1
|
McQuaid JH, Mandavia A, Cassidy G, Silva MA, Esmail K, Aragula S, Gamez G, McKenzie K. Persecution as stigma-driven trauma: Social determinants, stigma, and violence in asylum seekers in the United States. Soc Sci Med 2024; 350:116761. [PMID: 38701637 DOI: 10.1016/j.socscimed.2024.116761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Existing literature documents high rates of experienced violence in asylum seekers. Despite this high prevalence, experiences of traumatic stress are neither necessary nor sufficient grounds for claiming asylum, without documented experiences of persecution. The aim of the current study is to better understand the role of co-occurring pre-migratory social determinants, stigma, and trauma on the experiences of persecution among asylum seekers in the United States. METHOD We conducted a retrospective file review of legal declarations submitted by 25 asylum seekers who participated in forensic mental health evaluations at a pro-bono asylum clinic. We coded de-identified data for co-occurring events of trauma, social determinants of health, and components of "discrimination" from the legal definition of persecution - conceptualizing persecution as stigma-driven infliction of violence. Data was analyzed using a tiered deductive and inductive reflexive thematic analysis. RESULTS Findings suggest pre-migratory social determinants included demographics, neighborhood, economic, environmental, and social and cultural level disparities across various grounds for seeking asylum, and experiences of stigma were associated with the specific acts of violence and harm. CONCLUSIONS Our findings - specific to asylum seekers who have obtained legal representation and completed applications for asylum in the United States - describe the co-occurrence of social determinants, stigma and traumatic experiences among asylum seekers. To our knowledge, this study is the first of its kind to bridge the existing legal framework of asylum to a psychological construct incorporating trauma, stigma, and social determinants of health, lending support for the conceptualization of persecution as stigma-driven trauma.
Collapse
|
2
|
Cayreyre L, Korchia T, Loundou A, Jego M, Théry D, Berbis J, Gentile G, Auquier P, Khouani J. Lifetime sexual violence experienced by women asylum seekers and refugees hosted in high-income countries: Literature review and meta-analysis. J Forensic Leg Med 2024; 101:102622. [PMID: 38061112 DOI: 10.1016/j.jflm.2023.102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
Screening and care for victims of sexual violence (SV) among asylum seekers and refugees (ASRs) living in High-income host countries were prioritized by the WHO in 2020. The lack of stabilized prevalence findings on lifetime SV among ASRs in High-income countries hinders the development of adequate health management. The objective of this study was to determine the lifetime prevalence of SV experienced by ASRs living in High-income countries. We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in the meta-analysis if the sample consisted exclusively of asylum seekers or refugees over the age of 16 living in High-income countries and if they reported a lifetime prevalence of experienced SV. The results of the meta-analysis were expressed with 95 % confidence intervals (CIs) as estimates of lifetime SV prevalence using a random-effects model. The estimated lifetime prevalence of SV among women ASRs was 44 % (95 % CI, 0.24-0.67) and 27 % (95 % CI, 0.18-0.38) for both sexes. This meta-analysis revealed a high prevalence of SV among ASRs hosted in High-income countries and suggest the importance of developing specific screening and care programs in these host countries.
Collapse
Affiliation(s)
- Laura Cayreyre
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Théo Korchia
- Department of Psychiatry, La Conception University Hospital, Marseille, France; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
| | - Anderson Loundou
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Maeva Jego
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France
| | - Didier Théry
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Julie Berbis
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Gaëtan Gentile
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, Institut des Neurosciences des Systèmes, INS UMR1106, France
| | - Pascal Auquier
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Jérémy Khouani
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France.
| |
Collapse
|
3
|
Chaudhry A, Hebert-Beirne J, Hanneke R, Alessi EJ, Mitchell U, Molina Y, Chebli P, Abboud S. The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review. LGBT Health 2024; 11:1-19. [PMID: 37540144 DOI: 10.1089/lgbt.2022.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.
Collapse
Affiliation(s)
- Aeysha Chaudhry
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Rosie Hanneke
- Department of Information Services & Research, Library of the Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Uchechi Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
4
|
Milewski A, Weinstein E, Lurie J, Lee A, Taki F, Pilato T, Jedlicka C, Kaur G. Reported Methods, Distributions, and Frequencies of Torture Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2336629. [PMID: 37787994 PMCID: PMC10548313 DOI: 10.1001/jamanetworkopen.2023.36629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
Importance Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals worldwide, and health care practitioners globally are increasingly encountering refugee torture survivors in their clinical practices. The methods, geographic distribution, and frequency of torture globally are not well described, which limits health care practitioners' ability to adequately diagnose and treat the sequelae of torture. Objective To rank the commonness of torture methods and identify the regions of the world with which they are associated. Data Sources For this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Web of Science, and The Cochrane Library were searched from inception to July 2021. Study Selection Included studies were peer-reviewed articles in English, contained an independent sample population of individuals who experienced torture, and outlined the type(s) of torture experienced. Excluded studies were not peer reviewed, lacked an independent sample population, or did not specify torture methods. Articles were chosen for inclusion by 2 independent and blinded reviewers, and a third, independent reviewer resolved discrepancies. Overall, 266 articles-15.3% of the 1739 studies initially identified for full review-met the inclusion criteria. Data Extraction and Synthesis Data abstraction and quality assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 2 independent and blinded reviewers into predefined templates, and a third, independent reviewer resolved discrepancies. The risk of bias was evaluated using the Downs and Black Checklist. Main Outcomes and Measures Torture methods were ranked by their average frequencies, numbers of reporting studies, and numbers of countries wherein the methods occurred. Results A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor. Conclusions and Relevance The findings of this study suggest that torture remains widespread. Although innumerable torture methods exist, a limited number account for the vast majority of reported tortures. So that targeted therapies may be developed, additional investigation is needed to better elucidate the sequelae associated with the most common torture methods, described here.
Collapse
Affiliation(s)
- Andrew Milewski
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Eliana Weinstein
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Jacob Lurie
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Annabel Lee
- Weill Cornell Medicine Medical College, New York, New York
| | - Faten Taki
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Tara Pilato
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York
| | - Caroline Jedlicka
- Kingsborough Community College, City University of New York, Brooklyn
| | - Gunisha Kaur
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| |
Collapse
|
5
|
Al-Taj MA, Al-Hadari MH. Prevalence and drivers of female genital mutilation/cutting in three coastal governorates in Yemen. BMC Public Health 2023; 23:1363. [PMID: 37461020 DOI: 10.1186/s12889-023-16299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C), a violation of human rights, remains common in the coastal areas of Yemen. OBJECTIVE This study aimed to identify the prevalence of FGM/C and its risk factors among the youngest daughters in families in the Yemeni coastal areas, as well as the knowledge and attitudes of the local population towards FGM/C. METHODS A cross-sectional survey was conducted among 646 women and 345 men from six districts in three Yemeni coastal governorates between July and September 2020 using a structured questionnaire. Categorical data were described by proportion. The chi-square test was used to identify factors associated with FGM/C. All factors with a p-value of ≤ 0.05 were included in the multivariate analysis. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated in the multivariate logistic regression analysis. RESULTS The prevalence of FGM/C in Yemeni coastal areas was 89.0% (95% CI 84.0%-92.5%) among women and 79.8% (95% CI 73.5%-84.8%) among the youngest daughters in the surveyed families. Nearly two-thirds of women and half of the men recorded a poor knowledge level about the harms of FGM/C. Furthermore, almost two-thirds of both women and men would like to continue the practice of FGM/C. Among women, significant predictors of FGM/C among youngest daughters included advanced maternal age of ≥ 40 years (AOR 7.16, 95% CI 2.73-18.76), mother's desire to continue FGM/C (AOR 8.07, 95% CI 3.64-17.89), and living in a rural area (AOR 3.95, 95% CI 1.51-10.30). Daughters of mothers who did not undergo FGM/C were more protected from FGM/C than those whose mothers had undergone FGM/C (AOR 0.04, 95% CI 0.02-0.09). Among men, the father's desire to continue FGM/C (AOR 15.10, 95% CI 6.06-37.58) was significantly associated with FGM/C among the youngest daughters. CONCLUSION This study confirmed that FGM/C is still prevalent among communities in Yemeni coastal areas. Thus, community-based interventions with a focus on the rural population are vital to improving the awareness of various harms of FGM/C.
Collapse
Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine, Sana'a University, Mudbah Street, Sana'a, 773169022, Yemen.
| | | |
Collapse
|
6
|
Besera G, Goldberg H, Okoroh EM, Snead MC, Johnson-Agbakwu CE, Goodwin MM. Attitudes and Experiences Surrounding Female Genital Mutilation/Cutting in the United States: A Scoping Review. J Immigr Minor Health 2023; 25:449-482. [PMID: 36542264 PMCID: PMC10981529 DOI: 10.1007/s10903-022-01437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
To identify research and gaps in literature about FGM/C-related attitudes and experiences among individuals from FGM/C-practicing countries living in the United States, we conducted a scoping review guided by Arksey and O'Malley's framework. We searched Medline (OVID), Embase (OVID), PubMed, and SCOPUS and conducted a grey literature search for studies assessing attitudes or experiences related to FGM/C with data collected directly from individuals from FGM/C-practicing countries living in the United States. The search yielded 417 studies, and 40 met the inclusion criteria. Findings suggest that women and men from FGM/C-practicing countries living in the United States generally oppose FGM/C, and that women with FGM/C have significant physical and mental health needs and have found US healthcare providers to lack understanding of FGM/C. Future research can improve measurement of FGM/C by taking into account the sociocultural influences on FGM/C-related attitudes and experiences.
Collapse
Affiliation(s)
- Ghenet Besera
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | | | - Ekwutosi M Okoroh
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia.
| | - Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, Georgia
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, Georgia
- Creighton University School of Medicine, Phoenix, AZ, Georgia
- District Medical Group, Phoenix, AZ, Georgia
| | - Mary M Goodwin
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| |
Collapse
|
7
|
Longstreth GF, Attix C, Kuck J. Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives. Am J Med 2023; 136:244-251. [PMID: 36370801 DOI: 10.1016/j.amjmed.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination, which can provide strong evidence of torture. Female genital mutilation and cutting, a basis for asylum, is classified according to the World Health Organization. Many resettled refugees and foreign-born immigrants at urban health care facilities have been tortured, but few report it to physicians due to factors affecting both survivors and physicians. Specific torture methods can cause characteristic long-term sequelae. Painful somatic disorders of mind-body interaction and psychological disorders are common. Practices derived from cultural factors and traumatized individuals' feedback enhance management of survivors. Individual and group psychotherapy provide modest proven benefit, but assessment is limited. Physicians and psychotherapists should coordinate care.
Collapse
Affiliation(s)
- George F Longstreth
- Survivors of Torture International, San Diego, Calif; Veterans Administration San Diego Healthcare System, San Diego, Calif.
| | | | - Julie Kuck
- Survivors of Torture International, San Diego, Calif
| |
Collapse
|
8
|
Farouki L, El-Dirani Z, Abdulrahim S, Akl C, Akik C, McCall SJ. The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies. PLoS Med 2022; 19:e1004061. [PMID: 36048881 PMCID: PMC9436112 DOI: 10.1371/journal.pmed.1004061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. METHODS AND FINDINGS A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was "flesh removed" (Type I or II) in 19 countries. Among girls, "not sewn closed" (Type I, II, or IV) and "flesh removed" (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. CONCLUSIONS In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. TRIAL REGISTRATION Registration: CRD42020186937.
Collapse
Affiliation(s)
- Leen Farouki
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeinab El-Dirani
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Stephen J. McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
9
|
Lever H, Baranowski KA, Ottenheimer D, Atkinson HG, Singer EK. Histories of pervasive gender-based violence in asylum-seeking women who have undergone female genital mutilation or cutting. J Trauma Stress 2022; 35:839-851. [PMID: 35170100 DOI: 10.1002/jts.22791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/08/2022]
Abstract
Few studies have described the broader experience of survivors of female genital mutilation or cutting (FGM/C) who have sought asylum in the United States. To gain a better understanding of their exposure to gender-based violence (GBV), the study was conducted to help uncover themes and patterns of co-occurring individual and community factors among women asylum seekers who experienced FGM/C before they arrived in the United States. Following a retrospective chart review of FGM/C cases seen in a human rights clinic, 35 women met the inclusion criteria. The constant comparative method (CCM) was used to develop themes derived from clients' personal declarations and physicians' affidavits. A qualitative analysis revealed extensive histories of violence-physical, psychological, and sexual-demonstrating that FGM/C is only part of a larger arc of violence. Key themes developed via CCM include the experience of FGM/C, cultural attitudes toward FGM/C, cultural attitudes toward women, the lack of agency felt by women, silence around experiences of GBV and the constant reinforcement of that silence, the role of education in women's lives, and acts of resistance and social support. Placing FGM/C within its cultural context allows for a better understanding of its role in society's broader subjugation of women and elucidates how these social structures are maintained. For health care and other service providers, the high frequency of multiple forms of violence and the ingrained nature of women's oppression indicate the need for trauma-informed care and services as well as accessible resources beyond those explicitly related to FGM/C.
Collapse
Affiliation(s)
- Hazel Lever
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mount Sinai Human Rights Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kim A Baranowski
- Mount Sinai Human Rights Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Ottenheimer
- Mount Sinai Human Rights Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Harlem United/The Nest Community Health Center, New York, New York, USA
| | - Holly G Atkinson
- Department of Medical Education, City University of New York School of Medicine, New York, New York, USA
| | - Elizabeth K Singer
- Mount Sinai Human Rights Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
10
|
Chen VH, Caron J, Goddard B, Eng SM, Ades V. Polyvictimization and Psychiatric Sequelae Associated with Female Genital Mutilation/Cutting (FGM/C). J Immigr Minor Health 2022; 24:1020-1028. [PMID: 35217978 DOI: 10.1007/s10903-022-01343-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
Female Genital mutilation/cutting (FGM/C) is associated with enduring psychiatric complications. In this study, we investigate the rates of co-morbid abuses and polyvictimization experienced by survivors of FGM/C. This is a sub-analysis of a cohort study examining the patient population at the EMPOWER Center for Survivors of Sex Trafficking and Sexual Violence in New York City. A retrospective chart-review of electronic medical records was conducted for all consenting adult patients who had FGM/C and had an intake visit between January 16, 2014 and March 6, 2020. Of the 80 participants, ages ranged from 20 to 62 years with a mean of 37.4 (SD = 9.1) years. In addition to FGM/C, participants were victims of physical abuse (43; 53.8%), emotional abuse (35; 43.8%), sexual abuse (35; 43.8%), forced marriage (20; 25%), child marriage (13; 16.3%), and sex trafficking (1; 1.4%). There was a high degree of polyvictimization, with 41 (51.2%) experiencing 3 or more of the aforementioned abuses. Having FGM/C on or after age 13 or having a higher total abuse score was also found to be strong predictors of depression and PTSD. The high rates of polyvictimization among survivors of FGM/C are associated with development of depression and PTSD. Despite co-morbid abuses, patients still attribute substantial psychiatric symptoms to their FGM/C. Health care providers should understand the high risk of polyvictimization when caring for this patient population.
Collapse
Affiliation(s)
- Victoria H Chen
- New York University Grossman School of Medicine, New York, NY, USA.
| | - Jayne Caron
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Goddard
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA, USA
| | | | - Veronica Ades
- Department of Obstetrics & Gynecology, Jacobi Medical Center, Bronx, NY, USA.,Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
11
|
Female Genital Mutilation: Treatment Updates and the Need for Education. J Craniofac Surg 2021; 33:734-737. [DOI: 10.1097/scs.0000000000008205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Wenzel T, Kizilhan JI, Alksiri R, Dörfler D, Messerschmidt EJ, Chen AF. FGM and Restorative Justice-A Challenge for Developing Countries and for Refugee Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178913. [PMID: 34501503 PMCID: PMC8430822 DOI: 10.3390/ijerph18178913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.
Collapse
Affiliation(s)
- Thomas Wenzel
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
- CEHRI, The Centre for the Enforcement of Human Rights International, Schwarzspanierstraße 15/1/17, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-37230
| | - Jan Ilhan Kizilhan
- Duale Hochschule Baden-Württemberg, 78054 Villingen-Schwenningen, Germany;
- University of Dohuk, AJ Duhok 1006, Iraq
| | - Reem Alksiri
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
- CEHRI, The Centre for the Enforcement of Human Rights International, Schwarzspanierstraße 15/1/17, 1090 Vienna, Austria
| | - Daniela Dörfler
- Department Gynaecology, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Anthony Fu Chen
- World Psychiatric Association Scientific Section on Psychological Aspects of Persecution and Torture, 1226 Geneva, Switzerland; (R.A.); (A.F.C.)
| |
Collapse
|
13
|
Deps P, Collin SM, Andrade MAC, Aborghetti HP, de Oliveira TIA, Charlier P. Clinical agreement with self-report of physical violence and torture in women seeking asylum in France. Health Care Women Int 2021; 43:851-860. [PMID: 34106821 DOI: 10.1080/07399332.2021.1901902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women are a particularly vulnerable group among persons seeking asylum but are still required to provide clinical evidence of acts of violence inflicted against them. In this study the authors describe patient histories, dermatological lesions and other injuries arising from physical violence and torture in female asylum-seekers attending a specialist outpatient service in France. Twenty-seven women were assessed during 2016-2018. Clinical corroboration of lesions with patients' self-reports was affirmative in >90% (25/27) of cases. Health care services in recipient countries must be configured and resourced to support women seeking asylum, and health care professionals must be receptive and sensitive to women's self-reported histories.
Collapse
Affiliation(s)
- Patrícia Deps
- Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.,Laboratoire Anthropologie Archéologie Biologie (LAAB), Université Paris-Saclay UVSQ, Montigny-Le-Bretonneux, France
| | - Simon M Collin
- National Infection Service, Public Health England, London, UK
| | | | - Hugo Pessotti Aborghetti
- Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Philippe Charlier
- Laboratoire Anthropologie Archéologie Biologie (LAAB), Université Paris-Saclay UVSQ, Montigny-Le-Bretonneux, France
| |
Collapse
|