**11. Conclusion**

*Public Health in Developing Countries - Challenges and Opportunities*

the decision and, if they appreciate the cultural practice.

prevents promiscuity.

**consequences?**

and

countries).

efforts to stamp out FGM includes [1]:

have undesirable health consequence [8].

• wider international involvement to stop FGM;

visitor by giving the friend or visitor their wife to have sexual intercourse with for the night [4]. This cultural practice is called okujepisa omukazendu. This practice is deeply rooted in the communities, they believe that it deepens their friendship and

In a country with one of the highest prevalence of HIV infection, a cultural practice like this may be contributing to the spread of the disease. It will be interesting to find out if the wives given as sexual gifts to friends and visitors have a say in

The cultural practices described above are examples of the obvious ones with possibly deleterious health consequences. Some others are not as obvious but nevertheless may have significant adverse heath impact. An example is the cultural upbringing of male children to assume dominant and aggressive roles in relationship with the more docile brought up female partner. This cultural practice is common in many parts of Africa and has been associated with tolerance in the communities for

Female genital mutilation (FGM) was declared a public health concern due to the widespread practice of the culture and, the huge number of girls and women whose physical, psychological, and reproductive health have been adversely affected [2]. The international collaborative response to the practice involved the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA). The modality for the concerted

• international monitoring bodies and resolutions that condemn the practice;

• revised legal frameworks and growing political support to end FGM (this includes a law against FGM in 26 countries in Africa and the Middle East, as well as in 33 other countries with migrant populations from FGM practicing

Though the sustained and collaborative efforts resulted in reduced prevalence of the cultural practice, research revealed that if the communities that practice FGM themselves decide to abandon the cultural practice, FGM will be quickly eradicated [2]. So, how then do we get communities to be aware of the health consequences of aspects of their culture that have adverse consequences on health? I propose a multi-dimensional, sustained and motivational approach; similar to the motivational interviewing used medically to influence changes in individual behaviors that

This approach requires identification of influential individuals and stakeholders in the community and developing a relationship of respect and mutual trust in these identified people. Then, without being overtly critical of their cultural practice, they can be made aware of the health impact of the practice using subtle methods such as drama, movies and carefully prepared literature [7]. When the influential individuals and stakeholders are motivated to appreciate the harmful effects of the cultural practice, they may then be involved in peer influence of others in their

violence by husbands on their wives and, intimate partner violence [5–7].

**10. How do we address cultural practices with adverse health** 

**104**

It should be expected that motivating a change in a cultural practice that has been held and believed in by a community for decades or centuries would require tact, patience and sustained, multidimensional, collaborative effort. It may be several years before any appreciable change is achieved but nevertheless, it is expedient to start the change process.
