Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences

BACKGROUND: Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented. FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada. DISCUSSION: The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC. SUMMARY: Working partnerships between the public health sector and community based organisations with a true involvement of women and men from practicing communities will allow for more sensitive and congruent clinical guidelines. In order to honour the fundamental principles and values of medical ethics, such as compassion, beneficence, non-malfeasance, respect, and justice and accountability, socio-cultural interactions at the interface of health and migration will continue to require proper attention. It entails a commitment to recognise the intrinsic value and dignity of girls’ and women’s context

Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population

Objectives Growing attention has been given to considering sex and gender in health research. However, this remains a challenge in the context of retrospective studies where self-reported gender measures are often unavailable. This study aimed to create and validate a composite gender index using data from the Canadian Community Health Survey (CCHS). Methods According to scientific literature and expert opinion, the GENDER Index was built using several variables available in the CCHS and deemed to be gender-related (e.g., occupation, receiving child support, number of working hours). Among workers aged 18–50 years who had no missing data for our variables of interest (n = 29,470 participants), propensity scores were derived from a logistic regression model that included gender-related variables as covariates and where biological sex served as the dependent variable. Construct validity of propensity scores (GENDER Index scores) were then examined. Results When looking at the distribution of the GENDER Index scores in males and females, they appeared related but partly independent. Differences in the proportion of females appeared between groups categorized according to the GENDER Index scores tertiles (p < 0.0001). Construct validity was also examined through associations between the GENDER Index scores and gender-related variables identified a priori such as choosing/avoiding certain foods because of weight concerns (p < 0.0001), caring for children as the most important thing contributing to stress (p = 0.0309), and ability to handle unexpected/difficult problems (p = 0.0375). Conclusion The GENDER Index could be useful to enhance the capacity of researchers using CCHS data to conduct gender-based analysis among populations of workers

Critères pour apprécier les difficultés d’accès à l’indemnisation des travailleurs immigrants victimes de lésions professionnelles

Règle générale, presque tous les travailleurs du Québec victimes de lésions professionnelles peuvent se prévaloir d’indemnités. Mais l’accès à l’indemnisation est difficile pour bon nombre d’entre eux dont les travailleurs immigrants. Cet article décrit le processus d’évaluation et les critères ayant permis de juger des difficultés rencontrées par des travailleurs lors de leur parcours d’indemnisation. Trois groupes d’experts ont attribué des scores de difficulté à un échantillon de 104 travailleurs immigrants et non-immigrants de la région montréalaise victimes de lésions musculo-squelettiques. La comparaison des scores a été faite sous trois angles d’évaluation (médical, juridique et administratif) et le résultat demeure le même : les travailleurs immigrants ont des scores de difficultés supérieurs aux autres travailleurs et particulièrement lorsque l’analyse est faite sous les angles juridique et administratif. Les critères retenus ciblent les dimensions humaines liées aux incompréhensions lors des procédures, des problèmes de communication à lire la documentation ainsi qu’à compléter les formulaires et à s’exprimer précisément lorsqu’il s’agit de décrire les événements accidentels ou les circonstances entourant l’apparition de la lésion et les symptômes médicaux.As a general rule, almost all of Quebec’s workers who suffer work injuries will be taken care of by the worker compensation system. However, access to worker compensation is difficult for many workers, including immigrant workers. This article describes the evaluation process and the criteria used for assessing the difficulties encountered by workers during the compensation process. Three groups of experts assigned difficulty scores to a sample group from the Montreal region consisting of 104 immigrant and non-immigrant musculoskeletal injury victims. The difficulty scores were compared using three aspects for evaluation (medical, legal and administrative), which produced the same result: the immigrant workers had higher difficulty scores than the other workers and particularly from the legal and administrative standpoints. The criteria used targeted the human dimensions associated with the lack of understanding during the process and with communication problems in reading documents, completing forms and verbally describing precisely the accident events, the injury circumstances and the medical symptoms.En regla general, casi todos los trabajadores de Quebec que son víctimas de lesiones profesionales pueden acceder a indemnizaciones. Pero este acceso es difícil para un buen número de trabajadores, entre ellos, los trabajadores inmigrantes. Este artículo describe el proceso de evaluación y los criterios que permiten juzgar las dificultades encontradas por dichos trabajadores en el curso del proceso de indemnización. Tres grupos de expertos atribuyeron un puntaje según una escala de dificultad a una muestra de 104 trabajadores inmmigrantes y no-inmigrantes de la región de Montreal víctimas de lesiones musculoesqueléticas. Para comparar los puntajes se utilizaron tres ángulos de evaluación (médico, jurídico y administrativo). Los tres análisis concuerdan en el mismo resultado : los trabajadores inmigrantes tienen un puntaje de dificultad superior a los otros trabajadores, particularmente cuando el análisis se hace bajo los ángulos jurídico y administrativo. Los criterios retenidos se refieren a las dimensiones humanas relacionadas con la falta de comprensión durante los trámites, los problemas de comunicación al leer la documentación y al completar los formularios, y a expresarse de manera precisa cuando se trata de describir lo sucedido en el accidente, las circunstancias en torno a la aparición de la lesión y los síntomas médicos

Where boys don’t dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices

Abstract Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women’s rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women’s rights language, notably for causing violations of women’s right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women’s rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women’s rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women’s capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps

Does a change in health research funding policy related to the integration of sex and gender have an impact?

We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants' responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders

Evidence-based nursing practices in primary care services for migrants: A systematic literature review

Experiencing migration differently affects the health of individuals according to additional factors of vulnerability as gender or legal status. In primary care services, nurses are key actors in caring for such vulnerable migrants but evidence-based practices are still lacking. This literature review aims at identifying evidence-based nursing practices in primary care services for vulnerable migrant populations. Methods. We identified nursing interventions caring for migrants in primary care services in the literature published between 2000 and 2015. Vulnerability of the migrants was measured with the PROGRESS framework. Nursing components of the interventions were analyzed according to the 6 dimensions of the model of Advance Practice Nursing (Hamric et al. 2014). Quality appraisal included 8 criteria, each study received a score of quality. Results. We reviewed 104 papers and found 30 studies that met the inclusion criteria. Being vulnerable as a migrant was mostly defined as not being able to communicate with the health professionals (n=20). Most interventions targeted type 2 diabetes (n=8) and cardiovascular diseases (n=8). Attention to the specific needs of the migrants was achieved through cultural and linguistic adaptations but only one intervention included the intersectionality of risk factors (e.g. paying attention to migration, gender and socioeconomic status). Expert guidance/coaching and consultation were the two advanced practice nursing components reported in all studies. Collaboration, leadership, research and ethical decision-making skills were not reported in the retrieved studies. Overall, nursing interventions appear to be effective in improving health outcomes for migrants. Conclusion. This literature review provides a relevant basis for researches and professional development for nurses. Further studies should support the development of collaboration, leadership, research and ethical decision-making skills of nurses in primary care services

Synthesis : Pulling It All Together

Medicine, Faculty ofNon UBCReviewedFacult

CIHR panels exhibiting a significant tendency to not award grants re: sex and/or gender.

<p>(Italicized items have a P-Value above 0.05/no significant tendency).</p