An exploration of indigenous contraception among the Batswana of Ngaka Modiri Molema District Municipality, North West Province, South Africa

Abstract

Fertility regulation in pre-colonial Africa took place through a range of African cultural practices that ensured safe and effective prevention of unwanted pregnancies. One of the effective ways to prevent unwanted pregnancies was through prevention of conception, referred to as contraception. Contraception among indigenous communities in Africa was based on indigenous knowledge systems (IKS) and formed part of the African traditional medicine (ATM). This type of contraception is referred to as indigenous contraception and it includes both the natural and traditional forms of contraception. During the colonisation of South Africa, indigenous contraception was marginalised and emphasis was placed on western contraception. The aim of this study was to explore indigenous contraception among the Batswana of the Ngaka Modiri Molema district municipality (NMMDM), North West province (NWP) of South Africa with a view to establish its interface with western knowledge and systems of contraception. The study started with documenting the ethnobotanical knowledge of indigenous contraception among the Batswana and used their herbal mixtures to conduct safety and efficacy studies in the laboratory. In-depth interviews conducted with seven purposefully selected Batswana Traditional Health Practitioners (THPs) identified four practices of indigenous contraception. This includes birth spacing, virginity or postponement of first birth, stopping of reproduction and indigenous emergency contraception among others. Techniques of indigenous contraception included abstinence, use of herbs, drinking water, avoidance of certain foods, soil eating, waistbands and waist belts, burial techniques and male waist acupuncture. The ethno-botanical knowledge of medicinal plants used for contraception was documented and the most common herbs used for contraception included phate ya ngaka (Helichrysum caespititium), makgabenyane (Bulbine frutescens) and setlhokotlhoko (Teucrium trifidum). The knowledge, attitudes and perceptions of Batswana women in the Mahikeng local municipality towards indigenous contraception was investigated and showed that their knowledge was poor. The study revealed that the majority of young women (20-40 years) had a negative perception towards the safety and effectiveness of indigenous contraception. The safety and efficacy of the herbal mixture consisting of H. caespititium, B. frutescens and T. trifidum, as used by the Tradional Healing Practitioners (THPs) for indigenous contraception, was evaluated using cytotoxicity assay. The results showed a dose-dependent cytotoxicity with an increase in xx concentration. However, the results confirmed that the herbal mixture was safe, with an inhibitory concentration (IC50) of 755.2 ug/ml compared to the 30 μg/ml threshold placed by the American National Cancer Institute (NCI) guidelines. The safety of the herbal mixture was further evaluated with oral acute toxicity on female rats following the Acute Toxic method. The estimated LD50 was 2500 mg/kg and thus the herbal mixture was classified as category 5 substance in terms of toxicity. Acute oral toxicity studies further showed that the herbal mixture was safe, with no mortality or morbidity observed. The acute oral toxicity study was followed by phytochemical analysis using a gas chromatography mass spectrometry (GC-MS) where approximately 21 phytochemicals were identified from the herbal mixture, with the presence of two bioactive compounds; phenol and 2-methoxy-4vinylphenol (a phenolic compound). The results of an efficacy study showed that only one female rat from the 21 tested in the study did not fall pregnant. This result showed that the herbal extract had a low contraceptive efficacy in rats. In addition, results from the effect on size showed a small but non-signficant effect between dose (mg/kg) and weight (g). These findings are to be expected considering the holistic nature of indigenous contraception which dictates that a multiplicity of techniques and taboos be simultaneously applied to increase effectiveness. In addition, the sample size might have been too small, including low concentration range relative to the estimated lethal dose. The findings of the study revealed that the Batswana THPs in NMMDM possess rich knowledge about indigenous contraception. It is therefore, important that THPs be consulted during the drafting of policies and interventions meant to curb unwanted pregnancies in South Africa. The study further showed a need to educate and empower women by providing them with knowledge about indigenous contraception, and its safety and efficacy to change their negative perceptions. The study further showed that IKS and ATM practices were compatible with scientific principles and can be exposed to scientific scrutiny as part of knowledge expansion. This finding allows collaboration between THPs and Western health practitioners (WHPs) as well as integration of IKS and Western knowledge systems (WKSs) as part of developing a decolonised and modernised contraception in South Africa. Indigenous contraception plays a significant role in preventing unwanted pregnancies in South Africa. This study recommends further safety and efficacy studies on other herbal contraceptives, with THPs forming a central part of the investigations.