Cultural change after migration: Circumcision of girls in Western migrant communities
Johnsdotter S, Essén B
This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the ‘Pharaonic’ type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using – in a cautious way – the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.
Facts and controversies on female genital mutilation and Islam.
Department of Obstetrics and Gynaecology, King Abdulaziz University, Jeddah, Saudi Arabia. email@example.com Female genital mutilation (FGM) is a very ancient traditional and cultural ritual. Strategies and policies have been implemented to abandon this practice. However, despite commendable work, it is still prevalent, mainly in Muslim countries. FGM predates Islam. It is not mentioned in the Qur’an (the verbatim word of God in Islam). Muslim religious authorities agree that all types of mutilation, including FGM, are condemned. ‘Sensitivity’ to cultural traditions that erroneously associate FGM with Islam is misplaced. The principle of ‘do no harm’, endorsed by Islam, supersedes cultural practices, logically eliminating FGM from receiving any Islamic religious endorsement.
[Maternal and foetal prognostic in excised women delivery]. [Article in French]
Millogo-Traore F, Kaba ST, Thieba B, Akotionga M, Lankoande J. firstname.lastname@example.org
INTRODUCTION: The female circumcision constitutes by their frequency and complications a real problem of public health.
MATERIAL AND METHOD: Our study aims at comparing the maternal land fetal complications of the spontaneous vaginal delivery in the excised women and non-excised. We led a comparative survey case witness implying 227 excised pregnant women at the maternity in CHU YO of Ouagadougou.
RESULTS: The prevalence of the excision from January 1st to July 31, 2006 was 72.86%. The distribution of female genital mutilations in this population is the following: type I=27.75%, type II=69.61%, type III=2.64%. The middle age was 25 years and 79.30% of women were aged less than 30 years. Islam appeared like a factor of exposure to the practice of the excision with 67.40% of women excised that practise it against 41.90% at the non-excised group (P<0,0001). The maternal complications were dominated by the duration of fetal expulsion prolonged and perineal tears. The duration of fetal expulsion was superior to 30 minutes for 34.56% of excised woman childbirths 9 times more frequently than women non-excised (P=0.001). The frequency of perineal tears was 10.13% in the group of women excised against 5.73% in the group of the non-excised (P=0.008). These perineal lesions were more frequent with the primiparae and women excised at the 2nd and 3rd degree. The neobirth asphyxia affected 4.4% of newborns from mother excised against 0.2% in the non-excised group (RR=5.18; P=0.006). In the group of excised them the rate of mortinatality was 22.03 for 1000 births, against 8.81 for 1000 births in the group of the non-excised (P=0.22).
CONCLUSION: The prevention of these complications with the excised woman rests on the episiotomy and the instrumental extraction in the FGM of type III.
[Legal aspects of ritual circumcision]. [Article in German]
Schreiber M, Schott GE, Rascher W, Bender AW.
Abteilung für Kinderurologie, Urologische Klinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen. email@example.com
Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out – be it for medical or ritual reasons – without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.
The cultural context of the Sierra Leonean Mende woman as patient.
Kallon I, Dundes L.
Department of Sociology, McDaniel College, 2 College Hill, Westminster, MD 21157, USA.
This article provides a clinically pertinent overview of Sierra Leonean immigrants, a growing patient population that most health care workers know little about. The focus is on Sierra Leonean Mende women and the relevance of their cultural perspective to clinical care. A literature review and interview responses from seven Sierra Leoneans are the sources of data. Immigrants from Sierra Leone are coming from a country that since the late 1990s has been ranked at the bottom of the United Nations’ Human Development Index. Practitioner knowledge of cultural norms such as female genital mutilation and discomfort with opposite sex health practitioners can improve cross-cultural interactions in the health arena. Given that most clinicians are unfamiliar with this unique patient population, this article provides background information including special
attention to medically relevant aspects of the Sierra Leonean cultural milieu that will enhance the rapport between health care workers and these patients.
Vrachnis N, Salakos N, Iavazzo C, Iliodromiti Z, Bakalianou K, Kouiroukidou P, Creatsas G.
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. firstname.lastname@example.org
The number of migrants and refugees with a female genital mutilation (FGM) living in Greece is rising. This study explores the characteristics and psychosexual issues of women with FGM who were examined in the 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Greece during the year 2009. The women were asked to fill out an anonymous questionnaire asking for demographic data, obstetric history, current complaints, and psychosexual problems. The results are presented and discussed, as FGM is a new reality for Greece. Healthcare providers have to familiarize themselves with issues related to FGM and improve their skills in transcultural care, so as to manage and support women with FGM adequately.
Pediatrics. Oct 1, 2001 (108)4, 965 -971 (doi: 10.1542/peds.108.4.965)
Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician
Kamyar M. Hedayat and Roya Pirzadeh
The United States is becoming increasingly pluralistic. Pediatricians must become familiar with the factors that affect the emotional, physical, and spiritual health of their patients that are outside the ken of the traditionally dominant value system. Although many articles have addressed the cultural and ethnic factors, very few have considered the impact of religion. Islam, as the largest and fastest-growing religion in the world, has adherents throughout the world, including the United States, with 50% of US Muslims being indigenous converts. Islam presents a complete moral, ethical, and medical framework that, while it sometimes concurs, at times diverges or even conflicts with the US secular ethical framework. This article introduces the pediatrician to the Islamic principles of ethics within the field of pediatric care and child-rearing. It demonstrates how these principles may impact outpatient and inpatient care. Special attention is also given to adolescent and end-of-life issues.
Female circumcision: toward an inclusive practice of care.
Khaja K, Lay K, Boys S.
School of Social Work, Indiana University, Indianapolis, Indiana 46202, USA.
Female circumcision is a cultural tradition that includes cutting of female genitals without medical necessity. Over 130 million girls and women have been circumcised globally. This article reports on partial findings from a qualitative study that examined the lives of Somali Muslim women who were circumcised. A reoccurring theme of resentment toward North American health care practitioners who condemn the women for having experienced the practice of circumcision in their birth country was found. Discussion will include the physical and social stigma, the complex legal aspects, and ways to deal with female circumcision in a culturally competent manner.