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Johnsdotter S, Wendel L. Cultural change demands proportionate societal response in the handling of suspected FGM/C cases. Int J Impot Res 2022; 35:216-217. [PMID: 35132200 PMCID: PMC10159836 DOI: 10.1038/s41443-022-00535-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lotta Wendel
- Faculty of Health and Society, Malmö University, Malmö, Sweden
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2
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Johnsdotter S, Essén B. Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic. Arch Sex Behav 2021; 50:1943-1948. [PMID: 32170548 PMCID: PMC8275533 DOI: 10.1007/s10508-020-01676-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 05/13/2023]
Affiliation(s)
- Sara Johnsdotter
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden.
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Earp BD, Johnsdotter S. Current critiques of the WHO policy on female genital mutilation. Int J Impot Res 2020; 33:196-209. [PMID: 32457498 DOI: 10.1038/s41443-020-0302-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
In recent years, the dominant Western discourse on "female genital mutilation" (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called "the standard tale" of FGM (also termed "female genital cutting" [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO's terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.
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Affiliation(s)
- Brian D Earp
- Associate Director, Yale-Hastings Program in Ethics and Health Policy, Yale University, New Haven, CT, 06511, USA. .,The Hastings Center, Garrison, New York, NY, 10524, USA.
| | - Sara Johnsdotter
- Professor of Medical Anthropology, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, SE-205 06, Malmö, Sweden
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Wahlberg A, Johnsdotter S, Ekholm Selling K, Essén B. Correction: Shifting perceptions of female genital cutting in a Swedish migration context. PLoS One 2020; 15:e0229815. [PMID: 32101586 PMCID: PMC7043751 DOI: 10.1371/journal.pone.0229815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, girls. The discussion is based on data from 122 police files, including criminal investigations regarding suspected “female genital mutilation” (FGM). A growing body of research in European countries indicates that processes of cultural change are occurring among immigrant communities from areas where traditionally girls are subjected to what is construed as “circumcision”. Many studies show growing opposition to these practices among people who have migrated to Europe, and there is little evidence to support the assertion that large-scale illegal activities are prevalent. Yet there is a dominant discourse stating that FGM is secretively practised on a large scale among some immigrant groups in Europe, and policies encourage the detection of cases to charge in criminal court. I describe the current situation in Sweden and highlight some of the drawbacks of a very harsh, although well-intended, policy to check for FGM in Europe. While the ultimate aim is to protect girls at risk for FGM, current policies have ramifications that are invasive and sometimes even traumatising for the girls involved. This paper offers an empirical example of how politics in western multicultural societies may negatively influence the sexual health and rights of a target group, in this case, girls and young women whose families originate from countries where circumcision of girls is practiced.
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Affiliation(s)
- Sara Johnsdotter
- Professor of Medical Anthropology, Faculty of Health and Society , Malmö University , Sweden
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Wahlberg A, Johnsdotter S, Ekholm Selling K, Essén B. Shifting perceptions of female genital cutting in a Swedish migration context. PLoS One 2019; 14:e0225629. [PMID: 31800614 PMCID: PMC6892496 DOI: 10.1371/journal.pone.0225629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. METHODS In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants' approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala's B-statistic and Welch's t-test were used. RESULTS We found a substantial agreement between an individual's own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis-and especially other Swedish Somali women-approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3-27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4-9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%). CONCLUSIONS Swedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC.
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Affiliation(s)
- Anna Wahlberg
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | | | - Katarina Ekholm Selling
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Palm C, Essén B, Johnsdotter S. Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind-body dualism affecting social and health care professionals' perspectives. Sex Reprod Health Matters 2019; 27:1615364. [PMID: 31533573 PMCID: PMC7888010 DOI: 10.1080/26410397.2019.1615364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called “the FGM standard tale”. The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia’s role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual’s body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.
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Affiliation(s)
- Camilla Palm
- PhD Candidate, Faculty of Health and Society , Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden; Department of Women's and Children's Health (IMCH), Uppsala University , Uppsala , Sweden
| | - Birgitta Essén
- Professor, Department of Women's and Children's Health (IMCH) , Uppsala University , Uppsala , Sweden
| | - Sara Johnsdotter
- Professor, Faculty of Health and Society , Centre for Sexology and Sexuality Studies, Malmö University , Malmö , Sweden
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Wahlberg A, Essén B, Johnsdotter S. From sameness to difference: Swedish Somalis' post-migration perceptions of the circumcision of girls and boys. Cult Health Sex 2019; 21:619-635. [PMID: 30411652 DOI: 10.1080/13691058.2018.1502472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis' post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.
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Affiliation(s)
- Anna Wahlberg
- a International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Birgitta Essén
- a International Maternal and Child Health (IMCH), Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Sara Johnsdotter
- b Faculty of Health and Society , Malmö University , Malmö , Sweden
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Arvidsson A, Johnsdotter S, Emmelin M, Essén B. Being questioned as parents: An interview study with Swedish commissioning parents using transnational surrogacy. Reprod Biomed Soc Online 2019; 8:23-31. [PMID: 30911689 PMCID: PMC6416408 DOI: 10.1016/j.rbms.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 04/24/2018] [Accepted: 08/16/2018] [Indexed: 06/09/2023]
Abstract
This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process of parenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additional couples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish system contradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved a complex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood make people feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequences of an unregulated situation regarding surrogacy, and focus more on the child-parent relationship when regulating surrogacy.
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Affiliation(s)
- Anna Arvidsson
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
| | | | - Maria Emmelin
- Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
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Arousell J, Carlbom A, Johnsdotter S, Essén B. Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research. Midwifery 2019; 75:59-65. [PMID: 31005014 DOI: 10.1016/j.midw.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/08/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions. DESIGN Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. FINDINGS We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established. CONCLUSION We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception. IMPLICATIONS FOR PRACTICE This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.
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Affiliation(s)
- Jonna Arousell
- Department of Women's and Children's Health (IMCH), Uppsala University, 751 85 Uppsala, Sweden.
| | - Aje Carlbom
- Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
| | - Sara Johnsdotter
- Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health (IMCH), Uppsala University, 751 85 Uppsala, Sweden
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Arvidsson A, Vauquline P, Johnsdotter S, Essén B. Surrogate mother - praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India. Glob Health Action 2018; 10:1328890. [PMID: 28604252 PMCID: PMC5496060 DOI: 10.1080/16549716.2017.1328890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers. Objective: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy. Methods: In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam. Results: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a ‘blood’ relation – something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a ‘bad mother’ for selling her child, or as a ‘noble woman’ who has helped a childless couple and deserves payment for her services. Conclusions: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.
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Affiliation(s)
- Anna Arvidsson
- a Department of Women's and Children's Health/IMCH , Uppsala University , Uppsala , Sweden
| | - Polly Vauquline
- b Department of Women's Studies , Gauhati University , Guwahati , India
| | - Sara Johnsdotter
- c Faculty of Health and Society , Malmö University , Malmö , Sweden
| | - Birgitta Essén
- a Department of Women's and Children's Health/IMCH , Uppsala University , Uppsala , Sweden
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Arousell J, Carlbom A, Larsson E, Johnsdotter S, Essén B. 7.3-O8Unintended consequences of gender equality promotion in Swedish contraceptive counselling. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Arousell
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - A Carlbom
- Faculty of Health and Society, Malmö University, Sweden
| | - E Larsson
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - S Johnsdotter
- Faculty of Health and Society, Malmö University, Sweden
| | - B Essén
- Department of Women's and Children's Health, Uppsala University, Sweden
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Arousell J, Carlbom A, Johnsdotter S, Essén B. 1.11-P4Are ‘Low Socioeconomic Status’ and ‘Religiousness’ barriers to minority women’s contraceptive use in Sweden and Denmark? A qualitative interrogation of a common argument in health research. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Arousell
- Department of Women's And Children's Health, Uppsala University, Sweden
| | - A Carlbom
- Faculty of Health and Society, Malmö University, Sweden
| | - S Johnsdotter
- Faculty of Health and Society, Malmö University, Sweden
| | - B Essén
- Department of Women's And Children's Health, Uppsala University, Sweden
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Abstract
Purpose of Review The purpose of this review was to explore current research on the impact of migration on issues related to female genital cutting and sexuality. Recent Findings There is growing evidence that migration results in a broad opposition to female genital cutting among concerned migrant groups in western countries. In addition, after migration, affected women live in the midst of a dominant discourse categorizing them as "mutilated" and sexually disfigured. There is also, in contrast to what is shown by most research, a public discourse saying that female genital cutting (FGC) leads to lost capacity to enjoy sex. Concurrently, a vast body of research demonstrates a strong correlation between a negative body image or body shame and sexual dysfunction. Summary Care for women with FGC needs to be holistic and, while offering medical care when needed, the health care providers should avoid feeding into self-depreciatory body images and notions about lost ability to enjoy sexual life.
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Affiliation(s)
- Sara Johnsdotter
- Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
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Abdulcadir J, Abdulcadir O, Caillet M, Catania L, Cuzin B, Essén B, Foldès P, Johnsdotter S, Johnson-Agbakwu C, Nour N, Ouedraogo C, Warren N, Wylomanski S. Clitoral Surgery After Female Genital Mutilation/Cutting. Aesthet Surg J 2017; 37:NP113-NP115. [PMID: 29025234 DOI: 10.1093/asj/sjx095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jasmine Abdulcadir
- Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Omar Abdulcadir
- Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy
| | - Martin Caillet
- Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals
- CeMAViE; Department of Gynecology and Obstetrics, University Saint Pierre Hospital, Brussels, Belgium
| | - Lucrezia Catania
- Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy
| | - Béatrice Cuzin
- Division of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Pierre Foldès
- Institute of Reproductive Health, Saint Germain en Laye, Paris, France
| | | | - Crista Johnson-Agbakwu
- Refugee Women's Health Clinic, Obstetrics & Gynecology, Maricopa Integrated Health System
- Obstetrics and Gynecology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Nawal Nour
- Global Ob/Gyn and African Women's Health Center, Ambulatory Obstetrics, Office for Multicultural Careers, Division of Global Obstetrics and Gynecology, Brigham and Women's Hospital
| | | | - Nicole Warren
- Department of Community Public Health Nursing, John Hopkins School of Nursing, Baltimore, MD, USA
| | - Sophie Wylomanski
- Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France
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Richard F, Ahmed W, Denholm N, Dawson A, Varol N, Essén B, Johnsdotter S, Bukuluki P, Ahmed W, Naeema AGH, eltayeb D, Shell-Duncan B, Njue C, Muteshi J, Lamy C, Neyrinck P, Richard F, Verduyckt P, Alexander S, Kimani S, Esho T, Kimani V, Kigondu C, Karanja J, Guyo J, Touré M, Guindo YG, Samaké D, Camara L, Traoré Y, Traoré AA, Samaké A, Johnson-Agbakwu CE, Jordal M, Jirovsky E, Wu S, Fitzgerald K, Mishori R, Reingold R, Ismail EA, Say L, Uebelhart M, Boulvain M, Dallenbäch P, Irion O, Petignat P, Abdulcadir J, Farina P, Leye E, Ortensi L, Pecorella C, Novak L, Abdulcadir J, Cuzin B, Delmas FB, Papingui A, Bader D, Wahlberg A, Johnsdotter S, Selling KE, Källestål C, Essén B, Ibraheim AHHI, Elawad NAM, Ahmed W, Gasseer A, Naeema H, Maison E, Hussein H, Albagir AM, Bukuluki P, Albirair MT, Salih SAS, Ahmed W, Gasseer A, Naeema H, Maison E, Hussein H, Albagir AM, Albirair MT, Bukuluki P, Dawson A, Varol N, Esho T, Kimani S, Kimani V, Muniu S, Kigondu C, Nyamongo I, Guyo J, Ndavi P, Reingold R, Mishori R, Fitzgerald K, Wu S, Hedley H, Kuenzi R, Malavé-Seda L, Clare C, Greenfield J, Augustus P, Ukatu N, Manu E, Altonen B, Caillet M, Richard F, Foldès P, Cuzin B, Delmas FB, Papingui A, Wylomanski S, Vital M, De Visme S, Dugast S, Hanf M, Winer N, Johnsdotter S, Essén B, Seifeldin A, Mishori R, Fitzgerald K, Reingold R, Wu S, Villani M, Johnsdotter S, Essén B, Seinfeld R, Earp B, Cappon S, L’Ecluse C, Clays E, Tency I, Leye E, Johansen RE, Ouédraogo CM, Madzou S, Simporé A, Combaud V, Ouattara A, Millogo F, Ouédraogo A, Kiemtore S, Zamane H, Sawadogo YA, Kaien P, Dramé B, Thieba B, Lankoandé J, Descamps P, Catania L, Mastrullo R, Caselli A, Cecere R, Abdulcadir O, Abdulcadir J, Vogt S, Efferson C, O’Neill S, Dubour D, Florquin S, Bos M, Zewolde S, Richard F, Varol N, Dawson A, Turkmani S, Hall JJ, Nanayakkara S, Jenkins G, Homer CS, McGeechan K, Vital M, de Visme S, Hanf M, Philippe HJ, Winer N, Wylomanski S, Johnson-Agbakwu C, Warren N, Macfarlane A, Dorkenoo W, Lien IL, Schultz JH. Female Genital Mutilation/Cutting: sharing data and experiences to accelerate eradication and improve care: part 2. Reprod Health 2017. [PMCID: PMC5607483 DOI: 10.1186/s12978-017-0362-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVES To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. DESIGN Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. SETTING Sweden. PARTICIPANTS 372 Somali men and women, 206 newly arrived (0-4 years), 166 established (>4 years). PRIMARY OUTCOME MEASURES Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. RESULTS The support for anatomical change of girls and women's genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%-83% among established and 53%-67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. CONCLUSION A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. TRIAL REGISTRATION NUMBER Trial registration number NCT02335697;Pre-results.
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Affiliation(s)
- Anna Wahlberg
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | | | - Katarina Ekholm Selling
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Carina Källestål
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Wahlberg A, Johnsdotter S, Ekholm Selling K, Källestål C, Essén B. Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants - a cross-sectional study in Sweden. Reprod Health 2017; 14:92. [PMID: 28789667 PMCID: PMC5549348 DOI: 10.1186/s12978-017-0351-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis. Results Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44–20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46–5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25–13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. Conclusions Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0351-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Wahlberg
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
| | - Sara Johnsdotter
- Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden
| | - Katarina Ekholm Selling
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Carina Källestål
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
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Arousell J, Carlbom A, Johnsdotter S, Larsson EC, Essén B. Unintended Consequences of Gender Equality Promotion in Swedish Multicultural Contraceptive Counseling: A Discourse Analysis. Qual Health Res 2017; 27:1518-1528. [PMID: 28728532 DOI: 10.1177/1049732317697099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers' ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women's possibilities to obtain adequate support. At the end of the article, we suggest how health care providers' reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.
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Litorp H, Mgaya A, Mbekenga CK, Kidanto HL, Johnsdotter S, Essén B. Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting. Soc Sci Med 2015; 143:232-40. [DOI: 10.1016/j.socscimed.2015.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
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Arvidsson A, Johnsdotter S, Essén B. Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy. PLoS One 2015; 10:e0126518. [PMID: 25955178 PMCID: PMC4425515 DOI: 10.1371/journal.pone.0126518] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/03/2015] [Indexed: 11/19/2022] Open
Abstract
Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.
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Affiliation(s)
- Anna Arvidsson
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Sara Johnsdotter
- Department of Health and Welfare Studies, Malmö University, Malmö, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Affiliation(s)
- Birgitta Essén
- International Maternal and Child Health; Department of Women's and Children's Health/IMCH; Uppsala University; Uppsala Sweden
| | - Sara Johnsdotter
- Medical Anthropology; Faculty of Health and Society; Malmö University; Malmö Sweden
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Binder P, Johnsdotter S, Essén B. Conceptualising the prevention of adverse obstetric outcomes among immigrants using the ‘three delays’ framework in a high-income context. Soc Sci Med 2012; 75:2028-36. [DOI: 10.1016/j.socscimed.2012.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 07/29/2012] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
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Essén B, Johnsdotter S, Binder P. O234 NOT TOO FAR TO WALK BUT TOO FAR FOR RECIPROCITY: MATERNAL MORTALITY IN A MIGRATION CONTEXT USING THE ‘THREE DELAYS’ FRAMEWORK. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
This study focuses on communication and conceptions of obstetric care to address the postulates that immigrant women experience sensitive care through the use of an ethnically congruent interpreter and that such women prefer to meet health providers of the same ethnic and gender profile when in a multiethnic obstetrics care setting. During 2005-2006, we conducted in-depth interviews in Greater London with immigrant women of Somali and Ghanaian descent and with White British women, as well as with obstetric care providers representing a variety of ethnic profiles. Questions focused on communication and conceptions of maternity care, and they were analyzed using qualitative techniques inspired by naturalistic inquiry. Women and providers across all informant groups encountered difficulties in health communication. The women found professionalism and competence far more important than meeting providers from one's own ethnic group, while language congruence was considered a comfort. Despite length of time in the study setting, Somali women experienced miscommunication as a result of language barriers more than did other informants. An importance of the interpreter's role in health communication was acknowledged by all groups; however, interpreter use was limited by issues of quality, trust, and accessibility. The interpreter service seems to operate in a suboptimal way and has potential for improvement.
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Affiliation(s)
- Pauline Binder
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, SE-751 85 Uppsala, Sweden
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Abstract
BACKGROUND The literature concerning interpretation in research primarily concentrates on rigorous techniques to eliminate bias. This article analyses other significant issues that arise when interpreters participate in research. MATERIAL Empirical examples are drawn from a research project concerning mental ill health in a multicultural neighbourhood. DISCUSSION Interpreters influence interview data in ways commonly unnoticed by researchers. One often-overlooked factor is that languages are dynamic and interpreters are not instruments. CONCLUSION Research conducted with an interpreter is a complex undertaking. Solely relying on checklists to improve methodological rigour can result in a false sense of the material's validity.
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Essén B, Binder P, Johnsdotter S. An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth. J Psychosom Obstet Gynaecol 2011; 32:10-8. [PMID: 21291343 PMCID: PMC3055712 DOI: 10.3109/0167482x.2010.547966] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.
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Affiliation(s)
- Birgitta Essén
- Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Pauline Binder
- Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
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Abstract
The discrepancy in societal attitudes toward female genital cosmetic surgery for European women and female genital cutting in primarily African girl children and women raises the following fundamental question. How can it be that extensive genital modifications, including reduction of labial and clitoral tissue, are considered acceptable and perfectly legal in many European countries, while those same societies have legislation making female genital cutting illegal, and the World Health Organization bans even the "pricking" of the female genitals? At present, tensions are obvious as regards the modification of female genitalia, and current legislation and medical practice show inconsistencies in relation to women of different ethnic backgrounds. As regards the right to health, it is questionable both whether genital cosmetic surgery is always free of complications and whether female genital cutting always leads to them. Activists, national policymakers and other stakeholders, including cosmetic genital surgeons, need to be aware of these inconsistencies and find ways to resolve them and adopt non-discriminatory policies. This is not necessarily an issue of either permitting or banning all forms of genital cutting, but about identifying a consistent and coherent stance in which key social values - including protection of children, bodily integrity, bodily autonomy, and equality before the law - are upheld.
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Essén B, Blomkvist A, Helström L, Johnsdotter S. The experience and responses of Swedish health professionals to patients requesting virginity restoration (hymen repair). Reprod Health Matters 2010; 18:38-46. [PMID: 20541082 DOI: 10.1016/s0968-8080(10)35498-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An important determinant of family honour in many cultures is the chastity of women, with much importance attributed to virginity until marriage. The traditional proof of virginity is bleeding from the ruptured hymen, which has led some women to request genital surgery to "restore" virginity, or hymen repair. The aim of this study was to investigate whether Swedish health care providers have had experience of patients requesting this surgery. Questionnaires were sent to 1,086 gynaecologists, midwives, youth welfare and social officers, and school nurses and doctors in four Swedish cities. Of the 507 who returned the questionnaire, 271 had seen patients seeking virginity-related care. Of these, 14 had turned the patients away; 221 had made 429 referrals, mostly to a welfare officer or a gynaecologist; and 26 had referred patients to a plastic surgeon. Nine gynaecologists had carried out such surgery themselves. Swedish authorities have to date focused on this issue primarily from a social and legal perspective. No guidelines exist on how health professionals should deal with requests for surgery to restore virginity. Further research is needed on how best to meet the needs of this group of patients in a multi-ethnic society and how to address requests for hymen repair. Without this, medical practitioners and counsellors will remain uncertain and ambivalent, and a variety of approaches will persist.
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Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Sweden.
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Essén B, Binder P, Johnsdotter S. O280 Is female genital cutting the obstetric challenge for obstetricians, midwives and Somali women in UK? A interview study regarding perception and experinces of obstetric care, London 2005-2007. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Johnsdotter S, Moussa K, Carlbom A, Aregai R, Essén B. "Never my daughters": a qualitative study regarding attitude change toward female genital cutting among Ethiopian and Eritrean families in Sweden. Health Care Women Int 2009; 30:114-33. [PMID: 19116825 DOI: 10.1080/07399330802523741] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To explore attitudes toward female genital cutting (FGC) in a migration perspective, qualitative interviews were conducted with men and women from Ethiopia and Eritrea in Sweden. We found firm rejection of all forms of FGC and absence of a guiding motive. Informants failed to see any meaning in upholding the custom. We conclude that children of Ethiopian or Eritrean parents resident in Sweden run little risk of being subjected to FGC. A societal structure prepared to deal with suspected cases of FGC with a high level of alertness should be combined with a healthy sceptical attitude toward exaggerations of risk estimates.
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Elebro K, Rööst M, Moussa K, Johnsdotter S, Essén B. Misclassified Maternal Deaths among East African Immigrants in Sweden. Reproductive Health Matters 2007; 15:153-62. [DOI: 10.1016/s0968-8080(07)30322-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden.A majority of Swedish health care providers meet patients presenting with evidence of FGC performed long ago. However, very few of them have suspected recently cut patients. The results support the hypothesis that this practice is not as active among African immigrants in Sweden as in their countries of origin. If the prevalence was the same as in African countries, more pediatricians would be expected to meet current cut girls. National efforts and policy programs to prevent FGC in Sweden are recommended as effective, in accordance with current research and should especially be directed toward pediatricians.
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Affiliation(s)
- Leila Tamaddon
- Department of Clinical Sciences/Obstetrics and Gynaecology, University Hospital UMAS, Lund University, Malmö, Sweden
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Johnsdotter S, Essén B. [Is genital mutilation in Sweden confirmed now?]. Lakartidningen 2005; 102:2423-4; discussion 2426-7. [PMID: 16184901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Rööst M, Johnsdotter S, Liljestrand J, Essén B. A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala. BJOG 2004; 111:1372-7. [PMID: 15663121 DOI: 10.1111/j.1471-0528.2004.00270.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors. STUDY design Qualitative in-depth interview study. SETTING Rural Guatemala. SAMPLE Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala. METHOD Interviews with semi-structured, thematic, open-ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications. MAIN OUTCOME MEASURES Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants. RESULTS Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them. CONCLUSION Parameters in the referral system, such as logistics and socio-economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture-sensitive education should be included in maternal health programs.
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Affiliation(s)
- Mattias Rööst
- Department of Obstetrics and Gynaecology, University Hospital MAS, Lund University, Malmö, Sweden
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Essén B, Johnsdotter S. [Shortages in the management of genitally mutilated pregnant women in Swedish health care. Time to shift the focus from women's genitals to their whole being]. Lakartidningen 2004; 101:3003-4, 3006. [PMID: 15493642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Birgitta Essén
- Institutionen för obstetrik och gynekologi, Universitetssjukhuset MAS, Malmö.
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Johnsdotter S, Essén B. [Analysis of the legislation concerning female genital surgery. Esthetic and sexual motifs are accepted--but not the traditional and religious ones]. Lakartidningen 2004; 101:2810-2. [PMID: 15457824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
This article intends to present the Scandinavian legislation on female genital mutilation and explore the implications of the laws. Juxtaposing trends of plastic genital surgery in the West with claims that female circumcision may be a practice generally abandoned in Scandinavia, we highlight the double morality inherent in current public discussions. Finally, we pose the question: Is the legal principle of equality before the law regarded when it comes to alterations of the female genitals?
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Affiliation(s)
- Birgitta Essén
- Department of Obstetrics and Gynecology, University Hospital MAS, Lund University, Malmö, Sweden.
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Essén B, Johnsdotter S, Hovelius B, Gudmundsson S, Sjöberg NO, Friedman J, Ostergren PO. Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. BJOG 2000; 107:1507-12. [PMID: 11192108 DOI: 10.1111/j.1471-0528.2000.tb11676.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome. METHODS Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth. PARTICIPANTS Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden. RESULTS The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance. CONCLUSIONS Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as 'survival behaviours' related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.
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Affiliation(s)
- B Essén
- Department of Obstetrics and Gynaecology, University Hospital MAS, Malmö, Sweden
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Friedman J, Friedman KE, Persson J, da Rocha AMP, Westerlund H, Carlbom A, Johnsdotter S, Ericsson M, Sjoberg K, Sundberg A, Sjokvist J, Hornok I, Dahre U, Milla MA, Borba J, Lindberg K. Putting Cultural Anthropology Together AgainAssessing Cultural Anthropology.Robert Borofsky. Current Anthropology 1995. [DOI: 10.1086/204425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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