Africa, Oh My Beloved Africa

The African drumbeat and ululations rent the night air in a village 200 km away from the capital Lilongwe. The moon smiles down in a way acknowledging the initiates – “you are an African woman”! And the dancing starts. A dance for the sun-setting men and women celebrating their success at the initiation.

In Malawi, girls aged between 10 and 12 are initiated through ‘chinamwari’ – a ritual which forces the initiates to have sex with very old men. The ritual is organized by the old women in the village and is meant to scare girls from early sex. But, what about the dangers of HIV infection? Doesn’t this practice predispose the young girls to easy HIV infection given that the sex is forced, unprotected and nobody knows the status of the older men?

Culture is dynamic yet parts of sub Saharan Africa still choke from harmful cultural practices right into the 21^st century! Africa, south of the Sahara, remains the epicenter of HIV and AIDS hosting 21million of the 30 million people in the world living with HIV infection. Among HIV-infected people in the world, 6 out of 10 men, 8 out of 10 women, and 9 out of 10 children live in Africa (WB, 2005). And harmful cultural practices play a powerful role in this scenario.

Cultural practices and the spread of HIV

Multiple and concurrent sexual partnerships (MCP) is a cultural practice in Africa that fans the spread of HIV. In a research on MCP involving ten Southern African countries, “participants claimed that cultural norms encourage men to have more than one sexual partner”.  In mapping new HIV infections in Kenya, NACC observed high rates (approximately 25%) linked to MCP (KAIS and MOT reports).

Another harmful practice is that of wife inheritance. Among the Luo in Kenya, wife inheritance is wide spread without due consideration for cause of death of the departed soul. The Institute of Policy and Research (IPAR, 2006) has highlighted wife inheritance as a major route for the spread of HIV among the Luo community.

Cultural practice and maternal death

In Ghana, it is believed that a woman experiencing complications at childbirth points to her adulterous life. This can only be reversed by her confession otherwise death beckons.

26 out of 43 countries in Africa practice female genital cutting (FGC), a practice linked to complicated childbirths.

In Kenya, obstructed labour is a common cause of maternal and child disability and death (MoH). Obstructed labor can lead to brain damage of an infant and complications for the mother (eg fistula, an abnormal opening between the vagina and the bladder or the vagina and the rectum, which can lead to incontinence). “Women who have undergone FGC are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women. Among 33 infibulated mothers followed at Somalia's Benadir Hospital in 1988, all required extensive episiotomies during childbirth. Their second-stage labor was 5 times longer than normal, 5 of their babies died, and 21 suffered oxygen deprivation because of the long, obstructed labor”. (PATH).

Cultural practices and population growth

The culture of polygyny is a major cause of the ever-growing population in Africa. According to KDHS2008-09, “polygyny is common in Africa and has implications for frequency of sexual activity and fertility”. For example, in Kenya, provinces where men (aged 15-49) reported high percentages of keeping two or more wives – Western (7.8%), North Eastern (13.5%) and Nyanza (15.4%) - also recorded high fertility rates of 5-6 births per woman.

Despite the high mortality fanned by HIV, Africa’s population has continued to rise hitting one billion at the end of last year (BBC, 2010)!  In fact, Africa has the highest total fertility rate of 4.5 per woman of childbearing age on average with Kenya’s population growing at a million a year (KNBS, 2009) and Niger experiencing the highest fertility of up to 7.2 births per woman of childbearing age. This is nowhere comparable to Europe, e.g. Germany with less than 1.3births and Russia with a negative population growth of -0.4 percent (UNFPA, 2009 and PRB, 2010).

Cultural practices cause child death

Culture provides a perfect platform for child malnutrition.

Malnutrition contributes more than 35 per cent of child deaths in Africa (healthdev.net).

Among the Akan in Ghana, (reports UNICEF) newborn babies are denied the first yellowish breastmilk known for its rich source of minerals. The excuse is that the milk makes the baby’s head shape look funny. Young children are also denied eggs for fear that they will grow up to be thugs! In Kenya, only three percent of newborns are lucky to be exclusively breastfed for the first six months yet breastfeeding can save up to 1.2million newborn lives (KDHS 2008-09).

According to the KDHS, malaria compromises immunity and abortion or premature births leading to stillbirths, congenital infections, low birth weights and retarded growth in children. In a section of the Coast Province, in Kenya, women refused to use the white nets because the colour is perceived to reconnect with the spirits of dead people and/or evil spirits. This despite the exposure to the deadly malaria.

Conclusion

Given its economic, social, and cultural conditions, Africa has been and continues to be extremely vulnerable to the spread of HIV and other life-threatening diseases.

Can cultures change? Yes, indeed and hats off to Kenya’s Luo Council of Elders. The elders acknowledge new knowledge on male circumcision – for example - as a strategy for prevention of HIV and HPV. The Council has also embraced other cleansing rites and is educating its population on the harms of wife inheritance.

Across Africa, communities and governments are taking bold steps towards eradicating FGC. In Kenya, some FGC-practising communities are adopting rights-based approaches such as Alternative Rites of Passage (ARP). FGC is less prevalent in young girls aged 15-19 (14.6 percent) compared to women aged 45-49 (48.8 percent).Overall, FGC has reduced from a reported 32.2 percent in 2003 to 27.1 percent in 2008-09 (KDHS).