Aim. The aim of this study was to elucidate midwives experiences in providing care and counselling to women with FGM related problems. Setting. The study was conducted at a maternity clinic in Hargeisa, Somaliland. Method. A qualitative, inductive study were performed with eight midwives living in Somaliland. The interviews had semi-structured questions. Content analysis was used for the analysis. Findings. The main findings of the present study were how midwives are challenged by culture and religion when providing FGM counselling. The most prominent challenge is the perception that FGM is an important part of the culture and from this point of view the midwives work is apprehended as interfering and subverting the Somali culture. Having personal experience of FGM emerged as a benefit when counselling women. Conclusion. There is a contradiction between the professional actions of performing FGM despite a personal belief against FGM. Midwives as a professional group could be important agents of change and further research is needed about the midwives role in this process. 1. Introduction Female genital mutilation (FGM) is currently practiced in 30 African countries in the sub-Saharan and northeastern regions and in some countries in Asia and in the Middle East [1]. FGM is a serious public health problem and a global concern. It is estimated that around 140 million girls and women worldwide have undergone FGM and that at least two million girls are annually at risk of undergoing some form of the procedure. FGM is interfering with one of the most intimate aspects of a woman’s life and is a fundamental violation of women’s human rights [1]. The age when the primary FGM is performed varies depending on ethnic groups and geographic location. In Somalia and Sudan, FGM is often performed at the age of 5–10 years. In other areas, the procedure is undertaken on baby girls (Yemen) or at puberty (Sierra Leone) [2–4]. The motives of FGM are complex and vary between different contexts and are surrounded with myths and taboos [5]. Although the origin of FGM is concealed, the practice survives today and it is a culturally embedded phenomenon. Among those who practice it, FGM is often performed due to tradition, cultural conformity, or and religious reasons. It is thought to hamper women’s sexuality and preserve honor and virginity, thus enhancing their marriageability and marking ethnic boundaries [1, 6–9]. Since FGM practices differ greatly between ethnic groups and geographic regions, WHO has classified the predominant types of mutilation into four categories. Type
References
[1]
World Health Organization, “Prevalence of FGM,” 2010, http://www.who.int/reproductivehealth/topics/fgm/fgm.
[2]
A. Rahman and N. Toubia, Female Genital Mutilation. A Guide to Laws and Policies Worldwide, Zed Books, London, UK, 2000.
[3]
V. Berggren, Female Genital Mutilation (Studies on Primary and Repeated Female Genital Cutting), Karolinska University Press, Stockholm, Sweden, 2005.
[4]
B. Chalmers and K. Omer-Hashi, “What Somali women say about giving birth in Canada,” Journal of Reproductive and Infant Psychology, vol. 20, no. 4, pp. 267–282, 2002.
[5]
C. Momoh, “Female genital mutilation,” in Female Genital Mutilation: A Clinicians Experience, H. Gordon, Ed., pp. 29–36, TJ International, Cornwall, UK, 2005.
[6]
B. Berggren and S. Bergstr？m, “Kvinnlig och manlig omsk？relse, former av rituell k？nsstympning,” in L？robok I sexologi, P. O. Lundberg, Ed., pp. 145–153, Almqvist & Wiksell, Uppsala, Sweden, 2010.
[7]
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.
[8]
A. Schlytter, S. H？gdin, M. Ghadimi, ？. Backlund, and D. Rexvid, Virginity and Honour. An Investigation of Girls and Boys in Stockholm who Live with Honour Related Control-Summary and Character, Institution for Social Work; Stockholm University, 2009.
[9]
A. Talle, “Kulturellt och historiskt sammanhang,” in Kvinnlig K？nsstympning, V. Berggren and M. Franck, Eds., Studentlitteratur, 2008.
[10]
World Health Organization, Eliminating Female Genital Mutilation: An Interagency Statement: UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, Geneva, Switzerland, 2008.
[11]
E. Leye, R. A. Powell, G. Nienhuis, P. Claeys, and M. Temmerman, “Health care in Europe for women with genital mutilation,” Health Care for Women International, vol. 27, no. 4, pp. 362–378, 2006.
[12]
United Nations Population Fund, “A holistic approach to the abandonment of female genital mutilation/cutting,” 2007, http://www.unfpa.org/public/pid/407.
[13]
A. Warsame and A. Talle, “Female genital cutting: the transition from infibulation to smaller cutting in Somaliland,” In press.
[14]
H. Rushwan, “Female genital mutilation (FGM) management during pregnancy, childbirth and the postpartum period,” International Journal of Gynecology and Obstetrics, vol. 70, no. 1, pp. 99–104, 2000.
[15]
N. Toubia, “Female circumcision as a public health issue,” The New England Journal of Medicine, vol. 331, no. 11, pp. 712–716, 1994.
[16]
N. F. Toubia and E. H. Sharief, “Female genital mutilation: have we made progress?” International Journal of Gynecology and Obstetrics, vol. 82, no. 3, pp. 251–261, 2003.
[17]
World Health Organization, “Studygroup on female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries,” The Lancet, vol. 367, pp. 1835–1841, 2006.
[18]
A. A. El Dareer, “Epidemiology of female circumcision in the Sudan,” Tropical Doctor, vol. 13, no. 1, pp. 41–45, 1983.
[19]
P. C. Lundberg and A. Gerezgiher, “Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden,” Midwifery, vol. 24, no. 2, pp. 214–225, 2008.
[20]
World Health Organisation, “WHO-AIMS report on Mental Health System in Somaliland Region of Somalia,” 2006, http://www.who.int/mental_health/somaliland_who_aims_report.pdf.
[21]
World Health Organisation, “Female genital mutilation and other harmful practices,” 2013, http://www.who.int/reproductivehealth/topics/fgm/prevalence/en/.
[22]
World Health Organisation, “Improving human resources for sexual and reproductive health and maternity services in Somaliland through performance-based pay,” 2011, http://www.who.int/entity/workforcealliance/forum/2011/hrhawardses12/en/-22k.
[23]
W. S. Yirga, N. A. Kassa, M. W. Gebremichael, and A. R. Aro, “Female genital mutilation: prevalence, perceptions and effect on women's health in Kersa district of Ethiopia,” International Journal of Women's Health, vol. 4, no. 1, pp. 45–54, 2012.
[24]
R. J. Cook, B. M. Dickens, and M. F. Fathalla, “Female genital cutting (mutilation/circumcision): ethical and legal dimensions,” International Journal of Gynecology and Obstetrics, vol. 79, no. 3, pp. 281–287, 2002.
[25]
World Health Organization, “Global strategy to stop health-care providers from performing female genital mutilation,” 2010, http://www.who.int/reproductivehealth/publications/fgm/en.
[26]
V. Berggren, G. Abdel Salam, S. Bergstr？m, E. Johansson, and A.-K. Edberg, “An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth,” Midwifery, vol. 20, no. 4, pp. 299–311, 2004.
[27]
L. B. Berg, Qualitative Research Methods for the Social Sciences, Pearson Education, Boston, Mass, USA, 6th edition, 2007.
[28]
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.
[29]
M. Sandelowski, “Using qualitative research,” Qualitative Health Research, vol. 14, no. 10, pp. 1366–1386, 2004.
[30]
S. Miller, D. L. Billings, and B. Clifford, “Midwives and postabortion care: experiences, opinions, and attitudes among participants at the 25th Triennial Congress of the International Confederation of Midwives,” Journal of Midwifery and Women's Health, vol. 47, no. 4, pp. 247–255, 2002.
[31]
E. O. Asekun-Olarinmoye and O. A. Amusan, “The impact of health education on attitudes towards female genital mutilation (FGM) in a rural Nigerian community,” European Journal of Contraception and Reproductive Health Care, vol. 13, no. 3, pp. 289–297, 2008.
[32]
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.
[33]
I. Askew, “Methodological issues in measuring the impact of interventions against female genital cutting,” Culture, Health and Sexuality, vol. 7, no. 5, pp. 463–477, 2005.
