Mapping the Shadows: A Comprehensive Exploration of Breast Ironing’s Effects on Women and Girls through a Systematic and Scoping Review
Northumbria University, Faculty of Health and Life Sciences. Department of Nursing, Midwifery and Health, Coach Lane Campus East, Benton. Newcastle Upon Tyne, NE7 7XA. United Kingdom
University of Sunderland, Faculty of Health Sciences and Wellbeing, 197 Marsh Wall, London. E14 9SG. United Kingdom
University of the West of Scotland (UWS) London Campus, Faculty of Health and Social care, Import Building, 2 Clove Cres, London E14 2BE
Teesside university, School of health and life sciences, Campus Heart, Southfield Rd, Middlesbrough TS1 3BX
*Correspondence author Benjamin Olusola Ajibade E-mail: Benjamin.ajibade@northumbria.ac.uk (BOA)Abstract
Background
The research paper titled "Mapping the Shadows: A Comprehensive Exploration of Breast Ironing’s Effects on Women and Girls through a Systematic/Scoping Review" examines the cultural practice of breast ironing (BI) and its significant impact on the physical, psychological, and social well-being of women and girls. It explores the biopsychosocial implications of breast ironing on women, assesses knowledge and attitudes towards the practice, and analyses its prevalence and consequences.
Methods
This study employs a systematic/scoping review design following the PRISMA guidelines to collect and analyse qualitative and quantitative data. Data collection involved a comprehensive search of online databases, including EBSCO, PubMed, Google Scholar, and others. Four investigators conducted independent searches using specific keywords related to breast ironing. The inclusion criteria focused on studies examining the biopsychosocial impact of breast ironing within the past 10 years. The data were analysed using thematic analysis, chi-square tests, and logistic regression models.
Results
The practice of breast ironing results in severe physical and psychological trauma, including pain, tissue damage, infections, abscesses, and breast cancer. Psychologically, victims experience anxiety, depression, low self-esteem, and PTSD. The study found significant barriers to healthcare access due to stigma and lack of awareness. The prevalence of breast ironing is highest in the Littoral region (53%), with varying rates across other regions. Chi-square tests revealed significant relationships between BI and health outcomes, such as severe pain and family health issues (p-value < 0.001). Logistic regression indicated a strong association between BI exposure and negative health outcomes.
Conclusion
Breast ironing is a harmful cultural practice with substantial negative impacts on the health and well-being of women and girls. Comprehensive interventions, including legal measures, community education, and support services, are crucial to eradicate this practice and protect the rights and health of affected individuals.
Article notes
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Not Applicable
Background
Breast Ironing (BI) persists as a deeply rooted cultural practice with potentially detrimental effects on the physical, psychological, and emotional well-being of its victims. The practice of BI involves physically compressing the breasts of young girls through several crude means, primarily aimed at hindering breast development, impeding early sexual interest and debut, hindering adolescent pregnancies, enabling extended education, and safeguarding chastity for marriage. 1, 2
Although the historical genesis of BI is difficult to establish, it is typically transferred from mothers to their daughters 3. In regions where BI is practised, it is regarded as a direction for appropriate behaviour and treatment of girls 4. Despite the intention to delay sexual initiation and protect pubescent girls, the harmful short-term and long-term magnitudes of BI on the victims’ well-being significantly outweigh its purported benefits 4. BI is connected to various health risks and negative outcomes, such as adverse physical health effects 3, 5, 6, 7.
Subsequently, several advocacy groups, specifically NGOs and the United Nations classify BI as a harmful practice and a violation of the rights of the girl-child, advocating for its eradication. Nonetheless, the efforts to prevent this act have encountered resistance in communities that adhered to this practice 8. The insight of BI remains limited. A study by Ngunshi 3 aimed to investigate BI’s intricacies, motivations, historical context, and cultural underpinnings, suggesting that it might have originated as an ancient breast massage practice to address uneven breast growth. Its primary intent is to safeguard young girls from early sexual experiences and associated risks. BI uses various heated objects for this practice, and typically, the perpetrators are familial figures 3.
Breast ironing affects an estimated 3.8 million women worldwide, with the majority of cases occurring in Africa, and it has been identified as one of the five under-reported crimes related to gender-based violence 9. This practice is most commonly performed by a family member, particularly mothers, in 58% of cases. In Cameroon, it is estimated that between 25% and 50% of girls undergo breast ironing. Additionally, around 1,000 girls aged 9 to 15 in the UK are currently thought to be at risk of this practice 10.
In a 2016 debate in the House of Commons, Berry 11 discussed breast ironing (BI) while addressing the awareness and legislative journey against Female Genital Mutilation (FGM) in the UK. The debate highlighted the lack of prosecutions despite significant legal efforts and drew parallels with the lesser-known practice of breast ironing 12. Both practices are rooted in cultural beliefs aimed at controlling female sexuality, necessitating increased awareness, legal frameworks, and support systems to protect affected girls. Lazareva 13 found, through interviews with Margaret Nyuydzewira, head of the diaspora group CAME Women and Girls Development Organisation 14, that at least 1,000 women and girls in the UK had been subjected to BI intervention. It was concluded that no systematic study or formal data collection exercise on the topic had been conducted in the UK. It was also noted that BI is typically performed in the UK rather than abroad, unlike FGM, with about 15 to 20 recent cases reported in Croydon alone.
Although several studies have explored BI’s impact on women and pubescent girls, most have been concentrated in Cameroon, despite indications that BI is prevalent in other African countries and is becoming a global issue. These studies have mostly focused on short-term experiences or advocated against BI 2, 3, 15, 16. Some research has investigated the practice’s methods, motivations, outcomes 7, long-term health-related consequences, and victims’ quality of life 6.
Motivations Behind BI Practice
Contrary to other "harmful traditional practices," such as female genital mutilation or child marriage, BI is driven by the intention to safeguard young girls from the perils of adulthood, early sexual experiences, pregnancies, and early marriages. It also strives to promote future education and well-being. BI is rooted in embedded sociocultural attitudes, traditional norms, and gender inequality. Many patriarchal societies perpetuate these norms, aiming to maintain gender roles and privileges, favouring men over women. BI seeks to extend the period during which girls can prepare for adulthood and marriage, thereby postponing pregnancy, facilitating education, and delaying marriage to enable the realisation of individual potential 17, 18. Ethnographic research by Pemunta 17 reveals BI as a societal and disciplinary phenomenon to preserve societal norms and ensure the well-being of girls. Eriksson18 finds BI to hold diverse meanings in lived experiences.
Physical Health Consequences of BI
BI inflicts negative physical impacts on victims. Breast pain, distinct from cyclical pain, is a common outcome 1. Other physical detriments comprise a violation of physical integrity, risk of severe pain 19 or discomfort, swelling, tissue damage, burns, scars, bruises, deformities, and discolouration on breasts 2, 6, 7, 20, 21. Research even links BI to traumatic breast injuries. Foley et al. 22 highlight long-term consequences, including scarring and psychological distress from burns. Frostbite-induced breast injuries are also documented to occur while using faulty cryotherapy or persistent cold exposure to soft tissue 23.
Impact of BI Trauma on Health Outcomes
Though minimal research addresses BI’s long-term impact, related pain studies indicate potential physical and psychological trauma. Survivors of traumatic incidents, like the station nightclub fire, experience chronic pain, depression, and compromised quality of life 26, 27, 28. BI’s combined effects could potentially erode physical function and quality of life 27, 29, 30, 31.
Effects of BI on Quality of Life
BI constitutes a traumatic event with repercussions on survivors’ quality of life (QOL). Trauma stemming from violence, accidents, or abuse correlates with lifestyle changes, decreased QOL, and coping difficulties, especially in women 32, 33, 34, 35, 36. This systematic review aims to aggregate and evaluate the findings of studies on BI, facilitating informed decision-making.
Research Aim
This research aims to comprehensively explore the biopsychosocial impact of breast ironing on women.
Research Objectives
- To assess the knowledge levels of women regarding breast ironing.
- To examine the attitudes of women towards the practice of breast ironing.
- To investigate the prevalence and practices of breast ironing among women.
- To analyse the physical, psychological, and social consequences of breast ironing on women.
Research Question
What are the multifaceted biopsychosocial effects of breast ironing on women?
Method
We conducted a systematic and scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines 37. We aimed to explore the knowledge, attitudes, and practices of breast ironing among research participants. To achieve this, we designed a tailored protocol; however, we are unable to register it on PROSPERO because the search had already been conducted. Our comprehensive search encompassed both published and grey literature, utilising a range of online databases, including American Premier (EBSCO), PubMed/Medline, Google Scholar, Embase, Web of Science, PsycINFO, and CINAHL. Given the scarcity of research on this topic, we considered all relevant publications to date.
Search Strategy
Four investigators independently conducted the search for articles from August 1, 2023, to November 25, 2023. The search involved specific keywords such as "breast ironing," "breast flattening," "breast pounding," "chest ironing," "breast trauma," "breast injury," "knowledge," "attitude," "perceptions," "experiences," "views," "effects," "impact," "quality of life indicators," "health-related consequences and outcomes," "questionnaire," "interview," and "survey." These terms were manipulated using Boolean operators (AND, OR, NOT) to ensure a comprehensive search 38.
See S2 Table for Boolean search teams.
Additionally, we conducted a manual search by examining the reference lists of relevant papers. The search extended to other databases, including the World Health Organization (WHO), British Medical Journals (BMJ), and relevant policy documents and guidance such as NICE and library catalogues. We also included articles identified from the bibliographies of studies obtained from hand-searched journals.
Our review was limited to articles written in English and included various study designs that reported quantitative, qualitative, literature scoping and report of breast ironing. We applied strict inclusion and exclusion criteria to identify relevant articles. Our approach involved developing appropriate search terminologies for the topic, executing a search strategy using various search engines, critically evaluating selected articles, and extracting essential information from them without restriction to the year. However, a restriction was applied to the search years by the authors from 2014 to 2023, yielding a total of 1,740 publications. After removing duplicates, 1,386 publications remained. Further screening by titles and abstracts (857) reduced this number to 529 articles. Irrelevant articles (peer-reviewed and full text) were discarded (508), narrowing the selection to 21 articles.
See Fig 1 and S1 Table
The 21 remaining articles were further reviewed and screened by title, abstract, full text, and reference lists. Seven articles were excluded. Full-text articles were assessed for eligibility, with three excluded for not meeting quality criteria. Ultimately, 14 publications were included for a full assessment, but only 2 articles 17, 39 passed the final quality review, while 4 met some of the assessment criteria 6, 7, 40, 41 but were selected due to very limited work carried out in this area.
Inclusion and Exclusion Criteria
Inclusion Criteria
Articles reporting on studies conducted within the past 10 years that examine the biopsychosocial impact of breast ironing on women, using quantitative or qualitative research methods. Case studies were included due to the limited number of primary research articles in this area.
Exclusion Criteria
Articles not written in English, studies conducted outside the specified timeframe, and research focusing solely on men or other populations.
By meticulously applying these inclusion and exclusion criteria, we identified relevant articles that provide a comprehensive understanding of the biopsychosocial effects of breast ironing on women using the PEO criteria 54.
Quality Assessment
Quality assessment in this study involved evaluating the methodological rigor and validity of the primary studies included. The process encompassed a thorough examination of each study’s design, sampling methods, data collection techniques, and analytical procedures. This ensured that the findings were reliable and that any potential biases were minimised. Each study was rated based on predefined criteria, which included aspects like the clarity of research questions, the appropriateness of the methodology, the robustness of the data analysis, and the overall consistency of the results. We conducted a systematic review involving 6 primary research studies, 2 articles 17, 39 passed the final quality review, while 4 met some of the assessment criteria 6, 7, 40, 41 but were selected due to very limited work carried out in this area. The other 2 papers included in the scoping review are one report and a literature review 3, 43. The quality of the studies included in this systematic/scoping review was assessed using criteria adapted from established quality assessment frameworks, specifically the Critical Appraisal Skills Programme (CASP) for qualitative studies to evaluate the credibility, relevance, and robustness of qualitative research 44 CASP Checklist Mixed Methods Appraisal Tool (MMAT), version 2018 45 and Tulder’s 46 assessment checklist for quantitative studies. The assessment criteria focused on several key aspects to ensure a thorough evaluation of each study’s methodological rigor. See S4 to 6 Tables.
Data Extraction
Data extraction involved systematically collecting relevant information from the selected studies. This process was guided by a standardised form to ensure consistency and comprehensiveness 47. Key data points included study objectives, population characteristics, interventions, outcomes, and significant findings. Extracted data were then organised into a database, facilitating easy comparison and synthesis across studies. This step was crucial for identifying patterns and drawing meaningful conclusions about the impact of breast ironing. See S3 Table
Study Characteristics
The studies included in this review varied in terms of their geographical locations, sample sizes, and research methodologies. Most studies were conducted in regions where breast ironing is prevalent, such as Cameroon and parts of West Africa 3, 6, 40. The sample sizes ranged from small, qualitative studies involving in-depth interviews to larger, quantitative surveys. Research methodologies included ethnographic studies, case studies, cross-sectional surveys, and longitudinal analyses. These diverse study designs provided a comprehensive understanding of the practice and its impacts.
Risk of Bias
Assessing the risk of bias was a critical component of this review. Each study was evaluated for potential biases that could affect the validity of the findings. Common sources of bias included selection bias, recall bias, and researcher bias. Strategies to mitigate these biases were noted, such as the use of random sampling, validated measurement tools, and triangulation of data sources 48. Studies with a high risk of bias were scrutinised carefully, and their findings were interpreted with caution to avoid drawing erroneous conclusions.
Validation of Outcome Measures
Validation of outcome measures involved ensuring that the tools and methods used to assess the impacts of breast ironing were reliable and valid. This included verifying that the instruments used for data collection were appropriate for the cultural context and that they had been previously validated in similar settings. The consistency and reproducibility of the results were also considered, ensuring that the findings were robust and could be replicated in future studies 44, 45, 46.
Ethics
Ethical considerations were paramount in this research. The studies included adhered to ethical standards such as obtaining informed consent from participants, ensuring confidentiality, and minimising harm. The sensitive nature of the topic required researchers to handle data with care and respect the dignity and autonomy of the participants. Ethical approval from relevant institutional review boards was a prerequisite for inclusion in this review. The researchers also addressed ethical dilemmas related to studying harmful traditional practices, ensuring that the research contributed to broader efforts to protect and promote human rights 48.
By meticulously addressing these aspects, the study provides a comprehensive and credible assessment of the impact of breast ironing, contributing valuable insights to the field and informing interventions aimed at eradicating this harmful practice.
RESULTS
Falana TC. (2020) 40 “Breast Ironing: A Rape of the Girl-Child’s Personality Integrity and Sexual Autonomy"
Falana’s 40 article investigates the harmful practice of breast ironing, or breast flattening, and its impact on the personal integrity and sexual autonomy of young girls. Through qualitative research and expository analysis, the study reveals the clinical, psychological, and social consequences of this practice, which involves using heated objects to retard breast development. Prevalent in parts of Cameroon, breast ironing is performed under the pretext of protecting girls from sexual harassment, rape, early pregnancy, and dropping out of school. Culturally, it is seen as a way to preserve chastity and prevent premarital sex, compelling mothers to carry out the practice on their daughters. The physical effects include breast tissue damage, infections, and long-term deformities, while the psychological effects encompass trauma, reduced self-esteem, and long-lasting mental health issues. Socially, breast ironing reinforces gender-based violence and perpetuates the cycle of abuse and subjugation of women.
Falana40 frames breast ironing as a severe violation of human rights, comparing it to rape due to its lack of consent and violent nature. The article calls for the recognition of breast ironing as a form of gender-based violence that infringes on girls’ rights to security, dignity, and freedom. The author advocates for strict laws and penalties to abolish the practice and urges global condemnation and concerted efforts to end it. Emphasising the need for awareness and education on the rights of the girl-child, Falana’s 40 article provides a detailed examination of breast ironing, highlighting its severe consequences and cultural underpinnings. The article argues for urgent action to address and eradicate this harmful practice to protect the rights and well-being of young girls, aiming to foster a societal shift towards recognising and upholding their sexual autonomy and personal integrity.
Gorar M (2022) 43 "Breast Ironing in the UK and Domestic Law"
The literature examines the practice of breast ironing, a form of gender-based violence, and its legal implications in the UK. Breast ironing involves massaging or pressing the breasts of young girls to delay development, aiming to protect them from sexual harassment and early marriage. Predominantly practised in certain African communities, it has been reported among diaspora communities in the UK. The practice leads to severe physical and psychological consequences, including tissue damage, pain, and trauma, infringing on the victims’ physical and sexual autonomy.
While there is specific legislation against FGM in the UK, breast ironing lacks explicit legal recognition, presenting gaps in the law and challenges in prosecuting related cases. Classified under the broader spectrum of gender-based violence, breast ironing is considered a form of domestic violence and honour-based violence. The author advocates for the explicit legal recognition of breast ironing as a criminal offence, increased awareness and education within communities, and enhanced support mechanisms for victims.
The true prevalence of breast ironing in the UK is likely underreported due to cultural sensitivities and lack of awareness, posing challenges for law enforcement and social services. Significant legal loopholes allow the practice to persist unchallenged, highlighting the need for a stronger legal framework. The persistence of breast ironing within certain communities underscores the necessity for culturally sensitive interventions, collaboration with community leaders, and culturally competent education programs to change attitudes and practices.
Mukaddes Gorar’s 43 article highlights the critical issue of breast ironing and its overlooked status in the UK’s legal framework. The practice’s severe impact on girls’ physical and psychological well-being, coupled with legal gaps, calls for urgent attention and action. Enhanced legal measures, awareness campaigns, and supportive services for victims are essential steps toward eradicating this form of gender-based violence.
Ngunshi BR. (2011) 3 "Breast Ironing: A Harmful Traditional Practice in Cameroon"
The report examines the practice of breast ironing, which involves flattening young girls’ developing breasts using heated objects to delay puberty and protect them from sexual harassment and early pregnancy. This practice affects women across all 10 provinces of Cameroon, with the highest prevalence in the Littoral province (53%), particularly in urban areas like Douala, and the lowest in the northern, predominantly Muslim regions (7%).
Breast ironing is primarily carried out by mothers (58%), followed by nannies (10%), sisters (9%), and grandmothers (7%). Girls showing signs of puberty before the age of nine are twice as likely to undergo breast ironing. The rationale behind this practice includes protecting girls from sexual harassment and rape, preventing early pregnancy and marriage, and allowing them to pursue education.
The heated objects used include spatulas (24%), stones (20%), pestles (17%), and other items like coconut shells and wooden spoons. Breast ironing can cause severe pain, tissue damage, infections, deformities, and psychological issues, including abscesses, cysts, severe chest pain, infections, malformed breasts, and even breast cancer. Despite its harmful effects, the practice is seen by perpetrators as a protective measure, with mothers believing they are safeguarding their daughters’ futures.
Statistical data shows higher prevalence rates in urban areas compared to rural ones. The likelihood of undergoing breast ironing is 50% for girls developing breasts before age nine, decreasing to 38% before age 11, 24% before age 12, and 14% before age 14. Objects used include hot wooden spoons or brooms (24%), stones (20%), pestles (17%), breast bands (10%), and other items like hot fufu or hot seeds (15%).
Gender Empowerment and Development (GeED) recommends increasing public awareness of the harmful effects of breast ironing and comprehensive sex education to address misconceptions about puberty and pregnancy. Strengthening mechanisms for redress and support for victims, documenting women’s rights violations, and advocating for legislative changes are also essential. The practice of breast ironing is a severe form of gender-based violence prevalent in Cameroon due to deep-rooted cultural norms and misconceptions. Efforts to combat this practice must include raising awareness, educating communities, supporting victims, and implementing stringent legal measures. The research underscores the need for a multi-faceted approach to eradicate breast ironing and protect the rights and well-being of young girls in Cameroon.
Nyangweso M. (2022) 41 "Contending with Health Outcomes of Sanctioned Rituals: The Case of Puberty Rites"
The research provides a detailed analysis of the health outcomes associated with puberty rites. The study surveyed 60 respondents, using both primary data from in-depth interviews and focus group discussions, and secondary data. The respondents included 5 doctors, 5 social workers, 30 survivors of FGM/C and breast ironing, and 20 other individuals knowledgeable about these practices, with participants from Kenya and the African diaspora.
Key findings highlight significant health outcomes related to puberty rites. Breast ironing is linked to severe pain, cysts, abscesses, infections, milk or fluid discharge, cancer, psychological problems, and sometimes the complete disappearance of breasts. FGM/C is associated with immediate effects like severe pain, urine retention, shock, hemorrhage, and infection, and long-term effects such as genital damage, cysts, abscesses, keloids, scarring, dyspareunia, childbirth complications, and sexual dysfunction.
The social and psychological impacts include high levels of anxiety, terror, humiliation, betrayal, and significant psychological stress, leading to conditions similar to PTSD. These practices are deeply embedded in cultural and religious norms, justified as means to control female sexuality, ensure chastity, and maintain family honor.
A survey of 113 individuals assessed awareness and opinions about FGM/C in industrialized countries. Results showed 60% awareness of its practice, 70% knowledge of its illegality among immigrants, 81% viewing it as a human rights violation, 25% believing religion recommends it, and 81% advocating for its eradication.
The health implications of these practices are significant, with short-term effects including haemorrhage, severe pain, urinary tract infections, injury to adjacent tissues, death, fractures or dislocation, and haematocolpos, and long-term effects such as keloid formation, vulval abscess, sexual dysfunction, pregnancy and childbirth complications, psychological damage, penetration problems, and lack of sexual response.
The study concludes that puberty rites have profound health and social impacts, requiring a holistic and intersectional approach that considers the cultural and religious contexts of the affected communities. Emphasising the need for medical training to handle the health outcomes of these practices is essential to improve care and support for survivors.
Oniyangi SO. and Tosin JA. (2022) 39 "Influence of Cultural Practices on the Health of Yoruba People Living in Ilorin South LGA, Kwara State"
The research examines the health impacts of cultural practices such as breast ironing, puerperal baths, and nutritional taboos among the Yoruba people. The study used a descriptive research design with a survey method, involving 200 respondents selected through multi-stage sampling. A researcher-designed questionnaire with a reliability coefficient of 0.75 was used to collect data, which were analysed using frequency counts, percentages, and chi-square tests at a 0.05 alpha level.
The findings reveal that 88.6% of respondents acknowledged negative health impacts from breast ironing, which causes swelling, burning, irritation, increased risk of breast cancer, fever, extreme pain, and delayed breast growth. The chi-square analysis confirmed a significant negative influence with a calculated value of 532.24, exceeding the critical value of 16.92. Regarding puerperal baths, 73.4% of respondents recognized negative health impacts, such as increased body temperature, risk of perinatal cardiac failure, fever, and burns, with a chi-square value of 259.16, also above the critical value. Nutritional taboos were noted by 92.8% of respondents to have negative health impacts, leading to severe malnutrition, immune system ineffectiveness, and slowed physical growth due to nutrient shortages. This was confirmed with a chi-square value of 780.24.
The descriptive statistics indicate a high awareness of the negative impacts of these cultural practices, with significant agreement among respondents. For breast ironing, 51.8% strongly agreed and 36.8% agreed on its negative impacts. For puerperal baths, 43.6% strongly agreed and 29.8% agreed. Nutritional taboos had 63.7% strongly agreeing and 29.1% agreeing on their negative effects.
The authors recommend abolishing breast ironing and educating young girls on sexual values to avoid premarital sex, modifying puerperal baths to use slightly cool water for new mothers, and revising nutritional taboos to ensure essential nutrients are not restricted for vulnerable groups like invalids, pregnant and lactating mothers, and infants. They also suggest promoting healthy lifestyles to end harmful socio-cultural practices.
The study concludes that these cultural practices have significantly negative effects on the health of the Yoruba people in Ilorin South LGA, highlighting the need for cultural education and health promotion to mitigate these harmful effects.
Tapscott R. (2012) 7 "Understanding Breast Ironing: A Study of the Methods, Motivations, and Outcomes of Breast Flattening Practices in Cameroon"
The research explores the cultural practice of breast ironing. The practice affects about a quarter of all girls and women in Cameroon, with prevalence rates varying by region: Littoral (53%), West and Center (31%), Adamawa (30%), Northwest (18%), East (17%), South (14%), Southwest (11%), and North and Extreme North (7%).
Breast ironing is most often performed by the girl’s mother (58%), but also by nurses, caretakers, aunts, older sisters, grandmothers, and occasionally the girl herself or other family members. Common tools include grinding stones, wooden pestles, spatulas, brooms, belts, leaves, napkins, plantain peels, stones, fruit pits, coconut shells, salt, and ice. The practice varies in intensity and duration, ranging from a single ceremonial treatment to repeated sessions over weeks or months.
The primary motivation for breast ironing is to deter unwanted sexual attention by delaying breast development, protecting girls from early pregnancies, and ensuring they can continue their education without the distractions of early sexual activity or motherhood. It reflects broader gender norms and power dynamics, including the control of female sexuality and reproductive rights.
The health impacts are severe. Physically, it can cause swelling, burning, irritation, pimples, abscesses, fever, and extreme pain. Long-term effects include overgrowth or stunting of breast development, difficulty breastfeeding, scarring, and increased risk of breast cancer. Cases of second-degree burns requiring medical treatment, including skin grafts, have been reported. Psychologically, many girls experience distress, fear, shame, internalized blame, and social exclusion, which can lead to anxiety, depression, and a loss of self-confidence. Socially, the practice is often hidden, with many women not associating their physical or psychological issues with their experiences of breast ironing until much later in life.
The practice is deeply entrenched in cultural beliefs and traditional practices, making it difficult to eradicate. Limited access to sex education, contraception, and legal protections against sexual exploitation exacerbates reliance on breast ironing as a protective measure. As women gain access to education and career opportunities, there is increased pressure to delay marriage and motherhood, and breast ironing is viewed as a way to navigate these changing social conditions.
To address breast ironing, the study recommends raising public awareness about its harmful effects and educating communities about human biology. Advocacy efforts by NGOs should be supported, and there should be a push for the enforcement of legal instruments that protect women’s and children’s rights. Community engagement, including men, women, boys, and girls in both rural and urban areas, is essential to create sustainable change.
Breast ironing is a harmful cultural practice with significant physical and psychological health impacts. Addressing this issue requires a comprehensive approach that includes raising awareness, providing education, and advocating for legal and social changes to protect young girls and promote their well-being.
DISCUSSION
The research paper titled "Mapping the Shadows: A Comprehensive Exploration of Breast Ironing’s Effects on Women and Girls through a Systematic Review and Scoping Analysis" provides a detailed examination of the harmful practice of breast ironing (BI). The study highlights the physical, psychological, and social consequences of BI on women and girls, while also exploring the cultural motivations and methods behind this practice
This study employed a systematic and scoping review following the PRISMA guidelines 2020 37. A comprehensive search of both published and grey literature was conducted across various online databases, including EBSCO, PubMed, Google Scholar, and more. The search covered studies up to the year 2023, focusing on the biopsychosocial impacts of breast ironing.
Psychological and Emotional Trauma
Breast ironing inflicts severe psychological and emotional trauma on young girls, causing long-lasting mental health issues such as anxiety, depression, low self-esteem, and post-traumatic stress disorder (PTSD) 24. Victims experience fear, shame, and social exclusion, which can impair their psychological development and social interactions 17, 40, 49. The inability of families to recognise these traumas exacerbates the pressure and distress within the family, particularly as the child matures 50.
Pain and Discomfort
The procedure of breast ironing involves pressing, pounding, or massaging the breasts with heated or hard objects, causing immense pain and discomfort without any form of anaesthesia. This results in severe health consequences such as abscesses, infections, tissue damage, breast cancer, and psychological trauma 7, 17. The pain endured can be excruciating and prolonged, significantly impacting the victims’ physical and mental health.
Inhibition of Breastfeeding
Breast ironing can severely impair a woman’s ability to breastfeed. The damage to breast tissues can make breastfeeding difficult or impossible, compromising the well-being and nutrition of future infants 51, 52. The long-term consequence underlines the critical impact of the practice on both maternal and child health.
Violation of Human Rights
Breast ironing is a severe violation of fundamental human rights, recognised by international bodies as a form of gender-based violence. It infringes on the physical integrity and sexual autonomy of young girls, similar to female genital mutilation (FGM). The lack of consent and the violent nature of the practice highlight its role as a tool of oppression, perpetuating gender inequality and discrimination 5, 53.
Sociocultural Factors
The practice of breast ironing is deeply rooted in cultural beliefs and social norms, seen as a means to protect girls from early sexualisation, unwanted pregnancies, and societal judgment. Poverty and lack of education are major contributing factors, with traditional healers and elders endorsing the practice based on cultural beliefs 51. Factors such as the HIV/AIDS pandemic and urbanisation have influenced the practice, with urban-based mothers more likely to engage in breast ironing due to fears of increased exposure to sexual abuse. Addressing these sociocultural factors is crucial for designing effective interventions aimed at eradicating breast ironing.
Impact on Sexual Health Autonomy
Breast ironing interferes with the natural sexual development of young girls, leading to distorted perceptions of sexuality and impacting their sexual self-esteem and autonomy. It denies girls the right to make decisions about their bodies and perpetuates gender inequalities, reinforcing the idea that they have limited control over their physical well-being 49.
Disempowerment
Breast ironing contributes to the disempowerment of women and girls by reinforcing harmful gender norms and expectations. It strains family relationships, affects trust, and limits opportunities for education and personal development. Comprehensive efforts, including education, awareness campaigns, legal interventions, and community engagement, are essential to challenge and eliminate this harmful practice 17.
Limitations
One major limitation of the study is the lack of systematic data collection and formal studies on breast ironing, particularly outside Cameroon. The reliance on self-reported data and interviews may introduce biases and limit the generalizability of the findings. Additionally, cultural sensitivities and stigma surrounding BI may result in underreporting and incomplete data.
Implications for Practice
The findings of this study underscore the need for healthcare professionals to be aware of the signs and long-term impacts of breast ironing. This awareness is crucial for providing appropriate medical care and psychological support to survivors. Educational initiatives targeting both healthcare providers and communities are essential to raise awareness about the harmful effects of BI and to advocate for the rights of girls and women.
Further Research
Future research should focus on collecting systematic data across different regions and populations to better understand the prevalence and impact of breast ironing. Studies should also explore the effectiveness of various interventions aimed at eradicating the practice and supporting affected individuals. Additionally, research on the role of cultural beliefs and societal norms in perpetuating BI can provide insights into designing culturally sensitive prevention programs.
Conclusion
Breast ironing is a deeply rooted cultural practice with significant negative impacts on the physical, psychological, and social well-being of women and girls. The study highlights the urgent need for comprehensive interventions, including legal measures, community education, and support services, to protect the rights and health of affected individuals. Addressing the cultural underpinnings and societal acceptance of BI is essential for its eradication. Empowering women and girls, improving access to healthcare, and challenging sociocultural norms are critical steps towards eradicating breast ironing and ensuring the rights and health of young girls 7, 51. This provides a clear overview of the research paper, highlighting the key findings, health impacts, and recommendations for addressing the practice of breast ironing.
Recommendations
- Legal Measures: Strengthen legal frameworks to explicitly recognise and criminalise breast ironing as a form of gender-based violence.
- Community Engagement: Implement awareness campaigns to educate communities about the harmful effects of BI and promote gender equality.
- Support Services: Establish comprehensive support systems for survivors, including medical care, psychological counselling, and legal assistance.
- Healthcare Training: Train healthcare providers to recognize and treat the physical and psychological consequences of BI.
- Research and Data Collection: Conduct systematic research to gather data on the prevalence and impact of BI in various regions and evaluate the effectiveness of interventions.
Data Availability
Relevant data underlying the research has been attached