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Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual.

Int J Womens Health. 2013 Apr 15;5:165-75. doi: 10.2147/IJWH.S40447. Print 2013.FREE

Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual.

Schultz JH, Lien IL.

Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.

ABSTRACT

How do girls who have undergone female genital cutting understand the ritual? This study provides an analysis of the learning process and knowledge acquired in their meaning-making process. Eighteen participants were interviewed in qualitative indepth interviews. Women in Norway, mostly with Somali or Gambian backgrounds, were asked about their experiences of circumcision. Two different strategies were used to prepare girls for circumcision, ie, one involving giving some information and the other keeping the ritual a secret. Findings indicate that these two approaches affected the girls’ meaning-making differently, but both strategies seemed to lead to the same educational outcome. The learning process is carefully monitored and regulated but is brought to a halt, stopping short of critical reflexive thinking. The knowledge tends to be deeply internalized, embodied, and morally embraced. The meaning-making process is discussed by analyzing the use of metaphors and narratives. Given that the educational outcome is characterized by limited knowledge without critical reflection, behavior change programs to end female genital cutting should identify and implement educational stimuli that are likely to promote critical reflexive thinking.

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Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

Obstet Gynecol Int. 2013;2013:312734. doi: 10.1155/2013/312734. Epub 2013 Apr 18. FREE

Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

Gele AA, Bø BP, Sundby J.

Department of Social Science, Oslo University College, 0167 Oslo, Norway ; Section for International Health, Department of General Practice and Community Medicine, University of Oslo, 0167 Oslo, Norway.

ABSTRACT

Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people’s positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants’ knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the “zero tolerance policy” has failed to change people’s support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

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HIV/AIDS and female genital mutilation in the Somali’s nomads of eastern Ethiopia: a discussion paper.

World Hosp Health Serv. 2006;42(3):27-31.

HIV/AIDS and female genital mutilation in the Somali’s nomads of eastern Ethiopia: a discussion paper.

Omar M, Mohamed K.

Institute of Health Sciences and Public Health Research, University of Leeds, United Kingdom.

ABSTRACT

Female Genital Mutilation (FGM) is widely practised among the Somali nomads in Eastern Ethiopia. It may be categorized as one of many harmful traditional practices such as uvula cutting, gum piercing, cauterization and blood letting, which are conducted by unskilled traditional healers in unhygienic conditions, and which potentially increase the risk of HIV transmission. Other factors also play a significant role in the perpetuation of the HIV/AIDS epidemic in the region, such as lack of awareness, misconception about the routes of HIV transmission and ways of prevention, the practice of polygamy, and window inheritance. Pervasive poverty and recurrent famine also fuel the epidemic. Lack of official pastoralist-specific policy and strategy on HIV and FGM further complicates the problem. This paper discusses the possible relationship in terms of health risk between HIV/AIDS and FGM in the Horn of Africa and calls for more concerted efforts, including further research in order to address this potential risk.

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Female genital mutilation: Experience in a West London clinic.

J Obstet Gynaecol. 2007 May;27(4):416-9.

Female genital mutilation: Experience in a West London clinic.

Gordon H, Comerasamy H, Morris NH.

ABSTRACT

The Wellwoman African Clinic, Central Middlesex Hospital, London, UK. z.whitlock@imperial.ac.uk In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously.

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How experiences and attitudes relating to female circumcision vary according to age on arrival in Britain: a study among young Somalis in London

Ethn Health. 2004 9(1): 75-100. DOI:10.1080/1355785042000202763

How experiences and attitudes relating to female circumcision vary according to age on arrival in Britain: a study among young Somalis in London

Morison LA, Dirir A, Elmi S, Warsame J, Dirir S

ABSTRACT

Objective. To examine the association between age on arrival in Britain and experiences and attitudes relating to female circumcision among young, single Somalis living in London.

Design. The study population consisted of single male and female Somalis aged 16–22 years living in the Greater London area. Quantitative data were collected using a cross‐sectional survey based on snowball sampling aiming to obtain data on 100 males and 100 females. Qualitative data were collected from 10 males and 10 infibulated females.

Results. Quantitative data were obtained for 94 females and 80 males. Living in Britain from a younger age was associated with increased assimilation in terms of language, dress and socialising. Seventy per cent of the females reported being circumcised with two‐thirds of operations being infibulation. Those who were living in Britain before the usual age range for circumcision (before age six) were less likely to be circumcised (42%) than those who arrived after the usual age range for circumcision (11 or older) (91%). During in‐depth interviews, health and sexual problems due to female circumcision were described with great emotion and interviewees acknowledged the association between the importance of virginity for marriage and circumcision. Half of males who arrived aged 11 or older wanted a circumcised wife compared with less than a quarter of those who arrived at a younger age. Eighteen per cent of female respondents and 43% of males intended to circumcise any daughters. Females were less likely than males to agree with the assumptions about sexuality and religion that underpin the practice. Substantial proportions of respondents perceived that their parents’ expectations in terms of marriage and circumcision were more traditional than their own.

Conclusion. Living in Britain from a younger age appears to be associated with abandonment of female circumcision and with changes in the underlying beliefs on sexuality, marriage and religion that underpin it. Groups identified with more traditional views towards female circumcision include males, older generations, new arrivals and those who show few signs of social assimilation.

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Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district.

BMC Res Notes. 2013 Mar 27;6(1):122. [Epub ahead of print]FREE

Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district.

Gele AA, Bø BP, Sundby J.

BACKGROUND: Female circumcision is a major public health problem that largely contributes to the ill-health of women and their children globally. Accordingly, the international community is committed to take all possible measures to abolish the practice that is internationally considered to be absolutely intolerable. While the practice is a social tradition shared by people in 28 African countries, there is no country on earth where FC is more prevalent than in Somalia. Yet, since the early 1990s, there is no quantitative study that has investigated whether the perception towards the practice among Somali men and women in Somalia has improved or not. Thus, this cross-sectional quantitative study examines the attitudes toward the practice among people in Hargeisa, Somalia.

METHODS: A cross-sectional study of 215 randomly selected persons, including both men and women, was conducted in Hargeisa, Somalia from July to September of 2011. Participants were interviewed using structured questionnaires, with questions including the circumcision status of the female participants, the type of circumcision, if one has the intention to circumcise his/her daughter, whether one supports the continuation or discontinuation of the practice and men’s perceptions toward having an uncircumcised woman as a wife.Result: The findings show that 97% of the study’s participants were circumcised with no age differences. Of this, 81% were subjected to Type 3, while 16% were subjected to either Type 1 or 2 and only 3% were left uncircumcised. Approximately 85% of the respondents had intention to circumcise their daughters, with 13% were planning the most radical form. Among men, 96% preferred to marry circumcised women, whereas overall, 90% of respondents supported the continuation of the practice. The vast majority of the study’s respondents had a good knowledge of the negative health effects of female circumcision. In multivariate logistic regressions, with an adjustment for all other important variables, female circumcision (the Sunna form) is a religious requirement 16.5 (2.43-112.6) and the Sunna form is not harmful 25.1(2.35-281.1), are the two factors significantly associated with the continuation of female circumcision. Moreover, females were less likely to support the continuation of FC compared to their male counterparts (aOR 0.07; CI: 0.05-0.88).

CONCLUSION: The study shows that the support towards the persistence of the practice is profoundly high in Somalia. People are aware of the health and human rights effect of female circumcision, and yet they support the continuation of the practice. Therefore, over 30 years of campaigns with limited progress demand an alternative approach towards the eradication of female circumcision in Somalia.

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[Diagnostic image. A woman with a vulvar swelling]

Ned Tijdschr Geneeskd. 2009;153:A115.

[Diagnostic image. A woman with a vulvar swelling]. [Article in Dutch]

Lashley LE, Feitsma HA.

Leids Universitair Medisch Centrum, afd. Gynaecologie, Leiden, The Netherlands. lisalashley@hotmail.com

A 25-year-old woman presented with a tumour above the labia minora, due to an epidermal cyst.

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“They get a C-section…they gonna die”: Somali women’s fears of obstetrical interventions in the United States.

J Transcult Nurs. 2010 Jul;21(3):220-7. doi: 10.1177/1043659609358780.

“They get a C-section…they gonna die”: Somali women’s fears of obstetrical interventions in the United States.

Brown E, Carroll J, Fogarty C, Holt C.

University of Rochester Medical Center, Rochester, NY 14620, USA. elizabeth_brown@urmc.rochester.edu

ABSTRACT

The authors explore sources of resistance to common prenatal and obstetrical interventions among 34 Somali resettled adult women in Rochester, New York. Results of individual interviews and focus groups with these women revealed aversion to or outright fear of cesarean sections because of fear of death and substantial resistance regarding other obstetrical interventions. Because Somali women expressed resistance to many common U.S. prenatal/obstetrical care practices, educating health professionals about Somali women’s fears and educating Somali women about common obstetrical practices are both necessary to improve maternity care for non-Bantu and Bantu Somali women.

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Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study.

BMC Public Health. 2009 Jul 27;9:264. doi: 10.1186/1471-2458-9-264.FREE

Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study.

Mitike G, Deressa W.

ABSTRACT

BACKGROUND: Eastern Ethiopia hosts a substantial number of refugees originated from Somalia. Female genital mutilation (FGM) is a common practice in the area, despite the campaigns to eliminate it.

METHODS: A cross-sectional study was conducted among 492 respondents sampled from three refugee camps in Somali Regional State, Eastern Ethiopia, to determine the prevalence and associated factors of FGM. Data were collected using pre-tested structured questionnaires.

RESULTS: Although the intention of the parents to circumcise their daughters was high (84%), 42.4% of 288 < or = 12 girls were reported being undergone FGM. The prevalence increased with age, and about 52% and 95% were circumcised at the age of 7-8 and 11-12 years, respectively. Almost all operations were performed by traditional circumcisers (81%) and birth attendants (18%). Clitoral cutting (64%) and narrowing of the vaginal opening through stitching (36%) were the two common forms of FGM reported by the respondents. Participation of the parents in anti-FGM interventions is statistically associated with lower practice and intention of the procedures.

CONCLUSION: FGM is widely practised among the Somali refugee community in Eastern Ethiopia, and there was a considerable support for the continuation of the practice particularly among women. The findings indicate a reported shift of FGM from its severe form to milder clitoral cutting. More men than women positively viewed anti-FGM interventions, and fewer men than women had the intention to let their daughters undergo FGM, indicating the need to involve men in anti-FGM activities.

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Female circumcision/genital mutilation: Culturally sensitive care

Health Care for Women International. 1993 14(3) 227-238

Female circumcision/genital mutilation: Culturally sensitive care

Barbara L. Calder, Yvonne M.R. Brown & Donna I. Rae

ABSTRACT

The ancient ritual of female circumcision/genital mutilation is still a prevalent custom in some African countries. Because of increasing immigration of African families to Western nations, the practice has become an issue for health care providers, who may not be aware of the practice and its sequelae. Using a questionnaire administered by our Somalian research associate, we surveyed women in schools of nursing and education in Somalia, identifying the complications of circumcision, acceptable interventions for these complications, and caregivers considered appropriate by the respondents. By becoming aware of the practice and of which interventions are acceptable and unacceptable, health care providers can offer more comprehensive and culturally sensitive care.

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