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

https://arctichealth.org/en/permalink/ahliterature291440
Source
BMJ Open. 2017 Aug 11; 7(8):e017506
Publication Type
Journal Article
Randomized Controlled Trial
Date
Aug-11-2017
Author
Anna Wahlberg
Sara Johnsdotter
Katarina Ekholm Selling
Carina Källestål
Birgitta Essén
Author Affiliation
Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
Source
BMJ Open. 2017 Aug 11; 7(8):e017506
Date
Aug-11-2017
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adolescent
Adult
Attitude
Circumcision, Female - ethnology
Emigration and Immigration
Female
Genitalia, Female
Humans
Male
Middle Aged
Skin
Somalia - ethnology
Sweden
Young Adult
Abstract
To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration.
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.
Sweden.
372 Somali men and women, 206 newly arrived (0-4 years), 166 established (>4 years).
Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.
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.
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 NCT02335697;Pre-results.
Notes
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PubMed ID
28801440 View in PubMed
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Being different and vulnerable: experiences of immigrant African women who have been circumcised and sought maternity care in Sweden.

https://arctichealth.org/en/permalink/ahliterature63115
Source
J Transcult Nurs. 2006 Jan;17(1):50-7
Publication Type
Article
Date
Jan-2006
Author
Vanja Berggren
Staffan Bergström
Anna-Karin Edberg
Author Affiliation
Karolinska Institute, Sweden.
Source
J Transcult Nurs. 2006 Jan;17(1):50-7
Date
Jan-2006
Language
English
Publication Type
Article
Keywords
Adult
Africa, Eastern - ethnology
Aged
Attitude of Health Personnel
Attitude to Health - ethnology
Circumcision, Female - ethnology - legislation & jurisprudence - psychology
Emigration and Immigration
Female
Health Personnel - education
Humans
Maternal Health Services - utilization
Middle Aged
Pregnancy
Professional-Patient Relations
Research Support, Non-U.S. Gov't
Sweden
Abstract
The purpose of the study was to explore the encounters with the health care system in Sweden of women from Somalia, Eritrea, and Sudan who have been genitally cut. A qualitative study was performed through interviews with 22 women originally from Somalia, Sudan, and Eritrea who were living in Sweden. The women experienced being different and vulnerable, suffering from being abandoned and mutilated, and they felt exposed in the encounter with the Swedish health care personnel and tried to adapt to a new cultural context. The results of this study indicate a need for more individualized, culturally adjusted care and support and a need for systematic education about female genital cutting for Swedish health care workers.
PubMed ID
16410436 View in PubMed
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Care for infibulated women giving birth in Norway: an anthropological analysis of health workers' management of a medically and culturally unfamiliar issue.

https://arctichealth.org/en/permalink/ahliterature79132
Source
Med Anthropol Q. 2006 Dec;20(4):516-44
Publication Type
Article
Date
Dec-2006
Author
Johansen R Elise B
Author Affiliation
Institute of General and Community Health, University of Oslo, Norway. johansene@who.int
Source
Med Anthropol Q. 2006 Dec;20(4):516-44
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Anthropology, Cultural
Circumcision, Female - adverse effects
Delivery, Obstetric - methods - psychology
Female
Humans
Midwifery - methods
Norway
Pregnancy
Somalia - ethnology
Abstract
The focus of this article is on Norwegian health care workers' experience and management of birth care of women who have undergone infibulation. Because infibulation is the most extensive form of female genital cutting, infibulated women experience a higher risk of birth complications, and health workers generally experience delivery care for this group as challenging. Infibulated women, who come from recently arrived immigrant groups, are a challenge to the predominant Norwegian birth philosophy of "natural childbirth" and the positive evaluation of everything considered natural. The challenges relate to a mixture of technical know-how and a complex set of interpretations of central cultural elements of gender, nature, health, and gender equity. The findings suggest that a combination of taboo, silence, limited knowledge, and emotional difficulty along with a wish to be culture sensitive may at times prove counterproductive to giving the best help. Health care workers often seem to impose "imagined" cultural values on infibulated women, rather than clarifying them through personal communication.
PubMed ID
17225657 View in PubMed
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Challenges in providing quality care for women with female genital cutting in Sweden - A literature review.

https://arctichealth.org/en/permalink/ahliterature296531
Source
Sex Reprod Healthc. 2018 Oct; 17:91-96
Publication Type
Journal Article
Review
Date
Oct-2018
Author
Malin Jordal
Anna Wahlberg
Author Affiliation
Center for Gender Research, Uppsala University, Sweden. Electronic address: Malin.Jordal@gender.uu.se.
Source
Sex Reprod Healthc. 2018 Oct; 17:91-96
Date
Oct-2018
Language
English
Publication Type
Journal Article
Review
Keywords
Circumcision, Female
Clinical Competence
Communication Barriers
Cultural Competency
Delivery, Obstetric - education - standards
Ethnic Groups
Female
Gynecology - education
Health Personnel - education - psychology
Humans
Midwifery - education
Pregnancy
Pregnancy Complications
Professional-Patient Relations
Quality of Health Care
Self Efficacy
Sweden
Abstract
Due to migration, health care needs in relation to female genital cutting (FGC) are increasingly emerging in European health care contexts, with Sweden being no exception. Recent estimates suggest that up to 38?000 girls and women with some form of FGC are living in Sweden, the majority from Somalia. Despite receiving high numbers of immigrants from FGC practising countries, health care services in many European countries seem largely unprepared in caring for circumcised patients. This literature review aims to identify challenges involved in providing quality care for circumcised women in Sweden. Two themes were identified; lacking technical skills and communication problems and ethnocentric attitudes. Lacking technical skills involved midwives and gynaecologists feeling insecure in how to technically deal with infibulated women during childbirth, something that often resulted in ad hoc solutions and improvisation. They related this insecurity to a lack of theoretical and practical training of FGC related health problems. In communication problems and ethnocentric attitudes both health care professionals and circumcised women reported facing difficulties in communicating about FGC, largely due to language barriers and perceived sensitivity of the issue. In conclusion, skills among health care professionals in Sweden caring for circumcised patients could be strengthened. This should be taken into consideration when planning midwifery and gynaecology curricula, and in providing in-service training for health care professionals likely to meet circumcised women in their practice.
PubMed ID
30193727 View in PubMed
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[Confusing conclusion about circumcision].

https://arctichealth.org/en/permalink/ahliterature175509
Source
Duodecim. 2005;121(4):408
Publication Type
Article
Date
2005
Author
Pirjo Terho
Author Affiliation
pirjo.terho@turku.fi
Source
Duodecim. 2005;121(4):408
Date
2005
Language
Finnish
Publication Type
Article
Keywords
Circumcision, Female - standards - trends
Cultural Characteristics
Female
Finland
Humans
Infant, Newborn
Religion
Risk assessment
PubMed ID
15799258 View in PubMed
Less detail
Source
Ann R Coll Physicians Surg Can. 1994 Dec;27(8):486-8
Publication Type
Article
Date
Dec-1994
Author
I. Brake
Author Affiliation
University of British Columbia, Canada.
Source
Ann R Coll Physicians Surg Can. 1994 Dec;27(8):486-8
Date
Dec-1994
Language
English
Publication Type
Article
Keywords
Beneficence
Canada
Circumcision, Female
Cultural Diversity
Developing Countries
Emigration and Immigration
Ethical Relativism
Ethnic Groups
Female
Humans
Informed consent
Internationality
Paternalism
Patient Care
Personal Autonomy
Physician-Patient Relations
Physicians
Social Values
Abstract
Physicians in Canada are often required to practise cross-cultural medicine. This often leads to difficult ethical situations. Many of our medical decisions are based on values and beliefs about health that are uniquely tied to our culture. Although the temptation to assume they are universal is powerful, even our most basic ethical principles can be challenged. Female circumcision provides an interesting example of a conflict between our sense of beneficence and the desire to respect patient autonomy. Further problems arise with different interpretations of concepts such as individual human rights, informed consent and the value of human life. Physicians must recognize the potential for such conflict and work to achieve a better understanding of the issues relevant to each cultural group.
PubMed ID
12199230 View in PubMed
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The encounters that rupture the myth: contradictions in midwives' descriptions and explanations of circumcised women immigrants' sexuality.

https://arctichealth.org/en/permalink/ahliterature51957
Source
Health Care Women Int. 2004 Sep;25(8):743-60
Publication Type
Article
Date
Sep-2004
Author
Amy Leval
Catarina Widmark
Carol Tishelman
Beth Maina Ahlberg
Author Affiliation
Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
Source
Health Care Women Int. 2004 Sep;25(8):743-60
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Adult
Africa - ethnology
Anecdotes
Attitude to Health - ethnology
Circumcision, Female - ethnology - psychology
Cultural Characteristics
Female
Focus Groups
Humans
Male
Middle Aged
Midwifery - standards
Nurse's Role - psychology
Nurse-Patient Relations
Nursing Methodology Research
Pregnancy
Questionnaires
Research Support, Non-U.S. Gov't
Sexual Partners - psychology
Sweden
Women's Health - ethnology
Abstract
The purpose of the study was to analyze how Swedish midwives (n = 26) discuss sexuality in circumcised African women patients. In focus groups and interviews, discussions concentrated on care provided to circumcised women, training received for this care, and midwives' perceptions of female circumcision. An analytic expansion was performed for discussions pertaining to sexuality and gender roles. Results from the analysis show the following: (1) ethnocentric projections of sexuality; (2) a knowledge paradox regarding circumcision and sexuality; (3) the view of the powerless circumcised women; and (4) the fact that maternity wards function as meeting places between gender and culture where the encounters with men allow masculine hegemonic norms to be ruptured. We conclude that an increased understanding of cultural epistemology is needed to ensure quality care. The encounters that take place in obstetrical care situations can provide a space where gender and culture as prescribed norms can be questioned.
PubMed ID
15371079 View in PubMed
Less detail

Estimates of first-generation women and girls with female genital mutilation in the European Union, Norway and Switzerland.

https://arctichealth.org/en/permalink/ahliterature282291
Source
Eur J Contracept Reprod Health Care. 2016 Dec;21(6):474-482
Publication Type
Article
Date
Dec-2016
Author
Luk Van Baelen
Livia Ortensi
Els Leye
Source
Eur J Contracept Reprod Health Care. 2016 Dec;21(6):474-482
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Africa - epidemiology
Age Distribution
Circumcision, Female - statistics & numerical data
Developing Countries
Emigrants and Immigrants - statistics & numerical data
European Union
Female
Humans
Middle Aged
Norway
Prevalence
Switzerland
Women's health
Young Adult
Abstract
Female genital mutilation (FGM) is the practice of partial or total removal of female genitalia for non-medical reasons. The procedure has no known health benefits but can cause serious immediate and long-term obstetric, gynaecological and sexual health problems. Health workers in Europe are often unaware of the consequences of FGM and lack the knowledge to treat women adequately.
Our goal was to estimate the number of first-generation girls and women in the European Union, Norway and Switzerland who have undergone FGM. Before migration from FGM-practicing countries began, FGM was an unknown phenomenon in Europe.
Secondary analysis of data from the 2011 EU census and extrapolation from age-specific FGM prevalence rates in the immigrants' home countries to these data were used to provide our estimates. Estimates based on census and other demographic data were compared to our results for Belgium.
In 2011 over half a million first-generation women and girls in the EU, Norway and Switzerland had undergone FGM before immigration. One in two was living in the UK or France, one in two was born in East-Africa.
For the first time, scientific evidence gives a reliable estimate of the number of first-generation women and girls in Europe coming from countries where FGM is practiced. The use of census data proves reliable for policy makers to guide their actions, e.g., regarding training needs for health workers who might be confronted with women who have undergone FGM, or the need for reconstructive surgery.
PubMed ID
27652839 View in PubMed
Less detail

Estimating the magnitude of female genital mutilation/cutting in Norway: an extrapolation model.

https://arctichealth.org/en/permalink/ahliterature275734
Source
BMC Public Health. 2016;16:110
Publication Type
Article
Date
2016
Author
Mai M Ziyada
Marthe Norberg-Schulz
R Elise B Johansen
Source
BMC Public Health. 2016;16:110
Date
2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Africa - ethnology
Child
Child, Preschool
Circumcision, Female - ethnology - statistics & numerical data
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Infant
Infant, Newborn
Iraq - ethnology
Middle Aged
Norway - epidemiology
Risk
Young Adult
Abstract
With emphasis on policy implications, the main objective of this study was to estimate the numbers of two main groups affected by FGM/C in Norway: 1) those already subjected to FGM/C and therefore potentially in need for health care and 2) those at risk of FGM/C and consequently the target of preventive and protective measures. Special attention has been paid to type III as it is associated with more severe complications.
Register data from Statistics Norway (SSB) was combined with population-based survey data on FGM/C in the women/girls' countries of origin.
As of January 1(st) 2013, there were 44,467 first and second-generation female immigrants residing in Norway whose country of origin is one of the 29 countries where FGM/C is well documented. About 40 pct. of these women and girls are estimated to have already been subjected to FGM/C prior to immigration to Norway. Type III is estimated in around 50 pct. of those already subjected to FGM/C. Further, a total of 15,500 girls are identified as potentially at risk, out of which an approximate number of girls ranging between 3000 and 7900 are estimated to be at risk of FGM/C.
Reliable estimates on FGM/C are important for evidence-based policies. The study findings indicate that about 17,300 women and girls in Norway can be in need of health care, in particular the 9100 who are estimated to have type III. Preventive and protective measures are also needed to protect girls at risk (3000 to 7900) from being subjected to FGM/C. Nevertheless, as there are no appropriate tools at the moment that can single these girls out of all who are potentially at risk, all girls in the potentially at risk group (15,500) should be targeted with preventive measures.
Notes
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PubMed ID
26837303 View in PubMed
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46 records – page 1 of 5.