Nurses and Requests for Female Genital Mutilation: cultural rights versus human rights

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

Comparative Study of Meanings, Beliefs, and Practices of Female Circumcision Among Three Nigerian Tribes in the United States and Nigeria

The study was conducted to gain insight into the meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. Participant-observations occurred in three sites in Nigeria (Ibadan, Lagos, and Owerri) and in Essex County, New Jersey (Newark, Irvington, and East Orange). A total of 50 informants included adult males and females from the three main Nigerian ethnic tribes: Igbo, Yoruba, and Hausa. Leininger’s culture care theory of diversity and universality was the study framework. Findings revealed existence of similarities and differences in the cultural meanings, beliefs, and practices among the tribes. Religion, education, and occupation were significant factors influencing informants’ attitudes toward continuation of the practice. Government-sponsored public education and influence by the media were found to increase informants’ awareness of complications of female circumcision. Changes in attitudes toward the practice and use of alternative practices were evident.

Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on "FGM"

The spectrum of practices termed "Female Genital Mutilation" (or FGM) by the World Health Organization is sometimes held up as a counterexample to moral relativism. Those who advance this line of thought suggest the practices are so harmful in terms of their physical and emotional consequences, as well as so problematic in terms of their sexist or oppressive implications, that they provide sufficient, rational grounds for the assertion of a universal moral claim--namely, that all forms of FGM are wrong, regardless of the cultural context. However, others point to cultural bias and moral double standards on the part of those who espouse this argument, and have begun to question the received interpretation of the relevant empirical data on FGM as well. In this article I assess the merits of these competing perspectives. I argue that each of them involves valid moral concerns that should be taken seriously in order to move the discussion forward. In doing so, I draw on the biomedical "enhancement" literature in order to develop a novel ethical framework for evaluating FGM (and related interventions--such as female genital "cosmetic" surgery and nontherapeutic male circumcision) that takes into account the genuine harms that are at stake in these procedures, but which does not suffer from being based on cultural or moral double standards.

Female Genital Mutilation Is a Violation of Reproductive Rights of Women: Implications for Health Workers

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. This coercive practice is still prevalent in many parts of the world, in both developed and developing countries. However, FGM is more prevalent in African countries and some Asian countries. In this study, an attempt has been made to understand the prevalence and practice of FGM worldwide and its adverse effects on women's reproductive health. To fulfill the study objectives, the author collected evidence from various studies conducted by international agencies. Many studies found that FGM has no health benefits; is mostly carried out on girls before they reach the age of 15 years; can cause severe bleeding, infections, psychological illness, and infertility; and, most important, can have serious consequences during childbirth. The practice is mainly governed by the traditions and cultures of the communities without having any scientific or medical benefit. In conclusion, FGM is a practice that violates the human and reproductive rights of women.

Geographic Variation and Factors Associated with Female Genital Mutilation among Reproductive Age Women in Ethiopia: A National Population Based Survey

Background

Female genital mutilation (FGM) is a common traditional practice in developing nations including Ethiopia. It poses complex and serious long-term health risks for women and girls and can lead to death. In Ethiopia, the geographic distribution and factors associated with FGM practices are poorly understood. Therefore, we assessed the spatial distribution and factors associated with FGM among reproductive age women in the country.

Method

We used population based national representative surveys. Data from two (2000 and 2005) Ethiopian demographic and health surveys (EDHS) were used in this analysis. Briefly, EDHS used a stratified, two-stage cluster sampling design. A total of 15,367 (from EDHS 2000) and 14,070 (from EDHS 2005) women of reproductive age (15–49 years) were included in the analysis. Three outcome variables were used (prevalence of FGM among women, prevalence of FGM among daughters and support for the continuation of FGM). The data were weighted and descriptive statistics (percentage change), bivariate and multivariable logistic regression analyses were carried out. Multicollinearity of variables was assessed using variance inflation factors (VIF) with a reference value of 10 before interpreting the final output. The geographic variation and clustering of weighted FGM prevalence were analyzed and visualized on maps using ArcGIS. Z-scores were used to assess the statistical difference of geographic clustering of FGM prevalence spots.

Result

The trend of FGM weighted prevalence has been decreasing. Being wealthy, Muslim and in higher age categories are associated with increased odds of FGM among women. Similarly, daughters from Muslim women have increased odds of experiencing FGM. Women in the higher age categories have increased odds of having daughters who experience FGM. The odds of FGM among daughters decrease with increased maternal education. Mass media exposure, being wealthy and higher paternal and maternal education are associated with decreased odds of women’s support of FGM continuation. FGM prevalence and geographic clustering showed variation across regions in Ethiopia.

Conclusion

Individual, economic, socio-demographic, religious and cultural factors played major roles in the existing practice and continuation of FGM. The significant geographic clustering of FGM was observed across regions in Ethiopia. Therefore, targeted and integrated interventions involving religious leaders in high FGM prevalence spot clusters and addressing the socio-economic and geographic inequalities are recommended to eliminate FGM.

A qualitative study exploring how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England

OBJECTIVES

To explore how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England. We explored women's perceptions of deinfibulation, caesarean section and vaginal delivery; their experiences of care during pregnancy and labour; and factors that affect ability to access these services, in order to make recommendations about future practice.

DESIGN

A descriptive, exploratory qualitative study using face-to-face semistructured interviews. Interviews were audio-recorded, transcribed and data were analysed using a thematic approach. An interpreter was used when required (n=3).

SETTING

Participants recruited from 2 community centres in Birmingham, England.

PARTICIPANTS

Convenience and snowball sample of 10 Somali women resident in Birmingham, who had accessed antenatal care services in England within the past 5 years.

RESULTS

3 core themes were interpreted: (1) Experiences of female genital mutilation during life, pregnancy and labour: Female genital mutilation had a significant physical and psychological impact, influencing decisions to undergo deinfibulation or caesarean section. Women delayed deinfibulation until labour to avoid undergoing multiple operations if an episiotomy was anticipated. (2) Experience of care from midwives: Awareness of female genital mutilation from midwives led to open communication and stronger relationships with women, resulting in more positive experiences. (3) Adaptation to English life: Good language skills and social support networks enabled women to access these services, while unfavourable social factors (eg, inability to drive) impeded.

CONCLUSIONS

Female genital mutilation impacts Somali women's experiences of antenatal and intrapartum care. This study suggests that midwives should routinely ask Somali women about female genital mutilation to encourage open communication and facilitate more positive experiences. As antenatal deinfibulation is unpopular, we should consider developing strategies to promote deinfibulation to non-pregnant women, to align with current guidelines. Women with unfavourable social factors may require additional support to improve access to English antenatal care services.

Sexual Health Care, Sexual Behaviors and Functioning, and Female Genital Cutting: Perspectives From Somali Women Living in the United States

We investigated the sexual values, attitudes, and behaviors of 30 Somali female refugees living in a large metropolitan area of Minnesota by collecting exploratory sexual health information based on the components of the sexual health model-components posited to be essential aspects of healthy human sexuality. A Somali-born bilingual interviewer conducted the semistructured interviews in English or Somali; 22 participants chose to be interviewed in Somali. Interviews were translated, transcribed, and analyzed using descriptive statistics and thematic analyses. Our study findings highlighted a sexually conservative culture that values sexual intimacy, female and male sexual pleasure, and privacy in marriage; vaginal sexual intercourse as the only sanctioned sexual behavior; and the importance of Islamic religion in guiding sexual practices. Findings related to human immunodeficiency virus (HIV) revealed HIV testing at immigration, mixed attitudes toward condom use, and moderate knowledge about HIV transmission modes. Female genital cutting (FGC) was a pervasive factor affecting sexual functioning in Somali women, with attitudes about the controversial practice in transition. We recommend that health professionals take the initiative to discuss sexual health care and safer sex, sexual behaviors/functioning, and likely challenges to sexual health with Somali women--as they may be unlikely to broach these subjects without permission and considerable encouragement.

Female circumcision in Nigeria and attitudes towards its discontinuation

BACKGROUND

Female Circumcision (FC) is a harmful traditional practice and remains a public health problem particularly in the era of HIV/AIDS. Aside its numerous health implications, it can cause infertility, complications in childbirth and increased risk of newborn deaths. FC is widely practised in Nigeria.

OBJECTIVE

The study assessed the level of FC, daughters' circumcision and attitude towards discontinuation of the practice among women of reproductive age.

METHODS

Data were extracted from the 2008 Nigeria Demographic Health and Survey. Data were analysed using Chi-square and binary logistic regression models (á = 0.05).

RESULTS

Among the respondents, prevalence of FC was 49.2% with 30.6% having circumcised their daughters and 25.8% wishing the practice to continue. About 56% of circumcised women also circumcised their daughters whereas only 2.9% of uncircumcised women circumcised their daughters. Approximately 69.8% of women who had circumcised their daughters would like FC to continue compared to 8.8% of those who never circumcised any of their daughters. The likelihood of FC was higher (OR = 2.07; C.I = 1.85-2.30) among Moslems compare to Christians. Igbo women were less likely to discontinue FC compared to women of Hausa/Fulani ethnic group despite controlling for the confounding variables (OR = 0.57; C.I = 0.35-0.91).

CONCLUSION

Female circumcision is still practiced in all parts of Nigeria and a high proportion of women reported that the practice should continue. There is need to intensify efforts on the campaign against female circumcision in Nigeria.

Female genital cutting in Hargeisa, Somaliland: is there a move towards less severe forms?

According to several sources, little progress is being made in eliminating the cutting of female genitalia. This paper, based on qualitative interviews and observations, explores perceptions of female genital cutting and elimination of the phenomenon in Hargeisa, Somaliland. Two main groups of participants were interviewed: (1) 22 representatives of organisations whose work directly relates to female genital cutting; and (2) 16 individuals representing different groups of society. It was found that there is an increasing use of medical staff and equipment when a girl undergoes the procedure of female genital cutting; the use of terminology is crucial in understanding current perceptions of female genital cutting; religion is both an important barrier and facilitator of elimination; and finally, traditional gender structures are currently being challenged in Hargeisa. The findings of this study suggest that it is important to consider current perceptions on practices of female genital cutting and on abandonment of female genital cutting, in order to gain useful knowledge on the issue of elimination. The study concludes that elimination of female genital cutting is a multifaceted process which is constantly negotiated in a diversity of social settings.

FGM: dispelling the myths; exploring the facts

Female genital mutilation is a process that affects our practice. It is becoming more common in our ever-diversifying population and therefore education is vitally important to be able to put robust care plans in place. Understanding the psychological and physical difficulties experienced by women of childbearing age can help us to improve the care that we, as maternity healthcare professionals, can deliver. Looking at current research, this article examines some of the presumed cultural and societal beliefs behind the procedure and highlights some new evidence that change is welcomed by women and their families.

(Im)perishable Pleasure, (In)destructible Desire: Sexual Themes in U.S. and English News Coverage of Male Circumcision and Female Genital Cutting

Under what conditions do sexual pleasure and desire get addressed in news coverage of sexual health issues like female genital cutting (FGC) and male circumcision (MC)? In this study we employed an embodied ethnosexuality approach to analyze sexual themes in 1,902 items published from 1985 to 2009 in 13 U.S. and 8 English newspapers and news magazines. Journalists' discussions of sexual pleasure, desire, control, problems, and practices differed in quantity and quality depending on the practice and nation to which they pertained. News coverage in both nations presented FGC as impeding female sexual pleasure, desire, and activity in ways that reinforce (hetero)sexist understandings of sexuality. The English press depicted MC as diminishing male sexuality, whereas U.S. papers showed it as enhancing male sexuality. These patterns are influenced by, and serve to reinforce, cultural norms of embodiment and ethnosexual boundaries based on gender, race, and nationality. They may, in turn, shape public understandings of FGC and MC as social problems.

Reflections on female circumcision discourse in Hargeysa, Somaliland: purified or mutilated?

In communities where female circumcision is carried out, increasingly large segments of the population have been exposed to strong arguments against the practice. This study aimed to explore diverse discourses on female circumcision and the relationship between discourses and practice among informants who have been exposed both to local and global discourses on female circumcision. A qualitative study was carried out in 2009/10 in Hargeysa, Somaliland, employing interviews and informal discussion. The main categories of informants were nurses, nursing students, returned exile Somalis and development workers. The study findings suggest that substantial change has taken place about perceptions and practice related to female circumcision; the topic is today openly discussed, albeit more in the public than in the private arena. An important transformation moreover seems to be taking place primarily from the severe forms (pharaoni) to the less extensive forms (Sunna).

Prevalence and belief in the continuation of female genital cutting among high school girls: a cross - sectional study in Hadiya zone, Southern Ethiopia

BACKGROUND

Female Genital Cutting is a cultural practice among many ethnic groups in Ethiopia that has affected many girls over the past centuries. Although the trend is slowly decreasing in Ethiopia, the magnitude is still very high as the procedure has no known benefit but has many consequences. The objective of this study was to assess the prevalence and belief in the continuation of FGC among High School Girls in Hadiya Zone.

METHODS

A cross-sectional quantitative survey was carried out among high school girls in Hadiya Zone from January to February 2011. A multi-staged cluster sampling method was used for sample selection. In total, 780 girls completed a self-administered questionnaire for this study. Statistical analysis was done using bivariate and multivariate logistic regression.

RESULTS

Of 780 high school girls, 82.2% were circumcised at a mean age of 11(±2.3) years. Half of the total participants responded that FGC was being practiced in their village. About 60% of the circumcisions were performed by traditional circumcisers while health professionals had performed 30% of them. A few of the circumcised girls (9.4%) supported their status as a circumcised girl, but only 5% believe in the continuation of FGC. The odds of being cut was higher among girls whose fathers and mothers had educational status under high school level (AOR = 2.04; 95% CI: 1.25, 3.09) and (AOR = 1.84; 95% CI: 1.01, 3.38) respectively when compared to those whose parents had attended high school and above. The odds of believing in the continuation of FGC was 2.33(95% CI: 1.01, 5.33) times higher among those who responded that FGC was practiced in their areas.

CONCLUSION

While there is an urgent need to stop the practice of FGC in Hadiya Zone, cultural beliefs related to the hygiene of female genitalia and other social factors contribute to sustaining the practice. Local organizations in collaboration with religious institutions and community leaders should work together to engage in a process of change within the entire community by arranging awareness creation programmes on the harmfulness of the practice especially in the rural areas of the zone.

"It is important to know that before, there was no lawalawa." Working to stop female genital mutilation in Tanzania

This article is about efforts to unearth the facts about a myth in Tanzania about lawalawa, and the use of female genital mutilation (FGM) by some Tanzanian ethnic groups to cure lawalawa. The term lawalawa, used to describe certain vaginal and urinary tract infections, appeared soon after 1968, following the ban on FGM in the Arusha Declaration, and is still used today. When working with these ethnic groups on the subject of eliminating FGM, one always hears about lawalawa. Today, the arguments for using FGM to cure lawalawa are used not only in relation to small children, but also adolescent girls and boys. Lawalawa is not always limited to vaginal and urinary tract infections, but sometimes also when girls or boys have a fever for other reasons. This article is based on information from the continuous work against FGM in 45 villages by the Singida and Dodoma chapters of the Inter-African Committee on Traditional Practices, Tanzania, from 2003 through 2012. The lesson we have learned is that the only way of eliminating FGM is to accept lawalawa as a fact and to give information and counselling. Only in this way, and not by force, will it be possible to break the connection between lawalawa and FGM.

A tradition in transition: factors perpetuating and hindering the continuance of female genital mutilation/cutting (FGM/C) summarized in a systematic review

Understanding the forces underpinning female genital mutilation/ cutting (FGM/C) is a necessary first step to prevent the continuation of a practice that is associated with health complications and human rights violations. To this end, a systematic review of 21 studies was conducted. Based on this review, the authors reveal six key factors that underpin FGM/C: cultural tradition, sexual morals, marriageability, religion, health benefits, and male sexual enjoyment. There were four key factors perceived to hinder FGM/C: health consequences, it is not a religious requirement, it is illegal, and the host society discourse rejects FGM/C. The results show that FGM/C appears to be a tradition in transition.

Labia minora elongation as understood by Baganda male and female adolescents in Uganda

Labia minora elongation is a common traditional female genital modification practice among the members of the Baganda ethnic group in Uganda. In 2002, a study carried out by the Padua Working Group on Female Genital Mutilation analysed how Baganda girls residing in Wakiso District graphically represented their experiences of labia minora elongation. In the present study, using the same methodology and in the same geographic setting 10 years later, we asked young men and women to prepare graphical representations of this rite. The purpose was to learn about how the practice is perceived and represented, describing the differences found in their testimonies, and comparing the findings with the former study. A total of 36 respondents (21 male and 15 female), aged between 9 and 15 years old participated in the study. The drawings were analysed using a three-themes analysis frame with a focus on setting, subject and operator. Differences were detected between how young women and men represented this practice. Educational interventions may be helpful to address the doubts, concerns, anxieties and misconceptions that Baganda youth may have concerning traditional genital practices.