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African Journal of Reproductive Health
Women's Health and Action Research Centre
ISSN: 1118-4841
Vol. 6, Num. 2, 2002, pp. 7-12
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African Journal of Reproductive
Health, Vol. 6, No. 2, August, 2002 pp. 7-12
Editorial
Traditional Medicine and Reproductive
Health in Africa
Friday Okonofua*
Professor of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Nigeria
Code Number: rh02015
Available evidence
indicates that traditional medicine practitioners are increasingly involved
in providing reproductive health care to men and women in
many parts of Africa. A large proportion of pregnant women in the continent
are attended at birth by traditional birth attendants, and in some countries
up to fifty per cent of pregnant women rely on the services of traditional
birth attendants for antenatal care and delivery. In many sub‑Saharan
African countries, traditional medicine practitioners offer treatment for
sexually transmitted diseases and some have claimed successful cures for
HIV/AIDS.1‑3 Indeed, traditional medicines are often the
first method of choice for treatment of infertility in many parts of Africa4 and
there are touted but unproven traditional methods of fertility regulation.
No doubt, the use of traditional
medicines for reproductive health care is due in large part to subsisting
cultural beliefs about the causes of reproductive ill health and perceptions
regarding the effectiveness of various methods of treatment for addressing
them.1,2 The social stigma often associated with various reproductive
health problems in Africa and poor access to orthodox services are additional
factors that contribute to the persisting importance of traditional medicines
in reproductive health care in the continent.
Despite the use of traditional
medicines in reproductive health, there are to date very few reports that
evaluate the effectiveness of traditional medicines in reproductive health
care in Africa. The paper by Abrahams et al5 in this issue of
the journal and that by Imogie et al6 provide evidence of the
persisting use of traditional medicines and traditional birth attendants
for reproductive health care in two countries in Africa. As demonstrated
in both papers, there are subsisting community beliefs about the efficacy
of these forms of treatment in addressing reproductive health
in Africa. However, we believe that more empirical experimentation of these
methods is needed to provide appropriate scientific evidence for the continuing
use of the methods for reproductive health care in the continent.
When considering effectiveness
and safety, traditional medicines, as used for reproductive health care in
Africa, can be grouped into three broad categories. The first group consists
of those that are potentially useful and efficacious in addressing specific
reproductive health problems. There can be no doubt that when appropriately
trained and well motivated, traditional birth attendants can play important
roles in providing maternity care to underserved communities in Africa, especially
to women who would otherwise have no access to any form of assistance at
birth. In this regard, having a traditional birth attendant would be regarded
as better than not having any form of attendant at all.
The second category comprises
traditional medicines that are harmful or potentially harmful, and that can
worsen the state of reproductive health for men and women. The continued
practice of female genital cutting clearly falls into this category, as it
does not have any known benefit and has been shown to be harmful to women.
Additionally, the use of traditional methods of abortion, which produce serious
side effects and even death, and the use of herbs for the management of prolonged
labour, which sometimes lead to uterine rupture, are traditional treatments
that are harmful to women's reproductive health. A major challenge to contemporary
efforts at promoting reproductive health in Africa is to identify ways to
improve and refine the use of the beneficial methods while discouraging the
use of
harmful traditional methods. Clearly, this is an important area for intervention
research in Africa in the coming years.
Harm can also arise from traditional
medicines when there is delay in the use of effective orthodox medicines
because of reliance on an ineffective traditional treatment. To date, although
traditional practitioners claim cures for sexually transmitted diseases and
HIV/AIDS, there is no evidence that the available treatments are effective. Thus,
while a large number of patients utilise traditional methods for STDs and
HIV/AIDS treatment, there has been a nagging suspicion that these merely
lead to delay in seeking more efficacious orthodox treatments leading to
a worsening of the clinical condition. Indeed, we believe that a large majority
of traditional treatments offered for reproductive health care in Africa
fall in this third category of treatments that are neither effective nor
harmful, but which nevertheless result in delay in the use of effective orthodox
treatments. An important research question in many parts of Africa is to
identify factors that predict the use of traditional treatments versus orthodox
treatments for various reproductive health problems. Especially for those
conditions where traditional treatments have doubtful effectiveness, it would
then be relevant to determine how best to discourage traditional methods
of treatment while promoting more effective orthodox treatments.
There has been intense public
health debate in many parts of Africa to determine the most appropriate official
policy towards traditional medicines for reproductive health care. Some
countries have policies that discourage traditional medicines, while others
have supportive policies. The majority of countries do not have official
policies and have simply left traditional medicines to individuals to decide. However,
there is now a growing consensus that traditional medicine practitioners
would be difficult to wish away in Africa, and that the best policy is to
seek ways to integrate them into the formal system of health care delivery.7,8 Such
integration would involve the re‑training of traditional medicine practitioners
on basic principles of reproductive health care, the identification and mapping
out of specific roles, and arrangements made for supervision and referral
to the orthodox health care system. The priority to be accorded to implementing
such a comprehensive programme will differ between countries, and would depend
on the burden of reproductive ill health in the country, the relative importance
of traditional practitioners in the health care delivery system, and an assessment
of the cost‑effectiveness of the programme in preventing reproductive
morbidity and mortality.
It is clearly evident that traditional
medicines are important in reproductive health service delivery in Africa.
Despite this, there has been little substantive research to document the
effectiveness and cost‑effectiveness of traditional medicine for reproductive
health care and to identify ways to integrate it with the orthodox system
of care. Apart from curative care, traditional medicines would have even
more important roles to play in preventative reproductive health care. Traditional
practitioners are often rooted in the cultural and traditional consciousness
of populations, and they work more closely with the grassroots as compared
to orthodox practitioners. Therefore, traditional practitioners would be
more able to advocate for changing behaviours that impact negatively on reproductive
health in Africa. With appropriate re‑orientation, traditional medicine
practitioners can advocate for the eradication of harmful traditional practices
such as female genital cutting; they can offer counselling on family planning
and the use of condoms to prevent STDs/HIV; and they can link difficult cases
of reproductive ill health to the orthodox system of care. Surely, seeking
integrative and cooperative roles for traditional medicine practitioners
is a major challenge for reproductive health in Africa in the coming years.
REFERENCES
- Okonofua FE, Ogonor
JI, Omorodion FI, Coplan FM, Kaufman JA and Heggenhougen K. Assessment of
services for the prevention and treatment of sexually transmitted diseases
among adolescents in Nigeria. Sex Trans Dis 1999; 26(1): 184190.
- Okonofua FE, Osuji CS,
Tejere ER, Ogunsakin DE and Ogonor JI. Knowledge, beliefs and practices
of traditional healers towards prevention and treatment of sexually transmitted
diseases in Benin City, Nigeria. Sex Trans Dis 2002 (In press).
- Green E, Zokwe B and Dupree
J. The experience of an AIDS prevention programme focused on South African
traditional healers. Soc Sci Med 1995; 40: 503.
- Okonofua FE, et al. The
social meaning of infertility in southwest Nigeria. Hlth Trans Rev 1997;
7: 205220.
- Abrahams Naeemah, Jewkes
Rachel and Mvo Zodumo. Indigenous healing practices and self‑medication
amongst pregnant women in Cape Town, South Africa. Afr J Reprod Health 2002;
6(2):7986.
- Imogie AO, Agwubike EO
and Aluko K. Assessing the role of traditional birth attendants (TBAs)
in health care delivery in Edo State, Nigeria. Afr J Reprod Health 2002;
6(2):94100.
- Chiwuzie J, Ukoli F, Okojie
O, Isah E and Eriator E. Traditional practitioners are here to stay. World
Health Forum 1987; 8: 240244.
- World Health Organization. Traditional
healers in health services development. Report of a consultation: Accra, 48
August, 1980. WHO Regional office for Africa, Brazzaville, 1981, AFR/TRDM/2.
Copyright 2002 - Women's Health
and Action Research Centre
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