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1.
Reprod Health ; 18(1): 52, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648528

RESUMO

INTRODUCTION: The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. METHODS: This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. RESULTS: The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. CONCLUSION: Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices.


Assuntos
Circuncisão Feminina , Tomada de Decisões , Genitália Feminina/lesões , Adolescente , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Cultura , Feminino , Grupos Focais , Genitália Feminina/patologia , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Casamento/psicologia , Casamento/estatística & dados numéricos , Pesquisa Qualitativa , Religião , Determinantes Sociais da Saúde , Fatores Socioeconômicos
2.
Acta Obstet Gynecol Scand ; 100(4): 604-613, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33554342

RESUMO

INTRODUCTION: In Sweden, the law treats female genital cutting (FGC) differently from male genital cutting (MGC). However, the comparability of the medical, ethical, and legal aspects of genital cutting of girls and boys are increasingly discussed by scholars, although little is known about how practicing communities view these aspects. This study aimed to explore attitudes towards comparison of genital cutting of girls and boys among Swedish Somalis, and to investigate factors associated with considering the two practices to be comparable. MATERIAL AND METHODS: In a cross-sectional questionnaire with 648 Swedish Somali men and women from four Swedish cities, descriptive statistics and logistic regression were used for the analysis. RESULTS: Among the Swedish Somalis, 10% considered FGC and MGC to be comparable practices. A majority (98%) of the participants thought FGC could cause long-term health complications, but only 1% considered the physical health disadvantage of MGC would outweigh the physical health benefits. FGC was perceived to be a violation of children's rights by 60%, whereas this proportion for MGC was 3%. Individuals who had a dominant bridging social capital and those who expressed that performing FGC follows religion were more likely to think that FGC and MGC were comparable practices. CONCLUSIONS: The increased global attention and emphasis on the comparability of genital cutting of boys and girls was not reflected in this study among Swedish Somalis. Rather, attitudes reflected the common description of the two practices in global public health campaigns, portraying FGC as a harmful practice violating children's rights, while describing MGC as a public health measure. Social interactions and separation of FGC from religion could explain why FGC and MGC were not considered comparable.


Assuntos
Atitude Frente a Saúde , Circuncisão Feminina/psicologia , Circuncisão Masculina/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Somália/etnologia , Inquéritos e Questionários , Suécia
3.
Reprod Health ; 18(1): 51, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33639963

RESUMO

BACKGROUND: FGM/C is a cultural practice associated with adverse health outcomes that involves the partial or complete removal of the external female genitalia or injury to the genitalia. FGM/C is a form of violence against women and girls. There are no laws that specifically outlaw FGM/C in Sri Lanka and no national prevalence data. There is a lack of evidence about this practice to inform prevention efforts required to achieve the Sustainable Development Goal (SDG) target 5.3.2, which focuses on the elimination of all harmful practices, including FGM/C. METHODS: We undertook a qualitative interpretative study to explore the knowledge and perceptions of community members, religious leaders and professionals from the health, legal and community work sectors in five districts across Sri Lanka. We aimed to identify strategies to end this practice. RESULTS: Two-hundred-and twenty-one people participated in focus group discussions and key informant interviews. A template analysis identified five top-level themes: Providers, procedures and associated rituals; demand and decision-making; the role of religion; perceived benefits and adverse outcomes; ways forward for prevention. CONCLUSIONS: This study delivered detailed knowledge of FGM/C related beliefs, perceptions and practitioners and provided opportunities to develop an integrated programming strategy that incorporates interventions across three levels of prevention.


Assuntos
Circuncisão Feminina , Genitália Feminina/lesões , Medicina Preventiva , Adolescente , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Feminino , Grupos Focais , Genitália Feminina/patologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Motivação , Prevalência , Medicina Preventiva/métodos , Medicina Preventiva/normas , Pesquisa Qualitativa , Religião , Sri Lanka/epidemiologia , Adulto Jovem
4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32719089

RESUMO

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.


Assuntos
Circuncisão Feminina , Criança , Maus-Tratos Infantis , Cicatriz/etiologia , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/classificação , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/psicologia , Competência Clínica , Confidencialidade , Documentação , Feminino , Doenças Urogenitais Femininas/etiologia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Infecções/etiologia , Infertilidade Feminina/etiologia , Consentimento Livre e Esclarecido , Classificação Internacional de Doenças , Notificação de Abuso , Anamnese , Saúde Mental , Dor/etiologia , Pediatras , Exame Físico , Prevalência , Refugiados/legislação & jurisprudência , Sexualidade
5.
PLoS One ; 15(7): e0235867, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634170

RESUMO

OBJECTIVES: While the general practitioner (GP) in the Netherlands is the first point of entry to and gatekeeper of the healthcare system, no study exists to explore the experiences of women with female genital mutilation or cutting (FGM/C) in general practice. Therefore, the aim of this study is to look into the experiences of women with FGM/C in Dutch general practice. METHODS: Semistructured interviews were held with 16 women with FGM/C. Sampling was purposeful. The interview guide and thematic analysis were based on the Illness Perception Model and Kleinman's Explanatory model. Interviews were held in English or Dutch. All data were anonymized, and recordings were transcribed verbatim. Transcripts were coded and thematically analyzed. RESULTS: The women considered FGM/C to be connected to a range of health problems, for which not all of them sought medical care. They had difficulty discussing such a sensitive topic with their GP, did not know their problems could be relieved or perceived GPs to have insufficient knowledge of FGM/C. Lack of time during consultations and overall dissatisfaction with Dutch GP care hampered trust. They strongly preferred the GP to be proactive and ask about FGM/C. CONCLUSION: There is room for improvement as most women would like their GP to discuss their health problems related to FGM/C. GPs should take a proactive attitude and ask about FGM/C. In addition, to develop the trusted relationship needed to discuss sensitive topics and provide culturally sensitive person-centered care, sufficient time during consultations is needed.


Assuntos
Circuncisão Feminina/psicologia , Clínicos Gerais/normas , Pacientes/psicologia , Relações Médico-Paciente , Adulto , Feminino , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Países Baixos , Satisfação do Paciente , Inquéritos e Questionários , Confiança
6.
BMC Public Health ; 20(1): 1132, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32689963

RESUMO

BACKGROUND: Female genital mutilation (FGM) is a deeply-rooted cultural practice mainly undertaken in Africa, the Middle East and Asian countries. Evidence to date suggests that although first-generation migrants to the West are abandoning FGM, the custom continues in some places, albeit in small numbers. This study examined how young people living in FGM affected communities in the United Kingdom (UK), interpreted and explained FGM. METHODS: A community-based participatory research (CBPR) approach was used to recruit and train nine young people aged 15-18 as co-researchers. These comprised eight females and one male from second-generation FGM affected communities, living in Bristol. The co-researchers then undertook focus groups and semi-structured interviews with twenty participants aged 13-15 living in Bristol, Cardiff and Milton Keynes. The qualitative data from the training workshops, interviews and focus groups were collected and analysed using thematic analysis. RESULTS: There were conflicting views among participants. Some perceived FGM as a historical tradition that was of very little, if any, relevance to them. In contrast, others perceived that the more archaic, cultural interpretation of FGM, more commonly shared by older generations, had been supplanted by a new form of FGM, which they believed to be a safe procedure, made so by the availability of highly-trained, qualified doctors and better equipment in the UK. Participants spoke of challenges encountered when attempting to raise the issue of FGM with parents. Nevertheless, they acknowledged that- being born and raised in the UK - enabled them to talk openly and to challenge others. CONCLUSION: Future strategies to address and prevent FGM in the UK will require a public health approach that is holistic, intersectional and empowering. Such measures should be relevant to young people born and raised in the UK who interpret FGM differently to previous first-generation migrant relatives and communities. Tackling FGM requires a shift away from a principal preoccupation with harm reduction and criminalisation towards collaboration and active dialogue with communities, in positive and productive ways that acknowledge and engage issues of identity, race, gender, and generation, enabling people affected by FGM to take control of their health and well-being.


Assuntos
Circuncisão Feminina/psicologia , Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , África/etnologia , Circuncisão Feminina/etnologia , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Humanos , Masculino , Reino Unido
7.
Afr J Reprod Health ; 24(1): 165-181, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358948

RESUMO

In light of the relational account of autonomy and the modern (holistic and phenomenological) account of health, this paper examines ethical justifications for ̳consensual' reinfibulation. Significant and constant discomfort in the body following deinfibulation might make a case for reinfibulation (considered as medical treatment in the traditional sense of the term). In any other case, the following requirements should be met for reinfibulation to be considered medically plausible: a) strong evidence that reinfibulation could help effectively improve woman's relational well-being, b) insignificant complications are expected, c) congruence between first-order and second-order autonomy or -in the context of political liberalism- strong second-order autonomy, d) an -open door‖ for the woman to exit an oppressive context, e) rigorous scrutiny of woman's psychology, and f) woman's practical wisdom to organize her identity-related values, find a balance between her extreme emotions and realize her own goal of meaningful life in accordance with her own conception of the good. Conclusively, in carefully screened cases and individually judged requests for reinfibulation, it should not be ruled out that, after having been conducted a multi-disciplinary in- depth investigation at social, psychological and medical level may be met conditions that make a case for reinfibulation.


Assuntos
Circuncisão Feminina/psicologia , Procedimentos Cirúrgicos em Ginecologia/psicologia , Saúde da Mulher , Direitos da Mulher , Circuncisão Feminina/reabilitação , Ética Médica , Feminino , Procedimentos Cirúrgicos em Ginecologia/ética , Humanos
8.
PLoS One ; 15(5): e0233344, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437387

RESUMO

Female genital mutilation is a harmful traditional practice that violates girls' right to health and overall well-being. Most research cites social acceptance, marriageability, community belonging, proof of virginity, curbing promiscuity, hygiene, and religion as motivations for the practice. It is generally assumed that individual attitudes of parents and other family members have an impact on decisions related to the cutting of girls, and that such attitudes are influenced by social norms. The aim of this study is to understand how parental attitudes towards the practice of female genital mutilation influence decision making related to the cutting of girls. Data from 15 Demographic and Health Surveys were analyzed to assess whether couples with at least one living daughter aged 0 to 14 years share the same opinions about the continuation of the practice, and to what extent couples' opinions are associated with the risk of daughters being cut. The analysis reveals that a significant percentage of couples hold discordant opinions on the continuation of the practice including in countries where the practice is very common. While a daughter's likelihood of being cut is much higher when both parents think the practice should continue, the analysis also shows that many cut girls have parents who oppose the practice. It further suggests that female genital mutilation is more prevalent among daughters whose mothers want the practice to continue and whose fathers are opposed or undecided, compared to daughters with fathers who are the sole parent supporting its continuation. Understanding the extent to which parental opinions influence decisions and which girls are most likely to be cut is essential for developing appropriate interventions aimed at promoting the abandonment of the practice.


Assuntos
Circuncisão Feminina/psicologia , Relações Pai-Filho , Relações Mãe-Filho , Núcleo Familiar/psicologia , Adolescente , Criança , Pré-Escolar , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/estatística & dados numéricos , Pai/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Normas Sociais , Inquéritos e Questionários
9.
BMC Womens Health ; 20(1): 107, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429984

RESUMO

BACKGROUND: Female Genital Mutilation (FGM) is a public health concern with negative consequences on women's health. It is a harmful practice which is recognized in international discourses on public health as a form of gender-based violence. Women are not only victims of this, but also perpetrators. The practice of FGM remains a social norm which is difficult to change because it is deeply rooted in tradition and is embedded in the patriarchal system. However, some women have managed to change their attitudes towards it and have spoken out against it. This study identifies and describes turning points that have been defined as significant and critical events in the lives of the women, and that have engendered changes in their attitudes towards the practice of FGM. METHODS: We have conducted an inductive qualitative study based on the life story approach, where we interviewed 15 women who have undergone FGM. During the interviews, we discussed and identified the turning points that gave the research participants the courage to change their position regarding FGM. The analysis drew on lifeline constructions and thematic analysis. RESULTS: Six common turning points relating to a change in attitude towards FGM were identified: turning points related to (i) encounters with health professionals, (ii) education, (iii) social interactions with other cultures and their own culture, (iv) experiences of motherhood, (v) repeated pain during sexual or reproductive activity, and (vi) witnessing the effects of some harmful consequences of FGM on loved ones. CONCLUSIONS: The turning points identified challenged the understanding of what it means to be a 'member' of the community in a patriarchal system; a 'normal woman' according to the community; and what it means to be a 'good mother'. Moreover, the turning points manifested in conjunction with issues centered on emotional responses and coming to terms with conflicts of loyalty, which we see as possible triggers behind the shift experienced by the women in our sample.


Assuntos
Circuncisão Feminina/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Mães/psicologia , Adolescente , Adulto , Atitude , Bélgica , Criança , Pré-Escolar , Circuncisão Feminina/etnologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Núcleo Familiar , Gravidez , Pesquisa Qualitativa , Migrantes
10.
PLoS One ; 15(3): e0229917, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142530

RESUMO

We tested a feminist social-ecological model to understand community influences on daughters' experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15-49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. However, an integrated multilevel-level framework is lacking. We theorized that a more favorable community-level gender system, including stronger gender norms opposing FGMC and expanded extra-familial opportunities for women in the village or neighborhood, would be associated with a daughter's lower risk of FGMC and would strengthen the negative association of a mother's opposition to FGMC with her daughter's risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women's opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems framework of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and structural opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters, may be needed for sustainable declines in the practice.


Assuntos
Circuncisão Feminina/efeitos adversos , Demografia , Genitália Feminina/cirurgia , Núcleo Familiar/psicologia , Adolescente , Adulto , Circuncisão Feminina/ética , Circuncisão Feminina/psicologia , Egito/epidemiologia , Feminino , Feminismo , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Mães/psicologia , Religião , Fatores Socioeconômicos , Adulto Jovem
11.
PLoS One ; 15(3): e0229770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187198

RESUMO

INTRODUCTION: Millions of women and girls have been exposed to female genital cutting (FGC). The practice of FGC extends beyond countries in Africa and Asia in which it is traditionally practiced. Women living with FGC in Norway have been reported to be in need of healthcare, but there is evidence of suboptimal use of healthcare services among this group, and we lack the women's perspective about this problem. This study aims to explore the experiences and perceptions hindering access and use of the Norwegian healthcare system among sub- Saharan African (SSA) immigrant women exposed to FGC. METHOD: This qualitative research was conducted using purposive and snowball sampling to recruit thirteen SSA immigrant women in Norway previously exposed to FGC. Interviews were conducted from October 2017 to July 2018. The Interpretative Phenomenological Analysis method was used. RESULTS: The findings indicate that women experience barriers both in reaching out to the healthcare system and within the healthcare system. Barriers prior to contact with the healthcare system include lack of information, husband and family influence on healthcare, and avoiding disclosing health problems. Barriers within the healthcare system include care providers with insufficient knowledge and poor attitudes of care providers. CONCLUSION: This study reveals multiple barriers to healthcare access that co-exist and overlap. This indicates that SSA immigrant women are 'left behind' in being able to access and use the Norwegian healthcare system. Therefore, appropriate interventions to improve access to healthcare should be considered in order to reach Universal Health Coverage, thus having a positive impact on the health of these women. Equitable healthcare should be reflected in policy and practice.


Assuntos
Circuncisão Feminina/psicologia , Emigrantes e Imigrantes/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Adulto , África ao Sul do Saara , Circuncisão Feminina/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Noruega , Inquéritos e Questionários
12.
Eur J Contracept Reprod Health Care ; 25(1): 33-36, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31922433

RESUMO

Objectives: The study aimed to investigate the mental health status of women with female genital mutilation/cutting (FGM/C) and compare it with that of a similar group of women without FGM/C.Methods: A case-control study was carried out in 2018 among 122 women with FGM/C and 125 women without FGM/C who had been referred to one of the general health service centres in Kermanshah Province, western Iran. The 28 item General Health Questionnaire (GHQ-28) was used to collect data on participants' mental health. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with the outcome variable, mental health status.Results: The mean age of the FGM/C and control groups was 35.7 (standard deviation [SD] 8.6) and 31.3 (SD 7.2) years, respectively. According to the GHQ-28 questionnaire, 65.6% (n = 80) of the FGM/C group and 52% (n = 65) of the control group had symptoms of a mental health disorder; the difference between the groups was statistically significant (p = .03). The prevalence of severe depression in the FGM/C group was significantly higher than in the control group (p = .021). Multivariate logistic regression showed that having a history of FGM/C (adjusted OR 1.79; 95% confidence interval [CI] 1.05, 3.05) and being in employment (adjusted OR 3.46; 95% CI 1.23, 9.74) had a significant effect on presentation with symptoms of a mental health disorder (p < .05).Conclusion: Women who suffer from FGM/C are more vulnerable to mental health disorders such as depression.


Assuntos
Circuncisão Feminina/psicologia , Depressão/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Depressão/psicologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Inquéritos e Questionários , Adulto Jovem
14.
Nat Hum Behav ; 4(1): 55-68, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31792402

RESUMO

For a policy-maker promoting the end of a harmful tradition, conformist social influence is a compelling mechanism. If an intervention convinces enough people to abandon the tradition, this can spill over and induce others to follow. A key objective is thus to activate such spillovers and amplify an intervention's effects. With female genital cutting as a motivating example, we develop empirically informed analytical and simulation models to examine this idea. Even if conformity pervades decision-making, spillovers can range from irrelevant to indispensable. Our analysis highlights three considerations. First, ordinary forms of individual heterogeneity can severely limit spillovers, and understanding the heterogeneity in a population is essential. Second, although interventions often target samples of the population biased towards ending the harmful tradition, targeting a representative sample is a more robust way to achieve spillovers. Finally, if the harmful tradition contributes to group identity, the success of spillovers can depend critically on disrupting the link between identity and tradition.


Assuntos
Cultura , Tomada de Decisões , Modelos Psicológicos , Conformidade Social , Identificação Social , Adulto , Circuncisão Feminina/psicologia , Feminino , Humanos
15.
Women Health ; 60(6): 636-651, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31711407

RESUMO

Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration.


Assuntos
Circuncisão Feminina/psicologia , Vítimas de Crime/psicologia , Saúde Mental/estatística & dados numéricos , Trauma Psicológico/epidemiologia , Refugiados/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Quênia/epidemiologia , Fatores de Risco , Somália/etnologia , Adulto Jovem
16.
Aust N Z J Obstet Gynaecol ; 60(1): 76-81, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31197824

RESUMO

BACKGROUND: Although prohibited by specific legislation in Australia, patterns of global migration underscore the importance for local clinicians to recognise and manage potential complications associated with female genital mutilation/cutting (FGM/C). The incidence of antenatal depression in Australia is 10% and may be higher among those with a history of FGM/C (RANZCOG 2 statement: Perinatal Anxiety and Depression, 2012). The phenomenon of cultural embedding could represent a protective factor against an increase in mental health problems among these women. AIM: To determine whether women who have undergone FGM/C are at greater risk of depression in the antenatal period as defined by the Edinburgh Postnatal Depression Scale (EPDS). MATERIALS AND METHODS: A multicentre retrospective case-control study was performed. Participants who had delivered at either of two hospitals, had migrated from FGM/C-prevalent countries and who had undergone FGM/C were assessed and compared with the control group, case-matched by language and religion. RESULTS: Eighty-nine cases were included with an equal number of matched controls. No significant difference in the EPDS score was demonstrated when analysed as a continuous variable (P = 0.41) or as a categorical variable with a cut-off score of 12 (P = 0.12). There was no difference in the number of women who identified as having thoughts of self-harm between the two groups. CONCLUSION: There was no identified increase in the risk of antenatal depression among women who have undergone FGM/C from high-prevalence countries. Consideration must be given to the utility of the EPDS in this population, as well as factors such as cultural embedding.


Assuntos
Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Depressão/epidemiologia , Adulto , África/etnologia , Austrália/epidemiologia , Estudos de Casos e Controles , Emigrantes e Imigrantes/psicologia , Feminino , Humanos , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Medição de Risco
17.
PLoS One ; 14(12): e0225629, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800614

RESUMO

BACKGROUND: The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. METHODS: In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants' approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala's B-statistic and Welch's t-test were used. RESULTS: We found a substantial agreement between an individual's own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis-and especially other Swedish Somali women-approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3-27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4-9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%). CONCLUSIONS: Swedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC.


Assuntos
Circuncisão Feminina/psicologia , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Feminino , Humanos , Masculino , Casamento , Pessoa de Meia-Idade , Suécia
18.
BMJ Open ; 9(10): e034140, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31628134

RESUMO

INTRODUCTION: Female genital mutilation (FGM) is a significant global health concern and is likely to become an increasingly important healthcare challenge in destination countries such as the UK owing to rising levels of migration from FGM-affected countries. Currently, there is no consensus on the optimal timing of deinfibulation (opening) surgery for women who have experienced type 3 FGM and care provision remains suboptimal in the UK. This qualitative study aims to explore the views of survivors, male partners and healthcare professionals (HCPs) on the timing of deinfibulation and delivery of NHS FGM services. METHODS AND ANALYSIS: A qualitative study, informed by the Sound of Silence conceptual framework, will be undertaken via two work packages (WPs). WP1 will explore views on timing preferences for deinfibulation and NHS FGM services through interviews and discussion groups with FGM survivors (n~50), male partners (n~10) and HCPs (n~50). WP2 will use established techniques via two workshops (community (n~20-25 participants) and national stakeholder (n~30-35 participants)) to synthesise qualitative research findings and inform best practice and policy recommendations around the timing of deinfibulation and NHS FGM care provision. Supported by trained interpreters, data collection will be audio recorded and transcribed. Data will be analysed using the framework method to facilitate a systematic mapping and exploration of qualitative data from multiple sources. ETHICS AND DISSEMINATION: The study has received ethical approval from the North West Greater Manchester East Research Ethics Committee (18/NW/0498). The outputs for this study will be recommendations for best practice and policy around FGM care provision that reflects the views and preferences of key stakeholders. The findings will be disseminated via conference presentations, peer-reviewed publications, patient groups, third sector organisations and social media. TRIAL REGISTRATION NUMBER: ISRCTN 14710507.


Assuntos
Circuncisão Feminina/psicologia , Pessoal de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Parceiros Sexuais/psicologia , Sobreviventes/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Reoperação/psicologia , Reoperação/normas , Projetos de Pesquisa , Medicina Estatal , Fatores de Tempo , Reino Unido
19.
Sex Reprod Health Matters ; 27(1): 1615364, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533573

RESUMO

Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called "the FGM standard tale". The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia's role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual's body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.


Assuntos
Atitude do Pessoal de Saúde , Circuncisão Feminina/psicologia , Pessoal de Saúde/psicologia , Saúde Sexual , Imagem Corporal , Feminino , Humanos , Entrevistas como Assunto , Autoimagem , Aconselhamento Sexual , Suécia , Saúde da Mulher
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