Objectives of the Research:

1. Closing the vagina through elongation of the labia minora and use of vaginal products to enhance eroticism: Can these practices be considered FGM?ByBrigitte BagnolEsmeralda Mariano

2. International Coordination WHOAdriane Martin Hilber:Technical Officer, Department of Reproductive Health and ResearchRegional Coordinator for Southeast AsiaProfessor Terence Hull, Professor of Demography, The Australian National University, Canberra AUSTRALIAThailand research coordinator Dr. Wassana Im-Em, Institute for Population and Social Research (IPSR), Mahidol University, Bangkok, ThailandIndonesian research coordinators Ms. Ninuk Widyantoro, Women's Health Foundation, Jakarta, IndonesiaRegional Coordinator for Southern Africa Professor Eleanor Preston-Whyte: Director, Social and Behavioural Sciences - HIVAN, Centre for HIV/AIDS networking, University of Kwa-Zulu Natal, Durban, South AfricaMozambique Research Coordinators Dr. Brigitte Bagnol, Researcher, Dept. Anthropology, University of the Witwatersrand, Johannesburg, SAMs. Esmeralda Mariano, lecturer, Social Science unit, Faculty of Medicine, Eduardo Mondlane University, Moz. ICRH and Regional Centre for Health and Development (CRDS) Maputo

3. Objectives of the Research: • To identify, understand and document vaginal practices; • To describe the social context in which they are carried out; • To understand the women’s motivations, intentions, perceptions and experiences ; • To explore the possible impact of the sexual practices on women’s health and well-being (vaginal infections and sexual or genital dysfunctions).

4. Research area

5. Phase I: Ethnographic Research at Four Sites in the Province of TeteJuly- September 2005 Two in a rural area Two in an urban area

6. Sample 103 people participated in the study:25 men and 78 women.

7. Mozambican context: • The predominant African languages are Nyanja, Nyungwe and Sena (INE 1999: 32). • 22.7 percent of the population is Catholic, 17.5 percent Zionist and 4.3 percent Protestant or Evangelical but a majority of 43.9 percent states that they do not have any religion (INE 1999: 37). • City of Tete with an HIV prevalence of 25.8% amongst adults

8. Most common practices carried out • Elongation of the labia • Daily internal washing of the vagina with products and one finger • Washing or smearing the vulva with a range of substances • Cleansing with a cloth or fingers inside the vagina after intercourse • Insertion and use of vaginal products • Ingestion of sexual stimulants or products to improve vaginal condition • Ingestion of potions to stimulate the dilation of the cervix prior to giving birth • Ingestion of potions to close the vagina after giving birth • Incision and excision in the perineal area

9. Female genital mutilation (FGM) definition: FGM comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO 1997).

10. FGM Type IV: Unclassified: pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it; and any other procedure that falls under the definition given above (WHO, 1995).

11. Practices must be understood as part of a broader spectrum of love medicines used during the life cycle • Performance enhancement for sexual pleasure and pleasuring • Self-fulfillment in effort to achieve better body image • To be well, to be prepared, to be a woman • To feel good, heavy and hygiene (well being) • To modify sexual organs • To attract partner, to be popular • To keep a man to ensure fidelity and financial support and to ‘win’ the ‘competition’… • To address particular “problems” in their relationship with men • To act in a positive way on the partner’s behaviour with them • To negatively influence partner’s behaviour with a third person • To directly influence a third person

12. Motivations: • To promote and increase the friction during intercourse, to enhance sexual pleasure • To dry and tighten the vagina, • To reduce the vaginal orifice and secretions • To increase the temperature of the vagina • To replace virginity, create a sensation of virginity • To treat any perceived infection • To prevent or treat vaginal problems, as a an hygienic practice

13. Elongation of the labia Amongst different linguistic groups in: • Mozambique, • South Africa, • Tanzania, • Uganda, • Zimbabwe.

14. Insertion and use of vaginal products • Practice found in: • Mozambique, • Malawi, • South Africa, • Cameroon, • Zimbabwe.

15. Insertion - Mozambique Traditional and “modern” products

16. Perceived consequences of elongation (1) • Most women and men in Tete province see the elongation of the labia minora as having a very positive effect on men and women’s sexual lives and their relationships. • It is extremely rare to register negative effects. • However, the excessive length of the labia “creating water” or the fact that the elongating process is painful, especially at the beginning, were mentioned. • Sometimes, some products used for elongation can also cause lesions.

17. Perceived consequences of the use of vaginal products(2) • In relation to the vaginal products, a large majority of the women who use them stated that they did not have negative effect. • However, the excessive use of product and the use of new productcan in fact have unexpected effects. • Some women reported experiences of exfoliation of the vaginal mucosa, vaginal lacerations, burns, swellings and increased secretions.

18. Perceived consequences of the use of vaginal products(3) Focus group, Women Organisation of Mozambique, Tete. A woman explains: I know the kubvalira which I bought and inserted. (…) The next day, that exfoliated, something white scaling right off and that ruins the uterus (…) that thing is salt from Zimbabwe, small stones.

19. Perceived consequences of the use of vaginal products(4) • The pain reported by men and women during intercourse is generally a consequence of the use of vaginal products. • Lacerations on the penis and in the vagina are said to be a consequence of the effort needed to penetrate, and the friction occurring during coitus.

20. Perceived consequences of the use of vaginal products(5) • The vaginal products appear for some as being in direct opposition to the use of a condom, arguing that with the insertion and placement of vaginal products the sex act ought to be unprotected (with no condom) in order to allow a more direct contact between the vagina and the penis and to obtain greater sexual pleasure. • It was thus found that the majority of the interviewees do not use a condom.

21. Perceived consequences of daily or regular washing with soap and other products (6) • • The practice of daily or regular washing with soap and other products used with water is not seen as having any negative consequence and is even recommended by most nurses. • • The possibility of infection and laceration due to the daily or regular internal washing process has however been mentioned. • \

22. Perceived consequences of the use of vaginal products by health personnel (7) • A (male) nurse: • After inserting the stones (women) had a reaction involving discharge which never passes, a vaginal discharge. (...) When they arrive here [in the Health Post] they [women] seem to have an STI which is not STI. (…) The roots may provoke lesions outside or inside the vagina and represent a danger … with this problem of STIs and HIV/AIDS, she goes along there with those lesions and it’s easier to catch them. (MPD2, Male health-care provider, Mpadwe). • \

23. Perceived consequences of the use of vaginal products by health personnel (8) • • According to what was mentioned by few health workers, cancer of the uterus may have its origin in the vaginal insertion of some products as they may provoke infections, inflammations, or lacerations. • • Daily washing of the inside of the vagina with various substances destroys the vaginal flora, thus modifying its pH (acidity). • • According to them, this set of situations leads to a greater vulnerability to sexually transmitted infections (STI), including HIV. • \

24. General health issues related to the use of vaginal products • Increased susceptibility to infections and disease transmission due to the modification of the vagina flora • Risks of inflammation and irritation of the genital organs of both partners (Kun, 1998; Brown et al., 2000; McClelland et al., 2006) • Different products may have completely distinct effects, with some limiting and others increasing the risks of disease transmission (Myer et al., 2005)

25. Can these practices be considered FGM (1)? • • Eroticism, sexuality and some gender behaviours are the result of a learning process. • • The practices are generally associated with femininity and masculinity, and integrated into behaviours and bodies through modification, as a result of social norms amongst which heterosexuality and reproduction play a fundamental role. • • The incorporation/imposition of these gender behaviours takes as its basis the original biological body of “men” and “women”, yet modifying them so as to match the prevailing values. • \

26. Can these practices be considered FGM (2) ? • The data collected strongly demonstrate that the practices under study (elongation of the labia minora, use of vaginal products or ingestion of potions to modify the condition of the vagina) do not constitute a mutilation. • \

27. Can these practices be considered FGM? • Does the harm and modification carried out justify the ban? • Does the known and/or suspected consequences justify to ban the practice? • Can the practices be considered a violation of the human right? • Can they be considered a mean of control over women? • Is it a misunderstanding of culturally based forms of sexuality and eroticism? • Why are these practices considered mutilation and male circumcision is not? • Why are these practices considered mutilation and western women vaginal surgery considered esthetic surgery?

28. Need to deconstruct the conceptions on african sexuality • Taking into consideration the specific contexts; • listening to women point of view; • investigating historical discourses on woman sexuality

29. Process of othering • Legacies of Christianity • Legacies of colonialism and post-colonialism • legacies of marxist and communism Stereotypes: • Excessive sexuality; • Excessive promiscuity; • Traditional practices are seen as negative and retrograde; • Women are passive and oppressed.

30. Woman power versus woman subordination • Elongation aims at transforming young girl into real women and are very much connected to sexuality and reproduction (Arnfred, 1998, Simonsen, 2000; Johansen, 2006). • Bagnol (1996, 2003) analysed the implication of the practices on homo-attraction and gender roles.

31. Woman power versus woman subordination (…) • Arnfred (2003) highlighted the importance of an in-depth participative ethnography, so as to avoid preconceived Western models which condemn the practice as a form of genital mutilation. • Tamale (2005) claims for the removal of this practice from the FGM definition and to consider it an institution of female power.

32. Can these practices be considered FGM (1)? All the consequences mentioned, documented and/or suspected as the result of the elongation of the labia minora and the use of vaginal products do not require a ban as in the case of FGM Type I, II and III and cannot be targeted through human rights legislation on violence against children and/or women, bodily harm and child abuse.

33. Can these practices be considered FGM (2) ? Nevertheless, some practices can result in injuries – e.g. lacerations, tears – and might need to be discouraged when evidence of an increase of STIs and HIV/AIDS transmission is confirmed

34. Overall view • The effort to modify women’s body imply extension of external and reduction of internal genitalia • Vaginal practices are part of whole set of cultural norms and gender roles aiming at “being a woman”, “being beautiful/charming”, “being fertile”, “being healthy” and relate to sexuality, pleasure and eroticism • It is by complying/developing these practices that women are getting their power and are subjected by it. Men and women are both agent and subject of their sexuality. • These practice are an important aspect of women power and sexual knowledge • These practices should not be considered a FGM • Women knowledge and women sexual power should be respected and enhanced

35. Thank you