Undoing female genital cutting: perceptions and experiences of infibulation,defibulation and virginity among Somali and Sudanese migrants in Norway

Abstract

This paper explores the dynamics of change in meaning-making about female genital cutting among migrants from Somalia and Sudan residing in Norway. In both countries, female genital cutting is almost universal, and most women are subjected to the most extensive form – infibulation – which entails the physical closure of the vulva. This closure must later be re-opened, or defibulated, to enable sexual intercourse and childbirth. Defibulation can also ease other negative health consequences of the practice. In Norway, surgical defibulation is provided on demand by the public health services, also beyond the traditional contexts of marriage and childbirth. This study explores experiences and perceptions of premarital defibulation. It explores whether Somali and Sudanese men and women understand defibulation as a purely medical issue or whether their use of the services is also affected by the cultural meaning of infibulation. This study analyses data from in-depth interviews with 36 women and men of Somali and Sudanese origin as well as participant observation conducted in various settings during 2014–2015. It reports that although all of the informants displayed negative attitudes towards infibulation, cultural meanings associated with virginity and virtue constitute a significant barrier to the uptake of premarital defibulation.     

The social and cultural context of coping: action, gender and symptoms in a southern black community

Research was conducted on the relationships of coping styles, chronic economic stressors and symptoms of distress in a black community in the rural South. It was found that the effect of an active coping style in moderating the effects of stressors was different for males and females. For females, active coping buffered the effects of stressors; for males, active coping exacerbated the effects of stressors. These results are consistent with the social and cultural context of the community, and with cultural norms governing gender roles within the community. This study demonstrates the need to systematically incorporate cultural and social structural factors in models of the stress process. Cultural norms and structural constraints interact to systematically alter the meaning of different factors in the stress process and in turn alter the effects of those factors on health.     

Couples' experiences of postnatal depression: a framing analysis of cultural identity, gender and communication

Difficulties in communication have been associated with fathers' perceived lack of support for mothers suffering postnatal depression (PND). This paper investigates why the communication of the experience of PND is so difficult and considers how these difficulties might be linked, in part, to the diagnostic process. The study explores, through in-depth interviews, how six Australian couples talked about the new mothers' experience of mild to moderate PND. Framing analysis revealed discrepancies in the couples' explanations of the mothers' PND. The application of the concept of 'framing' has come to the study of mental health by way of Goffman's work on how experience becomes organised. Goffman used the technique of 'frame analysis' to identify and describe the taken-for-granted sociocultural elements that give meaning to a situation. This study identified that mothers and fathers used different frames, with mothers understanding their postnatal experience primarily from within an 'identity' frame and fathers understanding the mothers' experience primarily through a 'psychological' or 'physical hardship' frame. Implications for health service providers are considered.     

Situated influences on perceived barriers to health behavior change: cultural identity and context in Kazakhstan

Objective: The objective of this study was to identify the perceived barriers to lifestyle changes citizens of Kazakhstan suffering from cardiovascular disease and type II diabetes were experiencing.

Design: 14 focus groups were conducted with patients across two regions of Kazakhstan. Topics of discussion included accessing medical care, communicating with health care providers, and following doctor’s recommendations. The text of the discussions were analysed for trends and themes across the different groups.

Results: Patients identified a series of external and internal barriers to lifestyle changes, including the environment, a dependency on health care providers, a health care system they feel powerless to change, and a low level of self-efficacy. Most notable, however, was a constructed ethnic identity whose boundaries included unhealthy behaviors, specifically diet and untimely access of health care. This identity both was blamed as a cause for the patient’s condition and seen as an unchangeable barrier to health behavior change.

Conclusion: Current provider efforts to encourage lifestyle changes to manage disease are not taking into account the broader issue of ethnic identity, namely negotiating a fragile and previously suppressed identity that mostly exists alongside other ethnicities. Therefore, maintaining distinctiveness may be a greater need than modifying health behaviors. Efforts towards healthier lifestyles for the public must include not only messages regarding health but also constructions of a Kazakh identity that allows for such lifestyles to fit within the identity framework.     

The gender identity movement: A growing surgical-psychiatric liaison

The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This gender identity movement has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.This paper was presented at the Eighth International Gender Dysphoria Association Meeting, in Bordeaux, France, on September 16, 1983.     

The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.     

Fetal feminization and female gender identity in the testicular feminizing syndrome of androgen insensitivity

Interview data on aspects of sex and eroticism from a sample of 10 chromosomally male (XY) patients with the complete testicular feminization (androgen insensitivity) syndrome and from a sample of 23 patients with the late-treated adrenogenital syndrome showed marked differences. Homosexual experiences and/or dreams were lacking in the androgen-insensitive group as compared with the adrenogenital group (p0.01).The androgen-insensitive group reported lower frequency of sexual arousal from visual stimuli than did the adrenogenital group (p0.05).Findings on different aspects of sexual behavior suggest a tendency for the androgen-insensitive patients as a group to have a lower sex drive, to be less keenly aware of their sex drive, to be less assertive in heterosexual relations, and to be less versatile in coitus than the adrenogenital patients. No case of exclusive lesbianism, transsexualism, or transvestism was reported from either patient group. Although the two groups differed in sexual and erotic behavior, both were within the range of what in our culture is accepted as feminine. Nonetheless, the androgen-insensitive patients conformed more closely to the conventional feminine stereotype. Regarding explicit satisfaction with female sex role and with cosmetic and clothing interests, the androgen-insensitive group was characteristically feminine. Findings on the Draw-a-Person Test and the Guilford—Zimmerman Temperament Survey are compatible with the results of normal females, but are in sharp contrast with those of normal males. Interview and psychometric data thus concur in showing the androgen-insensitive patients to be unmistakably feminine in behavior and outlook. Their femininity is best conceived of as a product of hormonal nonandrogenization, prenatally and later, in combination with the social experiences of rearing and development, after initial assignment as a girl. Supported in research by Grants 5K03-HD18635 and 2R01-HD00325 USPHS.D. N. Masica was a Henry Strong Denison Scholar in Medical Research, The Johns Hopkins University, 1969-70.     

Human identity versus gender identity: The perception of sexual addiction among Iranian women

This qualitative study was conducted to explore the images of personal identity from the perspective of women with sexual addiction. The data required for the study were collected through 31 in-depth interviews. Sensing a threat to personal identity, dissatisfaction with gender identity, dissociation with the continuum of identity, and identity reconstruction in response to threat were four of the experiences that were common among women with sexual addiction. Painful emotional experiences appear to have created a sense of gender and sexual conflict or weakness in these women and thus threatened their personal identity and led to their sexual addiction.     

Body-image disorder and gender identity

Summary A person's body image is a representation in the mind and brain (mindbrain). It may be socially endorsed or idiosyncratic, even bizarre, by other people's criteria. In cases of sex reassignment, the three principles of body transformation are exemplified, namely, realignment and enhancement, obliteration and relinquuishment, and augmentation and amplification.     

Climacteric complaints, female identity, and sexual dysfunctions

Forty early menopausal women seeking relief from sexual symptoms within a long-term marital relationship and 40 matched women seeking relief of climacteric complaints completed questionnaires concerning three subject: vasomotor and psychosocial symptoms, sexual dysfunctions, and female identity. Results showed that women with sexual dysfunctions were more likely to suffer from vasomotor and psychosocial complaints and their feminine identity was based mainly on ideals of motherhood and beauty. In addition, sexual desire disorders were present significantly in those women with higher psychosocial symptoms, while sexual arousal disorders were particularly evident in women suffering more vasomotor symptoms.     

Understanding different positions on female genital cutting among Maasai and Samburu communities in Kenya: a cultural psychological perspective

This paper presents an analysis of different positions on female genital cutting, either legitimising the practice or challenging it. The framework it offers has been developed from cultural psychological theory and qualitative data collected in Maasai communities around Loitokitok and Magadi, Kajiado County, and Samburu communities around Wamba, Samburu County, in Kenya. Over the course of one month, 94 respondents were interviewed using maximum variation sampling. Triangulation took place by means of participant observation of significant events, such as alternative rites, participation in daily activities and informal talks while staying at traditional homesteads and kraals. The framework adds to understanding of why more contextual approaches and holistic interventions are required to bring an end to female genital cutting.     

The cultural context of infant feeding in Fiji

This paper describes traditional beliefs and practices regarding infant feeding in the Fijian and the Fiji‐Indian cultures and examines the cultural context and current practices in infant feeding and care in both cultures.

Information on traditional beliefs and practices was obtained using open‐ended interviews with elderly women and Fijian and Fiji‐Indian traditional birth attendants. Data on current beliefs and practices were obtained from open‐ended interviews with mothers, by using participant observation in the hospital and post‐natal clinic and the retrospective examination of hospital records of all deliveries for one year. The incorporation of traditional beliefs and values into current infant feeding methods is discussed. There is evidence that cultural factors inhibit exclusive breast‐ or bottle‐feeding but encourage a pattern of mixed feeding which appears to be both biologically and culturally adaptive.     

The cultural context of suicide stigma in Taiwan

In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their family members in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients' hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non-filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to "bad luck" or "a kan-huo (hot energy) problem," or by insisting that it was "not a true suicide." These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient's and the family's explanation of suicide experiences.     

The cultural context of infant feeding in Fiji

This paper describes traditional beliefs and practices regarding infant feeding in the Fijian and the Fiji-Indian cultures and examines the cultural context and current practices in infant feeding and care in both cultures. Information on traditional beliefs and practices was obtained using open-ended interviews with elderly women and Fijian and Fiji-Indian traditional birth attendants. Data on current beliefs and practices were obtained from open-ended interviews with mothers, by using participant observation in the hospital and postnatal clinic and the retrospective examination of hospital records of all deliveries for one year. The incorporation of traditional beliefs and values into current infant feeding methods is discussed. There is evidence that cultural factors inhibit exclusive breast or bottle feeding but encourage a pattern of mixed feeding which appears to be both biologically and culturally adaptive.     

Socio-cultural dynamics of female genital cutting: research findings, gaps, and directions

The goal of abolishing female genital cutting (FGC, or also FGM or 'female circumcision') requires that the socio-cultural dynamics of the practice be well understood if behavioural change is to be accomplished. This paper, based on the literature and the author's ethnographic research in Sudan, reports on the research issues of studying the variation in and complexity of cutting practices and their cultural correlates, arguing for multiple approaches and methods. It highlights directions for future research.     

Prevention of female genital mutilation in The Netherlands

Political attention was drawn to the item of female genital mutilation in The Netherlands in 2004. A task force has been installed to investigate the incidence of and evaluate the attitude towards female genital mutilation. The incidence is estimated to be 50 girls a year, especially girls from Africa. The government has decided to draw up rules for physicians and nurses in paediatric public health in order to influence the attitude of women and help them to abandon this tradition.     

The development of gender identity in the autistic child

Summary The Michigan Gender Identity Test (MGIT) was administered to 30 autistic children to determine whether autistic children could demonstrate a sense of gender identity. The results of the MGIT were correlated with other developmental indices obtained from the AlpernBoll Developmental Profile. From this sample of autistics, a significant relationship was found between gender identity and mental age, chronological age, communication skills, physical skills, social skills, self-help skills and academic (cognitive) skills.