Fundamental erotic element: Beads

1. (Des) objectifying the body notions, construction of sexuality and sexual health. Mozambican women’s experiences in Tete province (Mozambique)By Esmeralda Mariano and Brigitte Bagnol

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 ICRH and Regional Centre for Health and Development (CRDS) MaputoDr. Brigitte Bagnol, Researcher, Dept. Anthropology, University of the Witwatersrand, Johannesburg, SAMs. Esmeralda Mariano, lecturer, Social Science unit, Faculty of Medicine, Eduardo Mondlane University, Moz.

3. Even the most obvious elements which are a “given” and “natural” sexual characteristic of individuals, are shaped by social practices and the culturally signified.

4. There is a great variety of notions of sexuality, ways of being or of feeling oneself a man or woman, and of incorporating (embodied/including within the body/integrating/ personifying) social values. Sexuality is a power relation.

5. Notions concerning the body, erotic desires, love or sexual practices vary from one place to another, as a function of various factors which include amongst others, social class, ethnic group, religious beliefs, sex, age, etc.

6. Fundamental erotic element: Beads

7. These notions evolve over time and are intrinsically linked to political, social and cultural transformations.Women’s experiences of the body are not only biological and individualized. They are also an historical and socio-cultural product.

8. Research area

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

10. 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

11. 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).

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

13. 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 • 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 potion to close the cervic after giving birth • Incision and excision in the perineal area to heal health conditions (infertility and abortions)

14. Practices must be understood as part of a broader spectrum of medicines used during women’s 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 modify sexual organs • To prevent or treat vaginal problems, as a an hygienic practice • To tighten the vagina prior and after delivery • 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

15. Elongation: Kukhuna, puxa-puxa,kupfuwa From the kernel of the castor-oil plant Instruments

16. Ideal size for the labia

17. Mozambique All the women start stretching when 8-12 Motivations: • In order to close up • In order to be a woman • To keep the partners

18. Motivations of other vaginal practices (insertion, ingestion): To feel good, heavy and hygiene (well being) • 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

19. “The place to play is this one… When I play with my husband, every day he is opening me. The man is the one who opens the body (…) During delivery the vagina also gets opened. When she is open, with the vagina open, it is not good. The body is light. Thus it is necessary to shrink, to contract the body with the use of medicine (…) It is necessary to look for this medicine to contract, to feel well.” (Mpadwe, midwife, 60 years old)

20. Well-being: heavy/light Well-being is related to a ‘heavy body’, in opposition to having a ‘light body’, which means not being well. The interviewees say that when they don’t undertake this ‘treatment’, the body gets ‘light’, ‘lacking in strength’, ‘open’, ‘watery’, ‘airy’, and during sex it makes noise

21. Most important corporal notions Close/Open, Hot/Cold, Dry/Wet, Heavy/Light, Sweet/Not sweet, Life/Dead, Wealth/Poverty These are the core metaphors for sexuality and reproduction and it is through this symbolic language that most of the issues related to these matters are discussed.

22. Notions of health, reproduction, eroticism and sexual pleasure are interconnected (1) • Both male and female body are modified, manipulated and controlled socially from birth to the end of sexual activity • Vaginal and penis practices are carried out in association with other aiming at improving relationship with partner (love potions), reproduction and health

23. Notions of health, reproduction, eroticism and sexual pleasure are interconnected (2) • Prior to menarche women are linked to dryness and coldness a situation she also reach after menopause • During her sexual life woman is linked with wetness, hotness and reproduction through exchange of sexual fluids

24. Conceptions on the body BIO MEDICINE Natural body is healthy and interventions are negative EMIC Need to modify, to transform the «biological/ natural» body to be a «woman»

25. Conceptions on health and etiology of disease BIO MEDICINE • Protection/ prevention is an individual individual and societal matter (public health). Death is natural. • Diseases are natural and related to virus, microbes EMIC • Individual autonomy and control on the body is low but there is always possibility to repair. Death is not natural.

26. Need to integrate the plurality of notions on the body • Not a dichotomy between the different conceptions • Often a mix of conceptions during the therapeutic process or at the same time (people go to the church, the health centre and the healer)

27. Overall view • The notions of body, sexual health and well-being have a dynamic meaning taking into account women’s life cycle • The perceived side effects of insertion of vaginal products, such as lacerations or pain do not have the same meaning for the women who perform the practices and for biomedicine • The majority of the vaginal practices are related with notions of pleasure, beauty and well-being instead of notion of health.

28. Final considerations • Address and train the health care providers on cultural issues related to sexual and reproductive health is crucial • Inform women about their body physiology, the function of vaginal lubrication and different types of secretions; • Explore through clinical studies the level of women exposure and vulnerability to STI and HIV; • Classify different types of substances and practices that cause genital laceration and pain during sexual intercourse; • Test products to know their eventual harmful effects.

29. Thank you