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Continuity or Change?: Improved Understanding of Attitudes Towards Female Genital Cutting after Migration from Somalia to Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Birgitta Essen)ORCID iD: 0000-0002-4137-440X
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semi-structured interviews and focus group discussions were conducted. Data were collected in 2015.

The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1401
Keyword [en]
female genital cutting, circumcision, pricking, migration, gender, sexual and reproductive health and rights, Somalia, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-334703ISBN: 978-91-513-0166-2 (print)OAI: oai:DiVA.org:uu-334703DiVA, id: diva2:1160373
Public defence
2018-01-18, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2017-12-20 Created: 2017-11-27 Last updated: 2018-03-08
List of papers
1. Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?
Open this publication in new window or tab >>Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?
Show others...
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, article id e017506Article in journal (Refereed) Published
Abstract [en]

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: Trial registration number NCT02335697;Pre-results.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-334682 (URN)10.1136/bmjopen-2017-017506 (DOI)000411802700263 ()28801440 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00771; 2013-2095Swedish Research Council, 2015-03546Sven Jerring Foundation
Available from: 2017-11-26 Created: 2017-11-26 Last updated: 2018-02-27Bibliographically approved
2. Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants – a cross-sectional study in Sweden
Open this publication in new window or tab >>Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants – a cross-sectional study in Sweden
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2017 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, article id 92Article in journal (Refereed) Published
Abstract [en]

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.

Methods: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, >= 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis.

Results: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44-20.62); not a violation of children's rights (aOR: 2.86, 95% CI: 1.46-5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25-13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children's rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important.

Conclusions: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values.

Keyword
Female genital cutting, Female genital mutilation, Female circumcision, Pricking, Nicking, Diaspora, Migration, Sweden, Somalia
National Category
Occupational Health and Environmental Health Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-327391 (URN)10.1186/s12978-017-0351-0 (DOI)000407939200001 ()28789667 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2095, 2015-00771Swedish Research Council, 2015-03546
Available from: 2017-08-10 Created: 2017-08-10 Last updated: 2018-01-13Bibliographically approved
3. Shifting norms and conventions: Female genital cutting and the applicability of social convention theory in a migration context
Open this publication in new window or tab >>Shifting norms and conventions: Female genital cutting and the applicability of social convention theory in a migration context
(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-334695 (URN)
Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2017-11-27
4. From sameness to difference: Swedish Somalis’ post-migration perceptions of the circumcision of girls and boys
Open this publication in new window or tab >>From sameness to difference: Swedish Somalis’ post-migration perceptions of the circumcision of girls and boys
(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-334699 (URN)
Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2017-12-05

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