Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic

Johnsdotter, Sara; Essén, Birgitta

doi:10.1007/s10508-020-01676-0

Cited by 11 publications

(14 citation statements)

References 52 publications

(85 reference statements)

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“…Ultimately it may lead to suboptimal outcomes of the health encounter. A contrasting approach in the clinical encounter, as suggested by some interviewees in this study, is to start with an unbiased clinical assessment before giving recommendations, bearing in mind that FGC can, but does not necessarily have to, play a part in the person's illness (Johnsdotter & Essén, 2020). This is pertinent not the least in the context of uncertain evidence as regards menstrual pain and FGC (Lurie et al, 2020;Obermeyer, 2005).…”

Section: Implications For Practicementioning

confidence: 99%

Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals’ Approach to Menstrual Pain as an Empirical Example

Palm

Johnsdotter

Elmerstig

et al. 2021

Sexuality & Culture

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In Sweden, as well as in an international context, professionals are urged to acquire knowledge about possible health effects of female genital cutting (FGC) in order to tackle prevention and care in relation to the practice. While professionals are guided by policies and interventions focusing on medical effects of FGC, some scholars have cautioned that many popular beliefs about health risks rest on inconclusive evidence. The way professionals understand and respond to health information about FGC has in this context largely been left unexamined. This article aims to provide a qualitative exploration of how professionals in Sweden approach adolescent sexual and reproductive healthcare encounters in relation to acquired knowledge about FGC, using menstrual pain as an empirical example. The analysis shows that there was a tendency in counselling to differentiate young migrant women’s menstrual complaints from ordinary menstrual pain, with professionals understanding pain complaints either in terms of FGC or as culturally influenced. The study shows how professionals navigated their various sources of knowledge where FGC awareness worked as a lens through which young women’s health complaints were understood. Biomedical knowledge and culture-specific expectations and assumptions regarding menstrual pain also informed counselling. Finally, the article discusses how FGC awareness about health risks was used constructively as a tool to establish rapport and take a history on both menstrual pain and FGC. The analysis also recognises potential pitfalls of the approaches used, if not based in well-informed policies and interventions in the first place.

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Section: Implications For Practicementioning

confidence: 99%

Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals’ Approach to Menstrual Pain as an Empirical Example

Palm

Johnsdotter

Elmerstig

et al. 2021

Sexuality & Culture

Self Cite

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show abstract

“…We also noted that a woman may prefer to invite individuals who are close to her (e.g., elder female relatives, husband) during a clinical conversation about FGC and deinfibulation. In their commentaries, Johnsdotter and Essén (2020) and Johansen (2020) specifically recommended that, with a woman's agreement, her partner be included in clinical conversations. We suggest that women be given the agency to determine whether they provide information in a dyadic or group…”

Section: Who Is In the Best Position To Follow The Script That We Developed To Apply The Theory Of Planned Behavior To Qualitative Researmentioning

confidence: 99%

“…Finally, Johnsdotter and Essén (2020) and Leonard (2020) cautioned that professionals should be open to and respectful of women who wish to live with their infibulation. Johnsdotter and Essén stated that it was "clear that [we] see definfibulation as the desired outcome of the shared decision-making between caregiver and patient."…”

Section: Fear Of Pain and Re-traumatizationmentioning

confidence: 99%

“…To assess the intensity of women's attitudes, we suggest that a researcher or practitioner ask women how strongly they feel about expressed attitudes. Johnsdotter and Essén (2020) noted that there may be a situation of "pluralistic ignorance," where many individuals express an attitude that is aligned with perceived norms (e.g., infibulation or reinfibulation is good) rather than their personal belief (e.g., sex is more enjoyable when a woman is deinfibulated). Johansen (2020) described this process, too, suggesting that the gap between actual and perceived norms may be larger in the context of diaspora, because FGC has become "privatized and silenced" (i.e., condemned by the larger culture).…”

Section: What Do the Commentators Highlight As Missing Or Underdeveloped From The Conceptual Model And Script That We Developed?mentioning

confidence: 99%

“…Below, we summarize commentators' rationales for including each predisposing factor. Johnsdotter and Essén (2020) noted that perception of control (e.g., ability to exert autonomy and consent to procedures) likely varies as a function of age, education, and employment. Several colleagues highlighted body image, sexual feeling, and discourse on sexuality and FGC-related medical procedures as factors that many influence a decision to be deinfibulated.…”

Section: What Do the Commentators Highlight As Missing Or Underdeveloped From The Conceptual Model And Script That We Developed?mentioning

confidence: 99%

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Response to Commentaries: Applying the Theory of Planned Behavior to Female Genital Cutting and Deinfibulation

et al. 2021

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How Canadian Law Shapes the Health Care Experiences of Women with Female Genital Mutilation/Cutting/Circumcision and Their Providers: A Disjuncture Between Expectation and Actuality

et al. 2022

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This study explored how the reproductive health care experiences of women with female genital mutilation/cutting/circumcision (FGC) were shaped. We used Institutional Ethnography, a sociological approach which allows for the study of social relations and the coordination of health care. From qualitatively interviewing eight women with FGC, we learned that they felt excluded within the Canadian health care system because they were unable to access reconstructive surgery, which was not covered by Ontario’s universal health coverage (Ontario Health Insurance Plan). We then talked with seven obstetricians/gynecologists (OB/GYNs) and learned that while it was legal to perform certain genital (e.g., female genital cosmetic surgery) and reproductive (e.g., elective caesarean section) surgeries commonly requested by Western-born women, it was not legal for them to perform other genital surgeries often requested by immigrant populations (e.g., reinfibulation), nor were these covered by OHIP (e.g., clitoral reconstructive surgery). From participants’ comparison of clitoral reconstructive surgery and reinfibulation to female genital cosmetic and gender confirming surgeries, it became clear that the law and policies within the health care system favored surgeries elected by Western adults over those wished for by women with FGC. We found that the law had an impact on the choices that OB/GYNs and the women they treated could make, shaping their respective experiences. This created ethical dilemmas for OB/GYNs and a sense of exclusion from the health care system for women with FGC.

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Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic

Abstract: Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 11 publications

References 52 publications

Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals’ Approach to Menstrual Pain as an Empirical Example

Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals’ Approach to Menstrual Pain as an Empirical Example

Response to Commentaries: Applying the Theory of Planned Behavior to Female Genital Cutting and Deinfibulation

How Canadian Law Shapes the Health Care Experiences of Women with Female Genital Mutilation/Cutting/Circumcision and Their Providers: A Disjuncture Between Expectation and Actuality

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