Breast Ironing, a hidden endemic in Africa: a scoping review

Breast ironing (BI), which is also referred to as breast flattening, is a harmful cultural practice primarily observed in certain African communities (Tapscott, 2012). It involves pressing, hammering, or massaging the developing breasts of a girl with hot tools like pestles, spatulas, or stones (Eyumeneh, 2022). This practice is mostly reported in Cameroon but also found in countries like Nigeria, Togo, Guinea-Bissau, and some other Central and West African countries (Amahazion, 2021; Mukama & Domkam, 2007). This practice is normally carried out by mothers or female guardians with the intention of protecting the victims (girls) from unwanted pregnancies, forced marriages, early sexual attentions, and sexual assaults (Ajibade et al., 2024; Amahazion, 2021). This procedure is painful; hence, it is performed in private (Williams & Finlay, 2020). Across parts of Central and West Africa, girls as young as nine are subjected to this practice that is both physically excruciating and largely invisible in mainstream global health literature (Eyumeneh, 2022; Olofinbiyi et al., 2024). Although the rationale is perceived as protective by perpetrators, breast ironing constitutes a gendered form of violence, resulting in serious health risks such as burns, physical disfigurement, pains, psychological trauma, infection,breast tissue trauma, breast deformities, and violation of bodily autonomy (Adegbite & Olusegun, 2023; Cárdaba-García et al., 2024;Ajibade et al., 2024; Tchoukou, 2014 ). Despite the culturally motivated justification for BI, it is becoming more widely acknowledged as a violation of the victims’ rights (Gorar, 2022). The United Nations Population Fund (UNFPA) and the World Health Organization (WHO) have both recognized BI as a type of gender-based violence (GBV), similar to early marriage, female genital mutilation (FGM), and other detrimental cultural practices (Amahazion, 2021). BI is covert and domestic in nature and lacks reliable national data systems monitoring (Pemunta, 2016). This detrimental cultural practice, nevertheless, is understudied, underreported, and underregulated despite this recognition (Amahazion, 2021; United Nations Population Fund, 2006). However, in Cameroon, the practice is most well-documented. A study by the German Society for International Cooperation (GIZ) found that 1 in 4 females had undergone BI (Ngunshi, 2011). Evidence also suggested that BI is performed in the diaspora, particularly among African immigrant populations in countries like the UK (Gorar, 2022; Simangunsong, 2024). Unfortunately, because the procedure in performing BI is typically shrouded in secrecy and viewed as a domestic concern, its prevalence and full impact remain largely unknown (Adegite & Olusegun, 2023). Few countries have passed specific laws outlawing the practice or set aside funds for the prevention of BI, despite the UNFPA identifying its practice as one of five underreported forms of GBV in Africa (Amahazion, 2021). This practice remains less recognized in academic discourse and public health policy due to a lack of knowledge, cultural normalization, and policy inertia (Adegbite & Olusegun, 2023; Pemunta, 2016;Osam, 2024). Also, previous studies have limited the independent evaluation of breast ironing by frequently grouping it with other practices, including female genital mutilation (Campbell et al., 2020; Rose, 2016; Williams & Finlay, 2020). Consequently, girls who get exposed to this practice and similar cultural procedures endure silent suffering associated with scarring, tissue necrosis, breast abnormalities, and mental health conditions such as anxiety, sadness, and post-traumatic stress disorder ( Catarina et al., 2023; Im et al., 2020; Kaplan et al., 2013). Hence, BI has significant human rights and health ramifications. In some situations, breast ironing could lead to infection, increased risk of breast cancer, and difficulty nursing a child during adulthood (Africa Health Organisation, 2020). Furthermore, the victims may experience severe emotional distress, lose the feminist features, and suffer from bad body image (Osam, 2024). The combined effect of these situations with more general systemic problems like gender discrimination, poverty, and low educational achievement among those affected may result in long-term cycles of disadvantages (The Advocate for Human Rights, 2020). Even though some human rights groups and the United Nations agencies have acknowledged the BI practice, much research from the academic and gray literature that outlines the full extent and effects of breast ironing, as well as the factors influencing its practice over the past decades, hasn’t been done. The need for a scoping review is to systematically identify, map, and evaluate the body of evidence highlighted by the lack of focused research and growing concern from human rights organizations and transcultural healthcare providers (Adegbite & Olusegun, 2023) . Hence, the objective of this review is to assess the extent of the literature on the practice of breast ironing in Africa.