Sara Johnsdotter

Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden

Objective To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.

“Never My Daughters”: A Qualitative Study Regarding Attitude Change Toward Female Genital Cutting Among Ethiopian and Eritrean Families in Sweden

To explore attitudes toward female genital cutting (FGC) in a migration perspective, qualitative interviews were conducted with men and women from Ethiopia and Eritrea in Sweden. We found firm rejection of all forms of FGC and absence of a guiding motive. Informants failed to see any meaning in upholding the custom. We conclude that children of Ethiopian or Eritrean parents resident in Sweden run little risk of being subjected to FGC. A societal structure prepared to deal with suspected cases of FGC with a high level of alertness should be combined with a healthy sceptical attitude toward exaggerations of risk estimates.

Swedish Health Care Providers’ Experience and Knowledge of Female Genital Cutting

We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden. A majority of Swedish health care providers meet patients presenting with evidence of FGC performed long ago. However, very few of them have suspected recently cut patients. The results support the hypothesis that this practice is not as active among African immigrants in Sweden as in their countries of origin. If the prevalence was the same as in African countries, more pediatricians would be expected to meet current cut girls. National efforts and policy programs to prevent FGC in Sweden are recommended as effective, in accordance with current research and should especially be directed toward pediatricians.

Shared Language Is Essential : Communication in a Multiethnic Obstetric Care Setting

This study focuses on communication and conceptions of obstetric care to address the postulates that immigrant women experience sensitive care through the use of an ethnically congruent interpreter and that such women prefer to meet health providers of the same ethnic and gender profile when in a multiethnic obstetrics care setting. During 2005–2006, we conducted in-depth interviews in Greater London with immigrant women of Somali and Ghanaian descent and with White British women, as well as with obstetric care providers representing a variety of ethnic profiles. Questions focused on communication and conceptions of maternity care, and they were analyzed using qualitative techniques inspired by naturalistic inquiry. Women and providers across all informant groups encountered difficulties in health communication. The women found professionalism and competence far more important than meeting providers from ones own ethnic group, while language congruence was considered a comfort. Despite length of time in the study setting, Somali women experienced miscommunication as a result of language barriers more than did other informants. An importance of the interpreters role in health communication was acknowledged by all groups; however, interpreter use was limited by issues of quality, trust, and accessibility. The interpreter service seems to operate in a suboptimal way and has potential for improvement.

Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery

This article intends to present the Scandinavian legislation on female genital mutilation and explore the implications of the laws. Juxtaposing trends of plastic genital surgery in the West with claims that female circumcision may be a practice generally abandoned in Scandinavia, we highlight the double morality inherent in current public discussions. Finally, we pose the question: Is the legal principle of equality before the law regarded when it comes to alterations of the female genitals?

Seven Things to Know about Female Genital Surgeries in Africa

HASTINGS CENTER REPORT 19 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, antimutilation 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 littleknown 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. Some of the signatories of this policy statement support efforts to promote voluntary abandonment of all practices of genital surgery on children. Other signatories wish to allow parents to continue to circumcise males, but not females. Still other signatories seek to preserve the right of parents to carry forward their religious and cultural traditions and Seven Things to Know about Female Genital Surgeries in Africa

A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala.

Objective  To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors.

An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

Somali women in western exile: Reassessing female circumcision in the light of Islamic teachings

What happens to the practice of female circumcision among Muslims who live in Western countries and who come from countries where the tradition still exists? This article examines the practice of female circumcision among Somalis living in Sweden, and reviews the role of Islam in this context. It will be argued that this practice is now being abandoned by Swedish Somalis, principally on the basis of a reassessment of the religious imperative, for what used to be considered a religious duty in Somalia is, in the exile situation, being re-evaluated and re-interpreted as a violation of fundamental Islamic teachings. The inevitable reflection in exile upon the practice of female circumcision led the Somalis in this study to ask themselves and each other about the religious foundation of the custom, resulting in a total repudiation of pharaonic circumcision among almost all of them. When it comes to what is called the sunnah type of circumcision, there were several opinions on the matter. Most Swedish Somalis seem to have reached the conclusion that sunnah circumcision is acceptable if no harm is inflicted on the girl, but the practice itself is not necessary. In exile the ‘naturalness’ of the practice of female circumcision becomes questionable. Two strong motives for female circumcision in Somalia lose their significance: the earlier fear of social criticism for deviation and the demand for circumcision of girls for marriage-ability. In Sweden, young Somali girls would be the ones deviating from their peers if they were circumcised, and their mothers depend upon the hope that they one day can marry Somalis who have grown up in Western countries and have a new view of female circumcision. We could also see a general support for the enactment of Swedish law against female circumcision, even though some critics react against the cultural imperialism inherent in a law directed towards a specific group of immigrants. Indeed many informants expressed a deep fear of Swedish social authorities and were well aware of the right of the society to take over the custody of their children by force. However, the most important reason stated for individuals’ decisions to abandon this ancient Somali traditional practice focused on religious aspects, as will be discussed below.

Koran reading and negotiation with jinn: strategies to deal with mental ill health among Swedish Somalis

In this paper, we discuss traditional Somali concepts of mental ill health. Qualitative interviews were conducted with some 20 Swedish Somali interviewees about factors causing mental ill health, traditional classification, strategies to deal with mental ill health, and attitudes to the mental health care services in Sweden. Social mobilisation and religious healing are cornerstones of traditional Somali measures to deal with mental suffering. Traditional Somali views of mental ill health stand in stark contrast to classification of mental ill health in the western biomedical model. These views deserve attention since they may have an impact on health-seeking behaviour among Somali immigrants in western countries. Yet a too strong focus on cultural aspects may over-shadow the fact that much mental suffering among Somali migrants must be understood within social, economic, and political contexts.