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A Brief History of Barrayar
The planet Barrayar was settled by colonists who traveled there through a wormhole. However, the wormhole collapsed unexpectedly, sealing off Barrayar from the rest of the galaxy. This is now known as the "Time of Isolation". Terraforming, which had started out methodically, turned to chaos as the colonists turned every resource to survival. The technology that the colonists had brought with them was lost or was irreplaceable, and a non-technical feudal society eventually became the norm.
During this time, mutations started appearing within the population. Without technology or advanced medical capabilities and given the difficulty of survival on the planet, mutations were to be cut out of the genome by killing the deformed infants. The women were responsible for maintaining the genome, and many cultural practices where implemented, including a complete inspection of the bride and groom prior to marriage -- to insure that they did not carry any genetic problems. Even the betrothal ritual includes a knife as a symbol of being free from genetic defects and what needs to happen just in case there should be a problem.
The Time of Isolation is ended when a new wormhole route to Barrayar is found. Barrayar quickly catches up to galactic standard, particularly after they are invaded by the Cetagandan Empire. The Cetagandans have trouble taking over the planet, as the Barrayarans dig in and wage a guerilla war on the invaders. Eventually, the Cetagandans are driven from the planet and Barrayar becomes a force in its own right.
The Barrayarans build up their military might and engage in a number of decisive campaigns, first and not least, one against the planet Komarr, who had allowed the Cetagandans through the only wormhole with access to Barrayar. Determined not to allow that to happen again, Barrayar takes control of Komarr and starts the beginning of a Barrayaran empire.
However, back on the planet, even though the time of isolation is over, the views against mutants and others with disabilities still continues. The long standing cultural traditions have grave results for anyone who is seen to have a handicap. As a result, anyone who is deformed or disabled in any way is likely to be discriminated against -- or worse. Unprovoked attacks on disabled people are part and parcel of the cultural conditioning. Despite medical technology which can fix most problems - including the ability to fix problems at the genetic level, do complete body modifications, clone humans and even replace Miles' fragile bones with synthetic ones, the remote areas of Barrayar are still sites of infanticide. People with physical disabilities are often viewed as mutants - even "normal" birth defects. Hex signs are displayed at people with disabilities to ward off the evil. Folk stories from the Time of Isolation cast mutants into the roles of evil villains, and these stories are still told to children.
Culturally, it is going to take time for change. And changes have occurred - otherwise Miles would never have survived this far. But this is the world that Miles lives in and with which he must contend.