ObjectivesTo present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration.DesignBaseline 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.SettingSweden.Participants372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years).Primary outcome measuresWhether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.ResultsThe 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.ConclusionA 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 numberTrial registration number NCT02335697;Pre-results.

BackgroundPricking, 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.MethodsIn 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.ResultsThose 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.ConclusionsValues 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0351-0) contains supplementary material, which is available to authorized users.

BackgroundUndocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country’s Cause of Death Register (CDR).ObjectiveTo determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants.DesignThis is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample’s mean age at death±a half standard deviation.ResultsOut of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14).ConclusionsWe believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

BackgroundThe aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes.MethodsIn 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants’ approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala’s B-statistic and Welch’s t-test were used.ResultsWe found a substantial agreement between an individual’s own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis–and especially other Swedish Somali women–approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3–27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4–9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%).ConclusionsSwedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC.

In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis' post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.