Brigitte Bagnol

Vaginal practices: eroticism and implications for women's health and condom use in Mozambique.

This paper analyses two female sexual practices in Tete Province, Mozambique: (1) the practice of elongating the labia minora and (2) what is sometimes called ‘dry sex’ involving the insertion of natural and/or synthetic products into the vagina or the ingestion of these products orally. These practices are fundamental to the construction of female identity, eroticism and the experience of pleasure. Notions such as ‘closed/open’, ‘dry/damp’, ‘hot/cold’, ‘heavy/light’, ‘life/death’, ‘wealth/poverty’ and ‘sweet/not sweet’ are central to local understandings of sexual practices and reproduction. These notions may affect the womens sexual health because they influence preferences for sex without a condom. These practices may also be associated with the alteration of the vaginal flora and vaginal lesions that may make women more vulnerable to sexually transmitted infections.

Vaginal practices as women's agency in sub-Saharan Africa: a synthesis of meaning and motivation through meta-ethnography

This paper reports on a systematic review of qualitative research about vaginal practices in sub-Saharan Africa, which used meta-ethnographic methods to understand their origins, their meanings for the women who use them, and how they have evolved in time and place. We included published documents which were based on qualitative methods of data collection and analysis and contained information on vaginal practices. After screening, 16 texts were included which dated from 1951 to 2008. We found that practices evolve and adapt to present circumstances and that they remain an important source of power for women to negotiate challenges that they face. Recent evidence suggests that some practices may increase a womans susceptibility to HIV and other sexually transmitted infections. The success of new female-controlled prevention technologies, such as microbicides, might be determined by whether they can and will be used by women in the course of their daily life.

Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: Findings from a multicountry household survey

BACKGROUND Women worldwide use various vaginal practices to clean or modify their vulva and vagina. Additional population-level information is needed on prevalence and motivations for these practices, characteristics of users, and their adverse effects. METHODS This was a household survey using multistage cluster sampling in Tete, Mozambique; KwaZulu-Natal, South Africa; Yogyakarta, Indonesia; and Chonburi, Thailand. In 2006-2007, vaginal practices and their motivations were examined using structured interviews with women 18-60 years of age (n=3610). RESULTS Prevalence, frequency, and motivations varied markedly. Two thirds of women in Yogyakarta and Chonburi reported one or more practices. In Yogyakarta, nearly half ingest substances with vaginal effects, and in Chonburi, external washing and application predominate. In Tete, half reported three or four current practices, and a quarter reported five or more practices. Labial elongation was near universal, and 92% of those surveyed cleanse internally. Two thirds in KwaZulu-Natal practiced internal cleansing. Insertion of traditional solid products was rare in Chonburi and Yogyakarta, but one tenth of women in KwaZulu-Natal and nearly two thirds of women in Tete do so. Multivariate analysis of the most common practice in each site showed these were more common among less educated women in Africa and young urban women in Asia. Explicit sexual motivations were frequent in KwaZulu-Natal and Tete, intended for pleasure and maintaining partner commitment. Practices in Chonburi and Yogyakarta were largely motivated by femininity and health. Genital irritation was common at African sites. CONCLUSIONS Vaginal practices are not as rare, exotic, or benign as sometimes assumed. Limited evidence of their biomedical consequences remains a concern; further investigation of their safety and sexual health implications is warranted.

Effective communication: the key to efficient HPAI prevention and control

The current Highly Pathogenic Avian Influenza (HPAI) crisis, involving the H5N1 subtype, has developed quickly and has overwhelmed the human resource capacity of both international agencies and national governments in many affected countries. It has been recognized that the best way of preventing the emergence of a pandemic influenza virus of avian origin is to control the virus at source. The H5N1 subtype is now endemic in a number of countries and it has become clear that its control and eventual eradication will require a medium to long-term strategy involving multiple stakeholders. A common understanding of the problem and effective education and communication components are important elements of the control strategy. This paper reviews the challenges involved with the development of effective communication materials and methodologies for the wide range of partners involved in the prevention and control of HPAI, the communication lessons learnt to date and makes recommendations for improving the effectiveness and efficiency of communication activities in the future.

Impact of Avian Influenza on Village Poultry Production Globally

Village poultry and their owners were frequently implicated in disease transmission in the early days of the highly pathogenic avian influenza (HPAI) H5N1 pandemic. With improved understanding of the epidemiology of the disease, it was recognized that village poultry raised under extensive conditions pose less of a threat than intensively raised poultry of homogeneous genetic stock with poor biosecurity. This paper provides an overview of village poultry production and the multiple ways that the HPAI H5N1 pandemic has impacted on village poultry, their owners, and the traders whose livelihoods are intimately linked to these birds. It reviews impact in terms of gender and cultural issues; food security; village poultry value chains; approaches to biosecurity; marketing; poultry disease prevention and control; compensation; genetic diversity; poultry as part of livelihood strategies; and effective communication. It concludes on a positive note that there is growing awareness amongst animal health providers of the importance of facilitating culturally sensitive dialogue to develop HPAI prevention and control options.

Technically sound and sustainable Newcastle disease control in village chickens: lessons learnt over fifteen years.

Village chickens can be found in all developing countries and play a vital role in the livelihood strategies of many poor rural households. The implementation of effective village poultry production programmes in Asia, Africa and Latin America has resulted in increased poultry numbers, household purchasing power, home consumption of poultry products and decision-making power for women. The rapid and wide geographical spread of highly pathogenic avian influenza subtype H5N1 has drawn attention to the neglect of village poultry health. This crisis has presented an opportunity to invest in improved village poultry husbandry that can make a positive contribution to human development in rural areas across a range of endeavours including: empowerment of women (increased productivity, knowledge, participation in community life as vaccinators, etc); HIV/AIDS mitigation; wildlife conservation through a reduction in bushmeat consumption; improved understanding of disease transmission, prevention and control, human nutrition and hygiene; and, most importantly building trust between communities and government agencies. Key recommendations to support technically sound and sustainable Newcastle disease control programmes in village chickens include encouraging veterinary pharmaceutical manufacturers to develop and observe a code of conduct that supports the supply of appropriate vaccine with an adequate shelf life, giving instructions in local languages, using temperature indicators in vaccine containers and discouraging the payment of commission on the purchase of vaccine. Quality assurance activities should be built into all vaccination programmes to improve cost-efficiency, and should include post-vaccination serological monitoring of a representative sample of birds, especially when a new vaccine or new disease control programme is introduced. Also required is the participation of farmers (male and female) in monitoring and evaluating the effectiveness of vaccination campaigns; and active collaboration with the Ministries of Agriculture, Health and Education in village poultry improvement programmes.

Prevalence and Motivations of Vaginal Practices in Tete Province, Mozambique

ABSTRACT. Vaginal practices have been linked with an increase in risk for HIV transmission and other harms. In 2007, a household survey of 919 women was conducted in Tete province, Mozambique, as part of the World Health Organization Multicountry Study on Gender, Sexuality, and Vaginal Practices. Women aged 18 to 60 years old were interviewed to determine prevalence and motivations for vaginal practices. A large range of frequently used practices was identified. Nearly 80% of women reported three or more current practices, and virtually all had used at least three practices in their lifetime. Elongation of the vaginal labia minora was universal (99% of women), while a quarter stated they had made small vaginal cuts or incisions at least once. Ninety-two percent of women also reported ever use of intravaginal cleansing, and insertion of substances in the vagina was practiced by 72%. Around half (48%) reported ingestion of substances to affect the vagina, mostly to heat, tighten, or loosen the vagina. Application of substances on the genitalia (16%) and steaming (15%) were less popular. To prepare for sexual intercourse, women reported products were commonly applied, ingested, inserted, or steamed. Pregnancy, delivery, and postpartum were also associated with ingestion (26%), steaming (39%), and cutting (32%). Adoption of microbicides and condom use may be influenced by vaginal practices. HIV-prevention messages and interventions, including future microbicides, need to take into account the high prevalence of vaginal practices and motivations for their use. Further attention needs to be given to potentially harmful practices in HIV-prevention efforts in Mozambique.

Labia Minora Elongation and its Implications on the Health of Women: A Systematic Review

ABSTRACT Objectives: Labia minora elongation (LME) is a female genital modification practice categorized among the types included in the fourth group of female genital mutilation. In this article, we display the results of a systematic review of the evidence-based knowledge published on the health risks and benefits of LME as informed by African female respondents who are insiders of the practice. No other systematic review on this specific topic has been published before. Methods: A methodological bibliographic search was done in scientific databases by manual referencing and by contacting experts on this area of knowledge. Seventeen articles were eligible for this review, which corresponded to nine different studies. Eight of these studies were conducted in Eastern and Southern African countries and one was carried out in Italy. Results: This review concludes that pain at the beginning of the practice, nuisances related to the use of caustic herbs, and stigmatization in failing to comply with the practice are the principal health risks associated with LME. At the same time, there is evidence that labial elongation may benefit the sexual health and well-being of women. Conclusions: More research of a quantitative nature is necessary to determine the prevalence of LME across the practicing cultures and to determine its implications on the sexual and reproductive health of women who engage in this female genital modification.

Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation

Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for womens femininity and self-image. Further research is necessary on how female genital modifications influence Zambians’ sexual preferences to inform the development of culturally appropriate health promotion interventions.

Continuing education in the prevention and control of HPAI: a case study on Indonesia

Highly Pathogenic Avian Influenza (HPAI) subtype H5N1 is now endemic in large parts of Indonesia and this situation has revealed, among other constraints, a lack of human resource capacity in many institutions especially in terms of understanding of, and experience in, the control of poultry diseases. Cost-efficient prevention and control of HPAI must be built on a sustainable poultry health programme that incorporates collaborative research and development activities involving the public and private sectors. The programme should provide appropriate education, communication and services to: all poultry producers, workers and traders; community animal health workers; field veterinarians, livestock officers and extension workers; and senior-decision makers at national, provincial and district levels. Lessons learnt in the production of effective education and communication materials that are readily accessible to each target audience are described.