Photo by Swathi Sridharan

Among the remaining taboos of Cameroonian society are some gender and sexuality issues. Menopause is one of them. You hardly find anything in public discourse on this issue. There is no forum dedicated to menopause nor research groups or reports.

Social science researchers, especially anthropologists, have tried to understand menopause in Cameroon. Their view on the issue is binary and culturalist. Apart from Mbarga’s work comparing menopause in Cameroon and Switzerland[1], most of the studies are anachronistic and globally fail on giving a clear understanding of this issue in the contemporary context.

Research by the French anthropologist Jeanne-Francoise Vincent[2] on Beti women in the central region of Cameroon in the 1970s suggests that menopause signifies the end of sexual submission for women in this patriarchal society. The beti culture constructs menopause as the beginning of a period of “initiative and development”. Thus, menopause marks “the beginning of a new period in which women can also exercise their power and their ability to become equal to men” (2003 131). This transformation of the status of the person must be accepted by the husband. ” The arrival of menopause is for women therefore a way to lead their own life.

This change is evident in language which names “the menopausal woman in a rewarding way and designates her as” an important woman, an accomplished woman “nya mininga” (2003 134)). Being menopausal is, according to Vincent, a condition for positions of power, such as becoming a woman leader in the secret societies of the village. This role makes the woman who endorses her an eminent person with strong responsibilities and real power.

On the symbolic side described by ethnologists, menopause implies, on the one hand, a lifting of multiple prohibitions, for example acts and words in public spaces, and, on the other hand, an opening of possibilities among others, access to certain foods, acquiring new roles in the community such as therapist, midwife, leader of rituals etc. These symbolic benefits are still often reported in rural areas, but are not so visible in the city, where a heterogeneous population coexists with great cultural diversity.

In everyday life, however, the women interviewed in Yaoundé point out different experiences for which the reported facts do not overlap with the realities described by some anthropologists. One explanation is obviously the gap between the traditional and rural spaces in which some research has been conducted and the city where traditional values are diluted in more a globalized, westernized and at the same time individualistic environment.

There remains the experience that is often individual in the face of menopause. The women we interviewed had 3 types of interlocutors that illustrate urban social reconfigurations. The first interlocutor for educated women is their gynaecologist. He is the first to answer questions about physiological changes and disruptions. For all that, women point out that they get mixed and unsatisfactory answers. As some research points out, the current discourse on menopause is highly medicalised and ambivalent.

A second type of interlocutor is constituted by friends or professional networks. Finally a third source of information is the internet for those who have access to it. However, knowledge of the menopause and its symptoms remains very low among women interviewed in Yaoundé. This seems to be the case in the rest of Africa. An Ivorian study conducted on 278 women in 2017[3] showed that the symptoms and risks of menopause are unknown by 73.68% of women. However, a test carried out for this purpose shows that the level of knowledge of menopause is related of the level of schooling. This also seems true in Yaoundé where educated women seem to have a better knowledge of menopause in general and are able to search on google for medical information.

Another important point is the use of medicinal plants to treat or prevent symptoms. A majority of women interviewed in Yaoundé used plants purchased from herbalists and other traditional healers. They are either in the form of a concentrated liquid, in powder or simply as fresh or dried barks. Depending on the quality and intensity of the symptoms, some women go to the hospital to see a general practitioner. These women are often discouraged by healthcare professionals who explain that menopause can not be truly treated.

It is known that modern medicine offers menopausal hormone treatments (HRT) to cope with discomfort with the advantage of eliminating many symptoms, the risk of cardiovascular disease and osteoporotic fractures. However, concerns regarding possible harmful side effects of HRT has impacted on its uptake by women.  Hormone Replacement Therapy is not accessible and available in many African countries, particularly Cameroon.

Today, women are turning more and more to other medicines and plants. This poses a problem in the context where the marketing of medicinal plants remains poorly controlled, despite the willingness of public health services to better regulate the practice of traditional medicine through recognition of the function and quasi-union organization created for these actors.

Reference

[1]Josiane Mbarga, « Regards de Suissesses et de Camerounaises citadines sur la ménopause : dépasser les dichotomies binaires », Anthropologie & Santé [En ligne], 8 | 2014, mis en ligne le 31 mai 2014, consulté le 21 mai 2019. URL : http://journals.openedition.org/anthropologiesante/1396

[2] VINCENT J.-F., 1976. Traditions et transition : Entretiens avec les femmes beti du Sud-Cameroun. Paris, ORSTOM Berger-Levrault ; VINCENT J.-F., 2003. « La ménopause, chemin de la liberté selon les femmes beti du Sud-Cameroun », Journal des africanistes, 73(2) : 121-136.

[3] See Kouamé A, Koffi Y., Piba S.,  et al, 2018, « Niveau de connaissance de la ménopause et habitudes alimentaires et médicinales des femmes en Côte-D’Ivoire », European Scientific Journal, Vol 14 Ju 2018,

Photo (CC BY) Daniel Miller

For a project concerned with health and mid-life, menopause is an obvious target. What specifically does an anthropological perspective add, first to understanding menopause and second to envisaging a positive digital intervention? One key anthropological component, which is the comparative perspective, will have to wait until the team completes its research, but from my Irish fieldsite there are many possible insights. The challenge is firstly that no two women have the same experience. Menopause can start in your 30s or 50s. It can be almost symptom-free or have dramatic effects, some of which may never end.

The anthropologist will focus on the way medical issues are inextricable from the social context. The effect can be on close relationships. As a pharmacist told me, “Sometimes they come and say ‘I’m ready to kill my husband I think I’m going crazy’ very reassured when you say it could be the menopause”. Or women report that vaginal dryness makes it too painful to have sex. Women have told me that their mothers never mentioned menopause to them, or that they do or do not feel they can discuss the topic with their sister or close friends. Mostly they report that menopause is a topic that can only be broached through jokes. The impact might also be on wider relationships, such as to one’s work: “You might say to your colleague `could you just take over for a moment’ and then not explain why you would disappear, because you had a flush and you needed to remove yourself”.

Then there is the relation to wider medical authorities. Concerns about HRT or addictive sleeping pills may mean they prefer to consult complementary medicine rather than doctors. Knowledge seems to be a complete lottery, where some are well aware of the potential effects on bone density while others have never had anyone suggest this is something they might look into. Listening to women, within an ethnography, also alerts one to the considerable differences in perspective. One woman will give a feminist perspective about the need to rethink menopause as a celebration of a natural process, rather than merely a medical problem. While another, who is undergoing IVF and is desperate to have children, sees nothing to celebrate.

For us, the ASSA team, it is important that this same alertness to the social and wider context should manifest itself as the anthropological contribution towards delivering that will be of genuine benefit. One of the lessons from this research is that we need to see smartphone apps less as autonomous interventions and more as potential hubs. Different women will respond to different levels of information. There are those who are turned off by text and just want visuals, contrasted to those who want to read the medical journals. In my research so far, women have split equally between those who would prefer a discussion forum based on complete anonymity, to those who would only want to discuss these issues with people they can identity and feel some sort of relation to. In making relevant information more accessible all these factors need to be taken into account, but first and foremost comes listening to what a broad range of women say.