Women's empowerment and the intention to continue the practice of female genital cutting in Egypt

BACKGROUND

The study aimed to (dis)prove the association of the level of women's empowerment with their future intention to perpetuate female genital cutting for their daughters.

METHODS

In a national representative community-based sample of 14,393 currently-married women in Egypt, the level of empowerment, intention to continue the practice, and other socio- demographic variables were collected in the 2000 Egypt Demographic and Health Survey. Secondary in-depth analysis was conducted on data downloaded from MEASURE Demographic Health Surveys (MEASURE DHS) website.

RESULTS

About 14% of the women intended to discontinue the practice. Twenty-six percent of the women were empowered in all household decisions. Levels of women's empowerment adjusted for age, residence, education, interaction between empowerment and education, work status, and female genital cutting status of currently-married women were entered in six logistic regression models in a sequential way.

CONCLUSION

In the last model, those of high levels of empowerment and education were 8.06 times more likely not intending to perpetuate female genital cutting for their daughters than low- empowered low-educated women.

[Female circumcision--a new issue for gynecologists practicing in the E.U. countries?]

An increasing number of immigrants from countries practicing female genital mutilation (FGM) has begun to concern Europe as well. The aim of this article is to present recent medical data about FGM which, in the age of globalisation and migration of people, may become essential for gynaecologists working in Poland, but also those practising abroad.

Female genital mutilation

This article examines female genital mutilation and describes how a midwifery-led clinic was developed to meet the needs of women affected by this practice.

Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden

OBJECTIVE

to explore Eritrean immigrant women's experiences of female genital mutilation (FGM) during pregnancy, childbirth and the postpartum period.

DESIGN

qualitative study using an ethnographic approach. Data were collected via tape-recorded interviews.

SETTING

interviews in the Eritrean women's homes located in and around Uppsala, Sweden.

PARTICIPANTS

15 voluntary Eritrean immigrant women.

DATA COLLECTION AND ANALYSIS

Semi-structured interview and open-ended questions were used. The interviews were tape-recorded, transcribed verbatim and then analysed.

FINDINGS

six themes of experiences of FGM among Eritrean women during pregnancy and childbirth were identified. They are (1) fear and anxiety; (2) extreme pain and long-term complications; (3) health-care professionals' knowledge of circumcision and health-care system; (4) support from family, relatives and friends; (5) de-infibulation; and (6) decision against female circumcision of daughters.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

the Eritrean women had experiences of FGM and had suffered from its complications during pregnancy, childbirth and the postpartum period. Midwives and obstetricians should have competence in managing women with FGM, and they need increased understanding of cultural epistemology in order to be able to provide quality care to these women. At antenatal centres, circumcised women should be advised to de-infibulate before pregnancy. Special courses about anatomical differences should be offered to these women and their husbands. It is also important to inform them about Swedish law, which prohibits all forms of FGM.

Rwandan female genital modification: elongation of the Labia minora and the use of local botanical species

The elongation of the labia minora is classified as a Type IV female genital mutilation by the World Health Organization. However, the term mutilation carries with it powerful negative connotations. In Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male and female pleasure. Women regard these practices as a positive force in their lives. This paper aims to assess whether Rwandan vaginal practices should indeed be considered a form of female genital mutilation and whether the botanicals used by women are detrimental to their health. Research was carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were conducted with thirteen informants. Two botanicals applied during stretching sessions were identified as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to describe Rwandan vaginal practices as female genital modification rather than mutilation.

The impact of female genital cutting on health of newly married women

OBJECTIVE

To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems.

METHODS

Randomly selected (264) newly married women were the subjects of this work.

RESULTS

Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's dissatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001).

CONCLUSION

Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.

Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention

Female Genital Mutilation (FGM) which involves alteration of the female genitalia for non-medical grounds is prevalent in Sub-Saharan Africa, associated with long-term genitourinary complications, and possible HIV transmission. This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure. We performed an electronic search using Medline for articles published between 1966 to 2006 for evidence of FGM practice, its complications, and the nexus between this procedure and HIV sero-positivity. The results indicate ongoing FGM practice, albeit prevalence reduction, due probably to the increasing knowledge of the consequences of FGM as a result of non-sterile techniques. Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies in order to assess the association between FGM and HIV transmission.

Female genital mutilation: Experience in a West London clinic

In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously.

Swedish health care providers' experience and knowledge of female genital cutting

We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden.A majority of Swedish health care providers meet patients presenting with evidence of FGC performed long ago. However, very few of them have suspected recently cut patients. The results support the hypothesis that this practice is not as active among African immigrants in Sweden as in their countries of origin. If the prevalence was the same as in African countries, more pediatricians would be expected to meet current cut girls. National efforts and policy programs to prevent FGC in Sweden are recommended as effective, in accordance with current research and should especially be directed toward pediatricians.

REVIEW: Customs, Culture, and Tradition—What Role Do They Play in a Woman’s Sexuality?

INTRODUCTION

Sexual health is an assumed right for every individual, but we know little regarding customs, culture, or tradition and the role they play on the sexual experiences for a woman. A woman's sexuality must be considered in the context of the environment in which she and her partner live. Culture, social customs of the community, and religion often determine the acceptance and achievement of sexual health for both men and women.

AIM

This is a review of the available literature on the impact of culture on a woman's sexual satisfaction, with emphasis placed on information from cultures practicing female genital circumcision (FGC).

RESULTS

FGC provides a spectrum of surgical excisions and outcomes. The spectrum of FGC surgical excisions can alter well-being, obstetrical outcomes, and sexual responses. The psychologic aspects of a painful procedure in a young child may also impact her future sexual responsiveness.

CONCLUSION

There is a paucity of information on which to base conclusions and the effect of culture on a woman's sexual satisfaction. Preliminary data suggest the need for further research using markers specific to the culture and her satisfaction.

An Exploration of Female Genital Mutilation

Female genital mutilation (FGM) is a form of violence against women that has recently been labeled a public health issue. This article will define and describe the procedure as well as discuss its physical and psychological implications. An exploration of the cultural significance of the practice will shed light on its continued existence in underdeveloped and developed nations. In addition, an examination of suggested guidelines for creating and implementing effective interventions will ensue.

Being victims or beneficiaries? Perspectives on female genital cutting and reinfibulation in Sudan

Female Genital Mutilation (FGM) or the more value neutral term, Female Genital Cutting (FGC) is widely practised in northern Sudan, where around 90% of women undergo the most extensive form of FGC, infibulation. One new approach to combating FGC in Sudan is to acknowledge the previously hidden form of FGC, reinfibulation (RI) after delivery, when the woman is sewn back so much as to mimic virginity. Based on a qualitative study in Khartoum State, this article explores Sudanese women's and men's perceptions and experiences of FGC with emphasis on RI after delivery. The results showed that both genders blame each other for the continuation of the practices, and the comprehensive understanding of the perceptions and experiences was that both the women and the men in this study were victims of th e consequences of FGC and RI. The female narratives could be understood in the three categories: viewing oneself as being "normal" in having undergone FGC and RI; being caught between different perspectives; and having limited influence on the practices of FGC and RI. The male narratives could be understood in the three categories: suffering from the consequences of FGC and RI, trying to counterbalance the negative sexual effects of FGC and striving in vain to change female traditions. The results indicate that the complexity of the persistence of FGC and RI goes far beyond being explained by subconscious patriarchal and maternalistic actions, related to socially constructed concepts of normality, female identity,tradition and religion a"silent" culture betweenmen and women.

"Taming tradition": medicalized female genital practices in western Kenya

This article considers the question of female genital practices at the hands of health workers in western Kenya. Recent articles in Medical Anthropology Quarterly have critically engaged with the biomedical arguments condemning such practices. This article studies the case of medicalized circumcision in which biomedical concerns over health risks have become incorporated in their vernacular practice. Although some suggest that medicalization may provide a harm-reduction strategy to the abandonment of the practice, research in one region challenges this suggestion. It argues that changing and conflicting ideologies of gender and sexuality have led young women to seek their own meaning through medicalized practice. Moreover, attributing this practice to financial motivations of health workers overlooks the way in which these "moral agents" must be situated within their social and cultural universe. Together, these insights challenge the view that medicine can remain neutral in the mediation of tradition.

Health Care in Europe for Women with Genital Mutilation

The increasing number of immigrants from African countries practicing female genital mutilation (FGM) has raised concern in Europe. Health care professionals have developed three main responses: (1) technical guidelines for clinical management; (2) codes of conduct on quality of care; and (3) specialised health services for medical and psychological care and counselling. Much remains to be done, however, to ensure adequate care in Europe: (1) medico-legal/ethical discussions; (2) development of protocols to assist in making informed decisions; and (3) development of guidelines on counselling, communication strategies, and referral procedures. All agencies working in the field of FGM should be interlinked at the national level, in which members of the affected communities should be included. At the European level, a coordinated approach between all agencies should be developed.

Being different and vulnerable: experiences of immigrant African women who have been circumcised and sought maternity care in Sweden

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.

What do medical students in Alexandria know about female genital mutilation?

We explored the knowledge, beliefs and attitudes of 330 5th year medical students in Alexandria University towards female genital mutilation (FGM). The students' basic knowledge about the practice of FGM was unsatisfactory. Students were unaware of the prevalence of FGM in Egypt and the practices and procedures of FGM. They were also poorly informed about the complications of FGM, and the ethical and legal aspects of FGM in the country. As a result, 52.0% of the students supported the continuation of the practice and 73.2% were in favour of its "medicalization" as a strategy for reducing the risks of FGM. Most students (86.9%) thought that the issue of FGM should be incorporated into the undergraduate medical curriculum.

Virginity testing in South Africa: re-traditioning the postcolony

Umhlanga is a ceremony celebrating virginity. In South Africa, it is practiced, among others, by the Zulu ethnic group who live mainly in the province of KwaZulu Natal. After falling into relative disuse in the Zulu community, the practice of virginity testing made a comeback some 10 years ago at around the time of the country's first democratic election and coinciding with the period when the HIV pandemic began to take hold. In July 2005 the South African Parliament passed a new Children's Bill which will prohibit virginity testing of children. The Bill has been met with outrage and public protest on the part of Zulu citizens. Traditional circumcision rites are also addressed in the new bill but are not banned. Instead, male children are given the right to refuse to participate in traditional initiation ceremonies which include circumcision. This paper asks why the practice of virginity testing is regarded as so troubling to the new democratic order that the state has chosen to take the heavy-handed route of banning it. The paper further asks why the state's approach to traditional male circumcision has been so different to its approach to virginity testing. Finally, the paper asks what these two challenging cases in the country's new democracy tell us about the nature of liberal democratic citizenship in South Africa 10 years after apartheid's formal demise.