Female genital mutilation/cutting and psychological distress among Somali women in the United States

Michlig, Georgia J.; Johnson‐Agbakwu, Crista; Bass, Judith; Wachter, Karin; Surkan, Pamela J.

doi:10.1007/s12144-022-03391-6

Cited by 2 publications

(5 citation statements)

References 38 publications

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“…Being a racialized "other" has a significant impact on one's sense of belonging. Divisive politics and fear-mongering propaganda around alleged Somali terrorism have ostracized an already marginalized community and one may posit that they further compromised the fragile trust between the Somali community and public health institutions [59,34].…”

Section: Discussionmentioning

confidence: 99%

“…This finding is quite compelling considering the widespread notion that FGM/C irrefutably and systematically leads to trauma and mental illness, such as anxiety and depression. 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].…”

Section: Discussionmentioning

confidence: 99%

“…This is in line with our results, which reveal that while FGM/ C alone does not independently predict perceived psychological distress, discrimination does. While discrimination and the healthcare experience may play a large role in current self-reported psychological distress, prior analyses have indeed shown that when looking specifically among only those Somali women in the U.S. with FGM/C, recalling the FGM/C event as being traumatic is also associated with distress [34].…”

Section: Discussionmentioning

confidence: 99%

“…partnerships with the Somali community had been cultivated, nurtured, and sustained for nearly 10 years prior to the present CBPR engagement, wherein the community had already been engaged in meaningful community dialogue and educational outreach on FGM/C [30,[33][34][35][36]. Furthermore, health services for FGM/C-affected women and girls had been provided by the first author, who also possessed over 20 years of experience working directly with FGM/C-affected communities and who also delivered cultural sensitivity training to health care providers on engaging with and addressing the unique health care needs of FGM/Caffected communities.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2023

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While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women’s health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, (n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among ‘No FGM/C’ (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the ‘quadruple jeopardy’ of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination—and not FGM/C status per se—is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2023

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“…Many practitioners also report they lack knowledge of different types of FGC and struggle to comprehend the cultural intricacies linked to such experiences, and how they may affect experiences of sexuality and health . Both healthcare providers and female immigrant patients highlight issues such as distrust, suspicion, perceived discrimination, and problems with communication regarding this matter (Carver et al, 2023;Filippi et al, 2014;Michlig et al, 2023;Pavlish et al, 2010). In a Norwegian study, birth clinic staff avoided broaching the topic out of fear it would be taboo or sensitive to women.…”

Section: Welfare Encounters In Migrationmentioning

confidence: 99%

Navigating Conflicting Norms on Body and Sexuality: Exploring Swedish-Somali Women's and Swedish Welfare Workers' Perceptions of Female Genital Cutting

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Female genital cutting (FGC), sometimes referred to as female genital mutilation, is the subject of intense debate, exposing tensions between varying cultural values about bodies and sexuality. In Sweden, FGC is framed as a social problem designed to control female sexuality, and national efforts have long aimed to prevent it from being perpetuated. Welfare workers have a key role in interpreting and implementing FGC politics, making the welfare encounter a site where sometimes divergent cultural understandings about FGC, bodies, and sexuality converge. In this thesis, I explore how sexuality and sexual health are constructed in relation to FGC through welfare work and from the perspectives of different generations of Somali women in the Swedish setting of immigration. Based on individual interviews (16) and focus groups (3) with welfare workers (24) in social care, healthcare, and education, I investigate how FGC, sexuality, and sexual health, is approached in counseling and information targeting young women potentially affected by FGC. Through individual interviews (12) and focus groups (9) with Swedish-Somali women of different generations (53), I examine how women relate to and make sense of their own FGC experiences in light of changing social norms and discourse of FGC post-migration to Sweden. I discuss how concepts of FGC, body, sexuality, and sexual health are navigated and negotiated by investigating meanings ascribed to FGC by the various actors. I also consider the ways in which the understandings of these notions are changing depending on a complex interchange between individual experience, social interaction, and global discourse on FGC. The thesis consists of four papers. The first two papers explore the complexity of how to counsel and address FGC in welfare encounters while having a difficult dual role – working to protect future generations from the practice, while simultaneously encouraging and empowering those for whom it has already been done, without undermining body image or sense of sexual capacity. The first paper found that a key problem is the over-reliance on medical models of sexuality that tend to result in a reductionist focus on the genitals for sexual function, perhaps under-emphasizing the role of the mind, emotions, and sociocultural factors. This approach often led welfare workers to conclude that FGC inevitably negatively interferes with sexuality and sexual health. It was also primarily within a biomedical discourse that solutions and strategies to promote young women’s sexual wellbeing were sought. The second paper investigate how welfare workers understand and respond to health discourse about FGC, using counseling on menstrual pain as an empirical example. The study found that welfare workers navigate their various sources of knowledge, where acquired FGC-knowledge worked as a lens through which young women’s situations were understood. Medical discourse, and menstrual pain in particular, was also used as a starting point for discussing drawbacks of FGC, in order to deter young women from forwarding the practices to future generations. The third paper highlights how women navigate dominating discourse of FGC in their efforts to make sense of their experiences. The study found that imageries and dominant framings of FGC affect how women are perceived by others, or how they expect others to perceive them, also affecting women’s selfunderstanding. Women “talked back” to and talked through expected categorizations and elements of dominant discourse that put women with FGC in a stigmatized position. Doing this, they reinforced categorizations of the most extensive form of FGC (type III, pharaonic cutting) as stigmatized and harmful, while less extensive forms of FGC (type I-II, IV, sunna cutting) were disconnected from some of the stigma attached to FGC. The fourth paper examines subjective experiences and perceptions of sexuality in relation to FGC. The study found that while FGC has been seen as a means to mold a tempered female sexuality in line with cultural standards for proper gendered behavior, both gender standards and means to achieve them have changed under influence of migration and global FGC politics. The findings suggest that while premarital virginity remains as an important value, the external regulation of sexuality through FGC to protect female chastity has been replaced by increased emphasis on inner control and self-discipline. Women disqualified previous rationales for the practice by unsettling the connection of FGC to reduced sexual responsiveness. Many described sexual responsiveness as inherent and not necessarily adversely affected by FGC, although experiences varied. While most expressed positive expectations on sexual desire and pleasure, emerging was also more mixed understandings among some older and younger women. These were associated with notions of the clitoris as significant for sexual responsiveness, causing women to question their bodily and sexual adequacy. Such understandings shall be seen in light of previous cultural ideas about FGC as contributing to reduced sexual responsiveness, which is reinforced in the Swedish context which emphasizes the negative impact of FGC on sexuality. In conclusion, this thesis sheds light on the complex nature of FGC in a context of immigration, particularly highlighting FGC in relation to individual care and counseling in welfare encounters. In Sweden, FGC is framed as a social problem, shaping how women with FGC are perceived and understand themselves. Welfare workers predominantly address FGC from a health perspective, often adopting a genital reductionist approach. Medical discourse plays a dual role: empowering women through knowledge while also exerting control over their bodies, drawing boundaries of some bodies as normal, and others as pathological. Interviews with Somali women shed light on their interactions with FGCconstructs in the Swedish context, illustrating a complex interplay of sociocultural, individual, and global influences.

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Female genital mutilation/cutting and psychological distress among Somali women in the United States

Cited by 2 publications

References 38 publications

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

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

Navigating Conflicting Norms on Body and Sexuality: Exploring Swedish-Somali Women's and Swedish Welfare Workers' Perceptions of Female Genital Cutting

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