Lusaka, Zambia — They ingest snuff to self-medicate and insert it in their vaginas to increase their partner's sexual pleasure. But smokeless tobacco could compound the already steep health challenges they face.
At her makeshift stall, vegetable vendor Racheal Zimba retrieves a small white bottle from her bra and sprinkles some black powder onto her palm. She sniffs it, then sneezes a few times. She buries the remaining powder under her tongue and passes the bottle to another woman, a fellow trader, who also takes a sniff. Soon, a crowd of women gathers around her stall on Los Angeles Road in Kanyama, west of Lusaka's central business district. They eagerly wait their turn. The women are ingesting snuff, a finely ground black powder -- locally known as Nsunko -- crafted from a blend of tobacco leaves, salt, ashes, soda and other unknown additives.
Some women at the market claim using snuff alleviates stress, while others say it tightens their vaginas and makes them warm during sex. Others simply laugh in response, declining to share their reasons.
Health experts worry that the use of snuff, especially as a vaginal tightening agent, which is common among women in Zambia, exacerbates existing health challenges they face, including high rates of cervical cancer and HIV as inflammation of the genitalia can increase HIV risks, says Dr. Swebby Macha, a gynecologist at Zambia's largest hospital, the University Teaching Hospital.
Zimba says she started using snuff eight years ago to manage her low blood pressure, a practice health experts warn is harmful.
"I realized that every time I took it, especially on my tongue, my body [temperature] changed," she says.
Then, through her peers who are mostly in their 40s, the mother of three says she discovered she could use it to enhance sexual pleasure. Initially, Zimba says she doubted this, but she gave it a try. After, she says she observed her partner enjoying the experience more than usual. Her vagina was tighter and less watery, she says. She says she experienced pain, but that did not worry her.
In Zambia, women have traditionally used herbs to curb natural vaginal lubrication. This stems from a belief that less tight and overly lubricated female genitalia signify infidelity.
Smokeless tobacco use is high among women at 6.8%, compared to 2.2% of men, according to the latest data in a 2017 Ministry of Health survey.
Lucy Kafula admits that she started inserting snuff into her genitalia when she found out about her partner's infidelity. By using snuff, Kafula believed she'd retain his affection. She says she found it to be particularly effective.
"I heard from my friends how snuff worked when it comes to sex and I tried once. I could see that my partner had a whole different experience, so I started using it. I use it when I know we will be intimate," Kafula says.
Snuff is readily available in Zambia. Global Press Journal found that a small 100-gram package costs as low as 10 Zambian kwacha (less than half a United States dollar) and is often available from unlicensed sellers. This is despite the 2022 Tobacco Act which mandates that traders must obtain licenses.
Although users argue it's a harmless medicinal plant, scientific studies reveal toxic components.
Snuff contains nicotine, nitrosamines and elevated concentrations of such trace metals as cadmium, chromium, manganese and copper, according to a 2020 study in Toxicology Reports, a journal for toxicology research and clinical sciences. These substances make snuff potentially toxic and carcinogenic. The same study says that ingesting these toxic elements, orally or vaginally, can lead to gastrointestinal disorders, various cancers, degenerative conditions, cardiovascular issues, hematopoietic disorders, neurological and cognitive problems, and male infertility.
Macha, the gynecologist, says inserting these components into the vagina can lead to ulcerations of the vaginal walls. "Some of these habits of inserting things in private parts could be drivers of HIV, even cervical cancer," Macha says.
He adds that although women may not openly admit to using snuff, gynecology examinations often reveal the practice.
The practice could compound the already high burden of health challenges affecting women in Zambia. Cervical cancer, for example, makes up 40.2% of all cancers in Zambia and has high mortality rates, according to 2020 Global Cancer Observatory data. Meanwhile, HIV disproportionally affects women in the country at 13.8%, compared to 7.7% of men, as reported by the Joint United Nations Programme on HIV/AIDS, known as UNAIDS.
Dr. Selia Ng'anjo, a gynecologist and head of obstetrics at the Women and Newborn Hospital within the University Teaching Hospital in Lusaka, says that although there are no conclusive studies confirming the link between cervical cancer and the insertion of snuff tobacco, the practice poses severe health risks.
"It is possible to develop cervical cancer through the insertion of snuff because the components of tobacco are dangerous, especially when inserted into the vagina," she says.
The use of snuff as a vaginal tightening agent is also common in other countries, including South Africa, Senegal, Malawi, Zimbabwe, Saudi Arabia, Democratic Republic of Congo, Haiti, Costa Rica, Cameroon and Kenya.
A study from the National Library of Medicine also indicates that many women in southern Africa willingly insert herbal aphrodisiacs like household detergents and antiseptics into their vaginas before sex to increase friction and appease their partners, despite the pain it may cause during sex.
Although they are aware of the health warnings, both Zimba and Kafula remain skeptical about snuff's toxicity or its link to cervical cancer. Zimba argues that tobacco is simply a medicinal plant with beneficial properties.
"I have heard people discussing the dangers of snuff, but I believe it is just a medicinal plant that is not harmful. I have not had any side effects except for some pain during sex because of the tightness of the vagina. But men love it tight," Zimba says.
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Martin Banda, a barber, is hesitant about the use of snuff. He suggests alternative methods.
"Yes, a tighter and warmer sensation is preferable, but I believe there are other methods women can explore to achieve that, such as eating lemons and practicing Kegel exercises," he says.
Unlike Zimba and Kafula, trader Melody Chanda only uses snuff to manage her low blood pressure. Despite receiving multiple warnings from doctors about the risks associated with snuff use, she admits to struggling with addiction and has been unable to quit.
"The most ridiculous idea is putting it inside my vagina. That area is highly sensitive and prone to infections. Even in the past, our grandmothers only used snuff for sniffing, just as the name 'snuff' suggests," she says.
Dr. Fastone Goma, a cardiovascular expert, warns that using snuff to manage blood pressure should not be considered medical advice or a proven treatment method. He says snuff could have opposite results and lead to high blood pressure.
"People must refrain from self-prescribing substances they lack understanding about; it can be life-threatening," he says.
Prudence Phiri is a Global Press Journal reporter based in Lusaka, Zambia.
Prudence Phiri, GPJ, translated some interviews from Nyanja.
