Articles by Sara Johnsdotter
Sexual and Reproductive Health Matters, 2019
In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, gir... more In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, girls. The discussion is based on data from 122 police files, including criminal investigations regarding suspected "female genital mutilation" (FGM). A growing body of research in European countries indicates that processes of cultural change are occurring among immigrant communities from areas where traditionally girls are subjected to what is construed as "circumcision". Many studies show growing opposition to these practices among people who have migrated to Europe, and there is little evidence to support the assertion that large-scale illegal activities are prevalent. Yet there is a dominant discourse stating that FGM is secretively practised on a large scale among some immigrant groups in Europe, and policies encourage the detection of cases to charge in criminal court. I describe the current situation in Sweden and highlight some of the drawbacks of a very harsh, although well-intended, policy to check for FGM in Europe. While the ultimate aim is to protect girls at risk for FGM, current policies have ramifications that are invasive and sometimes even traumatising for the girls involved. This paper offers an empirical example of how politics in western multicultural societies may negatively influence the sexual health and rights of a target group, in this case, girls and young women whose families originate from countries where circumcision of girls is practiced.
Studies in Law, Politics, and Society , 2019
This chapter discusses adjudication, expertise, and cultural difference as it appears in criminal... more This chapter discusses adjudication, expertise, and cultural difference as it appears in criminal court cases concerning female genital cutting (FGM) in the EU, as reported in a 2015 comparative overview. It begins with the distinction between typical and atypical FGM cases; a distinction that connects court cases to the cultural realities of the practicing communities, suggesting that the lack of cultural knowledge can cause unnecessary suffering to families and/or individuals who wrongly undergo prosecution in alleged FGM cases. A contrario, the intervention of experts in FGM court cases could be a positive approach to assessing the legitimacy of public intervention in certain cases.
Purpose of Review: The purpose of this review was to explore current research on the impact of mi... more 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.
Objectives: To present the primary outcomes from a baseline study on attitudes towards female gen... more Objectives: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration.
Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden.
Setting: Sweden.
Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years).
Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.
Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration.
Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention.
Trial registration number NCT02335697; Pre-results.
Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Orga... more Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden.
Abstract
Media often report about circumcision of girls, or ‘female genital mutilation’ (FGM), in... more Abstract
Media often report about circumcision of girls, or ‘female genital mutilation’ (FGM), in ways that present this practice as a burning social problem, albeit secretively performed among African immigrants in Europe. In this paper we discuss the construction of FGM as a widespread social problem in Europe. We contrast the public discourse on FGM with empirical data on FGM criminal court cases in Europe in order to see to what extent the public discourse agrees with evidence. We conclude that there is a discrepancy between public discourse and media representations, on one hand, and empirical evidence, on the other. We suggest that the scarcity of criminal court cases in Europe to a large extent can be explained by processes of cultural change after migration. Further, we emphasise the importance of access to context-specific knowledge during court proceedings in FGM cases.
Key words
Female circumcision, female genital mutilation, social problem, court cases, media stereotypes, risk estimates
In this article, we explore how reproductive health care providers in Sweden, a country often des... more In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily
undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers’ ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women’s possibilities to obtain adequate support. At the end of the article, we suggest how health care providers’ reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.
There are few studies on how social workers deal with cases regarding transnational surrogacy. Ou... more There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers' conflicting views on how to best meet the surrogate mother's interest and the best interest of the child. Regulation is thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.
Unskilled traditional healers are widely blamed for complications to male circumcision performed ... more Unskilled traditional healers are widely blamed for complications to male circumcision performed in low-and middle-income settings. However, attributions of culpability are mostly anecdotal. We identify self-circumcision in adults that was performed during adolescence, hereby termed retrospective self-circumcision, and unexpectedly discovered during interviews with Somali men in Sweden in 2010. This study explores the phenomenon with the aim to increase our understanding about the health needs of this group. Two focus group discussions (six and seven participants), one informal discussion with three participants, and 27 individual interviews were conducted in 2010 and 2011 with Somali-Swedish fathers, guided by a hermeneutic, comparative natural inquiry method. Eight participants had performed retrospective self-circumcision while living in rural Somalia. Actions were justified according to strong faith in Islam. Genital physiology was described as adequate for producing children, but physical sensation or characteristics were implied as less than optimal. Few had heard about penile reconstruction. There was hesitation to openly discuss concerns, but men nevertheless encouraged each other to seek care options. Presently no medical platform is available for retrospective self-circumcision. Further systematic exploration is recommended in sexual, reproductive and urological health to increase interest in this phenomenon. Our findings suggest approachability if health communication is enabled within an Islamic context.
This paper reviews the current knowledge on cultural change after migration in the practice of fe... more This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the ‘Pharaonic’ type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using e in a cautious way e the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.
Acta obstetricia et gynecologica Scandinavica, 2015
PLOS ONE, 2015
Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate ... more Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.
In recent decades, there has been growing attention to the overuse of caesarean section (CS) glob... more In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5-6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital's CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have.
This is a reply to: Svoboda, J. Steven 2013. "Promoting genital autonomy by exploring commonaliti... more This is a reply to: Svoboda, J. Steven 2013. "Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting." Global Discourse. http://dx.
Objective: in light of the rising caesarean section rates in many developing countries, we sought... more Objective: in light of the rising caesarean section rates in many developing countries, we sought to explore women's and caregivers' experiences, perceptions, attitudes, and beliefs in relation to caesarean section.
Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.
Setting: a public university hospital in Dar es Salaam, Tanzania.
Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone a caesarean section within two months preceding the interview and were interviewed in their homes. Caregivers were consultants, specialists, residents, and midwives.
Findings: both women and caregivers preferred vaginal birth, but caregivers also had a favourable attitude towards caesarean section. While caregivers emphasised their efforts to counsel women on caesarean section, women had often reacted with fear and shock to the caesarean section decision and perceived that there was a lack of indications. Although caesarean section was perceived as involving higher maternal risks than vaginal birth, both women and caregivers justified these risks by the need to ‘secure’ a healthy baby. Religious beliefs and community members seemed to influence women's caesarean section attitudes, which often made caregivers frustrated as it diminished their role as decision-makers. Undergoing caesarean section had negative socio-economic consequences for women and their families; however, caregivers seldom took these factors into account when making decisions.
Key conclusions and implications for practice: we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness.
Transnational familyhood is a challenge to western societies, whose implementation of legislation... more Transnational familyhood is a challenge to western societies, whose implementation of legislation generally works with the assumption that families are nuclear and situated within a nation state. In the present case study, Somali transnational family organisation is juxtaposed with the western nuclear family model to illustrate the basic differences between the models. The mobility of children in the Somali family system is discussed in relation to child protection in European societies. Cultural variation in family organisation needs to be further discussed in societies that claim to be multicultural. The nature of child protection interventions by social workers will depend on whether society declares universalist or cultural-relativist values as more important.
Objective: to explore the sexual relationship and couples' perceptions about intimate partner sup... more Objective: to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth. Design: a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling. Setting:a diasporic context among participants living in six urban centres across Sweden. Participants: successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants). Findings: within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support. Implications for practice: to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.
Current public debate on “female genital mutilation” often renders the impression that it is poss... more Current public debate on “female genital mutilation” often renders the impression that it is possible to draw an unambiguous line between acceptable and condemnable practices of female genital cutting. In this paper, the cultural histories of cutting of the female genitalia are presented and discussed. Available historical accounts of female circumcision practices in Africa reflect Western, mainly European, ideas and ideologies at certain points in time. In a sense, these descriptions have more to say about “us” than “them”. Further, the historical descriptions of female circumcision in Africa are intertwined with time-bound notions and cutting practices in Western countries in different epochs. Through retrospective reflections, it is possible to see how current commonsensical standpoints, among them the hegemony of a “zero tolerance” attitude regarding cutting of the female genitalia among Africans, are a product of a recently introduced perspective, and also how this generally accepted perspective may render it more difficult to present multi-faceted ethnographic accounts of lived experiences today.
Starting in the early 1980s, media coverage of customary African genital surgeries for females ha... more Starting in the early 1980s, media coverage of customary African genital surgeries for females has been problematic and overly reliant on sources from within a global activist and advocacy movement opposed to the practice, variously described as female genital mutilation, female genital cutting, or female circumcision. Here, we use the more neutral expression female genital surgery. In their passion to end the practice, anti-mutilation advocacy organizations often make claims about female genital surgeries in Africa that are inaccurate or overgeneralized or that don't apply to most cases.
The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little-known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented.
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Articles by Sara Johnsdotter
Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden.
Setting: Sweden.
Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years).
Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.
Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration.
Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention.
Trial registration number NCT02335697; Pre-results.
Media often report about circumcision of girls, or ‘female genital mutilation’ (FGM), in ways that present this practice as a burning social problem, albeit secretively performed among African immigrants in Europe. In this paper we discuss the construction of FGM as a widespread social problem in Europe. We contrast the public discourse on FGM with empirical data on FGM criminal court cases in Europe in order to see to what extent the public discourse agrees with evidence. We conclude that there is a discrepancy between public discourse and media representations, on one hand, and empirical evidence, on the other. We suggest that the scarcity of criminal court cases in Europe to a large extent can be explained by processes of cultural change after migration. Further, we emphasise the importance of access to context-specific knowledge during court proceedings in FGM cases.
Key words
Female circumcision, female genital mutilation, social problem, court cases, media stereotypes, risk estimates
undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers’ ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women’s possibilities to obtain adequate support. At the end of the article, we suggest how health care providers’ reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.
Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.
Setting: a public university hospital in Dar es Salaam, Tanzania.
Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone a caesarean section within two months preceding the interview and were interviewed in their homes. Caregivers were consultants, specialists, residents, and midwives.
Findings: both women and caregivers preferred vaginal birth, but caregivers also had a favourable attitude towards caesarean section. While caregivers emphasised their efforts to counsel women on caesarean section, women had often reacted with fear and shock to the caesarean section decision and perceived that there was a lack of indications. Although caesarean section was perceived as involving higher maternal risks than vaginal birth, both women and caregivers justified these risks by the need to ‘secure’ a healthy baby. Religious beliefs and community members seemed to influence women's caesarean section attitudes, which often made caregivers frustrated as it diminished their role as decision-makers. Undergoing caesarean section had negative socio-economic consequences for women and their families; however, caregivers seldom took these factors into account when making decisions.
Key conclusions and implications for practice: we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness.
The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little-known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented.
Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden.
Setting: Sweden.
Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years).
Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.
Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration.
Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention.
Trial registration number NCT02335697; Pre-results.
Media often report about circumcision of girls, or ‘female genital mutilation’ (FGM), in ways that present this practice as a burning social problem, albeit secretively performed among African immigrants in Europe. In this paper we discuss the construction of FGM as a widespread social problem in Europe. We contrast the public discourse on FGM with empirical data on FGM criminal court cases in Europe in order to see to what extent the public discourse agrees with evidence. We conclude that there is a discrepancy between public discourse and media representations, on one hand, and empirical evidence, on the other. We suggest that the scarcity of criminal court cases in Europe to a large extent can be explained by processes of cultural change after migration. Further, we emphasise the importance of access to context-specific knowledge during court proceedings in FGM cases.
Key words
Female circumcision, female genital mutilation, social problem, court cases, media stereotypes, risk estimates
undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers’ ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women’s possibilities to obtain adequate support. At the end of the article, we suggest how health care providers’ reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.
Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.
Setting: a public university hospital in Dar es Salaam, Tanzania.
Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone a caesarean section within two months preceding the interview and were interviewed in their homes. Caregivers were consultants, specialists, residents, and midwives.
Findings: both women and caregivers preferred vaginal birth, but caregivers also had a favourable attitude towards caesarean section. While caregivers emphasised their efforts to counsel women on caesarean section, women had often reacted with fear and shock to the caesarean section decision and perceived that there was a lack of indications. Although caesarean section was perceived as involving higher maternal risks than vaginal birth, both women and caregivers justified these risks by the need to ‘secure’ a healthy baby. Religious beliefs and community members seemed to influence women's caesarean section attitudes, which often made caregivers frustrated as it diminished their role as decision-makers. Undergoing caesarean section had negative socio-economic consequences for women and their families; however, caregivers seldom took these factors into account when making decisions.
Key conclusions and implications for practice: we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness.
The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little-known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented.
These words are from the keynote lecture at the 9th FOKO conference in Sweden, Female Genital Cutting: The Global North & South, which appears as a chapter in this anthology. This keynote was delivered by Professor Ellen Gruenbaum, an American anthropologist who has done research on this subject for more than four decades. The other chapters build on research papers presented at the conference, covering studies done in countries where circumcision of girls is widely practiced as well as those from European countries which host migrant communities that are affected by these practices. The collection covers a wide range of the issues that currently demand attention among Nordic researchers in the field of female genital cutting.
With contributions of: Omar Abdulcadir, Jean-Loup Amselle, Esther Ayuk, Franca Bimbi, Lucrezia Catania, Giovanna Cavatorta, Gily Coene, Ricardo Falcão, Michela Fusaschi, Irwan Hidayana, Sara Johnsdotter, Bianca Pomeranzi, Ismail Sougueh Guedi and Michela Villani.
Despite the lack of documented illegal cases of female circumcision in Sweden, it is constantly claimed in the public discourse that female circumcision (female genital mutilation) is a practice upheld by the Somali exile group in Sweden.
This study presents the views of Swedish Somalis on female circumcision and contrasts them to the Swedish public discourse on the issue. Based on an analysis of the internal debate on female circumcision among Swedish Somalis in Malmö, it is argued that this practice is negotiated and reassessed by Somalis in Swedish exile. While some traditional values are maintained, even when in conflict with mainstream mentality of the Swedish society, other values and attitudes are debated and abandoned. Among the Somalis in this study, reassessment of the religious imperative in relation to female circumcision has played a crucial role. The study highlights the importance of a processual theory of cultural practices, in contrast to the prevalent essentialist perspective.
It is further argued that the prevalent discrepancy between the discourses – the discussion among Swedish Somalis and the public discussion in Sweden – is an obstacle in the process toward a complete abandonment of the practice of female circumcision in the Somali community in Sweden.
This study develops a comparative overview of recent FGM (Female Genital Mutilation) court cases within the EU, as well as an exploratory survey of transnational movement in relation to FGM. The legal aspects of 20 recent criminal court cases in Europe are analysed, and evidence about transnational movement to have FGM performed is assessed. The report is based on data collected by country experts in eleven European countries. Data include court decisions, migration background of groups from FGM-practising countries in the host countries, the process of FGM-reporting, and stakeholders’ proposals and opinions regarding FGM.
The report addresses the general legal context or framework to fight FGM in the eleven countries, and it briefly analyses the impact that the embracing of the due diligence standard could have, as a consequence of the signature of the Istanbul Convention by all the countries in the report. A finding of our study is the fact that the responses given by different countries to FGM are modelled by disparities of public prosecution systems in Europe. Calling upon state parties to apply the Istanbul Convention and accordingly modify existing provisions that limit their jurisdiction over FGM cases (art. 44) could have an impact on such procedural disparities, although further research is needed in this area.
The review of existing court cases shows the legal concepts of ‘error of prohibition’ and ‘neglect of care’ as novel approaches for both prosecution and prevention of FGM in Europe. As a consequence, the report points out that these aspects (due diligence, neglect of care, and error of prohibition) ought to be further explored in future discussions, not primarily for their potential to result in more criminal court cases of conviction, but because of their potential power as preventive tools.
In the analysis of collected data, we distinguish between ‘typical’ and ‘atypical’ cases, provide examples of those categories, and discuss what the criminal court cases tell us about the geography of illegal FGM activities among migrants in European countries. A strong tendency in the data is that rumours about a transnational movement to have FGM carried out state that girls are brought to their countries of origin to undergo FGM. This situation is reflected in court cases: although FGM has been carried out in France, Italy, Switzerland, and possibly in Spain, a majority of criminal court cases regard FGM performed in African countries.
As for the process of reporting suspicious, pending, or performed FGM cases, most countries establish for professionals a duty to report. However, there are conflicting interpretations of such duties between legal operators and lay people, provoking practical difficulties and ethical dilemmas.
Country experts collected possible reasons for the scarcity of reported suspected cases within the EU. Amongst the reasons stated by stakeholders in the different countries, the two more important were lack of first-hand information and fear of disproportional measures (such as parents under arrest and institutionalisation of children). Children at risk of FGM are not in abusive environments, but the system responds as if that were the case.
As for the policy suggested, the report briefly discusses the legal and ethical implications of some of the stakeholders’ suggestions. For instance, a valuable suggestion is the idea of creating incentives to report by offering better service provisions for affected women and girls. This suggestion tries to counterbalance the idea many professionals have that reporting will only make things worse for the affected family, as special services and provisions are not in place. Access to services or rights would not rely on the willingness of victims themselves to cooperate or report but on the establishment of a system of services that professionals can use when reporting such cases. A stronger emphasis in awareness-raising campaigns among professionals and communities, on medical and social support for affected girls and women would possibly strengthen as well the incentive to report.
The report identifies several areas where further research is needed. One such area is processes of social and cultural change as regards views and practice of FGM among immigrants from FGM-practising countries. A future key question is how legislation, policies, and preventive efforts can speed up the processes of abandonment of FGM among immigrant communities in Europe.
The paper will further discuss later developments in the form of an activist movement (the genital integrity movement, intactivists) contending that also boys without decision-making capacity need to have legal protection against non-medical procedures that irreversibly change their genitals.
Examples from the academic, medical, and political-legal fields in Europe will demonstrate a general trend in which the symmetries between circumcision of girls and boys are again being brought out, now within a children’s rights perspective.
Western understandings of sex rely heavily on ideas emanating from researchers that created the model of the Human Sexual Response Cycle (Masters and Johnson 1966), which has been criticized for its simplistic focus on genitals (and not on people). Physiological aspects are thus over-emphasized at the expense of psychological, social and cultural aspects of importance for outcome.
Sexual scripting theory, introduced by sociologists in the 1970s (e.g. Gagnon and Simon 1973), highlights the cultural and social dimensions of lived sexuality, demonstrates how sexuality is embedded in social and cultural contexts and how people learn how to enact their sexuality. In addition, anthropological research on sensations (e.g. Hinton et al. 2008) suggests that culturally based learning also takes place when it comes to how we perceive bodily sensations, whether we notice bodily signals or not, and how we interpret and give meaning to sensations. Based on these findings, we will discuss possible implications of current campaigning for immigrant women and girls, who have to deal with these public expectations about erased possibilities to feel sexual pleasure after genital cutting.
In summary, we suggest that research, preventive work and rehabilitation care better take into consideration that sexuality is a complex phenomenon, and we stress the need to avoid reductionist one-track approaches that may be more harmful than helpful.
References
Gagnon, J.H. and Simon, W. (1973). Sexual conduct. The social sources of human sexuality. London: Aldine.
Hinton, D. E., Howes, D. & Kirmayer, L.J. (2008). “Toward a medical anthropology of sensations: Definitions and research agenda.” Transcultural Psychiatry, 45(2),142–162.
Johnsdotter, S. (2013). “Discourses on sexual pleasure after genital modifications: The fallacy of genital determinism (a response to J. Steven Svoboda).” Global Discourse, DOI 10.1080/23269995.2013.805530 (e-pub ahead of print).
Masters, W. H. and Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.
In 2008, a Somali couple, refugees in Switzerland, were convicted of the clitoridectomy of their 2-year-old daughter. The procedure had been carried out by a Somali physician in the family's apartment in Zurich twelve years earlier. Subsequently, the parents abandoned the practice and did not perform it on their younger daughters, and the mother campaigned against it during meetings of Somali women. Obscuring the change in attitude of the prosecuted parents, the media coverage of this trial resulted in an upsurge of fear that female circumcision would be a contemporary reality on Swiss soil, albeit this case is the first and only case known to date of a female circumcision performed in the national territory. In order to deconstruct this «moral panic», this paper aims at providing critical analysis of media representations of female circumcision by examining the court report of this case. We will discuss discrepancies between the media coverage and what can be known from legal documents, and reflect on the effects of such media representations on the broader debate of immigrants' integration in Switzerland.