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Abstract
Objective. Twalet deba, a culturally mediated feminine hygiene practice, is widespread in Little Haiti, the predominately Haitian neighborhood in Miami, Florida. This practice may have important implications for susceptibility to sexually transmitted infections, including human papillomavirus, the principal cause of cervical cancer. Previous research has not examined the full context of twalet deba in consideration of cultural beliefs and norms about women's hygiene and sexual health.
Design. Ethnographic methods guided two phases of exploratory research. The first phase included observation, participant observation, and semi-structured in-depth interviews, which were conducted with key consultants (n=6) and a subsequent purposive sample of 35 women regarding gynecological health beliefs, hygiene practices, and associated home remedy agents. These data informed the second research phase, which involved observation and informal interviews with owners of botánicas in Little Haiti, Miami, FL, USA, to assess the availability of various ethnomedical remedies, their preparation, and preferred uses. All data were analyzed qualitatively to discern patterns in interview responses and using grounded theory to identify key themes.
Results. Cultural constructions of gynecological health and illness were generally incongruent with the biomedical model and emphasized the control of self-defined non-specific vaginal infections through routine hygienic practices using ethnobotanical and commercial agents to avert illness, including cancer. Such practices also encourage vaginal tightness and dryness, characteristics desired by male sexual partners, on whom women were frequently economically dependent. Data from the second phase of research reinforced these findings and revealed a wide variety of feminine hygiene agents available for purchase in local botánicas.
Conclusion. The results suggest that cultural beliefs about gynecological health and dependence on male partners influence women's routine feminine hygiene practices. Botánicas are culturally salient sites for health information. Ethnographic methods were critical for collecting personal sensitive data that are necessary to inform future intervention.
Acknowledgements
Three community-based organizations in Central and South Florida were instrumental in helping to facilitate this research: the Haitian American Alliance, Inc., the Center for Multicultural Wellness and Prevention, Inc., and the Center for Haitian Studies, Health and Human Services, Inc. We deeply appreciate the assistance of their talented members, with whom we share a strong commitment to positive health and social change. Research conducted in Little Haiti was funded by the National Cancer Institute (R21-CA-11981-01). We also thank the staff of the University of Miami Sylvester Comprehensive Cancer Center Disparities and Outreach Core for their continued support. We are particularly grateful to our research participants, who patiently helped us to understand cervical cancer as situated in the broader context of Haitian women's lives.