The humiliation of having a 'skinny wife': Beauty's Big problem where large is Better
"Force-feeding by way of physical abuse is practically a thing of the past; it is generally limited to remote rural areas," said Zeinabou Mint Taleb Moussa, head of the NGO Mauritanian Association for Mothers' and Children's Health (AMSME). "But young women wanting to gain weight and [resorting to extreme measures to do so] is indeed a reality."
Mauritanians told IRIN of recent cases in which young women died from taking drugs - including products formulated for livestock - to gain weight.
While aesthetic standards are slowly shifting and some women refuse the destructive practice of forcing weight gain, traditionally in Mauritania a plump figure on a woman signifies wealth and well-being. For generations families force-fed their daughters litres of cow's or camel's milk daily in part to improve their marriage prospects.
A proverb of Mauritania's Moor ethnic group says: "The woman occupies in her man's heart the space she occupies in his bed."
But in recent years, despite health warnings, some girls and women are voluntarily turning to other methods, like taking cortisone products - including one designed to make cattle gain weight; appetite-inducing syrups; and psychotropic medicines.
"Some months ago, my cousin went to the village to prepare for marriage," said an AMSME member who requested anonymity. "This preparation includes fattening up, and she died from an overdose of drugs designed to make one gain weight."
In another case, a young girl in a slum in the capital Nouakchott recently died after taking drugs designed for cattle, said Souleimane Cherif, president of the Mauritania pharmacists' association.
Social researcher Mohameden Ould Ekahe said one of the animal drugs women take "to self-fatten" is locally known as 'dregdreg' - a Hassaniyya word meaning a shaking of the heart, for one of the health hazards it can pose. "They want to meet the standard of a society in love with fat women," he said.
The products are easy to obtain and that is part of the problem, pharmacist Cherif told IRIN.
"Regulations are not strictly applied mostly because of the profits for some in the medical sector," he said. "Furthermore the state's resources are relatively limited. Still the authorities have made efforts in the past three years, including removing certain products from the markets."
Despite these efforts and a 2010 law stipulating harsher penalties for irregular drug sales, anyone can buy the products in markets and pharmacies. It is difficult to say how much money is spent on such products for these purposes, as much of the trade is on the black market.
Many women also request birth control pills just for the potential weight-gain, and appetite-inducing syrups, said Anna Fall, a midwife at a health centre in a lower-class neighbourhood of Nouakchott.
The push to pack on extra weight carries the threat of cardiovascular disease, kidney failure, diabetes and high blood pressure, said Mohammed Lemine Ould Cheikh, the health centre's head doctor. "Most women don't know that these medicines are dangerous; otherwise they wouldn't take them. It's a question of literacy."
Taleb Moussa said it is not all down to ignorance; some girls trying to put on weight dismiss the dangers of misusing drugs. "I was in a pharmacy one day and I saw some girls buying these products. I told them it's dangerous; they laughed and went about their business."
Indeed, social pressure and long-held standards persist.
Marième Diallo, 53, was force-fed as an adolescent. Her two daughters, 14 and 19, are slim and refuse to gain weight; Diallo said she will not force them, and for that she is derided by friends. "Recently my neighbour came round, telling me it's not normal, it's dishonourable for my family that my daughters are thin. She wanted to take them to the village to make them gain weight."
Many men still see size as a measure of beauty. "For some men it is still humiliating to have a skinny wife," AMSME coordinator Khadija Sakho told IRIN. "They are ashamed to have their friends come round."