Bad Cultures: Force-feeding young girls for marriage in Mauritania

In my previous blog post, I’ve talked about the practice of sexual cleansing among young girls in Malawi. Sexual cleansing, unfortunately, is only a small fraction of a much bigger problem that persists in Africa. More than religion, cultural practices and traditions have a bigger impact on many African societies. Africa is a deeply patriarchal society and most traditional African practices are generally biased against women. Therefore, it is no surprise that many of the Harmful Traditional Practices (HTPs) are targeted against women. In this post, I will shed more light onto this gender-insensitive issue and why it is still prevalent in today’s modern world. Since it is almost impossible to write about everything that is wrong with these harmful traditional practices, I will focus on the practice of leblouh or gavage in Mauritania, and use it as an example. 

A “fattener” shown forcefully feeding a young girl as she squeezes her feet between two sticks.

Leblouh refers to the practice of force-feeding young girls for marriage. Heavier girls and women are viewed as beautiful, wealthy and socially-accepted while their slimmer counterparts are considered inferior and bring shame on their families in Mauritanian society. In Mauritanian culture, being thin is unappealing. A fat girl symbolizes wealth and social class. This practice, also known as gavage, dates back to a time when Mauritania’s population consisted of lowly, white Moor Arabs. Back then, a Mauritanian man was considered wealthy and well-respected if his wives did not engage in housework. Since they spent most of their time just sitting and being lazy by not doing any work, these wives gradually gained weight. Of its 3.2 million people, one-third of Mauritania’s population belongs to the Moor tribe. Overtime, being overweight became culturally acceptable.

Girls as young as five years old are sent to fattening farms in Mauritania where they are forced to consume thousands of calories each day. These “fat camps” are run by elderly women known as “fatteners” whose main goals is to ensure these little girls are fed as many calories as possible in order to gain weight. In an interview with CNN correspondent Mohamed Yahya Abdul Wedoud, Mariam Mint Ahmed, who is 25, shares her experience with the leblouh practice. She recalls that girls who don’t finish the fattening meals put before them can be punished. One method, according to Mint Ahmed, is to tie a girl’s toes to sticks and if she does not eat, pressure is applied to the sticks sending shockwaves of pain through the girl’s feet. These girls were force-fed a whole foods diet of up to 16,000 calories, sometimes to the point of nausea and vomiting. They would eat four meals a day. For breakfast, the girls have breadcrumbs soaked in olive oil washed down with camel’s milk. They then have frequent meals throughout the day of goat’s meat, bread, figs and couscous, all with more camel milk to drink. After being force-fed, the girls would not be allowed to move or engage in any kind of exercise, and must rest instead.

Foot of a young girl being squeezed between two sticks as a form of punishment for refusing to consume more food.
Foot of a young girl being squeezed between two sticks as a form of punishment for refusing to consume more food.

According to a study conducted in 2008 by the Mauritanian Minister of Social Affairs, about 20% of Mauritanian women either voluntarily participate, or are forced to participate in the practice of force-feeding. There are obviously many health risks that follow the unhealthy weight gain of these girls. Girls of around eight can weigh 140kg (300lb) after force feeding, putting a huge strain on their hearts and jeopardising their health. Young women can tip the scales at 200kg. According to a study conducted by the World Health Organization, about 20 percent of females in Mauritania are obese, compared to 4 percent of men. 

Besides health risks caused by obesity, there seems to be a new practice called “chemical gavage” where girls are given drugs including growth hormones, contraceptives and corticoids – steroid hormones – to bulk up. Health risks include heart failure, renal failure, diabetes, reproductive health problems, and joint pain. Since the process of ingesting food seemed to be a major difficulty, taking pills became a much easier way to gain weight. The animal growth hormones end up giving the women who take them a disproportionate body shape with a big stomach, face and breasts but thin arms and legs.

Leblouh is intimately linked to early or child marriage and often involves a girl of five, seven or nine being obliged to eat excessively to achieve female roundness and corpulence, so that she can be married off as young as possible. The weight gain is believed to accelerate puberty and make younger girls appear more womanly.

Though still active, this practice of force-feeding girls is becoming old-fashioned. A study by the Mauritanian ministry of health has found that force-feeding is dying out. Now only 11% of young girls are force fed. Dr. Sidi Ahmed, a heart disease specialist at Nouakchott’s Sabah hospital says, “We have launched several campaigns aimed at putting an end to this mentality that links beauty and fat, which brings some people to review their customs and traditions.” 

Nearly 40% of women and 55% of men reported that gavage has no advantages. The most common reason given to not practicing gavage was improved health. In contrast, approximately a quarter of both men (23%) and women (25%) cited no disadvantages with the practice of gavage. Among respondents with at least one daughter, 17% of women and 11% of men reported the intention to practice gavage. The most important differences in attitude toward the continuation of gavage were observed among women and among men from different ethnic groups, with Arabs more likely to approve of the continuation of gavage.  

Stretch marks are a major turn-on for Mauritanian men.

The practice of leblouh is most prevalent among Arab women. Therefore, these Arab women could benefit from increased awareness and education related to the public health and psychological dangers that these practices pose. However, more importantly, the men in these societies that practice gavage should change their perception of the ideal Mauritanian wife. Once the men no longer find overweight women attractive, it will be easier for this practice to die out. It is this constant need to please and attract the males that puts the pressures on females, causing them to undergo customs and traditions that are actually harmful to them in many ways.

Continue reading “Bad Cultures: Force-feeding young girls for marriage in Mauritania”

Technology’s Role in Improving Maternal Mortality

Of the many factors affecting the overall health of the mother and her baby during pregnancy what seems to be the most important is socioeconomic status. As seen in many parts of the world women in poverty have significantly less access to resources and potentially life saving treatments.Not to mention, medical care often lacks resources and ‘up-to-date’ technology. Continue reading “Technology’s Role in Improving Maternal Mortality”

Women’s Health as Community Health

by Carly Dillis

The health of women is not only vital to women themselves, but also to all other members of society. Women’s health is integral to overall health in families, communities, and society as a whole. In many societies, gender roles are constructed in a way that ensures women to do all household chores. This includes cleaning, cooking, and child raising. Healthy women are the foundation for healthy families, and healthy families are a foundation for a stable community. Women’s health affects the family because it can cause disease to spread and cause the relapse of family structure, putting children and all family members at risk. Continue reading “Women’s Health as Community Health”

Mental Health Effects on FGM survivors

In this blogpost I will be focusing on the prevalence of psychiatric illnesses such as PTSD, depression, anxiety disorder and other mental illnesses in survivors of female genital mutilation. I will be focusing mainly on a study performed by Alice Behrendt and Steffen Moritz, Ph.D on Senegalese women to prove the correlation between FGM and mental illness. I will also draw upon two different journal entry from American Journal of Psychiatry. One journal entry focuses on unpacking a series of 10 studies based on mental illness and FGM, and the other focuses on the silent mental scarring survivors endure. I also draw from a research blog for an opinion from the Western World (UK) and a research article for a different opinion from Iraq. I quickly touch upon other policy papers and studies to emphasize the impact of the correlation of psychiatric illnesses and female genital mutilation.

The process of Female Genital Mutilation is physical scaring for young women and girls worldwide. As described in my peers blog “Medical Impacts of Female Genital Mutilation on Childbirth and Maternity”, FGM is the practice of removal of all or part of the external female genitalia for non-medical purposes. The illegal practice carries significant physical health ramifications including an increased chance of postpartum hemorrhage, HIV and shock. But, the practice also carries significantly painful mental health consequences.

According to a study conducted on 23 Senegalese women in Dakar who were victims of FGM, and 24 who were not. The study was the first to formally prove what experts have hypothesized for years; women that fall victim to FGM are at a higher risk then the general population of developing psychiatric illnesses. The results study on the 23 Senegalese women showed that to be true. 30% of these women had prevalent Post Traumatic Stress Disorder with accompanying memory problems, and 47.9% showed symptoms of psychiatric syndromes. The experts who performed the study attribute the higher risk of mental illness to the trauma these women endured during FGM.

After this study, many more of the kind came out connecting to what the original said; there is a definite correlation between mental health and FGM, specifically due to the trauma endured. Numbers between studies have varied from PTSD in victims being at as high of a rate as 44%, that’s up to 7 times higher than in the average young woman. But, no matter what the rate actually is, data has almost always proved that the risk is higher for mental illness for those who had endured the pain of FGM.

In many countries and cultures, PTSD, anxiety, depression, and somatic disturbances (unexplained mental disorders whose symptoms show as physical), are not treated due to strong stigmas and negative, harmful attitudes within religions and/or cultures, or fear from individuals. For a Western example, many doctors and psychologists have been treating patients with FGM trauma as if they endured cultural practice. New guidelines are being set into place by World Health Organization to treat patients with physical or mental FGM scars as victims of abuse. This attempt helps fight the stigma that victims of female genital mutilation should feel ashamed for the trauma they endured, which in turn helps fight the fears and stigmas that stop these women from getting help for mental illnesses.

There is a very clear, very direct correlation between psychiatric illnesses and the trauma that young women who fall victim to FGM practices world wide have to endure. Now, it is a global responsibility to acknowledge that and fight the stigmas and fears that stop women from getting the help they need, and let them continue to silently suffer mentally, emotionally and physically.



Sexual Pleasure After Female Genital Mutilation

A blog post published last week, found here, explores an unintended consequence of female genital mutilation: the significantly increased risk of complications, death, and infant mortality during childbirth after undergoing female genital mutilation. While it’s been reasonably well known in the western world that FGM carries with it serious physical dangers, there’s another consequence of the practice that’s very much intended, and that’s the lessened ability of women to experience sexual pleasure after FGM. 

A primary goal of FGM is respectability by means of sexual oppression. Because sexuality is such a taboo subject in regions where FGM is prevalent, and women’s sexuality even more so, to take away a woman’s sexual desire and her ability to experience pleasure is seen as a way of protecting her honor and reputation. This intact reputation is what makes her desirable to a husband, allowing her to lead a comfortable adult life, justifying the continuation of the practice. 

A survey conducted at an obstetrics and gynecology clinic in King Abdulaziz University Hospital suggests that FGM may not be as effective at curbing women’s sexuality as it had been thought to be. Of the women polled at the clinic, half had experienced FGM and half had not, and it was found that women who had undergone FGM were no more likely to experience pain during sex or a lessened desire for sex. However, they were less likely to experience arousal, natural lubrication, and orgasm during sex. The study was published in The Guardian by two Saudi Arabian doctors looking to change the practice of FGM from inside the cultural sphere, in the hopes of accomplishing more than outsiders could. 

Though FGM may not always accomplish it’s goal of curbing women’s sexual desire, it cannot be ignored that they have greater difficulty becoming aroused and achieving orgasm. Women subjected to FGM are being denied their right to their own sexuality and the message is clear nonetheless that they do not have ownership of their bodies.

Additionally, the survey conducted by the Saudi doctors is not representative of the experience of all women who have undergone FGM. Many women do endure pain during sex as a result of FGM, despite not being statistically more likely to. Despite the possibility of sex being agonizing for these women, they are still expected to have sex with their husbands in order to be dutiful wives. Time and time again, from the time they are cut as girls to the time they are obligated to have sex with their husbands as women, women’s agency over their bodies and their sexuality is taken away from them. In this regard, FGM accomplishes exactly what it sets out to: it takes away control. 

Naturally, the impact of FGM on a woman’s sexual desire will vary immensely from woman to woman. Though surveys have found that many women are still able to experience orgasm, many women find that not only is sex not pleasurable, but it’s painful. Several Egyptian women gathered to share their own experiences with sex, with descriptions ranging from boring to painful. Women who were bored with sex spoke of accepting that it wouldn’t be pleasurable for them but pretending that it was for the sake of their husbands, and others who found it painful said they hate the experience. Women who lose their ability to experience sexual pleasure all too often come to view sex as a duty for the means of procreation rather than a shared experience, wondering why they would need to keep having sex after already having children.

Mariya Karimjee describes her own experience with sex after undergoing female genital mutilation.

Mariya Karimjee said of her own experience losing her virginity at the age of 27 “the pain was everywhere. I couldn’t figure out what hurt and where.” She had always feared that she would never be able to enjoy a sexual experience; her right to enjoy her sexuality had been stolen from her at the young age of seven. Stories like hers never cease to be heartbreaking because so many girls and women have this ownership of their bodies and their sexuality stolen. The message is clear that women’s bodies and lives are not their own, and this mentality won’t end until governments crack down on abusive practices such as this. 



Randerson, James. “Saudi Doctors Work to Change Attitudes to Female Genital Mutilation.” The Guardian. Guardian News and Media, 13 Nov. 2008. Web. 17 Nov. 2016.

Dean, Laura. “» Global Post: ‘I Hate It. It Hurts’ – Egyptian Women Talk about Sex after Female Genital Mutilation.” » Global Post: ‘I Hate It. It Hurts’ – Egyptian Women Talk about Sex after Female Genital Mutilation. N.p., 16 July 2015. Web. 01 Dec. 2016.

Kutner, Jenny. “What It’s Like to Have Sex After Undergoing Female Genital Mutilation.” Mic. N.p., 13 May 2016. Web. 01 Dec. 2016.

Transgender Women’s Rights to Healthcare

Transgender women receive unequal treatment when it comes to healthcare. Insurance companies lack the coverage for sex changes, cross-sex hormone therapy, and therapy for ones mental health. More information can be seen from this policy paper. One of the issues is that the surgeries and medical changes have been scientifically proven safe, yet  insurance coverage is still an issue. One of the problems with transgender women not being able to receive the medical care they need is that suicide rates increase. Transgender women resort to unsafe uses to obtain the medical treatment needed. Over 50% of transgender individuals have injected hormones that they got illegally. This significantly increases HIV rates as well as other illnesses. Gynecologists are being informed on how to care for these individuals and treat them. 

The educational transgender health care plan outlines steps to apply for insurance as someone who identifies as transgender. One of the issues is that the person is required to present the name that appears on their social security card as well as the gender that is found on majority of their legal documents. This can lead to severe mental health problems, because this means transgender individuals may not be able to identify as their preferred gender on their healthcare plans. 

The New York Times mentions how transgender individuals usually don’t go to the doctor often out of fear. They are worried their treatment will cost more or they will be called by the wrong pronouns. The article writes about a women who was given a male roommate in a hospital in Brooklyn. The hospital claimed they had no idea that she was transgender. This is all the more reason why doctors need more training and knowledge on transgender individuals. 

 A story was released  about a lawsuit from Lincoln Nebraska where a transgender women was treated poorly by the Nebraska department for Health and Human Services. This women requested from the health department for female clothes and for a private room so she wouldn’t have to share a bathroom. The department laughed at her response and moved her to a room where everyone could see her, doing the opposite of her request and instead making her living space even more public. These humiliating types of actions are increasing the feelings of being different or unwanted in transgender individuals, and it certainly does not benefit their mental health. 


Unknown. “Health Care for Transgender Individuals.” Women’s Health Care Physicians. ACOG, Dec. 2011. Web. 16 Nov. 2016.

Unknown. “Transgender Health Care Coverage.” Federal Government, n.d. Web. 16 Nov. 2016.

Ellin, Abby. “Transgender Patients Face Challenges at the Hospital.” The New York Times. The New York Times, 2016. Web. 16 Nov. 2016.

Manna, Nichole. “Transgender Woman Alleges Discrimination from HHS.” Lincoln Journal Star. N.p., 11 Nov. 2016. Web. 16 Nov. 2016.


MDG5 and Its Role in Global Maternal Health

Around the globe, 4.3 babies are born every second . And so far in 2016, 123,120,000 have been born. However a few of those babies will grow up without a mother. Just this year alone, 294,500 and counting, women have died in childbirth. Continue reading “MDG5 and Its Role in Global Maternal Health”

Maternal Health and the Urban Poor of Sub-Saharan Africa

“One woman dies per minute in childbirth around the globe. Almost half of these deaths occur in Sub- Saharan Africa” (Maternal Health: Investing in the Lifeline of Healthy Societies & Economies). Many poor women across the world, living in the cities of developing countries suffer from inadequate maternal health care services. Continue reading “Maternal Health and the Urban Poor of Sub-Saharan Africa”

Sexual Cleansing: A Path to Womanhood

Warning: The following post is upsetting. Some readers may be offended by its content which includes discussion of a rite of passage practice in Malawi – the initiation of young Malawian girls into womanhood through “sexual cleansing”. 

Young girls of similar ages are sent to 'initiation camps' in Malawi.
Young girls of similar ages are sent to ‘initiation camps’ in Malawi.

A few months ago, I came across an article on the internet about a ‘Hyena’ man in Malawi who was arrested for having sex with young girls. I decided to read more about this ‘Hyena’ man, and find out why he was having sex with children to begin with. According to the article published by BBC, “In some remote southern regions of Malawi, it’s traditional for girls to be made to have sex with a paid sex worker known as a ‘hyena’ once they reach puberty. The act is not seen by village elders as rape, but as a form of ritual ‘cleansing’”. That’s when I heard the term for the very first time – “sexual cleansing”.

As shocking and disturbing as it may sound, sexual cleansing is actually a common practice in parts of Kenya, Zambia, Malawi, Uganda, Tanzania, Mozambique, Senegal, Angola, Ivory Coast, Congo, Ghana, and Nigeria. It is an African tradition where a woman is expected to have sex after her first period, after becoming widowed, or after having an abortion, as a cleansing ritual. In this blogpost, I will focus on the practice of sexual cleansing as a rite of passage for young girls in Malawi.

Districts in Malawi where ritual sex with girls takes place.
Districts in Malawi where ritual sex with girls takes place.

Malawi, located in southeast Africa, is one of the most underdeveloped countries in the world. There are many economic and health problems in the area including high rates of infant mortality and HIV/AIDS. Known locally as ‘kusasa fumbi’, sexual cleansing is considered a rite of passage for young girls in order to initiate them into womanhood. Girls as young as 6 years old are taught that they must have sex in order to get rid of “child dust”. They are taught to believe that unless they undergo sexual cleansing, they will suffer great misfortune or become diseased. Once the girls seem ready to understand the concept of sex, their parents (those who can afford it) send them to “initiation ceremonies” or sex camps where they are made to complete the ritual. In the camps, men (often sex workers) are hired to finish the rite by having sex with these young girls. The ‘Hyena’ is forbidden from wearing a condom and the use of any other form of protection is against the rules of the ritual. The ritual lasts for three days.

A 2007 Malawi survey that gathered information about adolescents’ reproductive health, knowledge and behavior found that, among 15-19 year olds, 26% of females and 49% of males are unmarried and sexually active. Among 20-24 year olds, 16% of females and 9% of males had had sexual intercourse by age 15, and by age 20, 79% of females and 74% of males had had sex. 

The practice of sexual cleansing not only is a form of rape, but also plays a big role in contributing to the increasing number of HIV/AIDS cases in Malawi. Going back to the BBC article about the ‘Hyena’ man, it was later found that Eric Aniva (the name of the ‘Hyena’ man talked about in the article) was HIV positive. He’s one of 10 ‘Hyenas’ in his community and is paid $4 to $7 each time he is hired. In another article also by BBC, Mr. Aniva says that he did not mention his HIV status to those who hired him. Shortly after the initial article gained media attention, a warrant for his arrest was issued by Malawi President, Peter Mutharika. In his own words, the President was quoted saying, “This man (Mr. Aniva) was abusing children. He infringed their rights and I am sure some have dropped out of school and others have been made pregnant or contracted the HIV. So arresting him is one of the solutions and the best sentence for him would be life imprisonment.” Presidential spokesman Mgeme Kalilani said in a statement, “(Mr. Aniva would) further be investigated for exposing the young girls to contracting HIV and further be charged accordingly.” Mr. Aniva claims to have slept with 104 women and girls, unfortunately.

If this ritual is clearly very horrible, why does it still persist? It is very sad and frightening to know that such a practice has managed to survive all these years despite the progress and development that the world has seen. According to Alinane Kamlongera, author of “What Becomes of ‘Her’?: A Look at the Malawian Fisi Culture and Its Effects on Young Girls”, “The Fisi (sexual cleansing) practice does not only serve the male appetite (in the case of a Fisi himself) but also that of the potential/future groom. The entire initiation based on teaching a girl how to please her potential suitor.” In Malawi, there is a clear favoritism of boys over girls. Could this be a reason why the practice of sexual cleansing isn’t given the urgency it deserves? Many of these young girls do not understand what they are forced into doing. The parents or guardians need to be informed of the consequences of unprotected sex and how this tradition contributes towards the spreading of STDs, or contraction of HIV/AIDS, for example. More awareness should be spread about this practice, so that these young girls understand that what is being done to them is so wrong in so many ways.  

Below is a video courtesy of CCTV Africa that provides a brief report on the ‘Hyena’ man and the issue of sexual cleansing in Malawi.