| 1. |
- Hanberger, Adam, et al.
(författare)
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Attitudes towards comparison of male and female genital cutting in a Swedish Somali population
- 2021
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 100:4, s. 604-613
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Jordal, Malin, 1973-, et al.
(författare)
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Challenges in providing quality care for women with female genital cutting in Sweden : A literature review
- 2018
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 17, s. 91-96
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Tidskriftsartikel (refereegranskat)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.
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| 3. |
- Jordal, Malin, 1973-, et al.
(författare)
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"Damaged genitals"-Cut women's perceptions of the effect of female genital cutting on sexual function. A qualitative study from Sweden
- 2022
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Ingår i: Frontiers in Sociology. - : Frontiers Media S.A.. - 2297-7775. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Female genital cutting (FGC) is a traditional practice, commonly underpinned by cultural values regarding female sexuality, that involves the cutting of women's external genitalia, often entailing the removal of clitoral tissue and/or closing the vaginal orifice. As control of female sexual libido is a common rationale for FGC, international concern has been raised regarding its potential negative effect on female sexuality. Most studies attempting to measure the impact of FGC on women's sexual function are quantitative and employ predefined questionnaires such as the Female Sexual Function Index (FSFI). However, these have not been validated for cut women, or for all FGC-practicing countries or communities; nor do they capture cut women's perceptions and experiences of their sexuality. We propose that the subjective nature of sexuality calls for a qualitative approach in which cut women's own voices and reflections are investigated. In this paper, we seek to unravel how FGC-affected women themselves reflect upon and perceive the possible connection between FGC and their sexual function and intimate relationships. The study has a qualitative design and is based on 44 individual interviews with 25 women seeking clitoral reconstruction in Sweden. Its findings demonstrate that the women largely perceived the physical aspects of FGC, including the removal of clitoral tissue, to affect women's (including their own) sexual function negatively. They also recognized the psychological aspects of FGC as further challenging their sex lives and intimate relationships. The women desired acknowledgment of the physical consequences of FGC and of their sexual difficulties as "real" and not merely "psychological blocks".
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| 4. |
- Jordal, Malin, 1973-, et al.
(författare)
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Surgical Healthcare Interventions after Female Genital Mutilation/Cutting : A Review of the Evidence
- 2022
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Ingår i: CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY. - : IMR Press. - 0390-6663 .- 2709-0094. ; 49:6
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Forskningsöversikt (refereegranskat)abstract
- Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them.Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review.Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects.Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical intervention after FGM/C, which may have implications for healthcare recommendations as well as satisfaction. This apparent ambiguity between providers' and recipients' perceptions of surgical interventions needs further investigation.
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| 5. |
- Jordal, Malin, 1973-, et al.
(författare)
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The benefits and disappointments following clitoral reconstruction after female genital cutting : A qualitative interview study from Sweden
- 2021
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Ingår i: PLOS ONE. - : PLoS. - 1932-6203. ; 16:7
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Tidskriftsartikel (refereegranskat)abstract
- Female genital cutting or mutilation refers to the cutting of girls' external genitalia. Due to migration from contexts where female genital cutting is common, it is estimated that around 38 000 cut women and girls live in Sweden. Clitoral reconstruction, a relatively new form of surgical healthcare offered to women with female genital cutting, was established in Sweden in 2014. This surgery aims at restoring clitoral function and anatomy, but there is yet a dearth of evidence demonstrating the effects of the surgery. The aim of this study was to explore how women undergoing clitoral reconstruction in Sweden between 2016 and 2019 experienced the surgical process and its aftereffects from a physical, sexual and psychosocial perspective. Eighteen women who had undergone clitoral reconstruction at a university hospital in Sweden agreed to participate in the study. The women were interviewed using semi-structured interviews, which were recorded, transcribed and analysed using thematic analysis. The results, based on self-categorization and labelling theory, demonstrated both benefits and disappointments following the surgery. Several women reported positive outcomes in terms of sexual, psychosocial and aesthetic terms. They experienced reduced genital pain, improvements in their sex lives, and a sense of feeling more empowered and at ease in their bodies. Yet, some women reported aesthetic, functional and process-related disappointment related to clitoral reconstruction. Nonetheless, the women expressed gratitude for the possibility of undergoing the surgery. In conclusion, the women reported that they experienced physical, sexual and psychosocial benefits of the surgery.
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| 6. |
- Wahlberg, Anna, 1988-, et al.
(författare)
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Baseline data from a planned RCT on attitudes to female genital cutting after migration : when are interventions justified?
- 2017
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- 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 NCT02335697; Pre-results.
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| 7. |
- Wahlberg, Anna, 1988-, et al.
(författare)
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Causes of death among undocumented migrants in Sweden, 1997-2010
- 2014
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 7, s. 24464-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country’s Cause of Death Register (CDR).Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants.Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample’s mean age at death±a half standard deviation.Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14).Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.
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| 8. |
- Wahlberg, Anna, 1988-
(författare)
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Continuity or Change? : Improved Understanding of Attitudes Towards Female Genital Cutting after Migration from Somalia to Sweden
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semi-structured interviews and focus group discussions were conducted. Data were collected in 2015.The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.
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| 9. |
- Wahlberg, Anna, 1988-, et al.
(författare)
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Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants : a cross-sectional study in Sweden
- 2017
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Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; :14:92
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis. Results: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44–20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46–5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25–13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. Conclusions: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values.
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| 10. |
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