Tag Archives: Social values

Abstract standards or empirical variables in social life which are believed to be important and/or desirable.

Powerlessness, Normalization, and Resistance: A Foucauldian Discourse Analysis of Women’s Narratives On Obstetric Fistula in Eastern Sudan.

Qual Health Res. 2017 Oct;27(12):1828-1841. doi: 10.1177/1049732317720423. Epub 2017 Aug 2.

Powerlessness, Normalization, and Resistance: A Foucauldian Discourse Analysis of Women’s Narratives On Obstetric Fistula in Eastern Sudan.

Hamed S, Ahlberg BM, Trenholm J.


Eastern Sudan has high prevalence of female circumcision and child marriage constituting a risk for developing obstetric fistula. Few studies have examined gender roles’ relation with obstetric fistula in Sudan. To explore the associated power-relations that may put women at increased risk for developing obstetric fistula, we conducted nine interviews with women living with obstetric fistula in Kassala in eastern Sudan. Using a Foucauldian discourse analysis, we identified three discourses: powerlessness, normalization, and covert resistance. Existing power-relations between the women and other societal members revealed their internalization of social norms as absolute truth, and influenced their status and decision-making power in regard to circumcision, early marriage, and other transformative decisions as well as women’s general behaviors. The women showed subtle resistance to these norms and the harassment they encountered because of their fistula. These findings suggest that a more in-depth contextual assessment could benefit future maternal health interventions.

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A mixed-method synthesis of knowledge, experiences and attitudes of health professionals to Female Genital Mutilation

J Adv Nurs. 2015 Oct 5. doi: 10.1111/jan.12823. [Epub ahead of print]

A mixed-method synthesis of knowledge, experiences and attitudes of health
professionals to Female Genital Mutilation

Reig-Alcaraz M, Siles-González J, Solano-Ruiz C.

AIM: To synthesize knowledge, attitudes and experiences of health professionals about Female Genital Mutilation.

BACKGROUND: Despite the World Health Organization campaigning to stop FGM, and it being illegal in many countries, the practice remains common in some countries and cultures. Migration has contributed to the growth of this practice in countries where it was not previously carried out.

DESIGN: Mixed-method synthesis.

DATA SOURCES: Search of ten electronic databases: 2006-2014. Manual scanning of reference lists and summary feeds from international organizations such as WHO, UN and UNICEF.

REVIEW METHODS: Thematic synthesis comparing country of origin where the practice was common with country of residence where migrant women affected by the practice reside. 17 included descriptive, quantitative, qualitative studies and grey literature studies in English or Spanish.

RESULTS: Seven themes were developed: Ignorance of FGM practice and its consequences; Lack of adherence to FGM protocols and guidelines; Socially constructed acceptance of FGM; Ignorance of legislation and legal status of FGM;  Condoning, sanctioning or supporting FGM; Lack of information and training; Nurses and Midwives as key to protecting and supporting girls and women.

CONCLUSIONS: Although some nurses and midwives are in the forefront of eradicating FGM this is counterbalanced by health professionals (including nurses and midwives) who condone, sanction or support the practice with some calling for medicalization of FGM as a legitimate procedure. Girls at risk need better protection and women affected need more competent and cultural care from health professionals. Health and legal systems, professional regulation and governance, and professional training require strengthening to eradicate FGM, prevent the medicalization of FGM as an acceptable procedure, and to better manage the lifelong consequences for affected girls and women.

This article can be accessed in this LINK

Circumvention tourism.

Cornell Law Rev. 2012 Sep;97(6):1309-98.FREE

Circumvention tourism.

Cohen G.

Harvard Law School Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics.


Under what circumstances should a citizen be able to avoid the penalties set by the citizen’s home country’s criminal law by going abroad to engage in the same activity where it is not criminally prohibited? Should we view the ability to engage in prohibited activities by traveling outside of the nation state as a way of accommodating cultural or political differences within our polity? These are general questions regarding the power and theory of extraterritorial application of domestic criminal law. In this Article, I examine the issues through a close exploration of one setting that urgently presents them: medical tourism. Medical tourism is a term used to describe the travel of patients who are citizens and residents of one country, the “home country,” to another country, the “destination country,” for medical treatment. This Article is the first to comprehensively examine a subcategory of medical tourism that I call “circumvention tourism,” which involves patients who travel abroad for services that are legal in the patient’s destination country but illegal in the patient’s home country–that is, travel to circumvent domestic prohibitions on accessing certain medical services. The four examples of this phenomenon that I dwell on are circumvention medical tourism for female genital cutting (FGC), abortion, reproductive technology usage, and assisted suicide. I will briefly discuss the “can” question: assuming that a domestic prohibition on access to one of these services is lawful, as a matter of international law, is the home country forbidden, permitted, or mandated to extend its existing criminal prohibition extraterritorially to home country citizens who travel abroad to circumvent the home country’s prohibition? Most of the Article, though, is devoted to the “ought” question: assuming that the domestic prohibition is viewed as normatively well-grounded, under what circumstances should the home country extend its existing criminal prohibition extraterritorially to its citizens who travel abroad to circumvent the prohibition? I show that, contrary to much of current practice, in most instances, home countries should seek to extend extraterritorially their criminal prohibitions on FGC, abortion, assisted suicide, and, to a lesser extent, reproductive technology use to their citizens who travel abroad to circumvent the prohibition. I also discuss the ways in which my analysis of these prohibitions can serve as scaffolding for a more general theory of circumvention tourism.

This article can be accessed in this LINK

A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review

Health Care for Women International. DOI10.1080/07399332.2012.721417. Accepted author version posted online: 04 Sep 2012

A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review

Rigmor C. Berg  & Eva Denison


Understanding the forces underpinning FGM/C is a necessary first step to prevent the continuation of a practice that is associated with health complications and human rights violations. To this end, a systematic review of 21 studies was conducted. Based on this review, the authors reveal six key factors that underpin FGM/C: cultural tradition, sexual morals, marriageability, religion, health benefits, and male sexual enjoyment. There were four key factors perceived to hinder FGM/C: health consequences, it is not a religious requirement, it is illegal, and the host society discourse rejects FGM/C. The results show that FGM/C appears to be a tradition in transition.

This article can be accessed for free in this LINK

Genitals and ethnicity: the politics of genital modifications

Reprod Health Matters. May 2010, 18(35):29-37.

Genitals and ethnicity: the politics of genital modifications

Johnsdotter S, Essen B


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 genitalmodifications, 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 offemale 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 genitalcutting, 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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Why are current efforts to eliminate female circumcision in Ethiopia misplaced?

Cult Health Sex. 2012 Oct 2. [Epub ahead of print]

Why are current efforts to eliminate female circumcision in Ethiopia misplaced?

Boyden J.


This paper discusses the eradication challenges of female circumcision in Ethiopia. It argues that despite an overall decline in the practice nationally, eradication efforts have caused significant quandaries for girls and their families. The most common justification by far for its continuance is that circumcision confirms a girl’s social place by proving her readiness for marriage and adulthood and thereby ensures her protection against material want. Hence, intervention has often resulted in the transformation, rather than the elimination, of the practice, the exchange of one type of risk for another, or even increased risk to girls. In discussing policy, the paper argues that there has been a misapplication of the risk concept in the promotion of change in Ethiopia. It calls for risk definitions and interventions that are more holistic, correspond more closely with children’s social realities and take into account the phenomenological dimensions of experience.

This article can be purchased in this LINK

Female circumcision among Egyptian women.

Womens Health. 1995 Winter;1(4):309-28.

Female circumcision among Egyptian women.

Ericksen KP.

Department of Psychology, University of California at Davis 95616, USA. kpericksen@ucdavis.edu

Although a remarkable degree of consensus has been reached among international agencies, policymakers, and women’s health advocates that the practice of female circumcision should be eliminated, such consensus is not necessarily shared by those who perform the operation or the families responsible for having girls excised. The surgical procedure is nested in a complex set of beliefs about identity, moral behavior, and the working of the female body. This article describes the dominant themes produced in 85 extensive interviews with mother and operators representing the broad spectrum of Egyptian society. The interviews detailed the operation itself, women’s emotional response to the operation, and the rationales put forth in support of the practice. Although institutional efforts to eliminate the practice will meet with resistance, significant demographic shifts already taking place are producing changes in family systems and the opportunity structure that coincide with the abandonment of excision in key sectors of the urban population.

There is no link to view this article online

Special Issues: Female Genital Mutilation

Lancet. 2003 Dec;362:26 – 27

Special Issues: Female Genital Mutilation

Sundby J


Female genital cutting, circumcision, or mutilation—this controversial practice has many names. Although the procedure resembles something medical, namely surgery, it is most often done by lay people with no formal training in surgical practice or hygiene. The procedure is described and categorised—type I to type IV excision, based on the degree of cutting. The least intrusive form of the procedure is sometimes called sunna, and the most severe, pharaonic circumcision. Thus, this procedure has a medical and a traditional vocabulary.

The cutting of female genitalia for non-medical reasons is a harmful traditional practice. It does not, from a medical point of view, benefit the subject of the procedure. This does not mean, however, that the procedure is never wanted by those who undergo it. In many societies circumcision is a prerequisite for entry to womanhood. It is a cultural phenomenon that affects millions of young women, especially across central Africa, southern Sahara, and some places in the Arab peninsula. Rates vary between regions and ethnic groups. More than 90% of Somali women have the most severe form of the procedure, in which the labia and clitoris are removed and the orifice stitched to leave only a very small opening. Three of four ethnic groups practise cutting in The Gambia, where the clitoris is excised, and sometimes the labia minora as well…

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Comment: Reaching the tipping point against female genital mutilation

Lancet. 2005 July;366(9483):347 – 349

Comment: Reaching the tipping point against female genital mutilation

Shaaban L, Harbison S


Female genital mutilation, also known as female genital cutting, is a deeply rooted cultural practice in more than 28 African countries, parts of the middle east, and pockets of Asia. Annually, an estimated 2 million girls come of age in such areas. Support for the practice in communities is broad-based. Mothers, mothers-in-law, fathers, and religious and community leaders defend the practice on the basis of a girl’s future role as wife and mother. Reasons cited for support include its role as a rite of passage into womanhood, marriageability, curbing sexual desire, and protecting virginity. It is not condoned by any major religion but often has socioreligious significance. Despite its cultural entrenchment, a gradual reduction is occurring in a number of countries, even without targeted interventions. The challenge is to identify successful approaches to accelerate the decline…

This article can be accessed in this LINK

Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline

Trop Med Int Health. 2002 Jan; 7(1): 91-100

Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline

Snow RC, Slanger TE, Okonofua FE, Oronsaye F, Wacke RJ


Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45–49 years, 48.6% among 30–34-year olds, and 14.5% among girls aged 15–19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.

This article can be accessed in this LINK.