Created by God : How Somalis in Swedish Exile Reassess the Practice of Female Circumcision

'Created by God' presents the views of Swedish Somalis on female circumcision and contrasts it to the Swedish public discourse on the issue. Despite the lack of documented illegal cases of female circumcision in Sweden, it is constantly claimed in the public discourse that female circumcision (female genital mutilation) is a practice upheld by the Somali exile group in Sweden. Based on an analysis of the internal debate on female circumcision among Swedish Somalis, it is argued that this is a practice negotiated and reassessed by Somalis in Sweden. While some traditional values are maintained, even when in conflict with mainstream mentality of the Swedish society, other values and attitudes are debated and abandoned. Among the Somalis in this study, reassessment of the religious imperative in relation to female circumcision has played a crucial role. The study highlights the importance of a processual theory of cultural practices, in contrast to the prevalent essentialist perspective. It is further argued that the prevalent discrepancy between the discourses - the discussion among Swedish Somalis and the public discussion in Sweden - is an obstacle in the process toward a complete abandonment of the practice of female circumcision in the Somali community in Sweden

Sexual Health among Young Somali Women in Sweden: Living with Conflicting Culturally Determined Sexual Ideologies

Young Somali women in Sweden are affected by two conflicting ideologies on sexuality: on the one hand, the traditional values demanding chastity and modesty in women and, on the other hand, the public sexual ideology in Sweden, emphasising sexual liberty and the dismissal of sexual taboos. In addition, they have to deal with national campaigns condemning “female genital mutilation”. Some of these young women arrived in Sweden already circumcised. The public message to them is that they are “mutilated” and, consequently, deprived of their ability to enjoy sex. A planned project, Sexual Health among Young Somali Women in Sweden, aims at a deeper understanding of the sexual experiences among older Somali women in Sweden, and intends to map the internal discourse in this field. The study also intends to find methods of transferring a positive self-image of sexuality, prevalent among older Somali women, to the younger women.1 Discussing sexual matters is traditionally taboo among Somalis. Even if this situation is changing in exile, many young Swedish Somali women have to make their sexual débuts with only limited knowledge about the possibilities of their own sexuality

Förhöjd förekomst av akuta kejsarsnitt bland kvinnor med ursprung i Somalia: Patientens eller vårdens ansvar?

Afrikanska kvinnor är överrepresenterade när det gäller både mödra- och barnadödlighet i västliga länder. Vidare löper de större risk att få genomgå akut kejsarsnitt, trots att studier visar att det finns en utbredd rädsla för kejsarsnitt bland kvinnor med ursprung i Somalia som migrerat till väst. I artikeln diskuteras hur denna situation kan motverkas genom att man lyfter fram konsultationen som arena inom graviditets- och förlossningsvården. Konsultationen – i motsats till behandlingen i sig – är ett sammanhang som tillåter en mer kritisk hållning till ett strikt biomedicinskt synsätt på sjukdom och kropp, och en större öppenhet för alternativa förståelsemodeller. En konsultationsmodell som är öppen för somaliska kvinnors speciella erfarenheter, men samtidigt lägger vikt vid varje patients individuella livssituation, ökar möjligheterna för en respektfull vård som i  förlängningen också kan leda till ett bättre utfall (lägre mödra- och barnadödlighet, färre akuta kejsarsnitt) för den somaliska invandrargruppen inom förlossningsvården

A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala.

OBJECTIVE: To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors. STUDY: design Qualitative in-depth interview study. SETTING: Rural Guatemala. SAMPLE: Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala. METHOD: Interviews with semi-structured, thematic, open-ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications. MAIN OUTCOME MEASURES: Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants. RESULTS: Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them. CONCLUSION: Parameters in the referral system, such as logistics and socio-economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture-sensitive education should be included in maternal health programs

Fear, blame and transparency: Obstetric caregivers\u27 rationales for high caesarean section rates in a low-resource setting

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers\u27 rationales for their hospital\u27s CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital\u27s CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have

Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?

OBJECTIVES: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. DESIGN: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. SETTING: Sweden. PARTICIPANTS: 372 Somali men and women, 206 newly arrived (0-4 years), 166 established (>4 years). PRIMARY OUTCOME MEASURES: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. RESULTS: The support for anatomical change of girls and women's genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%-83% among established and 53%-67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. CONCLUSION: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. TRIAL REGISTRATION NUMBER: Trial registration number NCT02335697;Pre-results

Female circumcision : violence in the name of religion?

This chapter discusses whether female circumcision can be seen as violence in the name of religion. The concept of 'violence' in relation to female circumcision is problematized, and the fact that there are many forms of the practice is emphasized

Medical statements politicized : The case of procedures involving the clitoris

We tend to view medical statements as empirically objective, while in reality they are politically determined: - Statements about sexual sensitivity after clitoris cutting vary in history with time-bound theories about female sexuality and also political agendas. - Prevalent inconsistencies become clear comparing medical statements about maintained or lost ability to enjoy sex after current surgeries involving the clitoris: compare for instance operations in intersexed persons and ‘designer vaginas’ in western medical settings vs. female circumcision in Africa. We need to be aware of how these authoritative statements are politically positioned and tinted by implicit ideas about morality and ethnicity