Tag Archives: Sudan

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.

ABSTRACT

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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Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

Am J Obstet Gynecol. 2017 Jul;217(1):62.e1-62.e6. doi: 10.1016/j.ajog.2017.02.044. Epub 2017 Mar 3. Effects of female genital mutilation/cutting on the sexual function of Sudanese women: a cross-sectional study.

Rouzi AA, Berg RC, Sahly N, Alkafy S, Alzaban F, Abduljabbar H.

ABSTRACT

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice that involves several types of removal or other injury to the external female genitalia for nonmedical reasons. Although much international research has focused on the health consequences of the practice, little is known about sexual functioning among women with various types of FGM/C. OBJECTIVE: To assess the impact of FGM/C on the sexual functioning of Sudanese women. STUDY DESIGN: This is a cross-sectional study conducted at Doctor Erfan and Bagedo Hospital, Jeddah, Saudi Arabia. Eligible women completed a survey and a clinical examination, which documented and verified women’s type of FGM/C. The main outcome measure was female sexual function, as assessed by the Arabic Female Sexual Function Index. RESULTS: A total of 107 eligible women completed the survey and the gynecological examination, which revealed that 39% of the women had FGM/C Type I, 25% had Type II, and 36% had Type III. Reliability of self-report of the type of FGM/C was low, with underreporting of the extent of the procedure. The results showed that 92.5% of the women scored lower than the Arabic Female Sexual Function Index cut-off point for sexual dysfunction. The multivariable regression analyses showed that sexual dysfunction was significantly greater with more extensive type of FGM/C, across all sexual function domains (desire, arousal, lubrication,
orgasm, satisfaction, and pain) and overall. CONCLUSION: The study documents that a substantial proportion of women subjected to FGM/C experience sexual dysfunction. It shows that the anatomical extent of FGM/C is related to the severity of sexual dysfunction.

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Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).

METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage.

RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy.

CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed.

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An explorative study of Sudanese midwives’ motives, perceptions and experiences of re-infibulation after birth

Midwifery. 2004, 20(4); 299–311.

An explorative study of Sudanese midwives’ motives, perceptions and experiences of re-infibulation after birth

Berggren V, Abdel Salam G, Bergström S, Johansson E, Edberg A

ABSTRACT

Objective: to explore Sudanese midwives’ motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. Design: triangulation of methods, using observational techniques and open-ended interviews. Setting and participants: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. Findings: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. Key conclusions and implications for practice: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives’ potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

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Prevalence of and factors affecting female genital mutilation among schoolgirls in Eastern Sudan.

Int J Gynaecol Obstet. 2013 Mar;120(3):288-9. doi: 10.1016/j.ijgo.2012.09.018. Epub 2012 Dec 7.

Prevalence of and factors affecting female genital mutilation among schoolgirls in Eastern Sudan.

Ali AA, Okud A, Mohammed AA, Abdelhadi MA.

Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, Sudan. abuzianab73@yahoo.com

There is no ABSTRACT available for this article

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Reinfibulation among women in a rural area in Central Sudan

Health Care Women Int. 2001 22(8):711-721. 10.1080/073993301753339933

Reinfibulation among women in a rural area in Central Sudan

Almroth-Berggren V, Almroth L, Bergström S, Hassanein OS, El Hadi N, Lithell U
ABSTRACT

Reinfibulation is performed on women previously subjected to infibulation and who have given birth. To investigate the practice and attitudes concerning reinfibulation, we randomly selected for interviews 60 young women and grandmothers in a rural village in central Sudan. Reinfibulation was widely practised in this area. The main motive for performing reinfibulation was to satisfy the husband sexually. The young women saw themselves as passive in the decision process, claiming that the midwife and female relatives were behind the decision. Men were not involved in decisions to perform reinfibulation but seemed to play a supportive role when decisions were made not to perform it. Some young women had decided to break the pattern and not be reinfibulated. Through the interviews, we found that the practice carries the risk of several serious complications, which demonstrates that reinfibulation is an important health issue.

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The effects of type of female circumcision on infertility and fertility in Sudan

J Biosoc Sci. July 2002 34(03): 363-377

The effects of type of female circumcision on infertility and fertility in Sudan

Larsen U

ABSTRACT

This study explores the association between type of female circumcision and infertility and fertility in Sudan using the 1989–90 Demographic and Health Survey. It is hypothesized that women with either Pharaonic or Intermediate circumcision would have higher infertility and lower fertility compared with women with Sunna circumcision, and that uncircumcised women would have the lowest infertility and highest fertility of the three groups. This hypothesis, a widely held assumption, proved to be largely incorrect. Though women with Pharaonic or Intermediate circumcision did have a higher prevalence of primary infertility than uncircumcised women, women with Sunna circumcision had even lower rates of primary infertility compared with uncircumcised women. This pattern prevailed in multivariate models controlling for confounding variables, where women with Pharaonic or Intermediate circumcision had significantly higher primary infertility. Moreover, though women with Pharaonic or Intermediate circumcision also had the highest prevalence of secondary infertility, once confounding covariates were controlled in multivariate models, there was no significant difference among the three groups of women. With respect to fertility, the total fertility rate was 7·6 for women with Pharaonic or Intermediate circumcision, 8·1 for women with Sunna circumcision and 8·3 for uncircumcised women. Differences in fertility were found to be insignificant when covariates were controlled. The multivariate models were estimated using logistic regression. In conclusion, Pharaonic or Intermediate circumcision may be associated with higher primary infertility while there was no evidence suggesting that either secondary infertility or fertility was associated with a woman’s circumcision status.

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Being victims or beneficiaries? Perspectives on female genital cutting and reinfibulation in Sudan.

Afr J Reprod Health. 2006 Aug;10(2):24-36.

Being victims or beneficiaries? Perspectives on female genital cutting and reinfibulation in Sudan.

Berggren V, Musa Ahmed S, Hernlund Y, Johansson E, Habbani B, Edberg AK.

Division of International Health Care Research (IHCAR), Department of Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden. Vanja.Berggren@staff.hkr.se

ABSTRACT

Female Genital Mutilation (FGM) or the more value neutral term, Female Genital Cutting (FGC) is widely practised in northern Sudan, where around 90% of women undergo the most extensive form of FGC, infibulation. One new approach to combating FGC in Sudan is to acknowledge the previously hidden form of FGC, reinfibulation (RI) after delivery, when the woman is sewn back so much as to mimic virginity. Based on a qualitative study in Khartoum State, this article explores Sudanese women’s and men’s perceptions and experiences of FGC with emphasis on RI after delivery. The results showed that both genders blame each other for the continuation of the practices, and the comprehensive understanding of the perceptions and experiences was that both the women and the men in this study were victims of th e consequences of FGC and RI. The female narratives could be understood in the three categories: viewing oneself as being “normal” in having undergone FGC and RI; being caught between different perspectives; and having limited influence on the practices of FGC and RI. The male narratives could be understood in the three categories: suffering from the consequences of FGC and RI, trying to counterbalance the negative sexual effects of FGC and striving in vain to change female traditions. The results indicate that the complexity of the persistence of FGC and RI goes far beyond being explained by subconscious patriarchal and maternalistic actions, related to socially constructed concepts of normality, female identity,tradition and religion a”silent” culture betweenmen and women.

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What’s “normal”: female genital mutilation, psychology, and body image.

J Am Med Womens Assoc. 2004 Summer;59(3):168-70.

What’s “normal”: female genital mutilation, psychology, and body image.

Adams KE.

Department of Obstetrics and Gynecology, Oregon Health and Sciences University, USA.

ABSTRACT

Despite international efforts to halt the practice of female genital mutilation (FGM), the number of African girls and women undergoing the procedure is not declining as rapidly as international observers had hoped when the World Health Organization began focusing attention on the practice in the 1960s. This article focuses on the psychological effects of FGM through the example of a patient who had undergone the procedure in childhood and now felt that her closed appearance was “normal” and that to be opened would be “abnormal.” Western advocates must educate themselves about the various cultural forces that lead to FGM in order to help women who have undergone the procedure heal psychologically, thereby breaking the pattern of abuse from generation to generation.

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Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.

Sex Transm Infect. 2003 Jun;79(3):220-3.

Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.

Herieka E, Dhar J.

Bournemouth GU Clinic, Bournemouth, UK. elbushra.herieka@rbch.tr.swest.nhs.uk

BACKGROUND: Female genital mutilation (FGM) or female circumcision is the removal of variable amounts of tissue from the female external genitalia. It is practised all over the world on very young girls. This study was conducted in Sudan where FGM is a criminal offence and not a religious dictate. We assessed the knowledge, attitudes, and perceptions of this practice among Khartoum university students and compared the differences between male and female student responses.

METHODS: An anonymised detailed questionnaire was distributed among the university students. In addition to the participant’s age, marital status, course studying, details regarding their attitude, knowledge of the practice of FGM, and their own experiences were collected.

RESULTS: Of the 500 questionnaires distributed, 414 (82.8%) were returned from 192 (46%) females and 222 (54%) males. 109 (56.8%) of the female respondents were themselves circumcised.18.8% of the male students and 9.4% of the female students thought FGM was recommended by their religion. Only 90 (46.9%) female students compared with 133 (59.9%) male students thought FGM was illegal. Though 16 (8.3%) female respondents thought FGM would increase their chances of marriage, the majority, 166 (74.8%), of the male students would prefer a non-circumcised female.

CONCLUSIONS: This study shows that 109 (56.8%) female university students who responded were circumcised. Confusing religious messages and ambiguous laws seem to be responsible for the continuation of this practice. The study highlights the partnership that needs to be established between religious leaders and educationalists to end this medieval practice.

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