Benefits of Traditional Medicinal Plants to African Women's Health: An Overview of the Literature.

From an extensive study of the literature, we attempted to collect data in different African countries on the use of plants by women as remedies for their health concerns. The tendencies of research were established from references recovered from PubMed, Scopus, Google Scholar, and Web of Science by combining the following research terms: abortion, adverse, Africa, attendant, birth, botanical, delivery, developing, drug, ethnomedicine, ethnopharmacology, excision, folk, gynecological, healing, infertility, herb, indigenous, lactation, medicine, native, obstetric, phytomedicine, plant, pregnancy, remedy, side, sub-Saharan, traditional, treatment, and women. The literature search covers the years 1946 to 2024. The reviewed papers were selected depending on how well they relate to the manuscript’s sections under consideration ( Figure 1 ). The limited available data that we could retrieve confirm that the major health problems of African women have not been consistently addressed and so, only certain aspects could be approached. The present review then addresses the plants explored for menstrual disorders, maternity care, and reproductive healthcare problems, including infertility, contraception, pregnancy, and breast cancer ( Figure 2 ).

The diseases that are treated appear to be as varied as they are complex, and, in many cases, are gynecological in nature, i.e., disorders of the female reproductive system, including the ovaries, fallopian tubes, uterus, vagina and vulva, ovarian or vaginal cysts, uterine fibroids and prolapse. These can include reproductive tract infections (sexually transmitted, lower or upper genital) and anomalies, endometriosis, benign tumors or gynecological cancers (of the cervix, uterus, breast, ovaries, etc.). This Section discusses the most prevalent disorders about plants used by African women for their healthcare. The plants most reported are Zingiber officinale Roscoe (ginger), Allium sativum L. (garlic), Cucurbita pepo L. (pumpkin), and Ricinus communis L. (common castor bean). The onset of menstruation is followed by several symptoms; these can be painful, too abundant, or irregular. Distinctive authors report that, to relieve menstrual pain, African women use various natural remedies ( Table 1 ). In young girls, the color of white discharge can reveal intimate hygiene problems; in the case of brown or greenish discharge, some solutions have been passed down through the millennia, mostly from mother to daughter. Similarly, different countries have numerous methods of employing plants for this purpose ( Table 1 ). Over all of Africa, 4 out of 5 women are reported to turn to traditional medicine during pregnancy [ 13 , 45 ]. Herbal medications employed can be different, depending on the African locations and/or nations; the indications, that are part of maternal care, are either mother- or child-linked [ 46 ]. The common cold or flu, constipation, flatulence, gastrointestinal issues, pain conditions, improved fetal outcomes, prevention of miscarriage, reduction of anxiety, anemia treatment and/or prevention, and edema treatment are among the most frequently reported indications [ 18 ]. To discuss the involvement of plants at each stage of pregnancy, the most frequently used plants and their effects are summarized in Figure 3 . For morning sickness, in almost all African countries, women generally turn to ginger ( Zingiber officinale Roscoe), a so-called “miracle plant” [ 45 ], taken as an infusion or chewed, to chamomile ( Chamomilla recutita (L.) Rauschert, synonym of Matricaria chamomilla Blanco), and to fennel ( Foeniculum vulgare Mill.). Regarding edema, in Mali, women use an infusion of corn ( Zea mays L.) to relieve edema during pregnancy [ 48 ]. Stomach burns are very frequent for some women; kongo bololo ( Chamomilla recutita (L.) Rauschert, synonym of Matricaria chamomilla Blanco) is an important treatment in the D.R. Congo [ 49 ]. Concerning migraines, in the Maghreb, linden ( Tilia spp.) is used to treat migraines [ 45 ]. To combat migraines and nervous tension in Egypt and Libya, women also use linden ( Tilia sp.) [ 39 , 40 , 45 , 48 ]. To combat constipation in Egypt and Libya, women use linseed ( Linum usitatissimum L.), which they leave to macerate in water overnight before drinking in the early hours of the morning [ 39 , 40 , 45 , 48 ]. Hemorrhoids are treated with a decoction or sitz bath of sulfur tree ( Morinda lucida Benth.) in Burkina Faso, Ghana, Nigeria, Sierra Leone, and Togo [ 50 ]. As for the tocolytic effect, in the D.R. Congo, castor oil ( Ricinus communis L.) is crushed and applied to the labia majora to close the cervix if it opens prematurely [ 51 ]. Infections are frequent during pregnancy since it is known as a period when a woman’s body is very vulnerable, and she is prone to a number of genital and urinary tract infections. In Ghana, Guinea-Conakry, Liberia, and Senegal, pregnant women apply to their genitals the crushed bark of the African lime tree ( Hallea stipulosa (DC.) J.-F.Leroy, synonym of Mitragyna stipulosa Kuntze) [ 52 , 53 ]. Preparation for childbirth follows several rituals; during this period, many African women are surrounded by their loved ones and receive advice and care, generally from their grandmothers. Raspberry infusion ( Rubus idaeus L.) is used for childbirth preparation in Senegal, Mali, Benin, Côte d’Ivoire, Niger, and Cameroon [ 40 ]. In preparation for breastfeeding, in Senegal, German chamomile ( Chamomilla recutita (L.) Rauschert, synonym of Matricaria chamomilla Blanco) and calendula ( Calendula officinalis L.) are ground and applied to the breasts [ 34 ]. For purgation, in the D.R. Congo, okra ( Abelmoschus esculentus Moench) and fat grass ( Commelina diffusa Burm.f.) are crushed and used to purge [ 54 ]. The same use is reported in Benin, Burkina Faso, and Côte d’Ivoire for kolatier ( Cola nitida (Vent.) Schott & Endl.) and djeka ( Alchornea cordifolia (Schumach.) Müll. Arg.) [ 55 ]. In Senegal, pelvic pain is alleviated through the use of tulip tree ( Spathodea campanulata P. Beauv) [ 56 ]. After the arrival of the baby, there are a series of treatments that the woman must undergo. In Ghana, Guinea-Bissau, Liberia, Nigeria, Senegal, and Sierra Leone, the infusion of wood stool ( Alstonia boonei De Wild.) is often used to help expel the placenta [ 57 ]. A drink made from boiled leaves of Gambian tea ( Lippia multiflora Moldenke) is also used [ 58 , 59 ]. For postpartum hemorrhage, a treatment commonly reported in Burkina Faso, Guinea, Mali, and Nigeria consists of infused leaves of African red sandalwood ( Pterocarpus erinaceus Poir.), kyama-guiguisuron ( Solanum torvum Sw.) and stinkweed ( Cassia occidentalis (L.) Rose and Cassia caroliniana Walter, both being synonyms of Senna occidentalis (L.) Link); this decoction is also used for fever resulting from pregnancy [ 36 , 39 , 40 , 45 , 48 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. In the Eastern regions of Nigeria, the fruits of the Aridan tree ( Tetrapleura tetraptera (Schumach. & Thonn.) Taub.) are used to prepare soups for nursing mothers from the first day of childbirth in order to prevent post-partum contractions [ 72 ]. Cameroon women who have just given birth drink and have their breasts massaged with a macerate of Cassia polyacantha Wild. Subsp. Campulacantha Hochst. Ex.A.Rich Brenan and Phyllanthus muellerianus (O. Kuntze) Exell. leaves [ 73 ]. According to Lockett et al. [ 74 ], the fruit extract of the desert date ( Balanites aegyptiaca (L.) Delile) is added to porridge and eaten by nursing mothers to stimulate milk production in Burkina Faso, Ghana, Mali, and Senegal. In Egypt, Greek clove ( Trigonella foenum-graecum L.) is boiled in water [ 75 ]. In Angola and Malawi, women are advised to drink carrot juice ( Daucus carota L.) and basil ( Ocimum basilicum L.) every morning to stimulate the milk production [ 40 , 48 ]. Throughout Africa, women are accustomed to applying Aloe vera (L.) Burm.f. gel after childbirth, or massaging the skin with olive oil ( Olea europaea L.) once or twice a day [ 76 ]. In the D.R. Congo, castor oil ( Ricinus communis L.) is introduced as a suppository into the vagina once a day to accelerate the shedding of the womb [ 77 ]. Plants can be involved at each stage of pregnancy; the most frequently used plants and the most significant ailments are summarized in Figure 3 and Table 2 , respectively. In Morocco, Algeria, Egypt, and Libya, ginseng ( Panax ginseng C.A. Mey.) [ 48 ], chaste tree ( Vitex agnus-castus L.), and “clover” ( Chamaelirium luteum (L.) A. Gray) are used to treat symptoms associated with this drop in estrogen and progesterone production. In the same region, women consider eating at least 10 g of oats for breakfast to help improve depression and low libido; also, sage infusion ( Salvia officinalis L.) helps relieve hot flushes and night sweats [ 39 ]. According to Telefo, Lienou, Yemele, Lemfack, Mouokeu, Goka, Tagne, and Moundipa [ 69 ], the problems of female infertility are solved in Ghana, Côte d’Ivoire, Nigeria, and Sierra Leone by the oral administration of 3 to 4 g of kwaonsuswaa fruit ( Solanum torvum Sw.) macerated in palm wine. In Nigeria, Prekese ( Tetrapleura tetraptera (Schumach. & Thonn.) Taub.) is reputed to be effective in the management of female sterility [ 72 ]. Pool [ 73 ] gives a list of plants that help in infertility treatment when administered as a decoction or infusion in the D.R. Congo. These include Annona senegalensis Pers., Nelsonia canescens Spreng, Zanthoxylon chalybeum Engl. Amorphophalus abyssinicus (A. Rich) N.E. Br., and Phyllanthus muellerianus (Kuntze) Exell. To treat uterine fibroids in Burkina Faso, Ghana, Mali, and Senegal, a zèkènè ( Balanites aegyptiaca (L.) Delile) decoction is employed [ 78 ]; bubinga sap ( Guibourtia tessmannii (Harms) J. Léonard) is used to purge every 2 days for a month; ginger ( Zingiber officinale Roscoe) and garlic ( Allium sativum L.) are crushed, added with a little water, mixed with aloe ( Aloes vera (L.) Burm. f.) and honey and drunk [ 79 ]. In Libya, a mixture of houseleek ( Sempervivum spp.) and honey is used [ 45 , 48 ]. Jaffré and de Sardan [ 51 ] list the various plants used in the D.R. Congo to “ solve matrix problems ”. Lengayamayi ( Ludwigia stenorraphe (Brenan) H. Hara) is ground and applied to the genitalia to treat a poorly positioned or trackless matrix. Tona, Cimanga, Mesia, Musuamba, De Bruyne, Apers, Hernans, Van Miert, Pieters, and Totté [ 61 ] highlight some Congolese beliefs that “ making a decoction and drinking an infusion of bark from any tree whose roots cross a road will cure a curved womb ”. There are not many African plant extracts specifically used for treating breast cancer, even though several of them have been found to exhibit anticancer action. For instance, Tabernaemontana stapfiana Britten (soccerball fruit) stem bark dried, ground into a powder, and combined with alcohol is used topically once per day for a month in Kenya. The dried leaves powder of Glycine wightii (Wight & Arn.) Verdc. (Synonym of Neonotonia wightii (Wight & Arn.) J.A. Lackey) ( perennial soybean ) is also applied topically. Tragia brevipes Pax (Climbing nettle) powder is infused and taken daily orally [ 80 ]. In Cameroon, Momordica charantia L. (Bitter melon) is known for its abortive characteristic [ 81 ]. In West African markets, seeds from this plant are regularly offered for sale as abortifacients [ 82 ]; its fruit juice causes uterine hemorrhage, and the vine’s seeds have abortifacient properties [ 83 ]. Extracts of Tanzanian plants, including Bidens pilosa L. (Beggar’s Tick), Commelina africana L. (yellow commelina), Desmodium barbatum (L.) Benth (synonym of Grona barbata (L.) H. Ohashi & K. Ohashi) (hairy beggarweed), Manihot esculenta Crantz . (manioc), Ocimum suave Willd. (synonym of Ocimum gratissimum subsp. gratissimum ), Oldenlandia corymbosa L. (two-flowered Oldenlandia), and Sphaerogyne latifolia Naudin (synonym of Miconia platyphylla (Benth.) L.O.Williams), have abortifacient effects since they induce strong uterine contractions [ 84 ]. In the north of Burkina Faso, drinking a watery solution made from the roots and leaves of Securidaca longepedunculata Fresen. (violet tree) supplies uterine contraction-stimulating ergoline alkaloids to induce abortions [ 85 ]. In Ghana, Musanga cecropioides R.Br. ex Tedlie (umbrella tree), Erythrina senegalensis DC. (Senegal coraltree), Ficus sur Forssk. (cape fig), and Physalis angulata L. (balloon cherry) are used as emmenagogues and to induce abortion [ 86 ]. A dose-dependent reversal of action may be implied by the fact that several species with a known spasmolytic activity (such as Zingiber officinale Roscoe and Citrus spp.) are also utilized to induce abortion, designed as “ uterine cleansing ” [ 10 ]. Some African nations still practice the age-old habit of female genital mutilation or female circumcision [ 87 ] but only scant information is available about plants used after the excision. To control any excessive bleeding, powdery mixtures of sugar, gum and herbs, ashes or pulverized animal manure are reported [ 88 ]. Birge and Serin [ 89 ] also indicate that a mixture of plants, cow dung, and butter have been used for wound healing while Nyangweso [ 90 ] stated that the circumciser pours some traditional herb on the wound, which causes “ excruciating pain ”. Only Vergiat [ 91 ] named the plants applied to the excision wound of women; these were recorded as the young shoots of Ampelocissus cinnamochroa Planch. (Synonym of Ampelocissus bombycina Planch.) and of Hymenocardia acida Tul. Plants used by African women for their healthcare.

There is limited scientific evidence about the effects of most medicinal herbs on the female body and more research is definitely needed to elucidate the active compounds and mechanisms of action for reported uses. A proprietary Ricinus communis L. non-polar seed extract is reported to present anti-implantation, contraceptive, and estrogenic activity in rats and mice, acting at multiple sites, including the oviduct, fallopian tube, uterus, and the endometrial implantation site, and disrupting the estrogen/progesterone cycle [ 120 ]. The seed and petroleum ether fraction (5–20 mg/kg) showed high antifertility efficacy in both animals and in women volunteers [ 121 ]. Another R. communis seed extract inhibited both steroid releases and suppressed the stimulatory effect of LH on progesterone release [ 122 ]. The seed oil may prevent women from ovulating in part by impeding the growth of follicles or through an estrogen-induced hyperprolactinaemic hypogonadal mechanism [ 123 ]. This effect may also be due to alterations in uterine smooth muscle quiescence and inertia [ 124 ]. Ricinoleic acid and sterols may be the cause of the altered lipid profiles, hormonal balance, and uterine histological changes observed in pregnant rats during the early stages of gestation [ 125 ]. R. communis fruit extract inhibits migration/invasion, induces apoptosis in breast cancer cells, and arrests tumor progression in vivo. These effects could be related to the alkaloid ricinine, to p -coumaric acid, epigallocatechin and/or ricinoleic acid [ 126 ]. Allium sativum L. is a natural remedy for various women’s ailments, reported to help regulate hormones, improve fertility, decrease menstrual pain, control the menstrual cycle, and diminish inflammation in the female reproductive system. Garlic contains a volatile oil (0.1–0.36%) with a complex mixture of sulfur compounds, notably diallyl sulfide and alliin, decomposed into allicin by the enzyme alliinase. Allicin is reported to modulate hormone levels and to present antioxidant and anti-inflammatory properties; other antioxidants of garlic include vitamin C and selenium that could protect the ovum from oxidative damage. Diallyl disulfide was found to stimulate the anterior pituitary gland, increasing the secretion of the luteinizing hormone, and raising the basophil count [ 127 ]. Garlic may be beneficial for post-menopausal women as it yields a partial recovery in serum estrogen titer; a garlic oil supplementation in bilaterally ovariectomized rats is consistently linked to improved bone mineral content preservation and increased calcium transference [ 128 ]. Zingiber officinale Roscoe has been studied mainly in pregnancy for reducing nausea and vomiting, either fresh or as a powder, essence, or extract, with doses ranging from 0.5 to 2.5 g/day [ 129 ]. Ginger is also reported as a natural remedy for dysmenorrhea and to manage the intensity of labor pain due to its content of gingerols, analgesic and anti-inflammatory cyclooxygenase (COX-2) inhibitors [ 130 ] and blockers of the coding genes that promote the synthesis and secretion of pro-inflammatory cytokines in the inflammatory region [ 131 ]. Cucurbita pepo L. seed may have estrogenic modulatory properties [ 132 ], possibly due to its high content in phytoestrogen substances with estrogenic-like properties, such as lariciresinol and secoisolariciresinol [ 133 ]. Pumpkin seed extract was reported to mitigate menopause-related disorders in ovariectomized rats through the improvement of lipid profiles, the reduction of oxidative stress and thermogenesis, and the increase in alkaline phosphatase activity [ 134 ].

Many rural dwellers in Africa believe that, since their ancestors “ used herbal blends/concoctions for their well-being in the past and with no adverse effects ”, they can assume that, as herbal blends are “ natural ”, their safety is necessarily guaranteed [ 135 ]. However, in most African countries, traditional healers and midwifes lack regulatory oversight to guide their practices and products. As the use and marketing of herbals are most often practiced without evaluation of quality and possible risks [ 136 ], a number of adverse effects are obviously associated with the use of some low-quality, adulterated, contaminated, mislabeled, or toxic products that have posed and still pose, in some African regions, serious threats to public health [ 137 , 138 ]. Although products can be purchased from an herbalist or prescribed by a traditional practitioner or midwife, household access to medicinal plants may consist of the direct collection of products in natura , a practice based on traditional popular knowledge, acquired from generation to generation and generally referred to as “ folk medicine ”. Self-medication is then a common habit among people living in rural and semi-urban communities in African countries as they usually have easy access to plant material [ 137 , 139 ]. However, at the exception of a few very popular neighboring plants, local knowledge is generally limited; confusions in botanical identity, collected organ, collection conditions (season, location, etc.), modes of preparation, disorder diagnosis, drug dosage, and posology are possible [ 138 ], increasing the risk of adverse effects, especially in vulnerable groups such as the elderly, children, and pregnant women. Also, mixtures of plants are often prepared without exact knowledge of each plant’s pharmaco-toxicology or of the possible interactions that may arise from its combination [ 137 ]. For example, the use of soy-based products raises questions about hormonal effects of their phytoestrogens and possible interference with gestational cycles. Isoflavones from soy induce mammary gland hyperplasia and renal tubule calcification in female animals [ 140 ]. Traditional healers are often very secretive about their practices and their prescriptions can be quite vague, sometimes resulting in over- or under-dosages, especially as no regulatory body controls the standardization or use of herbals [ 18 ]. Over- and under-dosages may lead to short-, mid-, and long-term adverse/toxic effects (including cardio-, neuro-, hepato-, nephro-, genotoxicities) and treatment failures [ 141 ]; these risks are amplified by patient-related factors, such as co-morbidities, and renal or hepatic impairments [ 138 ]. As stated in Section 3.2 , African women tend to turn to natural herbal medicines rather than prescription drugs to deal with pregnancy troubles, but also to “ ensure a healthy development of the fetus ” [ 15 , 18 , 47 , 142 ]. The risks and long-term negative health effects involve both maternal and neonatal morbidity and mortality. For example, side effects have been associated with the use of fenugreek ( Trigonella foenum-graecum L.), harmel ( Peganum harmala L.), nigella ( Nigella sativa L.), rosemary ( Rosmarinus officinalis L.), or Artemisia herba-alba Asso. (Synonym of Seriphidium herba-alba (Asso) Y.R. Ling), which are all popular pregnancy herbals in Morocco [ 142 ]. For some of these plants, these adverse effects are well-documented. Regarding fenugreek, despite that fact that it could enhance milk ejection by stimulating the secretion of oxytocin and prolong the duration of peak milk synthesis by modifying the insulin/GH/IGF-1 axis [ 143 ], the administration of its seeds significantly increase pituitary oxytocin expression and plasma insulin concentration, with a risk of uterine contractions and hypoglycaemia [ 94 ]. Peganum harmala’s different organs contain 1.7–5% of b-carboline alkaloids [ 144 ], known serotonin agonists and central anticholinergic agents (Achour et al., 2012); the poisoning of two pregnant women in Morocco led to uterine hypertonicity at term in one patient and to placental abruption in the other [ 145 ]. In animal studies, Nigella sativa seed extracts induce a significant decrease in fetal survival rates [ 146 ] while their major compound, thymoquinone, affects embryonic development [ 147 ]. Rosemary extracts are suspected of abortive effects [ 148 ]; in animal studies, an aqueous extract was associated with a possible anti-implantation effect without interfering with the normal developments of the concept after implantation [ 149 ]. In animal studies, transplacental exposure to A. herba-alba was found to increase infertility, delay memory function, and neuromotor reflex in offspring mice; this was ascribed to the plant content in isoflavones [ 150 ] that exhibit both estrogen-mimetic and anti-estrogen activity that may contribute to infertility and reproductive abnormalities [ 151 ]. In a major review study, Bernstein et al. [ 152 ] reported a list of other plants to avoid during pregnancy: Abrus precatorius L., Achyranthes aspera L., Ailanthus excelsus Roxb., Aloe vera (L.) Burm.f., Aristolochia indica L., Areca catechu L., Bambusa vulgaris Schrad. ex J.C. Wendl., Cassia occidentalis L., Cicer arietinum L., Cimicifuga racemose (L.) Nutt. ( Synonym of Actaea racemosa L.), Dolichandrone falcata (Wall. ex DC.) Seem., Ginkgo biloba L., Hydrastis canadensis L., Indigofera trifoliata L., Lavandula latifolia Medik., Maytenus ilicifolia Mart. ex Reissek, Momordica cymbalaria Fenzl ex Naudin, Moringa oleifera Lam., Musa rosacea Jacq. (Synonym of Musa balbisiana var. balbisiana ), Oxalis corniculata L., Phytolacca dodecandra L’Hér., Plumeria rubra L., Ricinus communis L., Ruta graveolens L., Stachys lavandulifolia Vahl, Senna alata (L.) Roxb., Trigonella foenum-graecum L., Vitus agnus-castus L., and Valeriana officinalis L. This list gives precious indications for evaluating safety measures to be considered with related species. Table 3 repertories the known side effects of some of the medicinal plants used in Africa by pregnant women. There appears to be a serious need to develop the awareness of the potential health risks associated with the use or abuse of herbals, especially for women who are particularly at risk in crucial periods, including during menstruation, pregnancy, and menopause. Because of issues with identity, purity, strength, and performance qualities, quality control is one of the most important factors in determining the safety and toxicity of a certain plant. Incorrect plant components, contaminants such pesticides and pollutants, hazardous metals, bacteria, molds, and mycotoxins, and processing impurities are examples of purity problems [ 168 ]. Masullo et al. [ 169 ] emphasize the necessity of critically assessing the effectiveness, safety, and quality of medicinal plants used for women’s health using analytical methods. For the identification of active/toxic compounds and the quality control of herbal items that contain a lot of different, low-concentration unknown chemicals, fingerprint analysis could be a straightforward method. According to Stephens [ 170 ], pregnant women should (i) be made aware of the potential risks of contaminants; (ii) be urged not to take unregulated drugs before and during pregnancy; (iii) obtain informed (medical/pharmaceutical) advice before using any herbal, considering the dosage, duration of use, mode of administration, and timing, with the first trimester being particularly at risk for teratogenesis. Many herbs used to treat menopausal symptoms might have unfavorable side effects such as gastrointestinal disorders ( Medicago sativa L., Hypericum perforatum L., Glycine soja Sieb.) [ 171 ] and skin and subcutaneous tissue diseases ( Glycine max (L.)) [ 168 ]. When Salvia officinalis L. is used excessively for managing the symptoms of menopause, it might result in tachycardia, fever, disorientation, and convulsions that resemble epilepsy [ 171 ]. As general precautions, concentrated extracts, high amounts of herbal compounds, and/or extended use should be avoided [ 170 ]. With such safety precautions being obviously difficult to apply in a rural African context, a training of traditional midwifes in the possible risks and in the detection of adverse events would be important. Due to the potential safety and toxicity issues that can be encountered with herbal products and the difficulty to establish quality specifications and controls [ 172 ], a specific pharmacovigilance system is recognized as important [ 173 , 174 ] and harmonizing national regulatory and programmatic pharmacovigilance efforts in Africa should be a priority. Pharmacovigilance should be integrated within communities and health facilities so that data concerning the composition, preparation, indications, and adverse effects of remedies can be collected [ 175 ]. The latency period between the use of an herbal product and the onset of an adverse event should also be determined, if possible, as this can make it easier to assess causality and propose eventual protective measures [ 172 ].

A number of important measures were put into place, and member states in the African area developed national policies and regulatory frameworks for traditional and complementary medicine practice, practitioners, and products between 2005 and 2018. As of 2018, the region outperformed the worldwide scenario in nearly every metric, with the exception of the regulation and registration of herbal medicines, where the proportion of member states in the region lagged behind that of all member states [ 176 ]. There are significant disparities in legislation and a wide range of procedures that must be followed when integrating medicinal plants into the traditional healthcare system. In reality, every nation has a kind of national authority; while phytomedicines are widely accepted in certain nations, they are regarded as foods in others, and their medicinal claims are not permitted [ 176 ]. There is also an array of different factors that might clarify these discrepancies among countries. The authorizations are specifically intended for the treatment and management of major and priority pathologies, including HIV/AIDS, respiratory conditions, hepatitis, malaria, and hypertension [ 177 ]. Among further variables, there is a lack of written scientific record, a lack of a national or regional pharmacopeia produced in this region of Africa, and a lack of a comprehensive monograph of the most significant medicinal plants [ 178 ]. One other possible explanation for the underutilization and paucity of research on therapeutic plants in several African nations could be their preference for exports; for example, Cameroon and Egypt claim to be the two largest African exporters of medicinal herbs [ 179 ]. Considering such unawareness of African women’s health practices, it is important to take measures to understand, concretize, facilitate (or sometimes discourage) their traditional uses of herbal medicines, in particular by encouraging researchers from all countries to conduct in-depth ethnobotanical studies on medicinal plants used by African women, both to compile information and to safeguard the traditional knowledge of the remedies applied to their specific health problems. It necessary to perform comparative studies between different regions and countries for the eventual converging of data that confirm the role of each plant and document their efficacy and safety. Recent years indicate major steps in this direction. In 2018, the research on traditional medicine attracted the interest of at least 34 research institutes in 26 African countries, compared to 18 and 20 in 2000 and 2012, respectively [ 178 ]. The challenges and possible approaches to merging traditional medical procedures with contemporary healthcare systems are numerous. They point to a need for developing coherent national policies in traditional medicine with efforts in healer recognition and accreditation, information, training, education, and communication. All parties involved in the health sector should receive training to develop platforms for cooperation and partnerships with reference laboratories and institutes which will help in mastering both practicians, practices, and products [ 176 ].

In Africa, because health facilities are either too expensive, insufficiently developed, or remote, contemporary healthcare and medicine are frequently only accessible to a small number of people [ 1 ]; hence, herbal medicines significantly contribute to maintaining population health, both in rural and urban areas [ 2 ]. Continuously rising healthcare costs and an increase in both infectious and non-transmissible diseases make the situation even worse; different independent national surveys in the African region indicate that 90% of Ethiopians and Burundians, 85% of South Africans, 75% of Malians, and 70% of Rwandans, Beninese, and Ghanaians depend on medicinal plants [ 3 ]. The use of herbal remedies may also be influenced by societal and cultural factors, perceived efficacy and safety, and general accessibility [ 4 ] when the traditional healer-to-population ratio can be 100 times higher than the medical practitioner-to-population ratio [ 5 ]. In the majority of African countries, the inability to provide care that is accessible and of adequate quality is a major factor of unfavorable trends in women’s health indicators. This situation certainly results from a lack of investments made in women’s health [ 6 ], but other factors are also involved, such as the insufficient empowerment of women, inappropriate health systems, sociocultural behaviors, distance to medical facilities, and travel costs. Also, unsafe and/or illegal abortions still account for a large portion of women’s deaths [ 7 ]. Numerous studies indicate that both industrialized and developing nations have significant rates of concurrent herb-drug use; women and traditional practitioners around the world have employed many plants in similar indications that support women’s reproductive health. Of note, in many societies, gender roles will develop into particular kinds of knowledge, such as the responsibility of the family healthcare, and so women are the ones who developed practical knowledge about therapeutic plants [ 8 ]. Traditional remedies of most ethnic groups have helped to improve women’s healthcare, notably the treatment of menstruation troubles and gynecological diseases. For example, more than 570 such medications have been reportedly used in Asia, Europe, Oceania, Africa, and America to help women with their menstruation health [ 9 ]. In such a context, customary cultural practices play a most important role; traditional and folk medicines generally rely on plants that are most commonly collected in the wild and, to a smaller extent, cultivated. It should be noted that menstrual disorders, despite their impact on women’s daily activities, are typically not considered by global health organizations as a major health issue; an indignity, considering that the access to analgesics and/or sanitary facilities is often poor or nonexistent. Menstrual disorders are then often treated with many medicinal herbs of unproven efficacy and safety, which can result in physical symptoms linked to fertility loss [ 10 ]. African women also exploit plants to treat a variety of gynecological and obstetric issues, including infertility, pregnancy, lactation, cysts, and vaginal and womb cleansing. Despite their frequent use, the information on therapeutic plants for women’s reproductive health is generally scarce and has historically received little attention. Hence, only a few ethnobotanical surveys and limited literature reviews on “women’s health issues” , in relation with traditional herbal treatments, have been conducted in Africa. These investigations are generally dedicated to a few well-defined topics, notably pregnancy [ 4 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], infertility [ 7 , 23 , 24 , 25 ], breastfeeding [ 26 ], breast cancer [ 27 ], contraception [ 28 ], or maternity care [ 29 , 30 , 31 ]. So far, no review has been conducted to cover all specific feminine health problems treated by African medicinal plants and the studies carried out generally focus on specific countries. This highlights important research gaps, such as the dearth of data from numerous African nations and the requirement for more thorough studies on the safety and effectiveness of these conventional therapies, especially when used throughout vulnerable periods, such as pregnancy or menopause. And so, the present study aims to identify (i) which medicinal plants are used for diseases that compromise women’s health in African communities, and (ii) which safety measures could be proposed to ensure a successful and risk-free use of these plants. In a context of low-access to a modern health system, this research therefore examines the role of traditional medicines for women health, including desirable conditions for their rational and safe use.

In an original approach, the present review attempted to compile the herbal treatments traditionally applied to all gender-specific health problems affecting African women, with emphasis on menstrual disorders, pregnancy-related problems, infertility, breast cancer, and postpartum care. A comprehensive approach allowed for a literature search, combining pertinent keywords to gather data from ethnobotanical surveys carried out throughout different parts of Africa. In most of the rural African population, traditional medicine and traditional midwifes are regarded as the primary healthcare choice for maternity [ 180 ] but some remedies are also recommended for less-common troubles. Indeed, traditional birth attendants and herbalists are freely accessible and there is a lot of confidence and respect among African women, with the perception that birth attendants are responsible for maintaining cultural traditions, which is considered a “must” for the baby. A widespread usage is recorded in many nations for almost 200 medicinal plants; some of the plants frequently used for women’s health include Ricinus communis (castor bean), Cucurbita pepo (pumpkin), Zingiber officinale (ginger), and Allium sativum (garlic). This review offers insightful information about African women’s traditional knowledge and practices, but also highlights important research gaps, such as the dearth of data from numerous African nations and the need for more thorough studies on the effectiveness and safety of these traditional remedies, and the hazards of toxicity and over- or under-dosage, particularly in pregnancy or otherwise vulnerable conditions. So far, the majority of reported investigations are only surveys or cross-sectional studies focusing on pregnancy. Lists of specific plants to avoid have been compiled as mother and newborn morbidity and mortality imply long-term detrimental health impacts. The identification of the responsible molecules and the estimation of the doses that would be safe are however still lacking. It is worth noting that the published works are often of low and median quality, medically speaking, and probably important methodological biases are rarely addressed. A rational use of the herbal medicines in African countries is also hampered by significant research gaps and a lack of a regulatory framework. There are also very few studies of women in the African diaspora who are likely to use such remedies, often in secret from their gynecologist.