1962-1978-1994 340 320

TENGANAN

300 280 260 240 220

BANJAR PANDE

200

31.12.94

31.12.92

31.12.90

31.12.88

31.12.86

31.12.84

31.12.82

31.12.80

31.12.78

31.12.76

31.12.74

31.12.72

31.12.70

31.12.68

31.12.66

31.12.64

31.12.62

180

It is difficult to analyse the structure of TENGANAN's population. Indeed, we must understand that its strict social rules are impeding the demographic balance by means of immigration and emigration. For example, some new social problems are arising at random: 47 male births compared to 31 female births which took place between 1979 and 1994 (Table 2), so as to say a difference of 16 males. This difference is dependant on the hazardous variation of the sex-ratio at birth, and is not the consequence of any biological manipulation such as abortion, for instance, which would be made following knowledge of the sex of the child during pregnancy... This technical improvement is still unknown in Bali! But this lack of balance may lead, within a few years, to an additional breaking of endogamy, as a result of a lack of local young girls available for marriage. This kind of imbalance in favour of women, is shown in the 20-29 and 30-39 years' series of the TENGANAN's demographic pyramid (18 more women than men). This lack of balance is not only a result of the partial breaking down of endogamy, whith 11 women coming from outside during these past 16 years, while 9 young girls emigrated after marriage with a man from outside. It is also a result of the greater mortality of male babies in their first year, as recorded between the years 1963-1978. By noticing the growth of TENGANAN's population (+21.7 individuals between the two periods which were studied) we could believe that both an improvement of the demographic situation and a slight increase of the mean age (+1.9 year) took place between the end of 1978 (32.5) and the end of 1994 (34.4). But in fact, according to the data shown in Table 2, we can notice that this increase is not due principally to a variation of the birth-rate; it is mainly a result of a decrease of the death rate (a 42% drop between 1979-94 as compared to 1963-78) subsequent to radical changes which have occurred in sanitary and medical conditions (which subject will be developed further on).

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Figure 4. Population pyramids (TENGANAN & BANJAR PANDE).

MEN N=163

WOMEN N=154

TENGANAN

90 to 99 y ears 80 to 89 y ears 70 to 79 y ears 60 to 69 y ears 50 to 59 y ears 40 to 49 y ears 30 to 39 y ears 20 to 29 y ears 10 to 19 y ears 0 to 9 y ears

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-30

-10

10

30

50

31.12.1994

MEN N=150

BANJAR PANDE

-30

-10

WOMEN N=179

90 to 99 y ears 80 to 89 y ears 70 to 79 y ears 60 to 69 y ears 50 to 59 y ears 40 to 49 y ears 30 to 39 y ears 20 to 29 y ears 10 to 19 y ears 0 to 9 y ears

-50

10

30

50

31.12.1994

This decrease in mortality is spectacular especially with respect to infants who are younger than one year (-100%), but is also very important with regards to children from 1 to 19 years old (-93%). This mortality decrease is still noticeable concerning adults from 20 to 49 years old (-53%). The recent evolution of TENGANAN's sanitary and medical conditions will be analysed later on. In fact and paradoxically, there is also a noticeable decrease of the birth-rate (-...