Aim. To explore female outpatients’ perspectives on problems related to female genital mutilation/cutting (FGM/C) and their views on information, care, and counseling. Setting. An FGM/C support center at a maternity clinic in Hargeisa, Somaliland. Methods. A qualitative, descriptive study, using content analysis of seven semistructured interviews with female outpatients. Results. All participants had been ignorant of the etiology of their FGM/C-related complications and hesitant to seek care. All had undergone infibulation but did not wish the same for their daughters. In recent years they had learnt through religious leaders and media campaigns that infibulation was unapproved by Islam. A less severe FGM/C type, “Sunna,” was more accepted; however, few could define what “Sunna” meant. Condemning and ridiculing attitudes against uncircumcised women prevailed in their community. Conclusions. New ideas and concepts related to FGM/C enter the common discourse in the Somali society while traditional norms and values still prevail. Religion was shown to have a strong impact on FGM/C practices and beliefs. Interventions aiming to raise awareness of health consequences of all types of FGM/C, as well as where to seek care for complications, are needed in Somaliland. Involvement of religious leaders in anti-FGM/C programs is essential. 1. Introduction The term female genital mutilation/cutting (FGM/C) describes procedures of total or partial removal of external female genitalia or other intentional injury to the female genital organs for nonmedical reasons [1]. When FGM/C first came to be discussed beyond the societies in which it was traditionally performed, it was generally referred to as “female circumcision”—a term that draws a direct parallel with male circumcision, creating confusion between these two distinct practices [2]. To emphasize the gravity of the FGM/C act, the word “mutilation” was adopted in the 1990s [3]. However, this term can be problematic at a community level, and local languages often instead use the less judgmental “cutting.” In 1999, the UN Special Rapporteur on Traditional Practices drew attention to the risk of “demonizing” certain cultures, religions, and communities. Hence, the term “cutting” has increasingly come to be used [2]. An estimated 100 to 140 million females of the world population have undergone FGM/C. They are most commonly living in east-, west-, and north-east Africa and in some parts of the Middle East and Asia. FGM/C is generally carried out by traditional circumcisers on girls between infancy and 15 years of age
UNICEF, Changing a Harmful Social Convention: Female Genital Mutilation/Cutting, Innocenti Digest, Florence, Italy, 2005.
[3]
A. Rahman and N. Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide, Zed Books, 2000.
[4]
WHO, “Classification of Female Genital Mutilation,” 2008, http://www.who.int/reproductivehealth/topics/fgm/overview/en/index.html.
[5]
WHO, “Health Complications of Female Genital Mutilation,” 2011, http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en/index.html.
[6]
World Bank & UNFPA, Female Genital Mutilation/Cutting in Somalia, World Bank & UN Population Fund, New York, NY, USA, 2004.
[7]
A. Warsame and A. Talle, “Female Genital Cutting: the Transition from Infibulation to Smaller Cutting in Somaliland,” Unpublished, 2011.
[8]
Ministry of Family Affairs and Social Development, MOFA&SD National Gender Policy of 2009–2012, 2009.
[9]
A. A. Gele, B. P. B？, and J. Sundby, “Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district,” BMC Research Notes, vol. 6, article 122, 2013.
[10]
NAFIS Project Document, Unpublished, 2010.
[11]
H.-F. Hsieh and S. E. Shannon, “Three approaches to qualitative content analysis,” Qualitative Health Research, vol. 15, no. 9, pp. 1277–1288, 2005.
[12]
U. H. Graneheim and B. Lundman, “Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness,” Nurse Education Today, vol. 24, no. 2, pp. 105–112, 2004.
[13]
L. Almroth, V. Almroth-Berggren, O. M. Hassanein et al., “A community based study on the change of practice of female genital mutilation in a Sudanese village,” International Journal of Gynecology and Obstetrics, vol. 74, no. 2, pp. 179–185, 2001.
[14]
M. Furuta and R. Mori, “Factors affecting women's health-related behaviors and safe motherhood: a qualitative study from a refugee camp in Eastern Sudan,” Health Care for Women International, vol. 29, no. 8-9, pp. 884–905, 2008.
[15]
G. Mitike and W. Deressa, “Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study,” BMC Public Health, vol. 9, article 264, 2009.
[16]
A. A. Gele, B. P. B？, and J. Sundby, “Attitudes toward female circumcision among men and women in two districts in Somalia: is it time to rethink our eradication strategy in Somalia?” Obstetrics and Gynecology International, vol. 2013, Article ID 312734, 12 pages, 2013.
[17]
K. Missailidis and M. Gebre-Medhin, “Female genital mutilation in eastern Ethiopia,” The Lancet, vol. 356, no. 9224, pp. 137–138, 2000.
[18]
Deutsche Gesellschaft für Technische Zuzammenarbeit (GTZ), “Addressing Female Genital Mutilation. Challenges and Perspectives for Health Programmes. Part I: Select Approaches,” 2001, http://gtz.de/en/dokumente/en-fgm-addressing-fgm.pdf.
[19]
M. J. Upvall, K. Mohammed, and P. D. Dodge, “Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach,” International Journal of Nursing Studies, vol. 46, no. 3, pp. 360–368, 2009.
[20]
M. A. Dirie and G. Lindmark, “Female circumcision in Somalia and women's motives,” Acta Obstetricia et Gynecologica Scandinavica, vol. 70, no. 7-8, pp. 581–585, 1991.
[21]
E. Gruenbaum, “Sexuality issues in the movement to abolish female genital cutting in Sudan,” Medical Anthropology Quarterly, vol. 20, no. 1, pp. 121–138, 2006.
[22]
A. Van der Kwaak, “Female circumcision and gender identity: a questionable alliance?” Social Science and Medicine, vol. 35, no. 6, pp. 777–787, 1992.
[23]
B. Shell-Duncan, K. Wander, Y. Hernlund, and A. Moreau, “Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory,” Social Science and Medicine, vol. 73, no. 8, pp. 1275–1283, 2011.
[24]
R. Sala and D. Manara, “Nurses and requests for female genital mutilation: cultural rights versus human rights,” Nursing Ethics, vol. 8, no. 3, pp. 247–258, 2001.
[25]
B. Shell-Duncan and Y. Hernlund, Female Circumcision in Africa: Culture, Controversy and Change, Lynne Rienner Publishers, Boulder, Colo, USA, 2000.
[26]
UN General Assembly, “Universal Declaration of Human Rights,” 1948, http://www.unhcr.org/refworld/docid/3ae6b3712c.html.
