ANS Adv Nurs Sci. 1996 Dec;19(2):43-53.
The culture of female circumcision.
School of Nursing, San Diego State University, California, USA.
The issue of female circumcision takes on special significance as more women migrate to the United States from countries where the practice has religious and traditional underpinnings. Female circumcision is a problem unfamiliar to most Western health care practitioners. This article describes an ethnographic study of the types of female circumcision, the reasons for and against the practice, the health implications of this practice, and cultural attitudes of circumcised women both in Western Africa and as migrant refugees living in the United States. Ethical dilemmas in dealing with this practice and implications for nurses and health care providers are discussed. PIP: In San Diego, California, health-care providers to a rapidly growing community of 3000-4000 Somali refugees have been confronted with female genital mutilation (FGM) for the first time. In order to help Western practitioners devise ways to deal with this phenomenon, this article describes the history of FGM, the various types of mutilation, attitudes towards the procedure, early attempts to abolish it, reasons why the practice is continued, and reasons why it should be ended. The article then describes the results of an ethnographic study of the procedure using data gathered in Liberia and Kenya and the results of a needs assessment among Somali refugees in San Diego. In Kenya, the Kpelle tribe conducts the Sande Bush School every few years. This school removes all the young girls from the villages for 6-12 weeks’ training, which includes the secret ritual of FGM. Not all of the girls survive this ordeal. In order to reduce the incidence of mortality, a local hospital sent physicians and nurses into the bush to perform the least destructive type of mutilation in a mobile van. In Kenya, respondents favored the least destructive type of circumcision and adamantly supported the practice. The Somali refugees in the US are undergoing stress adjusting to economic difficulties that make it necessary for women to work outside of the home and make large families prohibitively expensive. All of the interviewed women had the most severe type of infibulation performed, with many of the mutilations taking place in hospitals when they were 5-10 years old. Most of the women believed the practice was mandated by Islam and were distressed by the refusal of US medical personnel to perform FGM. While health care providers need to understand the cultural forces that support FGM, there is no doubt that it would be unethical as well as illegal to perform the procedure. Cultural diversity must be accepted while cultural change is promoted.