Women's Health


In human life, pregnancy and childbirth are major events that are surrounded with care and concern. We explore here the beliefs and practices of fertility, conception, gestation and childbirth. We also explore the working knowledge that the Sudanese call on to help them manage female fecundity and male virility, what their conceptions of sex life are, and what they think goes wrong when one is infertile, when a woman begets stillbirths, or suffers abortions or when congenital anomalies occur.

Conception and fertility

Marriage ceremonies and rituals emphasize the sexual behaviour that is needed to ensure the fertility of women and enhance the virility of men. Certain rites are meant to protect the couple, others to promote fertility. Relation of ovulation, hence the fertile period, to the menstrual cycle is vague at best. In Darfur, a woman would say: shal nadhafi (we had sex just after I got clean of menses), emphasizing a widely-held belief that the time immediately following the menstrual period is the best for conception. At this time the woman is regarded as nadhifa (ritually clean), and conception is expected if a couple mate at the onset of this period.[1] A premarital seclusion period called sibr al-suwaiba (granary rite) is enforced by some Nuba mountains’ tribes on girls who are at a marrying age. Each group of girls is confined in a room (not a granary) for a period of three to six months. In this period the girls are forbidden to go out of their room except at night and then only for chatting in the yard. They are fed in plenty so that at the end of seclusion they are well-prepared for married life.[2]

Menstruation is seen as no more than a regular emission shahriyya (monthly), ‘ada (routine), a dawra (cycle), wagib, (duty) or sunna (ordained nature)[3] that cleanses the womb of dirty blood and ushers in the bulugh (menarche) or sin al-taklif (age of responsibility). As long as menstrual blood is on, the woman is labelled nigsa (ritually unclean), and is, therefore, exempted from religious duties requiring ritual cleanliness in a Muslim society, and her activity restricted in various ways in several non-Muslim societies (see Pregnancy and confinement taboos page 192). Though the cycle causes motaib (dysmenorrhoea) and discomfort, these are considered normal functions rather than diseases. The timing of consummation or dukhla is a female concern, and it is usually the mother or grandmother of the bride who decides when this should take place, taking into consideration the time of the bride’s menstrual cycle.

That both partners should be fertile for conception to occur, and that the man’s role in the process is to ejaculate his fluid within the woman’s genitals, is common knowledge. What actually goes on within the woman’s belly remains a mystery. When conception is unduly delayed, people seek help from different sources. The woman first pays a visit to the family’s holy man begging him to invoke Almighty God to come to her help. Then, she tries the local materia medica. Several medicinal plants and recipes have been offered to promote fertility. A mixture of shieba (Usnia molluscula) a species of lichen indigenous in the Red Sea Hills, is taken with other plants to promote fertility. With sheiba also as the main ingredient, one or more of the following items is added: shamar (fennel, Foeniculum capillaceum), qirfa (cinnamon, Cinnamomum zeylanicum), ‘Irq sus (liquorice, Glycerrhiza glabra), qurunful (cloves, Eugenia cayophyllus), na’na’ (peppermint, Mentha piperita), harjal (argel, Solenostema argel), mahareb (Cymbopogon nercitus). The plants are usually boiled and taken as a drink. The makhmoura, a recipe of hilba (fenugreek), harial, mahareb, and dates, is claimed to be most efficacious in bringing about pregnancy.[4]

Some items, such as fish bones, pieces of coin or even qarad are worn to promote fertility symbolically. Fish bone is an important element in jirtiq (ritual decoration) of the pregnant woman; the bones express a wish that the woman be as fertile and prolific as fish. Other items are kept under the bed of the woman for similar reasons. These items include aubergine fruits, dura stalks, cumin seeds and dates, which all have one thing in common, that is, plenty of seeds. A faki’s help is frequently sought, and drinks of various plants including mahareb, harjal, hilba, and dates are tried.

Virility, femininity and sexuality

Modifying the sexual experience has been a subject of great concern to most Sudanese societies. In spite of this, no systematic study of the subject has been carried out. Men and women have devised respective methods that make sexual intercourse as gratifying as possible by seeking a long and pleasurable union. As Al-Sayigh, the Goldsmith of Omdurman, has copied verbatim in his Mukhtarat from different Medieval sources including Daoud Al-Antaki, The Tazkira. He identified several recipes that were thought to be tonic.

To improve performance in sex, the Arab societies of the Sudan, developed several practices. Female circumcision with its consequent plastic operations, tas-him and ‘adal, definitively forged a narrow vaginal opening. Women, on their part, tried other methods whenever the vagina became roomy, after repeated deliveries, for example. They occasionally applied shabb (alum) into the vagina to dry it up, makes it narrower, and probably causes atrophy of the mucosal linings with prolonged use, shrinkage and loss of secretions. They also exposed themselves to frequent dukhkhan sittings in the belief that the aromatic fumes in addition to their stimulant fragrance, would narrow the vagina.[5]

Men see virility as the hallmark of manhood, and spare no effort to protect or enhance sexual vigour and vitality. For example, virility and manly valour are highly esteemed by the Nuba. Their tribal sports: wrestling, stick-fighting and, even, dancing promote these attributes, and lack of these may disqualify a man for marriage. Nadel noted that among these tribes the cult of manliness is not a cult of aggressiveness and pugnacity. It fosters the ideals of strength, fitness, valour, untinged with the exuberance of willed destruction.[6]

The materia medica throughout the country abounds in aphrodisiac and tonic agents that are believed to potentiate ba’a (man’s sexual vigour), improve the sex act by prolonging the period of copulation or by increasing the erectile abilities of the man’s organs. Orally, several organic, mineral and herbal agents were ingested as aphrodisiac, frequently for their tonic effect. These included ‘aradeb (tamarind), karkade (red sorrel), jarjir (eruca), dalaib ( fan palm, Borassus aethiopum) wine, damsisa (Artemisia absinthium), hilba (fenugreek), ghleighla (Astrochlaena lachnosperma) rowand (rhubarb, Rheum officinalis), toum (garlic), ‘ishba (Smilax Species), and organic items such as honey, rhino’s tusk and a crocodile’s sex organ.[7]

The Hadandawa of eastern Sudan use the sheiba plant as an aphrodisiac, and in various places in northern Sudan, saikaran (datura) is added to marisa (the local alcoholic beverage), other alcoholic beverages are ingested, hashish and afyoun are used, all to prolong the sex act.

Medieval Arab writers addressed the subject of sexual sufficiency of men and its management with great concern. Little attention was paid to the woman’s role. Their medical texts included lengthy tracts describing ways and means of increasing sexual abilities in men, suitable times of day, and the correct positions to be taken during sexual intercourse. More than one book dealt exclusively with the Prophet Muhammad’s teachings and religious sanctions on appropriate sex.[8],[9] Traditional healers in the Sudan acquired many of these books, which became indispensable references on every traditional healer’s bookshelf. Examples of these books are: Al-Tazkirat by Daoud Al-Antaki, Shams Al-Ma’arif Al-Kubra, by Al-Bony, Al-Rahma fi Al-Tibbb wa Al-Hikma by Al-Siyouti and Shumus Al-Anwwar by Al-Tilmisani, not to mention Avicenna’s classic The Qanoun.

Sexual taboos

In the Sudan, all aspects of sex are surrounded by restrictions which govern the discussion of the subject as well as its performance. The concept that it is part of the relationship between a couple that might benefit from an exchange of views once in a while, have no place in the system. This section describes briefly and in general terms the state of affairs in this area. It alludes to the lay sex perceptions, conceptions and misconceptions and taboos in the hope that future research lends this area more attention. The area abounds in misconceptions and health-threatening practices, and hence there is more need for information to evaluate more rationally apparently controversial or misunderstood practices.

Men may talk among themselves, but with extreme reluctance. Women do talk about it, but discreetly. The area of sexual abilities, on the other hand, is taboo even between husband and wife. Procreation and love-making are mysteries for the whole family. Couples discuss this subject, if ever, in the most discreet fashion. Silence on subjects related to sex, the sex organs, sexual relations, and even words related to sex is considered both modest and decent.

As far as women are concerned, they are surrounded by a cult of virginity that defines all their activities before marriage. Northern Sudanese society does not only prohibit premarital sex, but equates girls’ virginity with the honour and pride of the whole family and clan. A girl is singly entrusted to preserve her hymen intact till marriage. For its part, the family excise the genitalia and suture the vaginal orifice except for a pin-hole opening, to protect the girl against male assaults (see Circumcision page 152).

Traditionally, the dukhla or consummation of marriage is used to confirm the virginity of the bride and therefore reinforce the honour of the family. In northern Sudan, dukhla is timed to coincide with the period immediately following menstruation. The wedding bed is covered with a white sheet in order to catch the blood resulting from the first penetration. In an earlier practice, women used to display the nuptial sheet bearing the blood spots outside the house for everybody to see. If the dukhla is to coincide with the period, the whole test will, of course, be useless.

There are other tests to confirm virginity and ‘honour’ of the bride, A perfect example is the rituals of hal al-hizzama,[10] ‘undoing the belt’ of the wrap-around skirt of the bride at consummation. The bride is instructed to impress her man by her outrage and disinterest in sexual intercourse. She is told to turn the whole exercise into a mock rape whereby she uses all her force, preferably coupled with audible screams, to prevent penetration. The bride is indeed dressed up for the fight. A sari is used by her as a skirt wrapped around her waist and belted with a strong robe. The robe is made into several knots designed in such a way that each time a knot is loosened, other knots get tighter.

Though slightly more fortunate than the bride, the groom also has a lot to worry about. His mother will show up in the early morning to be assured of the manhood of her son. Knowing the kind of resistance his bride is expected to give, the groom comes well prepared for a fight also. His wazir (best man) provides him with a cord of the type used to hold up underwear (tikka), but much stronger than usual. This he may use to subdue the bride by binding her hands or tying them to the bed if necessary. Defloration should be completed in the first night. However, if visible signs are not satisfactory, the bride is interrogated to tell the true story.

In order to make sure that the bride is telling the truth, she may be made to tell the story with a hand on the Quran. After listening to her, further tests my be in order to confirm her virginity. In rare cases, however, she is examined, and possibly decircumcised if necessary. Indeed, in the earlier times tas-him was performed prior to the wedding night, a practice, I was told, still maintained in some rural communities.

The anonymous writers (probably a French and an Italian) whose manuscript On the Frontiers of Islam was edited, translated into English and published by Richard Hill, gave a clear report of this practice in the Muslim Sudan around 1823. They reported that the bridegroom has to give the bride and her family presents of gold and money before they agree to perform this operation.[11] Incidentally, the manuscript provided as well evidence of the earliest official attempt to ban female circumcision in its infibulation form.[12]

The consummation of the marriage depends largely on the severity with which the woman has been circumcised: if this operation has been very severe, as the case is in the Pharaonic variety, consummation does not take place at all during the forty days of the marriage ceremony, and then only after the interference of a midwife. If consummation is successful, the family celebrates the occasion and invites all to be in witness of the spilt blood, or as they frequently say to ‘see the honour’ sharaf (literally honour) of their daughter.[13]

Few works have tried to unravel sexual behaviour in the Sudan. Enquiries into the matter of female circumcision surveys have yielded little information. Researchers have concluded that female circumcision, namely the Pharaonic type, leads to insufficient sexual satisfaction and frigidity in women, and that it is a possible cause of diminished potency in men. Many researchers, on the other hand, have seen in female circumcision a cause of pleasure to the husband; all these conclusions are to a great extent conjectural. Sexual intercourse during the menstrual period is considered sinful, a view which has its origin in the Quran:

“They ask thee

Concerning women’s courses.

Say: They are

A hurt and a pollution:

So keep away from women

In their courses, and do not

Approach them until

They are clean.

But when they have

Purified themselves,

Ye may approach them

In any manner, time, or place

Ordained for you by God.

For God loves those

Who turn to Him constantly

And He loves those

Who keep themselves pure and clean.[14]

Many non-Muslim societies share the view that sexual intercourse during the menstrual period is a potential cause of various ills; the least it may cause is venereal disease and sterility. In a study which covered ten Muslim and non-Muslim countries, the United Kingdom sample was the only one which did not share this belief.[15]Nadel noted that among the Heiban and Otoro tribes of the Nuba illicit sexual intercourse within the clan is a possible offence, and here the sanction is clearly formulated: it is punished, by God, with leprosy, which would not invariably visit the culprits themselves, but might appear among any of their relations.[16]


Society in the northern Sudan does not admit that men can contribute to infertility in any circumstances. No one should question a man’s competence. Women are always there to blame and therefore the ones required to seek treatment. Men rarely admit any deficiency on their part, and when a situation is becoming a cause of repeated nagging and gossip, women have to incur the liability. They are either divorced or forced to accept sharing the husband with another wife or more. Clark described the manners and customs of the Bega tribes of eastern Sudan and reported the following:

“Among the Bisharin at forty a woman is no longer fit to take to a man’s bed. She becomes ‘um el’aiyal,’ the mother of the family. A superstition is widely prevalent that if a man has intercourse with a woman after the menopause he does himself great harm, and seventy of his veins are dried up. Among the Arteiga this superstition is not held. The Bisharin believe, and they are not alone in this theory, that a young wife is able to transmit some of her own youth to an elderly husband but that in the process her own youth quickly fades.”[17]

For the management of infertility, women resort to magico-religious prescriptions first. A faki may prescribe mihaya, bakhra, or perform ‘azima or give a hijab. As internal medicine, a decoction of habbat al-muluk (croton oil seeds, Jatropha curcas) is believed to help. When the woman is desperate, she may agree to take bizarre recipes. She may drink willingly, for example, a decoction of a year-old cow dung soaked in water. Alternatively, she may wear a riyal (20-piastres-silver coin), and visit fallow land, which is being prepared for cultivation (possibly for the symbolic rich harvest expected).[18] Among the Nuba certain clans possess special magic faculties. The Amrus clan boasts a strong magic against infertility, and possesses a special, most powerful ceremony, called edowa and performed in six years’ intervals, which secures the fecundity of women of the whole Moro tribe.[19] Also each Tira Hill community has its own lobo [harvest fertility ceremony], performed by the old men of the local clan section. The same ceremony may also be performed, independently of any time schedule, to cure infertility of women—of any clan. The lobo of the Um Dordo Iltaro has gained special fame, and has become almost a place of pilgrimage for infertile women from many other districts, from Tira Mande and even Otoro.[20]

The course of gestation

Women know many facts about the onset of pregnancy, duration of gestation and the hazards they are liable to face during the period. They also know that missing a period and waham (morning sickness, food aversions and fads) are signs of pregnancy, and that human gestation is nine months long and that of a camel is twice as long.

It is widely believed in northern Sudan that a baby will survive if born two months premature (at the seventh month of pregnancy), but will surely die if born one month premature. Research has shed some light on this paradox. The level of a certain liquid surfactant that coats the inner surface of the alveoli in the foetus’s lungs determines the survival of such babies. This liquid increases during gestation to a level that makes survival at the seventh month possible, It then drops below the level necessary for survival at the eighth month. Eventually, it starts rising again to reach normal level at term. It is important to note here that such a belief, no doubt the outcome of a long experience, conditions the expectations of the family. They spare no effort to protect the two-months premature baby, but are psychologically prepared to accept the death of the eight-months old.

Many factors affect the mother and her baby during pregnancy. The mother is expected to select her food carefully and avoid tabooed items. She, her next of kin and the whole community around her should take extra care in their daily behaviour and activities. Women crave for certain items of food that vary from woman to woman and region to region. However, irrespective of whether the craved item is available or not, the craving has to be satisfied. Failure to do so affects the mother and her foetus badly.

The pregnant woman is particularly vulnerable to evil, natural or supernatural, during the late months of pregnancy. Owls, specially she-owls, are seen as signs of bad omen if a woman happens to see one during pregnancy. Owls, it is believed, are in the habit of going out between sunset and nightfall and visiting pregnant women to transfer evil. They cause abortions, stillbirths and all sorts of inexplicable illnesses. Owls are so feared that their mere cry is considered harmful.

A wide range of causes precipitates ante-partum bleeding and abortion. Exhaustion, stumbling, falling down, breach of taboos or getting anti-malarial injections are all possible causes. Parents sometimes produce congenitally deformed or mentally-retarded babies. The blame falls on the mother and the next of kin. The relatives might have broken a taboo, or the mother might have left the baby unattended in the cradle. The evil spirits might have exchanged it with a deformed one (changeling). To test whether this is true or not, they take the deformed baby to the nearest cemetery and lay it unattended for some time. If it is not human it will disappear!

Contraception and abortions

Though certain incidents are believed to induce abortion, such as a cry of an owl (possibly the spirit incarnated in the bird), the jealousy of a qarina (companion spirit) or the malice of um al-Subiyan (the evil spirit of children), other techniques to induce abortion or prevent conception are known. The Sudan Demographic Health Survey 1989/1990 interviewed a total of 5860 ever-married women aged 15-49 in six regions in northern Sudan (the southern regions were excluded due to the civil unrest), and reported that breastfeeding and postpartum abstinence provided substantial protection from pregnancy after the birth of a child.[21] In addition to the health benefits of the child, breast-feeding prolonged the length of postpartum amenorrhoea. In the Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in the Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent after one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child. The same survey found that 39 percent of women knew a traditional method of family planning though the report didn’t identify which methods were particularly used.

Mothers in Kordofan prevent their adolescent daughters from sucking lalobe, the fruit of hijlij tree (Balanites aegyptiaca). They believe that this helps to preserve their fertility later. A connection must have been made in that region, where the tree grows in abundance, between the consumption of the fruit and the low fertility of women who were noted to have consumed a lot of it during their adolescence.

Recent research has established that lalobe has a possible contraceptive effect in experimental animals. Oral administration of the edible part of the fruit produced a post-coital anti-fertility effect in female rats. This could either be due to inhibition of implantation or interruption of the normal process of pregnancy.[22] To use lalobe as a contraceptive, women suck a few unripe fruits. Sometimes, prolific women take large doses of cumin or habat al-‘arus seeds (Abrus precatorius) to bring about sterility.

In his study of a village community in central Sudan, Al-Tom noted the rather poor knowledge people generally hold about sterility. They often show a fatalistic attitude and ascribe the causes of all misfortune, including infertility, to God. They may, in addition, identify infections, complicated previous pregnancies and deliveries, and even vague hereditary notions, as contributing causes.[23], [24]

Bimbashi R.R. Anderson, a senior medical officer working for the Anglo-Egyptian army and posted to Kordofan, noted in 1908 that in that region abortion and death in utero were ascribed to evil influences, such as the evil eye, um al-subiyan, or the jealousy of another woman. The family would then make sure that all necessary charms to protect against this misfortune were secured. He also noted that if a woman should menstruate during a suspected pregnancy, the expected child was considered dead or in a state of suspended animation. In this condition, the foetus might remain for years in the womb without being delivered. Through an evil influence, too, a full-term child may remain alive in utero, being felt to move but showing no anxiety for delivery. One case is recorded in which this condition lasted for 17 years, during which time the ever-expectant mother spent most of her savings on worthless charms and remedies.[25]

Little is known about managing, abortion when it occurs. Amulets are prepared by a religious healer for her to wear, and drinks of sheeh (wormwood, Artemisia absinthium) or haza (Haplophyllum tuberculatum) are given to check bleeding. Abortion was also induced for criminal or social reasons: a handfull molokhiya (Jews mallow) seeds are swallowed with water and usher (Calotropis perocera) latex is applied as a tampon. On the other hard, to induce longer periods of sterility, a woman would ingest cammoun aswad (black cumin) seeds: a seed for every year of sterility.


[1] Abdullahi Osman E1 Tom and Ahmad El Safi. Traditional Practices Affecting the Health of Pregnant Women and Children. Traditional Medicine Research Institute (Khartoum) November, 1988, 59 pp (Photostat).

[2] Muhammad Haroun Kafi Op. Cit. Page 90.

[3] We interpret the word sunna in this context as an action which is ordained in nature, instituted and established, and that man has no control over or cannot change, even if he so wishes. When used to describe female circumcision, we think the word is being used in the same way, rather than in its religious sense, as a traditional teaching of the Prophet Muhammad.

[4] Abd Al-Rahim Sayyid Ali. Herbal Folklore Medicines in the Sudan. National Council for Therapeutics; March 1972; The Sudan Medical Council. Khartoum: 65-70.

[5] Recently, young women used a type of glue known by the brand name of Amir to make a rubbery sheet on the outer side of the introitus. This, in addition to providing resistance to intromissions, helps to narrow the vaginal opening by providing an artificial tight ring. The practice was not without reported injurious effects.

[6] Nadel, S.F. (1947) Op. Cit. Page 300.

[7] See A Sudanese Materia Medica for more items and for the binomial names and other details of these herbs.

[8] Ibn Qayyim Al-Jawziyya, Shams Al-Din Muhammad Ibn Abi Bakr Ibn Ayyoub (1292-1350). Kitab Al-Tibb Al-Nabawi [Arabic]. Cairo: Dar Ihiya Al-Kutub a!-Arabiyya; Many editions.

[9] Al-Zahabi, Al-Hafiz Abi Abd Allah Muhammad Ibn Ahmad Ibn Osman (1274/1348). Al-Tibbb Al-Nabawi [Arabic]. Cairo: Republican Library; 1946.

[10] Among the rubatab, a modified type is called qat’ al-sa’afa (cutting of the palm frond).

[11] ‘Abd Al-’Azim Muhammad Ahmad ‘Akasha, Translator into Arabic. ‘Ala Tukhoum Al-’Alam Al-Islami (On the Frontiers of Islam), two, manuscripts concerning the Sudan under Turco-Egyptian rule 1822-1845. Hill, R.L. , Editor and Translator from the Italian into English. Khartoum: Al-Matbou’at Al-Arabiya; 1987: page 68.

[12] It was reported that in 1845 (1261 A.H. ), the Governor of Khartoum, under public pressure, issued a decree banning this type of circumcision. The decree did not include the Egyptian type in which only the clitoris was excised, and prohibited any presents brides used to ask of husbands in order to perform plastic recircumcision. ‘Abd Al-’Azim Muhammad Ahmad ‘Akasha, Translator into Arabic. Ala Tukhoum Al-’Alam Al-islami (On the Frontiers of Islam): Two Manuscripts Concerning the Sudan Under Turco-Egyptian Rule 1822-1845, Hill, R.L. , Editor and Translator from the Italian int English. Khartoum: Al-Matboulat Al-Arabiya; 1987; page 68.

[13] Abdullahi Osman El Tom and Ahmad El Safi. Op. Cit

[14] Quran, The Holy. Translation and Commentary by A. Yusuf Ali, Islamic Propagation Centre International, Copyrighted 1946 by Khalil Al-Rawaf: Sura II, Baqara, or the Heifer, verse 222, pages 87, 88.

[15] Snowden, R., Christian, B. (eds. ). Patterns and Perceptions of Menstruation. Croom helm, London and Canberra and St. Martin’s Press, New York, 1983. Quoted by El Tom et al, Op Cit.

[16] Nadel. Op. Cit. Page 94.

[17] Clark, W.T. Op. Cit.

[18] Abdullahi Osman El-Tom et al. Op. Cit. 20-21.

[19] Nadel, S.F. The Nuba: An anthropological study of the Hill Tribes of Kordofan. London: Oxford University Press; 1947: 204.

[20] Nadel. Op. Cit. Page 192.

[21] Department of Statistics, Ministry of Economic and National Planning. Sudan Demographic and Health Survey 1989/1990. Department of Statistics, Ministry of Economic and National Planning, Khartoum, Sudan, and Institute for Resource Development/Macro International, Inc Columbia, Maryland USA.: 1991 May. 180 pages.

[22] Maha Nasr El-Din Babiker. Master of Veterinary Science, University of Khartoum, Oct. 1988. (unpublished thesis).

[23] Anderson, R.G. Op. Cit.

[24] Chaudhury, R.R.. Plant Contraceptives: Translating Folklore into Scientific Application. Adventures in MCH, Oxford University Press, 1985. For a review of the traditional methods of contraception in various parts of the world.

[25] Anderson, R.G. 1908. Op. Cit.


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