The Role of Women’s Traditional Knowledge in Sexual and Reproductive Health Management in Haiti

1. Introduction

Whether in Haiti or elsewhere, low-income women are generally subject to negative biopolitical control on the alleged grounds that they are incapable of planning a pregnancy or adequately ensuring the education and well-being of their children. Haitian women living in rural areas are victims of testimonial injustice (Fricker, 2007), gender and class biases that expose them to permanent sterilization practices (e.g., tubal ligation) and non-consensual chemical contraceptive methods such as medroxyprogesterone acetate, known as Depo-Provera (Damus, 2023). The ontological and epistemic intolerance of those who hold so-called scientific and technical knowledge (Damus, 2021, 2024a), whether Haitian or foreign, prevents them from acknowledging that many Haitian women from lower socioeconomic classes use natural contraceptives out of fear of becoming pregnant for the first time or of becoming pregnant again after yet another childbirth. This form of intolerance, of which modern healthcare professionals are unaware, constitutes the lifeblood that flows from colonial roots to the very heart of modern medicine.

The Mortality, Morbidity, and Service Utilization Survey (EMMUS-VI 2016–2017) reveals gender disparities in access to family planning information disseminated through the media and via mobile phone: “Nearly three-quarters of women (73%) compared to just over half of men aged 15–49 (53%) were not exposed to any messages on family planning. Radio was the most common source of information on family planning for both women and men (22% and 40%, respectively), followed by television (11% and 19%, respectively). The proportion of men exposed to family planning messages through newspapers/magazines is more than twice as high as that of women (15% versus 6%). The percentage of women and men who received family planning messages via cell phone is the lowest. However, this percentage is significantly higher among men than among women (6% versus 2%)” (2018, pp. 111–112).

These gender inequalities in exposure to family planning messages are primarily explained by the constant repression of female sexuality by Haitian religious institutions and patriarchal society, by unequal social relations between men and women (for example, the underrepresentation of women in Haitian media as directors, hosts, and guests), by the links between gender and poverty, by women’s low level of education, as well as by geographic inequalities in access to health services offering contraceptive methods.

Haitian women did not wait for the arrival of modern contraceptive methods to manage their fertility. They have developed strategies of resistance (such as the art of mixing herbs to induce an abortion) in the face of multifaceted patriarchal surveillance and medical neocolonialism. Passed down from woman to woman, natural contraceptive methods not only help offset social, economic, and geographic inequalities in access to hormonal contraceptives but also allow women to discontinue, if necessary, medical contraceptives whose harmful effects on physical, psychological, and sexual health of the women who have adopted them - whether voluntarily or under duress - have been analyzed by researchers (Burrows, Basha, and Goldstein, 2012; Casey, MacLaughlin, and Faubion (2017); Damus, 2023; Anaba, Wright, Alor et al., 2025). In light of such complexities, the question, therefore, is whether the exclusive use of and return to natural contraception (herbal contraceptives) can be explained by regenerative and restorative principles (Damus, 2024a).

2. Materials and Methods

As part of an interview-based study on fertility management in Haiti, I conducted remote interviews with six women and one man (the husband of one of the women surveyed) living in rural areas. Lasting between 60 and 90 minutes, the interviews were conducted in Haitian Creole in a semi-structured manner from June 18 to July 1, 2024. The responses to the various questions were recorded on the participants’ phones, with the exception of two interviews, which were recorded on my laptop (Windows Voice Recorder).

The interview-based survey was supplemented by a 120-minute local dialogue workshop conducted in Creole. The information shared by the six women was recorded via Skype on November 23, 2024. All data collected during the various individual interviews and the local dialogue workshop were transcribed manually and in full by a research assistant under my supervision. The limited amount of empirical data was compensated for by utilizing some of the information on sexual and reproductive health management that I collected on September 12, 2021, during a local dialogue workshop in the town of Palmari (Roy-Sec, Central Plateau), a workshop attended by 17 holders of local and ancestral knowledge (leaf doctors, midwives, traditional birth attendants, houngans, and ventizè). Data collected in January 2022 during an in-depth interview — conducted with a midwife-nurse working at a public hospital — on bebelis, a traditional female medicine used by rural women for multiple purposes (Damus, 2023), will also be analyzed here. Before converting to Protestantism, this midwife-nurse helped women perform abortions using traditional medicine.

Unlike a research interview, characterized as an extractivist research technique, the local dialogue workshop is a regenerative and restorative method (Damus et al., 2022; Damus 2024b, Damus 2024c) insofar as it allows for the production of knowledge within a logic of co-construction that respects language, worldviews, the environment (physical, cultural, economic, social, political…), and the participants’ modes of thought and action. This technique of cognitive co-construction, through which multifaceted knowledge is produced with and for the participants, is rooted in an alternative epistemological model that aims to critique the pernicious role of current epistemological paradigms while promoting regenerative and restorative modes of knowledge, thought, and action.

The local dialogue workshop is a space for sharing individual and collective experiences, knowledge, and firsthand or observed experiences. Its success depends on several factors, such as mutual trust and respect, the use of a common language, the horizontal nature of the exchanges, and the encouragement of mutual feedback, among others. My fluency in Creole, my rural background, and the preliminary persuasion work carried out by my field mediators with the participants are the key ingredients for the mutual trust necessary for the smooth running and success of a local dialogue workshop.

During the local dialogue workshop on November 23, 2024, each woman was asked to introduce herself in Creole by stating her name, her occupation, and her socio-geographic background (the name of the rural section to which she belongs). They were not treated as anonymous participants, but as traditional promoters of sexual and reproductive health. A climate of mutual trust thus developed between them and me (the field facilitator did not take part in the discussions). I told them: “You are my teachers. I have come here to learn. You are all experts. When someone speaks, do not correct them. Let them speak freely. Everyone has their own practices or experiences. All experiences are valid. You may fill in the gaps in a participant’s story if she has a memory lapse. As soon as she finishes her testimony, you may offer feedback to energize the dialogue workshop.”

The goal was to encourage these women to reflect on their personal and professional experiences (cognitive stimulation). Questions were asked about the themes of each workshop, themes we had discussed before the workshop began. I repeatedly asked the participants to respect the personal and professional experiences of their peers. The objective was to bring out common interests among the different rural sections. I refrained from adopting a judgmental attitude toward the participants. For perhaps the first time in their lives, they were positioned as scholars rather – as had often been the case – than as uneducated individuals who needed to be taught best practices in fertility management. I took the role of the uneducated one, learning from them.

2.1. Data Processing and Analysis

To analyze the interviews collected from the informants both longitudinally (each interview is analyzed on its own terms) and cross-sectionally (multiple accounts are compared to identify similarities and differences in meaning), I employed content analysis techniques (Bardin, 1997; L’Écuyer, 1987). I also analyzed the primary data using the classic inductive methods of interpretive sociology (Glaser and Strauss, 1967) with regard to the local knowledge systems employed in fertility management. I took into account the dual phenotypic (manifest meaning, explicit meaning, the said) and genotypic (implicit meaning, the unsaid) dimensions of the empirical material. The data analysis process consisted primarily of identifying themes and subthemes in the material, conducting segmentation (identifying and coding units of meaning), and categorizing the material (grouping semantic units into various categories). Since both the subject and the researcher participate in the construction of reality, the meaning of this constructed reality results from the fruitful conjunction of emic constructs (the descriptions and interpretations proposed by the subject) and etic constructs (the researcher’s descriptions and attempts at objective interpretation, De Sardan, 1998).

Given the inevitable influence of the context of utterance on the form and content of the participants’ discourse, it is useful to distinguish here between the terms “text” and “discourse.” When an interview is transcribed, it must be considered a text. However, a text is an “empirical object considered independently of its conditions of production.” (Sarfati, 1997). Even if certain empirical elements can be analyzed independently of their context (universalist stance), our principle of analysis and interpretation is based on the fact that the meaning of our empirical material is intimately linked to its context of production (contextualist or particularist stance, local and feminist epistemologies). In this case, it seems more appropriate to prefer the concept of discourse to the word text, which is defined as an “empirical object with its conditions of production” (Sarfati, 1997). Awareness of the existence of a spatio-temporal bias (space and time determine the nature of discourse production) inherent in the collection of empirical data allowed me, during my analytical process, to connect this trilogy: the discursive material, the socio-anthropological questions, and the empirical context. Excerpts from the collected testimonies were translated from Creole into French.

2.2. Ethical Approval

The Multifaculty Research Ethics Committee at Laval University (Quebec, Canada) authorized data collection in Haiti on fertility management as part of the joint research project titled “Women Educators in Alternative Fertility Management: Women’s Health, Contraception, and Religion in Quebec and Haiti” (File number: 2023-373 A-1/ 05/24/2024).

2.3. Socio-Demographic Characteristics of the Study Sample

Aged 45 to 69, the six women interviewed are traditional health practitioners—specifically, midwives (66%), traditional healers (83%), and mambos (50%)—who play an important role in managing sexual and reproductive health within their rural communities, which lack both material and medical resources. Three of these women (50%) are traditional abortion practitioners. Living in rural areas, the majority of these women are practitioners of Vodou (83%). Thirty-three percent of them are Catholic. Four of them (66%) are reported to have completed primary school. One woman and her husband are illiterate. The most educated participant is the one who completed high school. These women are highly prolific, as they have an average of about six children each. Their high fertility is explained by the fact that, in their communities, natural contraceptive methods are preferred over hormonal and mechanical methods (hormonal injections, tubal ligation, male condoms, intrauterine devices), that they share the belief that nulliparous and primiparous women must avoid all chemical contraceptives for fear of being sterilized, and that one should not have multiple abortions (abortion is perceived by some Haitian women as an act of violence against the uterus). The repression of sexuality in rural areas and the prohibition of fornication by Catholicism and Protestantism constitute a barrier to the adoption of chemical contraception among religious nulliparous women, as such adoption implies an active sexual life that must be concealed.

Table 1. Socio-demographic characteristics of the study sample.

Participant	Gender	Age	Occupation	Number of Children	Place of Residence	Religion	Level of Education
Participant 1	Female	49	Herbalist, massage therapist	7	Rural	Catholic	Illiterate
Participant 2	Female	62	Herbalist	10	Rural area	Voodoo	Elementary
Participant 3	Female	45	Matron, socio-cultural journalist, manbo makout	4	Rural area	Voodoo	Secondary
Participant 4	Female	48	Matron, traditional healer, farmer, shopkeeper	8	Rural	Voodoo	Elementary
Participant 5	Female	69	Midwife, herbalist, manbo azogwe	4	Rural	Voodoo	Elementary
Participant 6	Female	68	Herbalist, midwife, manbo makout	1	Rural	Voodoo	Elementary
Participant 7	Male	63	mason	7	Rural	Catholic	Illiterate

Table 1. Socio-demographic characteristics of the study sample.

Participant	Gender	Age	Occupation	Number of Children	Place of Residence	Religion	Level of Education
Participant 1	Female	49	Herbalist, massage therapist	7	Rural	Catholic	Illiterate
Participant 2	Female	62	Herbalist	10	Rural area	Voodoo	Elementary
Participant 3	Female	45	Matron, socio-cultural journalist, manbo makout	4	Rural area	Voodoo	Secondary
Participant 4	Female	48	Matron, traditional healer, farmer, shopkeeper	8	Rural	Voodoo	Elementary
Participant 5	Female	69	Midwife, herbalist, manbo azogwe	4	Rural	Voodoo	Elementary
Participant 6	Female	68	Herbalist, midwife, manbo makout	1	Rural	Voodoo	Elementary
Participant 7	Male	63	mason	7	Rural	Catholic	Illiterate

3. Results

3.1. Social and Cultural Representations of Female and Male Fertility, Infertility, and Sterility

According to data collected from the women surveyed, fertilization occurs when a man’s sperm meets a woman’s “menstrual blood stored in the cervix.” Menstrual blood is a sign of fertility. A woman must have her period regularly. Women who have never given birth must not use chemical contraception, or they risk becoming infertile. On the other hand, natural contraceptive methods based on herbal knowledge cannot cause infertility. The participants are traditional healers — matrons, herbalists, manbo — who advise women against taking chemical contraceptives after the birth of their first child, as these products could render them unable to conceive again. Even though some of them have used chemical contraceptives in the past, all participants advocated for non-pharmacological management of female fertility and male infertility. Female infertility may be due to a thermal imbalance (excess internal cold) that can be corrected by consuming hot foods. A woman whose womb is “cold” is infertile. It must be warmed so that she may (re)gain fertility. A woman whose uterus is “salty” is sterile.

The rural women interviewed know that husbands are not always capable of impregnating their wives. Infertility is therefore not solely a female issue. A man whose sperm is weak is infertile. He must drink a bottle of natural remedies (remèd fèy) to thicken his semen. Furthermore, his blood and the woman’s must not be incompatible.

Fertility management for women continues after childbirth. New mothers receive three gwo beny (external body washings) and ti beny (internal body washings). Their uterus is returned to its usual position. These women protect themselves from the cold, drink hot herbal teas, and bind their bodies by tying their belts with a strip of cloth. One participant explains postpartum care in these terms:

“There are two types of baths: the full bath (gwo beny) and the small steam bath (ti beny). The small bath involves exposing the new mother’s vagina to the steam from hot leaves. We use ti bonm leaves and salt. We put hot water in a bucket, and the new mother sits over it so that her vagina receives the steam from the hot leaves. Then, she is asked to wash her vagina with a salty herbal tea.

The other baths are for the woman’s body. Salt and orange leaves are added. The woman’s body is massaged to firm it up. She takes the full bath and the small bath for three days. The full bath is mainly beneficial for the body, while the small bath is primarily for the vagina.

The new mother cleans her private parts with warm water. Her vagina must be covered with cloth for three months. Her waist must be bound with a cloth. She must not bend over, or squat in any way, for fear of opening her vagina. In other words, she must be securely bound with a cloth and carefully washed so that her vagina makes no noise.” [Participant 3, midwife, manbo makout, female, 45 years old]

3.2. Perceptions and Representations of the Negative Health Impacts of Hormonal Contraceptives

The subjective and objective effects of hormonal contraceptives on their health lead many women to consult the Creole medicine practitioners we met during our research on sexual and reproductive health management. Among rural women who have adopted a chemical contraceptive method such as Norplant, contraceptive amenorrhea is perceived as a problem that blocks their fertility by preventing “menstrual blood from cleansing” their bodies. In rural patriarchal society, women must always be fertile. This is one of the reasons why some of them adopt a modern contraceptive method without their husbands’ knowledge. It is not only physical and mental health issues (“dizziness, weight loss, changes in humoral and thermal balance, diaphoretic reactions, headaches, blurred vision, etc.”) caused by a particular chemical family planning method that drive women to consult a traditional healer, but also the feeling of impurity and the fear of becoming infertile that they experience. They believe that the flow of menstrual blood flushes out impurities introduced into the body by hormonal contraceptives. Post-contraceptive amenorrhea is sometimes interpreted by women living in rural areas as a sign of infertility, whereas it is actually a temporary fertility disorder.

One participant describes how she helps women on birth control who want to restore their menstrual cycle:

“I often see women who have enrolled in a family planning method that needs to be renewed every five years. If they don’t want to renew their family planning method, they have to wait patiently for their periods to return. The blood flows with difficulty, which causes them lower abdominal pain. So, their periods don’t come normally. In this case, we need to prepare a remedy for them to unblock the menstrual cycle. Do you understand? We give them a remedy to drink. When blood doesn’t flow, it can affect women’s health. The blood that doesn’t flow turns black. When it finally flows, it appears very black, like charcoal.” [Participant 2, traditional healer, herbalist, female, 62 years old]

“When combined with ‘fredite’ (a subjective sensation of cold), the contraceptive causes severe pain. There are remedies made from coral leaves that can help restore the menstrual cycle. In women taking hormonal contraceptives, menstrual flow can be very slow. A decoction of coral leaves promotes normal flow, allowing the blood to eliminate impurities associated with contraceptive use. It drains blood clots. If the woman didn’t know why she took this remedy, she would think it was an induced miscarriage.” [Participant 1, herbalist, massage therapist, female, 49 years old]

Unlike other chemical contraceptive methods, the pill does not block menstrual blood. This blood is perceived as a purifying fluid for women’s bodies. This is why the pill is the preferred chemical method among rural women. It is recommended by Participant 2:

“A woman who takes the pill is more likely to have her period every month. It’s better when you take the pill called Plan B. When you take this pill, you get your period every month (you ‘bloom’) and you don’t have any problems. However, if a woman has varicose veins, she can’t take the pill or get an injection.”

Some participants are convinced that hormonal injections (Planin) destroy women’s eggs if they do not have sex. In young women, these contraceptives can cause a vaginal infection. First-time mothers on hormonal contraception may develop ovarian cysts due to the accumulation of impurities in their bodies caused by the absence of menstruation.

“If a woman practices sexual abstinence, she should not be on birth control. If she uses a chemical contraceptive method, she will lose her blood cells. Young women who take hormonal contraceptives will develop an illness. Early use of a family planning method causes an intravaginal disease (nan nati). [Participant 4, midwife, traditional healer, female, 48 years old]

“A woman who decides to start using contraception after her first childbirth may not be able to get pregnant again. If she does not rid her body of the accumulated impurities, she may develop an ovarian cyst.” [Participant 1, traditional healer, massage therapist, female, 49 years old]

The menstrual cycle plays a fundamental role in shaping the maternal and feminine identity of the rural women we met. They believe it helps cleanse the internal parts of the body, particularly the uterus. Contraceptive and post-contraceptive amenorrhea is experienced not only as a loss of fertility — whether temporary or permanent — but also as a possible cause of anemia. The data I collected on the psychological consequences of contraceptive injections on the lives of rural women align with health professionals’ observations regarding these women’s anxieties and concerns.

“Women typically ask for combined oral contraceptives (COCs) and long-acting contraceptive injections (three months), such as Depo-Provera or DMPA. They also ask for Norplant, which is a long-acting implant (5 years). Currently, we give them an implant that lasts three years. It’s called the Sino-implant. Previously, we offered them DMPA or Depo-Provera, as well as Norplant. These are the contraceptives that block the menstrual cycle for six to twelve months. In reality, this isn’t a problem. But, you know that Haitian women like to see their periods every month. That’s why they take a bebelis to bring back their period. When they take birth control pills, they don’t take this medication to bring back their periods, because they continue to come every month. In the Haitian mindset, if periods don’t come every month, women think they’ve gone into hiding. Contraceptives can stop menstruation by blocking ovulation. For a woman to ovulate every month, she must have her period. Since she doesn’t need to get pregnant, her period can be blocked. When this is explained to some women, they stop worrying about the absence of menstrual blood. But others want to see their period every month. [Testimony from a Haitian nurse and midwife working in a public hospital]

3.3. Natural Family Planning Methods

Natural family planning methods refer to a body of naturalistic knowledge and resistance practices developed by nulliparous, primiparous, and multiparous women aimed at countering the harmful effects attributed to chemical contraceptive methods imposed by knowledge holders from the North. The appeal and renewed interest in natural contraceptives can be explained by their cultural, cognitive, economic, and geographic accessibility. No negative health impacts of these methods were reported by the respondents. These natural methods of birth control, which have biological (exclusion of chemicals, respect for the menstrual cycle), spiritual, magical, and ecological dimensions, allow women to maintain or regain their self-confidence and control over their bodies. The lactational amenorrhea method is considered a natural contraceptive by the women surveyed. Rooted in a regenerative and restorative epistemological framework, natural contraceptive methods also offer rural women the opportunity to escape patriarchal surveillance as well as biomedical neocolonialism evidenced by the experimentation with Depo-Provera on their bodies.

“There are women who can get pregnant two weeks after giving birth. There are those who get pregnant once they’ve weaned their child. As soon as they stop breastfeeding their baby after 12 or 24 months, they get pregnant. There are also women who don’t conceive again twelve months after weaning.” [Participant 6, manbo-makout, matron, traditional healer, 68 years old]

“How do I prepare the parsley-based contraceptive remedy (planin pèsi)? I put a bunch of parsley and some wine in a gallon-sized container. The woman drinks it before having sex. Even if she doesn’t have sex, she must drink it. Since it’s a family planning method (planin), she must drink it every day.” [Participant 4, midwife, herbalist, female, 48 years old]

“After giving birth, a woman can use an herbal contraceptive method. She can use seven castor beans. After removing the sprouts, she can swallow seven castor beans to become infertile for seven years. I haven’t used this method. Having a child depends on my conscience and God’s will. A woman told me she had taken seven castor beans. She didn’t get pregnant. Today you swallow two, tomorrow you take two more… The person who told me about this has many children. She decided to use this method.” [Participant 1, traditional healer, massage therapist, female, 49 years old]

3.4. Sterilization Methods

Rural women also use “permanent” herbal contraceptive methods. Although an irreversible surgical method, such as tubal ligation, has no harmful effects on women’s health, some of them prefer to use fetal byproducts (placenta, umbilical cord), plants, and magic formulas to “sterilize” themselves and render other women infertile.

“I know a contraceptive formula. I buy a small pot of salt without haggling over the price. I look for a stalk of bitter cassava. I go to the base of a palm tree with the umbilical cord of the baby born to a woman who has just given birth. I perform a ritual at the base of the palm tree by burying the umbilical cord there. That woman will never give birth again.” [Participant 6, midwife, female manbo makout, 68 years old]

“To prevent a woman from getting pregnant, I give the woman who has just given birth a decoction made from pine wood. The bundle of pine wood contains a resin that prevents her from conceiving. You can also place her placenta in a pot of salt that you bought without haggling over the price, and then bury the whole thing. That woman will never get pregnant again. You’ve never heard anyone insult a woman this way: ‘Your womb is salted. You can no longer bear children.’ [Participant 3, local dialogue workshop, midwife, manbo makout, woman, 45 years old]

One participant reported having undergone forced or coerced sterilization at a health clinic following a difficult childbirth. The obstetrician took advantage of her psychological vulnerability and the anxiety of her mother and partner to convince them to agree to a tubal ligation before she left the maternity ward.

“After giving birth to four children, I underwent a tubal ligation performed by a doctor. He told me not to have any more children because of my difficult delivery. So that I could survive, the father of my children and my mother gave him their consent. I was so young that the doctor had to speak to the father of my children and my mother, who were in the delivery room. I didn’t feel well at all. I was staring death in the face. That’s why my mother and my husband were asked to give their consent. I continued to have my period every month until menopause.” [Participant 5, Matrone, traditional healer, manbo azogwe, woman, 69 years old]

3.5. The Use of Abortion

Although abortion is criminalized under the Haitian Penal Code of 1835 (Article 262) and is prohibited by the dominant religions (Catholicism, Protestantism, the Jehovah’s Witnesses, etc.), this does not prevent many Haitian women from seeking abortions for various reasons. Among these reasons are large families, economic poverty, unplanned pregnancy, continuing education, unknown paternity, and tocophobia (the fear of pregnancy and childbirth), etc. The women we interviewed as part of the 2024 survey did not report having had one or more abortions in their lifetime. They view abortion as a sin (“God condemns abortion”). Some of them (50%) nevertheless had the courage to share that they had assisted women in terminating pregnancies using their own knowledge of abortive plants. Others (50%) stated that they had never helped a woman have an abortion.

According to the collected data, the development of this knowledge of abortion is mainly due to the fact that rural women do not always have access to modern contraceptives (chemical and mechanical), that alternative contraceptives — natural, magical, or symbolic — are not always effective, and that nulliparous and primiparous women refrain from using hormonal contraceptives due to the negative reputation associated with them. Couple-based self-control techniques (withdrawal, cycle-based methods, etc.) do not always prevent unwanted pregnancies. Rural women who are economically disadvantaged and have low levels of education often resort to clandestine abortion when they decide not to continue a pregnancy.

“Sometimes women come to me asking for abortion remedies. Even though they are the ones who come to see me, this matter affects me personally. I ask how far along she is in her pregnancy before helping a woman have an abortion. If she is one-month pregnant, I can help her terminate her pregnancy. Abortion is a sin. It takes a lot of time and patience to dissuade a woman from having an abortion. The woman who decides to have an abortion will be responsible for her actions. Since I’m paid, I feel obligated to help her have an abortion.” [Participant 4, traditional midwife, herbalist, woman, 48 years old]

This traditional midwife and herbalist sometimes gives a fake abortion remedy to women who want to have an abortion in order to save their embryo. Her goal is to encourage women to reflect on the consequences of abortion and to allow their pregnancy to reach a stage too far along to consider termination using emmenagogue herbs. She explains:

“Sometimes I give the woman who comes to see me a fake abortion remedy to show her that I’ve responded to her request. This remedy allows her to keep her pregnancy. If she comes back to me after realizing there was not bleeding and asks me to give her the same remedy, I tell myself she really wants to have an abortion. I manipulate her by saying, ‘If you haven’t seen any bleeding, it’s because God didn’t want you to lose your child. My remedy is always effective. I don’t administer it twice to the same person during the same pregnancy.’

“Some women love having children. Others don’t want to have children. If a woman doesn’t want to have children, it depends solely on her will. She’ll give me money so I can provide her with an abortifacient. She has to pay me because she’s pushing me to commit a crime. The plants I use to induce an abortion are the following: Chapo kare, diven jezi, kamomi (chamomile), palto Sen Jozèf, dechouke.” [Participant 6, midwife, female manbo makout, 68 years old]

The midwife and nurse I interviewed in January 2023 is (was) an abortion provider who frames (framed) her practice within a pluralistic epistemological approach or a complementary alliance between Southern and Northern knowledge (Damus, 2020). This maternal health worker had already helped between 100 and 150 rural women have abortions when I met her.

“Since I’ve been working as a nurse, I’m often contacted about abortion. But I’m no longer a provider of abortions because of my Christian faith. I’ve helped many women have abortions between 100 and 150 women. I have also refused many requests for abortions. Since I’ve been working in a hospital setting, I refuse these requests every day. To help a woman have an abortion, I give her abortion pills and a bebelis. The pill causes the cervix to dilate more quickly. The bebelis allows the person to cleanse herself (to flush out the uterus).”

According to the testimonies collected, many rural women do not rely solely on natural abortion methods to delay the arrival of their first child or to space out births, as they know how to use birth control pills and medications that can induce an abortion.

“I no longer see the following tablets on the market: Saridon, Valodon, chloroquine. These tablets were used to induce abortions. Cytotec is a pill taken by women who want to have an abortion. I believe it is also used to treat stomach ulcers. Young women take it to induce an abortion. Generally speaking, this pill causes a miscarriage when taken. Flu and fever-reducing pills should not be taken by pregnant women. Many pregnant women have terminated their pregnancies after taking a fever-reducing pill. Some say that their “baby was eaten” by their neighbor, even though they had taken a tablet that is contraindicated during pregnancy. Although known as a medication that treats stomach ulcers, Cytotec is a drug that breaks down the embryo or fetus. It is administered orally or vaginally." [Participant 3, midwife, manbo makout, woman, 45 years old]

After undergoing an “illegal” (clandestine) and non-medical abortion, women require more care than women who have given birth. Post-abortion care aims to restore and heal women’s reproductive systems and bodies. However, the fear of being judged by family members and their community poses a barrier to receiving this care.

“When you’ve just given birth, everyone sees that you’re taking medicine. But if you’ve just had an abortion, you have to get treated in secret. Abortion is dangerous for a woman’s health. After giving birth, you can receive baths and medicine in full view of everyone, whether your child is alive or dead. On the other hand, after an abortion, you have to take more precautions, receive more vaginal douches (lavman bòbòt), and take more medicine. That’s just how it is.” [Participant 3, midwife, manbo makout, woman, 45 years old]

4. Discussion

Among traditional practitioners and the women who consulted them, the knowledge associated with combating the negative physical and psychological effects of hormonal contraceptives, preparing natural family planning methods, and managing fertility and post-abortion care is part of a regenerative and restorative pedagogy in action that deserves to be explored (Damus, 2024a). This pedagogy aims to reduce or eliminate processes of self-destruction, as well as to regenerate and repair the material self (the physical body) and the immaterial self (psychic, spiritual, and inner) from a perspective of human, ecological, and planetary sustainability. The non-pharmacological management of fertility, birth planning, and the destructive effects of certain modern contraceptives enables women (traditional practitioners and their clients) to participate in nature conservation, regeneration, and the maintenance of the anthropo-ecological bond.

The preliminary results of our study contradict research that denies rural women’s agency in alternative family planning practices. To cite just one example, a study conducted in two rural Haitian communities among 200 adolescent girls and young women aged 14 to 24 suggests that the high rate of unplanned pregnancies (86 participants, or 43%, had already become pregnant) can be attributed to “a lack of knowledge” regarding modern contraception and the “dissemination of misinformation, both about contraception in general and its side effects” (Masonbrink, Hurley, Schuetz, Rodean, Rupe, Lewis, Boncoeur, Miller, 2023). Although the authors conducted interviews with the participants in their study, they did not take into account any natural family planning methods that might have been used, nor did they consider these women’s use of natural abortifacients to regulate births. The results of my study and those of these authors nevertheless agree that misinformation about the side effects of contraception and the fear of being perceived as sexually active prevent many rural women from using modern contraceptives.

The reason the traditional abortion providers we interviewed have helped so many women terminate their pregnancies is that natural contraceptives are far less effective than chemical contraceptives (Damus, 2023). Abortion is therefore a method of birth control for many rural women. They view hormonal injections and other invasive methods, such as implants, as a violation of their bodily autonomy, as well as a denial of their self-control (“I stopped taking the injections and then the pill. I control myself so I don’t get pregnant. I ask my husband to ejaculate outside when I feel he’s about to reach orgasm,” Participant 1). My findings demonstrate that hormonal methods are a source of anxiety for rural Haitian women. In contrast, the results of a study conducted by Anaba, Wright, Alor et al. (2025) among 1,690 sexually active Mozambican women aged 15 to 49 show that hormonal contraceptives reduce anxiety among these women.

Although based on limited samples, the results of my study show that sexual and reproductive health among rural women is a complex phenomenon, the management of which lies at the intersection of Haitian Creole medicine and biomedicine. Whether erroneous or accurate, the beliefs gathered reflect the strategies rural Haitian women use to seek help and their agency. Guided by specific beliefs, these women turn either to traditional healers or to modern healthcare professionals to manage their sexual and reproductive health.

Numerous studies have demonstrated both the negative and positive effects of hormonal contraceptives on female sexual function (Burrows, Basha, Goldstein, 2012; Casey, MacLaughlin, Faubion, 2017). It is highly likely that Participant 1’s (age 49) loss of libido was caused by the modern method she adopted: “Even if my husband desires me, it leaves me completely indifferent. Sexuality isn’t compatible with my age. At this age, I shouldn’t be having children. We have teenage daughters. They’re the ones who should be having children.” In this Catholic family, non-procreative sexual relations might be considered a sin. As for Participant 5, she did not mention any negative effects of her tubal ligation on her sexual function: “My tubal ligation has not caused me any problems to date.” My mother, who regretted having undergone this procedure, ended her sexual life in her forties. A study on the impact of tubal ligation on sexual function and quality of life among 150 Iranian women (Sadatmahalleh, Ziaei, Kazemnejad, Mohamadi, 2015) shows that rates of sexual dysfunction are higher among these women than among those who used condoms (N = 150, control group). The lack of information on the negative consequences of hormonal contraceptives on women’s sexuality could be explained by psychological factors (shame, guilt, regret, fear of being judged), as well as sociocultural and historical factors (colonial religions, rural patriarchy, etc.). Some rural women used modern contraception without their husbands’ knowledge (“My husband didn’t know I was using contraception. One day, I decided to go to the hospital to get one without telling him. The nurses suggested it to me. When the side effects of this method started to appear, my children told my husband about my decision. He then got angry with me.”).

The originality and significance of this study lie in the fact that it is based on the testimonies of women who are accustomed to providing concrete answers to questions posed by their peers regarding fertility management, infertility prevention, discontinuation of chemical contraceptives, adoption of natural contraceptive methods, abortion, post-abortion care, etc. The preliminary results obtained complement Haitian studies (Salla, 2016; Institut Haïtien de l’Enfance, ICF, 2018) in which the voices of the women in question — whether explicitly or implicitly — are often overlooked, even though listening to them is essential if we are to support them in overcoming the misconceptions associated with managing their health.

To address the limitations of the findings, a local dialogue workshop on traditional knowledge used in family planning, as well as on the negative and positive consequences of contraceptive options, should be organized with traditional practitioners, their clients, and the clients’ husbands. It is not only economic, cultural, geographic, social, and historical factors that explain the use of natural contraceptive methods, but also the negative implications of chemical methods on marital relationships and women’s sexual and physical health.

5. Conclusions

This study has the merit of showing that traditional practitioners and their clients do not confine themselves to a passive role in the face of patriarchal, marital, and religious scrutiny, in particular. Contrary to biomedical and colonial prejudices, many of them are well-informed about the existence of certain modern contraceptive methods and the negative consequences of these methods on their physical, psychological, and sexual health. To reduce the hermeneutic injustice they face (very few of them have access to written information on modern contraceptive methods), maternal and neonatal health officials must better inform and educate women about all types of contraception.

Contraceptive education for rural women must not exclude the natural contraceptive methods to which rural women have access through solidarity and mutual aid networks, as well as through the intra- and intergenerational transmission of these methods. The fertility of many rural women is rooted in a multifactorial constellation of which they are not fully aware due to their lack of formal education. As indicated by the testimonies of the traditional practitioners interviewed, many rural women rely on herbal abortion as their primary method of birth control. Contextualized or culturally adapted contraception education will help reduce the number of unsafe abortions while enabling rural women to make an informed choice between various hormonal or mechanical contraceptive methods.

The number of unsafe abortions performed worldwide each year stands at 25 million, according to the World Health Organization (WHO, 2017). Considering this, as part of realistic and pragmatic contraceptive education, trainers should be permitted to advise women to go immediately to the hospital following an incomplete abortion. Certain traditional herbal medicines for women, such as bebelis, can cause incomplete abortions requiring care from modern healthcare professionals (Damus, 2023).