Breast ironing in Cameroon: cultural practice and health consequences

Breast Ironing in Cameroon

Sexual mutilations have a long and controversial history. Sexual mutilations include a diverse variety of practices, including male circumcision, breast removal, clitorectomy, female genital mutilations, castration, cosmetic surgeries targeting sexual organs, and breast ironing. While each of these practices may seem barbaric to people outside of the culture, they generally have strong in-cultural support, which makes it difficult to eradicate these practices. These body modifications are practiced for a variety of different reasons, and, those reasons can vary tremendously. For example, breast ironing is allegedly practiced to make girls less desirable to men, thereby preventing adolescent girls from prematurely engaging in sexual behavior. However, breast augmentation, another form of sexual mutilation, is performed to make females more attractive, and, therefore, one would assume more likely to engage in sexual behavior. Regardless of the individual characteristics of sexual mutilation, they are frequently met with expressions of outrage and bewilderment by people outside of the perpetrating community, but with acceptance by people within the community. This is certainly the case for breast-ironing, a practice that seems repulsive and dangerous to the people who do not practice it, but appears to be a prophylactic and protective measure by the mothers who inflict it upon their young girls.

Definition of Breast Ironing

While many forms of sexual mutilation are aimed at changing genitalia, breast ironing is aimed at changing the shape of a girl's breasts. As the name suggests, breast ironing refers to attempts to flatten a girl's breast. The practice usually begins with the onset of puberty, when girls begin to form breasts. The flattening can be accomplished in a wide variety of ways, but generally involves the use of some sort of coal-heated tool rubbed on a girl's breasts. It is not uncommon for the person doing the flattening to use a grinding instrument, such as a grindstone or pestle, to abrade the area when attempting to flatten the breast. In addition to the immediate effect of breast ironing, breast ironing creates a large possibility of negative long-term and short-term side effects. It "exposes girls to numerous health problems such as abscesses, infections, dissymmetry of the breasts, cysts, and even the complete disappearance of one or both breasts."

Cameroon

Breast ironing is mainly practiced in the small African country of Cameroon. "It is also practiced in countries such as Guinea-Bissau, Chad, Togo, Benin, and Guinea." However, those countries do not have the same rate of breast ironing, and share similar cultural justifications with the people of Cameroon for the breast ironing.

Therefore, to understand breast ironing, one must understand its background cultural context. From a modern historical perspective, it seems fair to conclude that the Bakas (Pygmies) were the first inhabitants of Cameroon, and they still inhabit parts of southern and eastern Cameroon. The Bakas were followed by the Bantu, and then the Fulani. The first Europeans in Cameroon were the Portuguese in the 1500s, and European involvement from that time to the late 1870s was focused on the slave trade and coastal trade with natives. In the late 19th century, Christian missionaries established missions in Cameroon. In 1884, Cameroon became part of the German colony of Kamerun. The area remained under German control until the League of Nations mandate in 1919, which partitioned it between Britain and France. In 1955, the Union of the Peoples of Cameroon (UPC), which was mainly composed of the Bamileke and Bassa ethnic groups, began the struggle for independence. In 1960, French Cameroon gained independence and became the Republic of Cameroon. The Southern third of British Cameroon, which was largely Christian, joined the Republic of Cameroon and formed the Federal Republic of Cameroon. However, the British and French regions retained some autonomy. In 1972, the federation became a unitary state. Currently, Cameroon is ruled by former Prime Minister Paul Biya, a member of the Bulu-Beti ethnic group. Biya has been president since 1982 and his party holds a majority in the legislature, as well.

Today, Cameroon is relatively ethnically diverse. It is composed of 31% Cameroon Highlanders, 19% Equatorial Bantu, 11% Kirdi, 10% Fulani, 8% Northwestern Bantu, 7% Eastern Nigritic, 13% other Africans, and less than 1% non-Africans. As one might expect given its ethnic diversity, in Cameroon they speak French, English, and languages from 24 different major African language groups. The country is religiously diverse as well with 40% of people practicing indigenous beliefs, 40% Christian, and 20% Muslim. Like most other African countries, Cameroon has been devastated by HIV / AIDS, so that the average life expectancy is only 53.3 years.

From an international perspective, Cameroon has several human rights issues. One of the most significant of those may be that:

Cameroon is a source, transit, and destination country for women and children trafficked for the purposes of forced labor and commercial sexual exploitation; most victims are children trafficked within country, with girls primarily trafficked for domestic servitude and sexual exploitation; both boys and girls are also trafficked within Cameroon for forced labor in sweatshops, bars, restaurants, and on tea and cocoa plantations; children are trafficked into Cameroon from neighboring states for forced labor in agriculture, fishing, street vending, and spare-parts shops; Cameroon is a transit country for children trafficked between Gabon and Nigeria, and from Nigeria to Saudi Arabia; it is a source country for women transported by sex-trafficking rings to Europe.

In addition, Cameroon's security forces committed numerous unlawful killings, torture, and beatings. Furthermore, the law provides for the arrest of homosexuals and those not carrying identification cards. The government restricts the rights to free speech, press, assembly, and association.

In addition, Cameroon is an impoverished country:

Cameroon is overwhelmingly poor, with a mainly agricultural economy. Although the country earned significant debt relief under the International Monetary Fund/World Bank Heavily Indebted Poor Countries (HIPC) initiative, the resources released by the program have not been diverted to antipoverty efforts. Unemployment hovers around 20%, and Cameroon was ranked 144 out of 177 countries in the UN Development Programme's 2007 Human Development Index.

Although Cameroon is a poor country, there is potential for it to improve its economic situation. For example, since 1995, Cameroon has been a member of the World Trade Organization. However, it has not proven competitive internationally because "the absence of a competition regime and the transfer of monopolies from state-owned enterprises to private sector have contributed to maintaining prices high; this affects the competitiveness of the country's goods and services."

Other Sexual Mutilations

Though breast ironing may be mostly limited to Cameroon, sexual mutilation is rampant in Africa. The most well-known and horrifying of these sexual mutilations may be female genital mutilation. According to the World Health Organization:

Female genital mutilation (FGM) includes procedures that intentionally alter or injure female genital organs for non-medical reasons. An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM. In Africa, about three million girls are at risk for FGM annually. The procedure has no health benefits for girls and women. Procedures can cause severe bleeding and problems urinating, and later, potential childbirth complications and newborn deaths. It is mostly carried out on young girls sometime between infancy and age 15 years. FGM is internationally recognized as a violation of the human rights of girls and women.

Internationally, there is much greater awareness of female genital mutilation than there is of the practice of breast ironing. Moreover, the international reaction to this practice, which creates irreversible physical and psychological damage to the victims, has been absolute horror at the practices, though they were not considered sex-based violence or torture by an internationally recognized group until 1995. Despite the strong international reaction to this practice, the fact is that it continues to exist. In order to understand how such a practice that is internationally recognized as a human rights violation can continue unabated, one must understand the reasons that female genital mutilations are performed:

The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities. Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. FGM is often motivated by beliefs about what is considered proper sexual behavior, linking procedures to premarital virginity and marital fidelity. FGM is believed by some to reduce a woman's libido and help her resist "illicit" sexual acts...FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are "clean" and "beautiful after removal of body parts that are considered "male" or "unclean." Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support. Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination. Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation.

Though a tremendous range of practices fall under the title of female genital mutilation, understanding what is involved in the process really helps one understand why it is internationally condemned as a violation of human rights. The most drastic type of female genital mutilation is infibulation. A standard infibulation process is as follows:

The amount of tissue removed is extensive. The most extreme form involves the complete removal of the clitoris and labia minora, together with the inner surface of the labia majora. The raw edges of the labia majora are brought together to fuse, using thorns, poultices or stitching to hold them in place, and the legs are tied together for 2-6 weeks. The healed scar creates a hood of skin which covers the urethra and part or most of the vagina, and which acts as a physical barrier to intercourse. A small opening is left at the back to allow for the flow of urine and menstrual blood. The opening is surrounded by skin and scar tissue and is usually 2-3 cm in diameter but may be as small as the head of a matchstick.

If after infibulation the posterior opening is large enough, sexual intercourse can take place after gradual dilatation, which may take weeks, months or, in some recorded cases, as long as two years. If the opening is too small to start the dilatation, recutting (defibulation) before intercourse is traditionally undertaken by the husband or one of his female relatives using a sharp knife or a piece of glass. Modern couples may seek the assistance of a trained health professional, although this is done in secrecy, possibly because it might undermine the social image of the man's virility.

Furthermore, because infibulations can make penetration and intercourse so painful for a woman, especially after additional scarring caused by deinfibulation and childbirth, the practice can actually lead to a higher divorce rate.

While most Westerners find the prospect of sexual mutilations horrifying, the reality is that Westerners, specifically Americans, regularly engage in a variety of sexual mutilations. The most widespread of them may be the practice of male circumcision. Circumcision involves the removal of the male foreskin from the penis, usually within a few hours of days of the birth of a newborn male:

At birth, the penis is covered with a continuous layer of skin extending from the pubis to the tip of the penis where the foreskin (prepuce) folds inward upon itself, creating a double protective layer of skin over the glans penis. The inner lining of the prepuce is mucous membrane and serves to keep the surface of the glans penis (also mucous membrane) soft, moist, and sensitive. The prepuce is often erroneously referred to as "redundant" tissue, which allows the medical community and society-at-large to consider the foreskin an optional part of the male sex organ and, therefore, to condone its routine removal in a variety of procedures collectively known as "circumcision."

Although the majority of males in the world are not circumcised, the practice is considered so routine in the Western world that it is considered a routine part of the birth process, and its horrifying aspects may not be understandable unless one realizes what actually occurs during the practice:

Usually, the procedure for circumcision in America involves the baby being strapped spread-eagle to a plastic board, with his arms and legs immobilized by Velcro straps. A nurse scrubs his genitals with an antiseptic solution and places a surgical drape - with a hole in it to expose his penis - across his body. The doctor grasps the tip of the foreskin with one hemostat and inserts another hemostat between the foreskin and the glans. (in 96% of newborns, these two structures are attached to one another by a continuous layer of epithelium, which protects the sensitive glans from urine and feces in infancy and childhood.) the foreskin is then torn from the glans. The hemostat is used to crush an area of the foreskin lengthwise, which prevents bleeding when the doctor cuts through the tissue to enlarge the foreskin opening. This allows insertion of the circumcision instrument. The foreskin is crushed against this device circumferentially and amputated.

Though there are cultural reasons for infant circumcision, there do not appear to be any valid health benefits for circumcised infants. Proponents of male circumcision often cite hygiene as a cause for circumcision, but an uncircumcised penis is easy to keep clean as long as a child or caregiver takes basic and easy steps to ensure its cleanliness and prevent infection. However, the reality is that "Circumcision is not a medical decision. Preventing an improbable future infection is a spurious indication. The standard of care is antibiotics, not amputation." Moreover, although recent evidence has suggested that circumcised males are less likely to contract HIV / AIDS than non-circumcised males, the reality is that male infants are not engaging in sexual behavior that places them at risk for contracting those diseases.

Furthermore, even for adult males, condoms are much more effective at curbing the spread of HIV / AIDS than circumcision.

While female genital mutilation is prohibited in much of the Western world, male genital mutilation is routinely accepted. However, people have recently begun to challenge those laws, alleging that they discriminate on the basis of sex. In addition, these opponents allege that the behavior is a violation of a child's indelible human rights. Despite these concerns, the practice remains legal within the United States.

While the majority of sexual mutilations are justified by the idea that they discourage sexual behavior or disease transmission, in Western cultures, a number of people undergo voluntary sexual mutilations. Those mutilations are oftentimes referred to as enhancements or augmentations. Breast augmentation surgery is a frequently-performed surgery with the goal of making breasts larger, and, thus, increasing one's sexual attractiveness. "Breast cutting is epidemic among popular female performers and celebrities, leading young women to believe that surgical alteration is necessary to achieve their dreams."

Although these surgeries are performed on consenting adults, the similarities between them and other forms of sexual mutilation bear some consideration. Breast implants surgeries carry the risks of additional surgeries, capsular contracture, breast pain, changes in nipple and breast sensation, rupture, and migration of silicone gel for silicone implants. However, it must be noted that there is a significant difference between breast implants and other forms of sexual mutilation, since breast implants are chosen by consenting adults. They may face tremendous cultural pressure to conform to societal norms of beauty, but there are some feminists who adamantly argue that a woman should have the right to choose to have breast implants.

Analysis

If mothers are worried that their daughters are going to be victimized by predatory males, many logical people would question why the mothers are trying to physically alter the daughters, rather than physically altering their sons. After all, most of the people involved in the practice do not seem to suggest that their daughters are engaged in intentional behavior that would violate cultural behavior norms. However, penis ironing has not become a problem in Cameroon. To understand this, one needs to understand the underlying gender issues in Africa. One commentator has described it as follows:

African culture and traditions essentially view women as a prey and men as hunters. Women are sexual objects and a man is almost never wrong when he succumbs to the charms of a woman by having sex with it with or against her consent. Breast ironing is the result of these anti-female beliefs, which lead parents to destroy their daughter's breast in order to avoid shame and to avoid their daughters to become a sexual object, which a man will possess too early in life.

While it may be simplistic to describe women as prey and men as predators, the status of women in Cameroon would certainly suggest that they are considered lower than males. Although the constitution protects women in Cameroon, the reality is that neither the civil law nor customary law protects women, who are afforded a subservient status in basic matters, such as marriage and sexual choices, property ownership, and ability to obtain a divorce. Women in Cameroon are at the beginning stages of a feminist movement, and are taking steps to change their lower social status. The Cameroon Grassroots Women Educational, Economic and Social Advancement network, CAGWEESA, [recently] organised the workshop in Bamenda to empower some 60 women to battle such issues as HIV / AIDS, rights to own land and inheritance, and also to promote reproductive and family health.

In addition, one has to understand the problem of rape in Africa to understand why mothers would engage in such seemingly irrational behavior to try to prevent the rape of their daughters. The reality is that rape is absolutely rampant in much of Africa, including Cameroon, and that the complex environment that has led to rape rates that are not proportionate to those found in the rest of the world, has nothing to do with sexuality. For example, rape in Africa is frequently used as an act of war or political intimidation. In addition, some women are stolen and raped by armed bandits, who keep them in rape concentration camps. It seems inconceivable that such men would be deterred by a woman's lack of breasts. However, it also seems inconceivable that a mother of a daughter would not want to try to exert some control and try to protect her child from the possibility of a brutal attack. Therefore, it seems unlikely that this problem will be eradicated if the surrounding cultural climate is not changed.

From an international perspective, it is difficult to impose human rights on other people who claim cultural tradition as a basis for a ritual, because that opens up claims of racism and cultural insensitivity, which would also violate human rights. One difficulty is that there is no single international standard for human rights.

On December 10, 1948, the United Nations adopted the Universal Declaration of Human Rights, which outlines basic human rights. Since that time, there have been nine total core international human rights treaties, some of them dealing specificially with children and with gender discrimination. At the Convention on the Elimination of All Forms of Discrimination Against Women, United Nations member nations ratified a prohibition against any type of gender-based discrimination. In addition, the Convention on the Rights of the Child discusses a child's right to be raised by her parents in a family environment without undue governmental interference, but also discusses the child's right to be raised by a best interests standard. Clearly, in the case of something like breast ironing, reconciling the two is impossible. In addition, while these declarations of rights are admirable, they are only enforceable on UN member nations, and have only been enforced in the context of state action. Cameroon has criminalized the practice of breast ironing, so it would be difficult, if not impossible, to suggest that state actors are playing a role in perpetuating the process. That is not to say that some have not suggested that other sexual mutilations, most notably female genital mutilation, be treated and prosecuted as torture, but the international community has not responded positively to those calls.

There is also the problem of accountability. Establishing international human rights standards is a lofty ideal, but there has not been a practical means established to deal with offenses. Of course, there are international human rights tribunals established to try government officials for violations of human rights. Research shows that human rights trials do have a positive impact on the citizens of the country in question and can actually have an ancillary positive impact on neighboring countries. In addition, the United States has taken steps to try to enforce international law in a domestic context. 18 U.S.C.S. 2340A (a) provides that: "Whoever outside the United States commits or attempts to commit torture shall be fined under this title or imprisoned not more than 20 years, or both, and if death results to any person from conduct prohibited by this subsection,