Understanding intravaginal practices for gynecologic health among Haitian migrant women: A mixed-methods analysis

Haitian migrant women in the U.S. experience disproportionate rates of cervical cancer. Intravaginal practices (IVPs) are widely used among Haitian women and have been linked to an increased risk of human papillomavirus (HPV) infection. Although IVPs are well-documented in the Haitian community, little is known about Haitian migrant women's perceptions and motivations underlying their use. This exploratory sequential mixed-methods study examined Haitian migrant women's motivations for engaging in IVPs, products used for IVPs, and indications for their use. A convenience sample of Haitian migrant women in South Florida were recruited through active and passive recruitment approaches in community-based centers. Semi-structured qualitative interviews (n = 25) explored perceptions, motivations, and products used for IVPs. Qualitative results informed the development of survey items measuring IVPs, which were administered to participants (n = 151). Chi-square analysis with a Bonferroni adjustment examined associations between IVP products and IVP indications. All women in the qualitative sample (n = 25, 100%) confirmed IVP use compared to 68.9% (n = 104) of women in the quantitative sample. Qualitative interviews revealed that IVP preferences were rooted in cultural expectations with most women starting these practices either during puberty or after sexual debut. IVP products (e.g., plant and herbal agents, astringent washes, and antibiotics) were often chosen based on specific gynecologic indications, with this finding being consistent across both samples. Pigeon pea (pwa kongo) was the most frequently used IVP product in the quantitative sample (n = 74, 71.2%) and was associated with nearly all IVP indications (p ≤ 0.004). Given the high prevalence of IVPs in our sample, researchers and practitioners should further examine the meaningful health risks and protective effects associated with IVPs.