Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters

Abstract

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women’s engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends’ experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.

Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?

“…Perhaps in part due to discrimination based on their migrant status and religion, Somali individuals (especially in FGM/Caffected communities) have reported feeling "not normal" and "different" in their Western host country [68] a notion perpetuated by discriminatory public discourse depicting the "barbaric" nature of FGM/C and related cultures [69]. A critical discourse analysis of Somali men and women found that Somalis described experiencing discrimination regarding their Muslim identities and that these experiences had perceived impacts on their use of health services [35].…”

“…However, it is important to consider the ways in which distress related to vivid recollection of the original FGM/C experience can be triggered when women traverse social systems such as health care [34]. For example, women with FGM/C in Canada have reported such recollection elicited by vulvar/vaginal examinations, in which their doctors did not know how to care for their resultant emotional responses [69]. Similarly, West African women with FGM/C reported negative and insensitive reactions from medical professionals regarding their FGM/C status that created feelings of shame [7].…”

“…The performance of surgical vulvar reconstructive procedures such as defibulation (for Type III FGM/C) and clitoral reconstruction (for any form of clitoral excision performed in Types I, II, or III FGM/C), while potentially ameliorating some obstetric, gynecologic, or sexual morbidity in women, has been demonstrated to also trigger post-traumatic stress at times [73,74]. While women's distress may seem directly related to FGM/C, what must also be considered is the health care system's under-preparedness to care for women with FGM/C and conditions prominent in Black communities-a notion reported by women with FGM/C themselves [69] and by their service providers [75,76]. This is in line with our results, which reveal that while FGM/ C alone does not independently predict perceived psychological distress, discrimination does.…”

“…Additionally, studies conducted on the 2017 Travel Ban also reveal profound feelings of disempowerment and fear of racist attacks in the Somali community [89]. North American public discourses (i.e., anti-FGM discourses), though well-intentioned, often further 'other' and even defame FGM/ C-affected communities and cultures under the banner of humanrights advocacy, increasing the work such communities must engage in to prepare for encounters with health systems, which they fear will perpetuate the same discrimination [69,[90][91][92]. It is now wellestablished that SDoH are a significant driver of population health inequities [83,93] and that racism is a public health crisis [94,95].…”

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

“…In our previous work, we found that the goal of eradicating FGC on a global level was entangled in anti-female genital mutilation (FGM) public conversations. Although those who engaged in/co-produced anti-FGM discourse (such as media and news outlets) often aimed to “protect” uncut girls and women and advocate for women with FGC, these discursive strategies also often resulted in the stigmatization of women, their bodies, and their cultures (Jacobson et al, 2021 ). This is not the first instance in which the “stigmatizing nature of much current activist, academic, and social-policy discourse” regarding FGC has been discussed (for example, see Earp, 2020a , p. 1).…”