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Olorunsaiye CZ, Badru MA, Osborne A, Degge HM, Yaya S. Mapping the evidence on factors related to postpartum contraception among sub-Saharan African immigrant and refugee women in the United States of America: A scoping review protocol. PLoS One 2024; 19:e0304222. [PMID: 38809899 PMCID: PMC11135752 DOI: 10.1371/journal.pone.0304222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Postpartum contraception is essential to sexual and reproductive health (SRH) care because it encourages healthy spacing between births, helps women avoid unwanted pregnancies, and lessens the risks of health problems for mothers and babies. Sub-Saharan African immigrant and refugee populations are rapidly increasing in the United States, and they come from a wide range of cultural, linguistic, religious, and social origins, which may pose challenges in timely access to culturally acceptable SRH care, for preventing mistimed or unwanted childbearing. The objective of this scoping review is to assess the extent of the available literature on postpartum contraception among sub-Saharan African immigrant and refugee women living in the United States. METHODS We developed preliminary search terms with the help of an expert librarian, consisting of keywords including birth intervals, birth spacing, contraception, postpartum contraception or family planning, and USA or America, and sub-Saharan African immigrants, or emigrants. The study will include the following electronic databases: PubMed/MEDLINE, PsycINFO, CINAHL, EMBASE, and the Global Health Database. The sources will include studies on postpartum care and contraceptive access and utilization among sub-Saharan African immigrants living in the US. Citations, abstracts, and full texts will be independently screened by two reviewers. We will use narrative synthesis to analyze the data using quantitative and qualitative methods. Factors associated with postpartum contraception will be organized using the domains and constructs of the PEN-3 Model as a guiding framework. CONCLUSION This scoping review will map the research on postpartum contraception among sub-Saharan African immigrant and refugee women living in the US. We expect to identify knowledge gaps, and barriers and facilitators of postpartum contraception in this population. Based on the findings of the review, recommendations will be made for advocacy and program and policy development toward optimizing interpregnancy intervals in sub-Saharan African immigrants living in the US. TRIAL REGISTRATION Review registration Open Science Framework: https://osf.io/s385j.
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Affiliation(s)
| | - Mariam A. Badru
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, PMB, Freetown, Sierra Leone
| | - Hannah M. Degge
- Department of Health and Education, Coventry University, Scarborough, United Kingdom
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Albert J, Wells M, Spiby H, Evans C. Examining the key features of specialist health service provision for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North: a scoping review. Front Glob Womens Health 2024; 5:1329819. [PMID: 38840583 PMCID: PMC11150566 DOI: 10.3389/fgwh.2024.1329819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C specialist care. Methods The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of "specialist" (as opposed to "generalist") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary. Results Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided. Conclusion Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.
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Affiliation(s)
- Juliet Albert
- University of Nottingham and Division of Womens, Children and Clinical Support, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom
| | - Mary Wells
- Nursing Directorate, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust (ICHNT), Imperial College London, London, United Kingdom
| | - Helen Spiby
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Catrin Evans
- The Nottingham Centre for Evidence Based Healthcare, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Aboagye RG, Ahinkorah BO, Seidu AA, Frimpong JB, Adu C, Hagan JE, Ahmed SAE, Yaya S. Female genital mutilation and safer sex negotiation among women in sexual unions in sub-Saharan Africa: Analysis of demographic and health survey data. PLoS One 2024; 19:e0299034. [PMID: 38758930 PMCID: PMC11101093 DOI: 10.1371/journal.pone.0299034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/02/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.
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Affiliation(s)
- Richard Gyan Aboagye
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
| | - Abdul-Aziz Seidu
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - James Boadu Frimpong
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Department of Kinesiology, New Mexico State University, Las Cruces, NM, United States of America
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Social Research in Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Salma A. E. Ahmed
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Mwakawanga DL, Massae AF, Kohli N, Lukumay GG, Rohloff CT, Mushy SE, Mgopa LR, Mkoka DA, Mkonyi E, Trent M, Ross MW, Rosser BRS, Connor J. The need for and acceptability of a curriculum to train nursing and medical students in the sexual healthcare of clients with female genital mutilation/cutting in Tanzania. BMC Womens Health 2024; 24:198. [PMID: 38532377 DOI: 10.1186/s12905-024-03034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is tied to one of the most conservative cultures in the Mediterranean and Sub-Saharan Africa. More than 200 million girls and women in 30 African, Asian and the middle Eastern countries have undergone FGM/C. However, healthcare professionals are not adequately trained to prevent and manage FGM/C-related complications including sexual health problems. This study aimed to assess the need and acceptability of a curriculum to train nursing and medical students in the sexual healthcare of clients with FGM/C in Tanzania. METHODS We used a descriptive and cross sectional study design to collect and analyse information from 271 medical and 137 nursing students in Tanzania. A Qualtrics online survey was used to obtain quantitative data on training interest, previous training received, and the curriculum delivery method. Open-ended questions were used to explore their insights on significance to obtain the necessary competencies to treat and prevent FGM/C. Descriptive statistics were used to analyze quantitative data while qualitative data were analyzed using a thematic approach. RESULTS Almost half of the participants reported they had little to no training in sexual healthcare for women with FGM/C (47%). In all, 82.4% reported the training to be acceptable. Following thematic analysis of open-ended questions, participants expressed a desire to improve their competencies to meet the current and future sexual and psychological health needs of women and girls who have undergone FGM/C. CONCLUSION It is a necessary and acceptable to develop a curriculum to train healthcare students to diagnose, treat and prevent sexual health complications related to FGM/C. In our study, designing a culturally sensitive curriculum and its delivery method, that includes practical sessions with simulated patients, was considered the most beneficial and favorable.
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Affiliation(s)
- Dorkasi L Mwakawanga
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Nidhi Kohli
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Corissa T Rohloff
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Stella Emmanuel Mushy
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Dickson Ally Mkoka
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Maria Trent
- Johns Hopkins University, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Michael W Ross
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - B R Simon Rosser
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA.
| | - Jennifer Connor
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
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Connor JJ, Abdi C, Chen M, Salad M, Pergament S, Afey F, Hussein I, Robinson BBE. Our Body Our Health (Jirkeena, Caafimaadkeena): Somali Women's Narratives on Sexual Health. JOURNAL OF SEX RESEARCH 2023:1-15. [PMID: 38047877 PMCID: PMC11147957 DOI: 10.1080/00224499.2023.2288077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Women across the globe have been subject to female genital cutting (FGC), with the highest rates in Somalia. FGC can result in sexual concerns, especially sexual pain and lower pleasure. Due to ongoing civil war and climate disasters, there is a large number of Somali immigrants and refugees living in countries where healthcare providers may be unfamiliar with the impact of FGC. In this qualitative study, sixty Somali women between the ages 20 and 45 and living in the U.S. shared their perspectives on how FGC has affected their sexual lives, including how they have coped with any complications attributed to FGC. Participants were recruited through convenience sampling and interviewed by a bilingual community researcher in either Somali or English. Data were analyzed through a participatory analysis process by academic and community researchers. Themes included sexual desire, arousal, and pleasure; sexual satisfaction; sexual pain at first intercourse; coping with sexual pain at first intercourse; long-term sexual pain, coping with long-term sexual pain. Results are discussed with a focus on agency of the participants, role of partners, and implications for healthcare professionals.
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Affiliation(s)
- Jennifer Jo Connor
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Cawo Abdi
- Department of Sociology, University of Minnesota
| | - Muzi Chen
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Munira Salad
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Shannon Pergament
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Foos Afey
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Intisar Hussein
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Beatrice Bean E Robinson
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
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Ho CH, Denton AH, Blackstone SR, Saif N, MacIntyre K, Ozkaynak M, Valdez RS, Hauck FR. Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review. J Immigr Minor Health 2023; 25:1426-1462. [PMID: 37009980 DOI: 10.1007/s10903-023-01477-2] [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] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.
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Affiliation(s)
- Chi H Ho
- Department of Public Health Sciences, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Sarah R Blackstone
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Nadia Saif
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Kara MacIntyre
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine, Department of Public Health Sciences, University of Virginia, PO Box 800729, Charlottesville, VA, 22908-0729, USA.
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Lamba A, Mohajir N, Rahman S. A review of the psychosocial factors that contribute to sexuality, female sexual dysfunction, and sexual pain among Muslim women. Sex Med Rev 2023:7160016. [PMID: 37169514 DOI: 10.1093/sxmrev/qead019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Sexual pain disorders are complex conditions experienced by women around the world. Muslim women experience sexuality and sexual dysfunction in a distinct manner that is influenced by religious and cultural standards. Muslim women experiencing sexual pain are a unique patient population whose cultural background should be understood by health care professionals to provide culturally competent care. OBJECTIVES To identify the psychosocial factors that influence Muslim women's experience of sexual pain. METHODS A comprehensive review of the literature through PubMed and Google Scholar was conducted to compile information related to sexual dysfunction, sexual pain, and treatment options in the Muslim women population in the United States and internationally. RESULTS Painful sex among Muslim women has been associated with female genital cutting, cultural taboos, lack of sex education, absence of language to discuss sex, negative cognitions about sex, expectations to bear the male partner's inconsiderate sexual performance, and familial interference. Typical treatments for sexual pain in Islamic countries were explored, with new treatments that have recently been tested. CONCLUSION Understanding sexual pain among Muslim women, including the religious and cultural factors that are potentially associated with this pain, is important for health care professionals to care for their Muslim patients in a culturally competent manner and reduce the implicit bias that may affect quality of care. It appears that providing sexual education, with treatment modalities such as psychotherapy and physical therapy, is useful in treating female sexual pain. We suggest that sexual education, as well as a cultural shift that embraces women's sexual agency, is needed to reduce and prevent sexual pain.
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Affiliation(s)
- Arleen Lamba
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Nadiah Mohajir
- HEART Women and Girls, HEART, Chicago, IL 60637, United States
| | - Sameena Rahman
- Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3008, United States
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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.
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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
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Jahangirifar M, Fooladi E, Davis SR, Islam RM. Menopause symptoms, sexual dysfunctions and pelvic floor disorders in refugee and asylum seeker women: a scoping review. Climacteric 2023:1-8. [PMID: 36779420 DOI: 10.1080/13697137.2023.2173572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Refugee and asylum seeker women face a variety of health challenges. However, little is known globally about health problems in these women at midlife and beyond, including menopausal symptoms, sexual dysfunctions and pelvic floor disorders. This scoping review aimed to understand these neglected health issues with respect to prevalence and risk factors. Eight databases were searched in August 2022 without the limit of publication year. Data were analyzed narratively. A total of 10 reports from seven studies were included with 945 women living in Australia, Canada, the USA and Pakistan. Three reports were addressing menopause, seven addressed sexual dysfunctions and one addressed pelvic floor disorders. There were no data regarding menopause symptoms; however, perceptions of menopause varied widely across studies. Few studies reported a high prevalence of sexual dysfunctions and pelvic organ prolapses, but none of them used a validated questionnaire. Taboos and cultural factors, lack of knowledge and education, lack of family support, language insufficiency and financial problems were common barriers to not seeking care for these health issues. This review demonstrates lack of evidence of these neglected health issues in refugee and asylum seeker women at midlife, and further studies with validated questionnaires and larger samples are warranted.
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Affiliation(s)
- M Jahangirifar
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - E Fooladi
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - S R Davis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - R M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Chalmiers MA, Karaki F, Muriki M, Mody S, Chen A, de Bocanegra HT. Refugee women's experiences with contraceptive care after resettlement in high-income countries: A Critical Interpretive Synthesis. Contraception 2021; 108:7-18. [PMID: 34971601 DOI: 10.1016/j.contraception.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
Refugee women often share histories of forced displacement, economic hardship, or gender-based violence and may face common barriers to reproductive healthcare access after resettlement in high-income countries. This Critical Interpretive Synthesis integrates the available data on contraceptive care for refugee women after resettlement. The review examined shared aspects of the refugee experience that impact women's access to high-quality contraceptive care and transcend the particularities of specific health systems or countries of origin. These include possible shifts in gendered norms and fertility preferences after resettlement, prior experiences with contraception in home countries, refugee camps, and other sites of first-asylum, and negative experiences with healthcare providers after resettlement (i.e. communication barriers or experiencing discrimination). Our findings demonstrate the need for further methodologically-rigorous research in the field of refugee reproductive health, specifically in relation to evidence-based approaches to training interpreters and providers in contraceptive care for refugees and on male partners and their influence on contraceptive use.
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Affiliation(s)
- Morgen A Chalmiers
- Department of Anthropology, Medical Scientist Training Program, University of California, San Diego.
| | - Fatima Karaki
- Department of Medicine, University of California San Francisco.
| | - Maneesha Muriki
- Public Health Sciences, School of Medicine, University of California Davis.
| | - Sheila Mody
- School of Medicine, Department of Gynecology, Obstetrics and Reproductive Sciences, University of California, San Diego.
| | - Andy Chen
- School of Medicine, Loyola University.
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Earp BD. Protecting Children from Medically Unnecessary Genital Cutting Without Stigmatizing Women's Bodies: Implications for Sexual Pleasure and Pain. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1875-1885. [PMID: 31965452 DOI: 10.1007/s10508-020-01633-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Brian D Earp
- Yale-Hastings Program in Ethics and Health Policy, Yale University, New Haven, CT, 06511, USA.
- The Hastings Center, Garrison, NY, USA.
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Sturgeon JA, Kraus SW. Resilience in Women's Sexual Pain After Female Genital Cutting: Adaptation Across Time and Personal and Cultural Context. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1891-1895. [PMID: 31482425 DOI: 10.1007/s10508-019-01536-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, 98105, USA.
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Brady SS, Connor JJ, Chaisson N, Sharif Mohamed F, Robinson BBE. Female Genital Cutting and Deinfibulation: Applying the Theory of Planned Behavior to Research and Practice. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1913-1927. [PMID: 31359211 PMCID: PMC6987000 DOI: 10.1007/s10508-019-1427-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 05/09/2023]
Abstract
At least 200 million girls and women across the world have experienced female genital cutting (FGC). International migration has grown substantially in recent decades, leading to a need for health care providers in regions of the world that do not practice FGC to become knowledgeable and skilled in their care of women who have undergone the procedure. There are four commonly recognized types of FGC (Types I, II, III, and IV). To adhere to recommendations advanced by the World Health Organization (WHO) and numerous professional organizations, providers should discuss and offer deinfibulation to female patients who have undergone infibulation (Type III FGC), particularly before intercourse and childbirth. Infibulation involves narrowing the vaginal orifice through cutting and appositioning the labia minora and/or labia majora, and creating a covering seal over the vagina with appositioned tissue. The WHO has published a handbook for health care providers that includes guidance in counseling patients about deinfibulation and performing the procedure. Providers may benefit from additional guidance in how to discuss FGC and deinfibulation in a manner that is sensitive to each patient's culture, community, and values. Little research is available to describe decision-making about deinfibulation among women. This article introduces a theoretically informed conceptual model to guide future research and clinical conversations about FGC and deinfibulation with women who have undergone FGC, as well as their partners and families. This conceptual model, based on the Theory of Planned Behavior, may facilitate conversations that lead to shared decision-making between providers and patients.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Jennifer J Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Connor JJ, Brady SS, Chaisson N, Mohamed FS, Robinson BBE. Response to Commentaries: Understanding Women's Responses to Sexual Pain After Female Genital Cutting. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1907-1912. [PMID: 34100144 DOI: 10.1007/s10508-021-02047-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Jennifer Jo Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 180, Minneapolis, MN, 55454, USA.
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicole Chaisson
- Smiley's Clinic, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 180, Minneapolis, MN, 55454, USA
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Connor JJ, Brady SS, Chaisson N, Mohamed FS, Robinson BBE. Understanding Women's Responses to Sexual Pain After Female Genital Cutting: An Integrative Psychological Pain Response Model. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1859-1869. [PMID: 31011992 PMCID: PMC8240838 DOI: 10.1007/s10508-019-1422-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 05/05/2023]
Abstract
The World Health Organization estimates that over 200 million women and girls have experienced female genital cutting (FGC). Many women and girls who have undergone FGC have migrated to areas of the world where providers are unfamiliar with the health needs associated with FGC. Both providers in Western healthcare systems and female immigrant and refugee patients report communication difficulties leading to distrust of providers by women who have experienced FGC. Sexual pain is one common problem requiring discussion with healthcare providers and possible intervention. Yet, existing clinical and research literature provides little guidance for assessment and intervention when sexual pain is a result of FGC. Several conceptual frameworks have been developed to conceptualize and guide treatments for other types of pain, such as back pain and headaches. In this article, we integrate four prominent models-the fear avoidance model, eustress endurance model, distress endurance model, and pain resilience model-to conceptualize sexual pain in women who have experienced FGC. The resulting integrative psychological pain response model will aid in providing culturally responsive clinical management of sexual pain to women who have experienced FGC. This integrative model also provides a theoretical foundation for future research in this population.
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Affiliation(s)
- Jennifer Jo Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA
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16
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Badre-Esfahani S, Petersen LK, Tatari CR, Blaakær J, Andersen B, Seibæk L. Perceptions of cervical cancer prevention among a group of ethnic minority women in Denmark-A qualitative study. PLoS One 2021; 16:e0250816. [PMID: 34061863 PMCID: PMC8168878 DOI: 10.1371/journal.pone.0250816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) and human papillomavirus vaccination (HPVV) are effective measures against cervical cancer (CC). Attendance in HPVV and CCS provides the greatest protection, while combined non-attendance in HPVV and CCS provides little to no protection. It is hence concerning that some large ethnic minority groups show considerably lower HPVV and CCS attendance than other women-especially women from Middle-Eastern and North African (MENA) countries and Pakistan. Little is, however, known about the reasons for this low combined attendance pattern n. AIM To explore perceptions of and barriers to HPVV and CCS, among MENA and Pakistani women in Denmark. METHOD Focus group interviews were conducted. Data was transcribed verbatim, and analysed using systematic text condensation. FINDINGS Seventeen long-term resident women originating from six major MENA countries and Pakistan were included. Mean age was 36 years. We found that these women, across different age groups and descent, had sparse knowledge and understanding about CC, and their perceived relevance of disease prevention was low. Compared to HPVV, their barriers to CCS were more fixed and often linked to socio-cultural factors such as taboos related to female genitals and sexuality. Moreover, they presented unmet expectations and signs of mistrust in the healthcare system. However, at the end of the interviews, participants became more attentive toward CC prevention, particularly toward HPVV. CONCLUSION Elements of insufficient knowledge and understanding of CC and its prevention were found among a group of MENA and Pakistani women. Their socio-cultural background further represents a barrier particularly towards CCS. Additionally, negative experiences and unmet expectations lessen their trust in the healthcare system. All of which underlines the need for new tailored CC preventive strategies for this group. Based on our findings we suggest that future studies develop and evaluate interventions aiming to improve HPVV and CCS, including user-involvement.
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Affiliation(s)
- Sara Badre-Esfahani
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C, Denmark
- Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Rahr Tatari
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Blaakær
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Seibæk
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Perović M, Jacobson D, Glazer E, Pukall C, Einstein G. Are you in pain if you say you are not? Accounts of pain in Somali-Canadian women with female genital cutting. Pain 2021; 162:1144-1152. [PMID: 33105438 DOI: 10.1097/j.pain.0000000000002121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT As a rite of passage to womanhood, 2 million girls undergo female genital circumcision (FGC)-the tradition of cutting, and often removing parts of the vulva-every year. The current study is the first to focus on the connection between peripheral nerve damage and chronic neuropathic pain in women with FGC. We used mixed methods-quantitative, qualitative, and physiological-to study chronic pain in Somali-Canadian women (N = 14). These women have the most extensive form of FGC, which includes removal of the glans clitoris, labia minora, medial portion of the labia majora, and stitching together the remaining parts of the labia majora. Our results indicate a multifaceted pain experience in women with FGC. Although they report good overall health and very low pain levels on the short form of the McGill Pain Questionnaire, pressure-pain quantitative sensory testing of the vulvar region applied through vulvalgesiometers shows pain thresholds consistent with those reported by women with chronic vulvar pain. Furthermore, qualitative interviews reveal a considerable amount of often debilitating pain in daily life. These results challenge the use of assessment tools offering elicited verbal pain language and highlight the importance of culturally sensitive ways of conceptualizing, measuring, and managing pain.
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Affiliation(s)
- Mateja Perović
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Danielle Jacobson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Glazer
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Caroline Pukall
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Rotman Research Institute, Baycrest Hospital, Toronto, ON, Canada
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Hearld KR, Wu D, Budhwani H. HIV Testing Among Muslim Women in the United States: Results of a National Sample Study. Health Equity 2021; 5:17-22. [PMID: 33564736 PMCID: PMC7868576 DOI: 10.1089/heq.2020.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: More than one million Americans are living with human immunodeficiency virus (HIV), and less than half of Americans have ever accepted an HIV test. There are no national HIV testing estimates for Muslim Americans, an underserved and often stigmatized population. Considering the lack of HIV testing estimates for this population, we conducted an exploratory study on HIV testing and potential associates in American Muslim women from across the United States. Methods: We applied logistic regression models to examine the Muslim Women's Health Project data, collected in 2015 (N=218). Results: Health care engagement and intimate partner violence were significantly associated with having been tested for HIV. Respondents using contraceptives received an influenza vaccination, and received an abnormal pap test had more than two times higher odds of having been tested for HIV (odds ratio [OR]=2.56, OR=2.43, OR=2.93, respectively; p<0.05 all). Having been sexually abused was associated with more than two times higher odds of having been tested for HIV (OR=2.49; p<0.05). Conclusion: Respondents reported higher rates of HIV testing as compared with the general public, signaling HIV knowledge, engagement in preventative health care, and possibly HIV risk. Scholars and practitioners should not assume that Muslim patients are at low risk for HIV and do not engage in HIV-risk behaviors. Thus, assumptions about Muslims women's willingness to accept HIV testing should be further examined to elucidate HIV risk among this population.
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Affiliation(s)
- Kristine R. Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Danielle Wu
- Department of Nutrition, College of Human Ecology, Cornell University, Ithica, New York, USA
| | - Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ziyada MM, Lien IL, Johansen REB. Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway. PLoS One 2020; 15:e0233440. [PMID: 32421757 PMCID: PMC7233551 DOI: 10.1371/journal.pone.0233440] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. Methods We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. Findings We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants’ intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. Conclusion The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.
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Affiliation(s)
- Mai Mahgoub Ziyada
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Inger-Lise Lien
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - R. Elise B. Johansen
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Kimani S, Kabiru CW, Muteshi J, Guyo J. Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:3. [PMID: 31992317 PMCID: PMC6986153 DOI: 10.1186/s12914-020-0222-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/20/2020] [Indexed: 01/29/2023]
Abstract
Background Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. Methods We drew on qualitative data collected from purposively selected women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. Results Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals’ and health facilities’ capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. Conclusion Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.
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Affiliation(s)
- Samuel Kimani
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya. .,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.
| | | | - Jacinta Muteshi
- Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya
| | - Jaldesa Guyo
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
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21
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Araujo JDO, de Souza FM, Proença R, Bastos ML, Trajman A, Faerstein E. Prevalence of sexual violence among refugees: a systematic review. Rev Saude Publica 2019; 53:78. [PMID: 31553381 PMCID: PMC6752644 DOI: 10.11606/s1518-8787.2019053001081] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.
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Affiliation(s)
- Juliana de Oliveira Araujo
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Fernanda Mattos de Souza
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Raquel Proença
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Mayara Lisboa Bastos
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Anete Trajman
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa de pós-Graduação em Clínica médica. Rio de Janeiro, RJ, Brasil
- McGill University. Montreal, QC, Canadá
| | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
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Hawkey AJ, Ussher JM, Perz J. Negotiating sexual agency in marriage: The experience of migrant and refugee women. Health Care Women Int 2019; 40:870-897. [PMID: 30985270 DOI: 10.1080/07399332.2019.1566334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, adult migrant and refugee women's negotiation of sexual agency in the context of marriage is explored. In Sydney, Australia and Vancouver, Canada, 78 semistructured individual interviews, and 15 focus groups, comprised of 82 participants, were conducted with women who had recently migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. Women's negotiation of sexual agency was evident with respect to husband choice, disclosure of sexual desire, pleasure, pain, and sexual consent. While some participants took up subjugated sexual subject positions reflecting dominant cultural or religious discourses, many women also resisted these discourses to enact sexual agency.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
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Turkmani S, Homer CSE, Dawson A. Maternity care experiences and health needs of migrant women from female genital mutilation-practicing countries in high-income contexts: A systematic review and meta-synthesis. Birth 2019; 46:3-14. [PMID: 29954045 DOI: 10.1111/birt.12367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for nontherapeutic indications. Due to changing patterns of migration, clinicians in high-income countries are seeing more women from countries where the practice is prevalent. This review aims to understand the sociocultural and health needs of these women and identify opportunities to improve the quality of maternity care for women with FGM. METHODS We undertook a systematic review and meta-synthesis of peer-reviewed primary qualitative research to explore the experience and needs of migrant women with FGM receiving maternity care. A structured search of nine databases was undertaken, screened papers appraised, and a thematic analysis undertaken on data extracted from the findings and discussion sections of included papers. RESULTS Sixteen peer-reviewed studies were included in the systematic review. Four major themes were revealed: Living with fear, stigma, and anxiety; Feelings of vulnerability, distrust, and discrimination; Dealing with past and present ways of life after resettlement; and Seeking support and involvement in health care. CONCLUSIONS The findings suggest that future actions for improving maternity care quality should be focused on woman-centered practice, demonstrating cultural safety and developing mutual trust between a woman and her care providers. Meaningful consultation with women affected by FGM in high-income settings requires cultural sensitivity and acknowledgment of their specific circumstances. This can be achieved by engaging women affected by FGM in service design to provide quality care and ensure woman-focused policy is developed and implemented.
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Affiliation(s)
- Sabera Turkmani
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Shahawy S, Amanuel H, Nour N. Perspectives on female genital cutting among immigrant women and men in Boston. Soc Sci Med 2019; 220:331-339. [DOI: 10.1016/j.socscimed.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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The lived experience of female genital cutting (FGC) in Somali-Canadian women's daily lives. PLoS One 2018; 13:e0206886. [PMID: 30399181 PMCID: PMC6219790 DOI: 10.1371/journal.pone.0206886] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/21/2018] [Indexed: 11/30/2022] Open
Abstract
Many of the Somali women who have immigrated to other countries, including Canada, have experienced Female Genital Circumcision/ Mutilation/ Cutting (FGC). While there is literature on the medical aspects of FGC, we were interested in understanding the daily life experiences and bodily sensations of Somali-Canadian women in the context of FGC. Fourteen women living in the Greater Toronto Area were interviewed. Interview data were analyzed using a phenomenological approach. We found that the memory of the ceremonial cutting was vivid but was frequently described with acceptance and resignation–as something that just is; that was normal given the particular context, familial and cultural, and their young age. Most of the women recounted experiencing pain and discomfort throughout their adult lives but were intent on not noticing or giving the pain any power; they considered themselves healthy. The following themes emerged from our interviews: Every Body Had It: Discussing FGC, I’m Normal Aren’t I?, and Feeling in My Body–all themes that work at normalizing their bodies in a society that they know views them as different. They dealt with both pain and pleasure in the context of their busy lives suggesting resilience in spite of the day-to-day difficulties of daily life.
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Abuelezam NN, El-Sayed AM, Galea S. The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review. Front Public Health 2018; 6:262. [PMID: 30255009 PMCID: PMC6141804 DOI: 10.3389/fpubh.2018.00262] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field. Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly). Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination. Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.
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Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States
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Hunt SL, Connor JJ, Ciesinski A, Abdi C, Robinson B'BE. Somali American female refugees discuss their attitudes toward homosexuality and the gay and lesbian community. CULTURE, HEALTH & SEXUALITY 2018; 20:591-605. [PMID: 28857678 DOI: 10.1080/13691058.2017.1367036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Minnesota is home to the largest population of Somalis in the USA - most arriving as refugees from the civil war in Somalia. As Somali Americans adjust to life in the USA, they are likely to undergo shifts in their belief systems - including changes in their attitudes toward gays and lesbians. We examined the attitudes of 29 Somali American women in the Minneapolis-St. Paul metropolitan area toward homosexuality via face-to-face, semi-structured interviews. Transcripts were translated, transcribed and analysed using an approach informed by grounded theory. Three major themes were identified: (1) Islamic prohibitions against homosexuality; (2) homosexuals exiled to a hidden community; and (3) community members exploring tolerance. Participants' attitudes toward homosexuality were heavily influenced by religious doctrines and cultural contexts. This is the first known study in the USA of Somali American attitudes toward gays and lesbians. As people mass migrate from nations with negative attitudes toward homosexuality to countries with more progressive attitudes toward varied sexual orientations, refugee attitudes about homosexuality will undergo change. Through research and education, we can better understand how to increase tolerance toward and opportunities for visibility among gay and lesbian refugees throughout the diaspora.
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Affiliation(s)
- Shanda L Hunt
- a Health Sciences Libraries , University of Minnesota , Minneapolis , MN , USA
| | - Jennifer J Connor
- b Program in Human Sexuality , University of Minnesota , Minneapolis , MN , USA
| | - Amanda Ciesinski
- c Department of Health and Kinesiology , Concordia University , Saint Paul , MN , USA
| | - Cawo Abdi
- d Sociology Department , University of Minnesota , Minneapolis , MN , USA
- e Sociology Department , University of Pretoria , Pretoria , South Africa
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Johnsdotter S. The Impact of Migration on Attitudes to Female Genital Cutting and Experiences of Sexual Dysfunction Among Migrant Women with FGC. CURRENT SEXUAL HEALTH REPORTS 2018. [PMID: 29541003 PMCID: PMC5840240 DOI: 10.1007/s11930-018-0139-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of Review The purpose of this review was to explore current research on the impact of migration on issues related to female genital cutting and sexuality. Recent Findings There is growing evidence that migration results in a broad opposition to female genital cutting among concerned migrant groups in western countries. In addition, after migration, affected women live in the midst of a dominant discourse categorizing them as "mutilated" and sexually disfigured. There is also, in contrast to what is shown by most research, a public discourse saying that female genital cutting (FGC) leads to lost capacity to enjoy sex. Concurrently, a vast body of research demonstrates a strong correlation between a negative body image or body shame and sexual dysfunction. Summary Care for women with FGC needs to be holistic and, while offering medical care when needed, the health care providers should avoid feeding into self-depreciatory body images and notions about lost ability to enjoy sexual life.
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Affiliation(s)
- Sara Johnsdotter
- Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
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Kuittinen S, García Velázquez R, Castaneda AE, Punamäki RL, Rask S, Suvisaari J. Construct validity of the HSCL-25 and SCL-90-Somatization scales among Russian, Somali and Kurdish origin migrants in Finland. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17542863.2016.1244213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Saija Kuittinen
- School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | | | - Anu E. Castaneda
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Shadia Rask
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Team of Multicultural Wellbeing, National Institute for Health and Welfare, Helsinki, Finland
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