Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula.
Peterman A, Johnson K.
University of North Carolina, Department of Public Policy, Chapel Hill, NC 27599-3435, USA. firstname.lastname@example.org
Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.
The social vagina: labia elongation and social capital among women in Rwanda.
Department of Social Policy, London School of Economics and Political Sciences, London, UK. email@example.com
Far from being an individual concern, vaginas are located within complex socio-cultural settings. The acceptability of policies that focus on health-promoting behavioural change is influenced by values regarding normative gender and sexual roles. In Rwanda, the elongation of the labia minorathrough manual manipulation is not an individual act but takes place in social groups and thus cannot be fully understood by focusing one’s attention solely on the individual-related behavioural components but, rather, on the social environment in which it exists. This paper aims to increase knowledge about labia elongation and assesses whether this vaginal practice produce social capital.
Rwandan female genital modification: elongation of the Labia minora and the use of local botanical species.
Koster M, Price LL
Department of Social Sciences, Wageningen University, Netherlands. firstname.lastname@example.org
The elongation of the labia minora is classified as a Type IV female genital mutilation by the World Health Organization. However, the term mutilation carries with it powerful negative connotations. In Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male and female pleasure. Women regard these practices as a positive force in their lives. This paper aims to assess whether Rwandan vaginal practices should indeed be considered a form of female genital mutilation and whether the botanicals used by women are detrimental to their health. Research was carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were conducted with thirteen informants. Two botanicals applied during stretching sessions were identified as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to describe Rwandan vaginal practices as female genital modification rather than mutilation.