Archives Original research

The changing nature of adolescence in the Kssena-Nankana District of Northern Ghana

Stud Fam Plann. June 1999 30(2)95–111, June 1999

The changing nature of adolescence in the Kssena-Nankana District of Northern Ghana

Mensch BS, Bagah D, Clark WH, Binka F


This study reports the results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, an isolated rural area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus-group discussions with adolescents, parents, chiefs, traditional leaders, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The social environment that adolescent boys and girls in the Kassena-Nankana District encounter and its links to reproductive behavior are described. The principal question is whether even in this remote rural area, the social environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in girls’ education and the beginning of a decline in the incidence of early marriage. The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives ofadokscent boys and girls have eroded, leading to an apparent increase in premarital sexual activity.

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Preparing for microbicide trials in Rwanda: Focus group discussions with Rwandan women and men

Culture, Health & Sexuality. 2006 8(5): 395-406 LME

Preparing for microbicide trials in Rwanda: Focus group discussions with Rwandan women and men 

N. Veldhuijzen, J. Nyinawabega, M. Umulisa, B. Kankindi, E. Geubbels, P. Basinga, J. Vyankandondera & J. Van De Wijgert


The acceptability and feasibility of microbicide studies and future microbicide use are influenced by existing norms and values regarding sexual and contraceptive behaviour. In preparation for microbicide research in Rwanda, focus group discussions were conducted to assess sexual and contraceptive behaviour, preferences for vaginal lubrication, and hypothetical acceptability of microbicides among Rwandan women and men. Seven focus group discussions were conducted among sexually active married women, unmarried women, sex workers, female students, older women and men living in Kigali, Rwanda, and an additional group of women living in a rural area. The results indicate that condom use is low among Rwandan men and women and that condoms are mainly used by men during commercial sex. Women have limited power to negotiate condom or family planning use. Vaginal hygiene practices are very common and consist primarily of washing with water. Lubrication during sex is highly preferred by both men and women. Hypothetical microbicide acceptability after an explanation of what microbicides are and a demonstration with lubricant jelly was high.

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Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory.

Soc Sci Med. 2011 Oct;73(8):1275-83. Epub 2011 Aug 26.

Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory.

Shell-Duncan B, Wander K, Hernlund Y, Moreau A.

University of Washington, Department of Anthropology, Box 353100, Seattle, WA 98195-3100, United States.


Recent reviews of intervention efforts aimed at ending female genital cutting (FGC) have concluded that progress to date has been slow, and call for more efficient programs informed by theories on behavior change. Social convention theory, first proposed by Mackie (1996), posits that in the context of extreme resource inequality, FGC emerged as a means of securing a better marriage by signaling fidelity, and subsequently spread to become a prerequisite for marriage for all women. Change is predicted to result from coordinated abandonment in intermarrying groups so as to preserve a marriage market for uncircumcised girls. While this theory fits well with many general observations of FGC, there have
been few attempts to systematically test the theory. We use data from a three year mixed-method study of behavior change that began in 2004 in Senegal and The Gambia to explicitly test predictions generated by social convention theory.
Analyses of 300 in-depth interviews, 28 focus group discussions, and survey data from 1220 women show that FGC is most often only indirectly related to marriageability via concerns over preserving virginity. Instead we find strong evidence for an alternative convention, namely a peer convention. We propose that being circumcised serves as a signal to other circumcised women that a girl or woman has been trained to respect the authority of her circumcised elders and is  worthy of inclusion in their social network. In this manner, FGC facilitates the  accumulation of social capital by younger women and of power and prestige by elder women. Based on this new evidence and reinterpretation of social convention
theory, we suggest that interventions aimed at eliminating FGC should target women’s social networks, which are intergenerational, and include both men and women. Our findings support Mackie’s assertion that expectations regarding FGC are interdependent; change must therefore be coordinated among interconnected members of social networks.

Published by Elsevier Ltd.

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Building community-based participatory research partnerships with a Somali refugee community.

Am J Prev Med. 2009 Dec;37(6 Suppl 1):S230-6.

Building community-based participatory research partnerships with a Somali refugee community.

Johnson CE, Ali SA, Shipp MP.

Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Phoenix AZ 85004, USA.

BACKGROUND: The U.S. has become home to growing numbers of immigrants and refugees from countries where the traditional practice of female genital cutting (FGC) is prevalent. These women under-utilize reproductive health care, and challenge healthcare providers in providing culturally appropriate care. PURPOSE: This study examined Somali immigrant women’s experiences with the U.S. healthcare system, exploring how attitudes, perceptions, and cultural values, such as FGC, influence their use of reproductive health care. METHODS: A mixed-method community-based participatory research (CBPR) collaboration with a Somali refugee community was conducted from 2005 to 2008 incorporating surveys, semi-structured focus groups, and individual interviews. Providers caring for this community were also interviewed to gain their perspectives and experiences. RESULTS: The process of establishing a partnership with a Somali community is described wherein the challenges, successes, and lessons learned in the process of conducting CBPR are examined. Challenges obtaining informed consent, language barriers, and reliance on FGC self-report were surmounted through mobilization of community social networks, trust-building, and the use of a video-elicitation device. The community partnership collaborated around shared goals of voicing unique healthcare concerns of the community to inform the development of interventional programs to improve culturally-competent care. CONCLUSIONS: Community-based participatory research using mixed-methods is critical to facilitating trust-building and engaging community members as active participants in every phase of the research process, enabling the rigorous and ethical conduct of research with refugee communities.

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Female genital mutilation/cutting and issues of sexuality in Egypt.

Reprod Health Matters. 2010 Nov;18(36):181-90.

Female genital mutilation/cutting and issues of sexuality in Egypt.

Fahmy A, El-Mouelhy MT, Ragab AR.

UNFPA-Egypt, Cairo, Egypt.

Female genital mutilation/cutting (FGM/C), officially referred to as female circumcision and at community level as tahara (cleanliness), is still prevalent in Egypt. This study was designed to examine the role of female sexuality in women’s and men’s continued support for FGM/C, and their perceptions of its sexual consequences. The study was conducted in 2008-09 in two rural communities  in Upper Egypt and a large slum area in Cairo. Qualitative data were collected from 102 women and 99 men through focus group discussions and interviews. The clitoris was perceived to be important to, and a source of, sexual desire rather than sexual pleasure. FGM/C was intended to reduce women’s sexual appetite and increase women’s chastity, but was generally not believed to reduce women’s sexual pleasure. Men and women framed sexual pleasure differently, however. While men, especially younger men, considered sexual satisfaction as a cornerstone of marital happiness, women considered themselves sexually satisfied if there was marital harmony and their socio-economic situation was satisfactory. However, sexual problems, including lack of pleasure in sex and sexual dissatisfaction, for whatever reasons, were widespread. We conclude that political commitment is necessary to combat FGM/C and that legal measures must be combined with comprehensive sexuality education, including on misconceptions about FGM/C.

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Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach.

Int J Nurs Stud. 2009 Mar;46(3):360-8. Epub 2008 Jun 11.

Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach. 

Upvall MJ, Mohammed K, Dodge PD.

Eta Epsilon Chapter, Carlow University, School of Nursing, 3333 Fifth Avenue, Pittsburgh, PA 15213, USA.

BACKGROUND: The purpose of this study was to explore healthcare perspectives of Somali Bantu refugees in relation to their status as women who have been circumcised and recently resettled in the United States. These women and their families were already uprooted from Somalia to Kenya for over 10 years, increasing their vulnerability and marginal status beyond that of women who have  been circumcised.

METHODS AND PARTICIPANTS: A purposive, inclusive sample of 23 resettled Somali women in southwestern Pennsylvania of the United States participated in focus group sessions for data collection. A supplemental interview with a physician who provided care to the women was also conducted. Verbatim audio taped transcripts from the focus groups and physician interview were coded into primary and secondary levels.

RESULTS: Implications for development of culturally competent healthcare providers include attention to providing explanations for routine clinic procedures and accepting the Somali women regardless of anatomical difference, not focusing on the circumcision. Healthcare providers must also develop their skills in working with interpreters and facilitate trust to minimize suspicion of the health care system.

CONCLUSION: Circumcision is considered a normal part of everyday life for the Somali Bantu refugee woman. Communication skills are fundamental to providing culturally competent care for these women. Finally, healthcare providers must take responsibility for acquiring knowledge of the Somali women’s challenges as refugees living with circumcision and as immigrants in need of healthcare services.

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