Very Superstitious: How health myths spread in sub-Saharan Africa

R emember when you were younger and (enter name of a person older and consequently wiser than you here) was an unerring fountain of wisdom incapable of leading you astray? What kinds of things did they tell you?

  • Don’t sit too close to the TV, it will ruin your eyes;
  • Don’t swallow those watermelon seeds. A watermelon will sprout in your stomach!
  • Yes, we’re almost there.

Older siblings, kids at school, that maybe-intoxicated uncle at your family reunion ever-present when it came time to bestow some unsolicited, yet surprisingly sagacious wisdom upon you… the source of these ideas never much mattered. If they came from someone even remotely credible, we rushed to lap them up like Pavlovian dogs– and later, upon assuming a position of credibility of our own, used the same power of being “older and wiser” to pass on these myths to others naive enough to accept our words as scripture.

The danger in this not-so-virtuous cycle, of course, is that small tidbits of misinformation intended for individual consumption often reach persons en masse. And when that happens, myths seemingly too far-fetched for even a naked emperor to take seriously become widely accepted points of reference for how we ought to live our lives.

All of this begs two questions:

  1. How do such wive’s tales come to be; and
  2. What happens when they spread– especially when they concern a person’s health?

The Research

Over the past decade, organizations all over the world have conducted more research than we’ve got the time (or desire) to reference, in efforts to address and promote sustainable development in sub-Saharan Africa. Those familiar with the Sustainable Development Goals (SDGs) released in 2015 will attest to the fact that words like ‘sustainable,’ and ‘global development’ are hardly narrowly-defined, and encompass issues ranging from water availability and gender equality to economic empowerment and accessibility of education.

Like the SDGs, the reports generated from that research cover a range of issues but shed a lot of light on some of the causes of endemic problems in the countries studied, as well as the cyclical impact that not addressing their root causes has on communities where they’re present.

Of particular interest is a spate of surveys that focus on sexual health and family planning practices among populations in sub-Saharan nations.

The National Adolescent Surveys of Ghana, Malawi, Burkina Faso, and Uganda provide the basis for findings published in a 2007 Guttmacher Institute report geared towards ‘Learning from Adolescents to Prevent HIV and Unintended Pregnancy.’ Baseline data published in 2015 by the Measurement, Learning & Evaluation project– also generated by The Guttmacher Institute– provides valuable insight as well.

Further findings gleaned from women aged 15–49 living in select cities in Kenya, Nigeria, and Senegal, address “Belief in Family Planning Myths at the Individual and Community Levels,” while also looking into “Modern Contraceptive Use in Urban Africa.”

Collectively, the results published in the 2007 and 2015 reports point to a number of eye-opening trends currently active in these countries. Most notably, that major areas of the sub-Saharan are a jumble of family planning and sexual health misinformation, rivaled perhaps only by backwoods bible belt school systems in the United States.

The Myths

As a baseline, it might be useful to consider a few ideas related to the promotion of sexual health. Below is a small collection of survey statements posed to respondents from the aforementioned nations studied:

The AIDS virus can be transmitted by…

  • Sharing Food (Yes/No)
  • A Mother to Her Child During Delivery (Yes/No)
  • Mosquito Bites (Yes/No)
  • Witchcraft or Supernatural means (Yes/No)

Transmission of the AIDS virus can be prevented by…

  • Using a condom correctly at every sexual intercourse (Yes/No)
  • Avoiding sharing toothbrushes (Yes/No)

Can a man infected with the AIDS virus be cured if he has sex with a virgin?

  • Yes; No; I don’t know.

Can a female get pregnant the first time she engages in intercourse?

  • Yes; No; I don’t know.

The results of the 2004 National Survey of Adolescents in Ghana as they pertain to sexual and reproductive health provide a telling glimpse into the degree to which some of these misconceptions are held:

The responses here are indicative of a couple of disconcerting truths:

  1. Considering that many less-commonly held myths were not included in this table, it’s probably safe to conclude that the range of myths floating around these and other developing communities is quite vast; and
  2. The degree to which much of the counterfactual information in this table is either accepted or not fully rejected (“don’t know”) indicates a severe deficiency in the way of quality, evidence-based sexual health and family planning information– an issue which, in and of itself, deserves further investigation.

As the prior tables indicate, within these communities, there are more health-related myths than one could shake the proverbial stick at. Though they cover a series of different sexual activities, the two most consistently documented issues pertain to disease transmission and the use of contraception. We could certainly spend all day brainstorming a list of every myth that’s come into existence, but it’s probably a bit more practical to simply address the ones that are more widely accepted today.

 Common Misconceptions of Pregnancy and Disease Transmission

  • HIV can be transmitted through a mosquito bite
  • Men infected with HIV can be cured by having sex with a virgin
  • HIV can be transmitted through the sharing of food
  • HIV can be transmitted through witchcraft

Common Misconceptions of Contraceptive Use

  • Use of contraceptive injection can make a woman permanently infertile
  • People who use contraceptives end up with health problems
  • Contraceptives can harm your womb
  • Contraceptives can cause cancer
  • Contraceptives can lead to birth defects
  • Women who use family planning/ birth spacing become more promiscuous

How common are these myths?

The table below provides a summary of adolescent beliefs across Malawi, Ghana, Uganda, and Burkina Faso as they relate to pregnancy and disease transmission. Following that is a table summarizing belief in family planning myths in Kenya, Senegal, and Nigeria.

sex myth awareness by country and gender*All pregnancy-related percentages combine affirmative responses with “Don’t Know” responses.

There’s a lot to digest here. It goes without saying that a variety of myths exist in each of these communities, but what’s perhaps more remarkable is the extent to which they are held to be valid. More fascinating still is the fact that with respect to the disease transmission and pregnancy myths, there’s no pattern of note as it relates to a nation’s belief in one myth carrying over to beliefs in others.

For example, while teens in Uganda are the least likely to believe that HIV can be transmitted through witchcraft or other supernatural means, they are tied for first in the likelihood of believing that those infected with HIV can be cured by having sex with a virgin. Likewise, Burkinabe teens– most likely to believe that HIV can be transmitted through a mosquito bite– are merely in the middle of the pack in their acknowledgment of witchcraft or other supernatural forces as causes linked to transmission.

This selective acceptance of myths devoid of across-the-board buy-in points to significant geographic, cultural, or ethnic differences among survey participants, which could partially explain divergent levels of belief in the myths.

Let’s have a look at the reported data on family planning myth belief in Kenya, Nigeria, and Senegal:

As might be expected, findings from this study indicated a negative association between individual acceptance of these myths and the use of contraceptives. Kenyan women, for example, who believed an average of 4.6 out of 8 myths presented to them, would be roughly half as likely to use contraceptives as Nigerian women, who believed an average of 2.7 out of 8 myths.

An item that catches the eye is the fact that regardless of the myth, or sex of the respondent, Kenyans are significantly more likely to believe in a myth than are their counterparts. One explanation for this phenomenon points to the state of sexual education in Kenya.

Though the publicly-funded sex ed programs that exist in the nation are fairly holistic in terms of their content and in comparison to other nations of similar human developmental progress, the courses are generally just extra-curricular, meaning that little if any of the content is mandatory within schools for adolescents. The void created by the lack of compulsory sexual health and family planning courses in primary and secondary schools, then, leaves ample space for the propagation of myths and rumors surrounding the ills of contraception.

Myth Origins

Many, if not all, of the pregnancy myths commonly held in communities in sub-Saharan Africa, are also prevalent in a number of other regions throughout the world. For this reason, we’ll focus more on disease transmission and contraceptive myths that are more unique to the communities being discussed.

Myth 1: Virgins Cure HIV

The notion of virgins possessing supernatural healing capabilities associated with sexual illness has its roots in Europe, where such myths were first reported in the 16th century. In the years that followed, tales of virgins as living, breathing cure-alls for any number of diseases, particularly Syphilis and Gonorrhea, took root in Victorian England and saw their popularity peak in the 19th century. A common theory regarding the significance of the virgin as a powerful healer stems from the evolution of Christian legends of virgin martyrs, whose purity served as a form of protection in battling demons. Still widely-held in many circles today, support for this myth would likely be common among those that believe HIV is propagated by witches or other demonic forces.

Myth 2: HIV is caused by witchcraft

Adam Ashforth, a Humanities professor at the University of Michigan with an extensive track record in research surrounding the pervasiveness of witchcraft in sub-Saharan Africa, notes, ‘a disease or complex of symptoms better suited to interpretation within the witchcraft paradigm than AIDS would be hard to imagine.’ This is because the symptoms of AIDS — diarrhea, tuberculosis, and wasting are also the classic symptoms of poisoning through witchcraft.

Similar symptoms can also be found in many diseases brought about by mosquito bites, such as malaria and dengue fever, thus giving similar credence to the myth of mosquitoes transmitting HIV.

So, even when people accept that AIDS is caused by a sexually transmitted virus, suspicions of witchcraft may be retained as potential explanations for the infection.

This breathes life into a kind of Que Sera Sera belief system, wherein adolescents argue that using contraception to prevent the spread of diseases is pointless: those who are destined to get HIV will get it one way or another anyway.

Myth 3: Contraceptive Use Leads to Negative Health Impacts

Having a look back at the contraceptive myths table (I’ll wait)

you’ll notice that the most popularly-held notion is that the use of contraceptives will in one way or another lead to negative health outcomes for women. In the same way that these purported negative impacts take many forms, the rationale behind the belief in the myths supporting them is massively varied.

A 2015 report highlighted the dangers and potential origins of such beliefs:

“Misperceptions about contraceptives appear to stem from multiple sources. Women’s experience of side effects may lead to misperceptions about methods. For example, the myth that hormonal contraceptives cause blood to accumulate in the body and cause tumors may have its origin in menstrual disturbances/ amenorrhea that is a documented side effect of some methods. When women experience this side effect in the absence of correct information, they may create a narrative that explains it.”

Another report identifies social networks as a significant source of misinformation, noting, for example, that women in rural Kenya have sought information from others whose bodies and circumstances were similar to their own as a supplement to information that is either counterfactual or packaged as one-size-fits-all clinical advice with which the women cannot identify.

Thus, even when women proactively seek health information about contraceptives from reliable sources, they often end up adopting advice received while chatting with more trusted, albeit less-reliable, friends and neighbors in similar health states. Assuming that those sources of information have already created their own explanations for their deteriorated health, misinformation can spread every bit as easily as an STD.

can a woman get pregnant if she watches herself after sex

source: 2004 National Survey of Adolescents

How sexual health myths spread

As the bit about contraceptive myth origins alludes to, social networks in both rural and urban communities are the straw that stirs all kinds of myth-laced drinks– particularly among female would-be contraceptive users. It’s often the case that while nurses and other health experts actually provide positive information that promotes effective family planning methods and dispels rumors tied to contraceptives, the information is explained in a way that patients either don’t understand or feel isn’t applicable to their particular circumstances. Ultimately, they end up seeking supplemental advice in the form of anecdotes from friends, neighbors, and relatives.

Traditional healers also play a significant part in dissemination amongst communities in which their expertise is revered. This, it is argued, serves as one of the chief contributors to the epidemic of HIV/AIDS incidences throughout parts of Africa. Many healers perpetuate myths, which encourage HIV-positive men to cure their diseases by having sex with virgin girls, or individuals thought to be sexually undesirable–and by consequence, also virgins– such as the blind, deaf, physically impaired, and mentally disabled. The blood produced by intercourse with the presumed virgin, the myth holds, will fully cleanse the infected person’s blood of the disease.

Corrective action

There’s a lot going on with respect to what contributes to these myths, as well as the rate and extent to which they spread in communities. Cultural, geographic, and religious differences; distrust of external entities; adherence to tradition; and plainly not knowing any better all have a part to play in an issue that’s led to scores of health and subsequent other developmental issues in recent decades.

Taking all of this into account, is there a conceivable way that concerned parties could try to remedy some of these problematic beliefs?

Bad news first:

Best-case scenario: trying to correct misperceptions may only yield a mixed-bag with respect to impact. Worst-case scenario: efforts to directly address misperceptions– via evidence-based information or through some other means– run the risk of actually strengthening pre-existing notions. This particularly pernicious caveat to solving the problem of myth belief manifests itself in a few ways.

One challenge that comes along with combating a long-held belief with evidence-based information is the way in which such a pitch is ultimately interpreted.

Think back to the case of the Kenyan women seeking advice that resonated with them. Research has found that people often interpret information within the context of their personal experiences and worldview. This means that an attempt to transmit fact-based information about disease transmission or contraceptives ultimately turns into a game of telephone, with the subsequent spread of additional misinformation.

Even if we assume that the evidence-based information being shared is taken at face value by its recipients, there’s still a two-headed monster to be dealt with in the form of familiarity bias and ‘stickiness.’

Stickiness refers to how deeply embedded a pre-existing myth is in one’s memory– despite their being made aware of new, contrasting information– and is often a factor of how emotionally-compelling the initial myth was.

Think of a particularly ‘sticky’ myth– like the virgin cure– as an egg that’s thrown at your car. You can scrub and scrape and use scalding hot water, but removing it takes a lot of doing.

Familiarity bias exacerbates the issues precipitated by stickiness in that the very mention of myths, even within the context of trying to correct them, can lead to stronger belief in them. Each mention of a given myth (“…and Mexico’s going to pay for it!”) makes it increasingly ‘familiar,’ and by consequence, makes us more likely to believe it to be true.

The “Good” news:

In light of the laundry list of roadblocks that could potentially arise in attempting to reverse myth belief, understanding how people process information and which strategies are most effective at dispelling myths might be a bit useful.

To help us with that, below is a sampler platter of best practices identified by cognitive scientists to be used in debiasing people who hold misperceptions:

  • Focus on providing correct information rather than negating myths;
  • Keep the information simple and limited (for example, three pieces of information can have more impact than ten);
  • Create an alternate, compelling explanation to replace the myth (fighting stickiness with stickiness);
  • Present messages through sources that are trusted by the intended audience;
  • When possible, present information visually.

Employing a more humanized approach to myth reversal in these ways enables those seeking guidance to actually absorb valuable information, rather than being bogged down by it.

Part and parcel of ensuring that such information gets absorbed would be an overhaul in the way that contraceptive side effects are communicated.

Per a 2015 report on countering myths and misperceptions about contraceptives:

Women report that providers are often dismissive about side effects, counseling that they are ‘normal’ or ‘nothing to worry about.’ Providers also may tend to emphasize effectiveness as much more important than side effects. However, when providers dismiss side effects, it trivializes the disruption that they can have on women’s lives and may cause clients to “give up” on the health care system, instead seeking services or information from less reliable sources.”

This brings us full circle to women soliciting health information from unqualified sources, which fans the flame for a lot of the issues surrounding family planning myths that we’ve already tackled.

The long and short of it is that for a variety of reasons, a slew of myths and misperceptions about sexual health and family planning continue to persist in these communities. To be sure, sub-Saharan Africa isn’t the only region in the world in which such misinformation remains rooted in the psyche of a considerable percentage of its people. However, it is far and away the hardest-hit among any world region if we’re talking HIV prevalence and incidence, global birth rates, infant mortality, and a menagerie of other developmental indicators.

Once the gobsmacking feeling attached to the idea of people actually believing these myths subsides, you’re left with the sobering realization that there is a lot to be said for dogma’s role in impacting the health of people in these communities.

Reversing this trend isn’t the job for a bleeding heart non-profit, a Western volunteer corps, or some church group that happens to end up in one of these communities on a week-long voluntourism stint. Nor could it ever be. Trust in outside entities that come in trying ‘make an impact’ without first understanding the cultural nuances at play, has eroded so substantially over recent decades that there’s no way any external initiative could ever have any teeth.

Change here would be better suited coming from within– with trusted community members acting as a vehicle to promote education through the eradication of long-held myths. Even with the most concerted of efforts, it goes without saying that this transformation won’t be a quick one. Getting men and women to accept evidence-based information won’t magically wipe away the alarmingly high rates of HIV incidence or prevalence that persist from the practices of generations past… but you get the feeling that it might be a bit more effective than virgin blood.

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