Abstract
Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.
Highlights
In the last decade, migrant health and migrants’ equitable access to healthcare has received increased attention in Europe [1,2,3,4]
We found that most of our participants were positive towards psychosexual counseling and would use it if available
We identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants’ intention to use Female Genital Cutting (FGC)-related services
Summary
Somalia Sudan Age (years) 16–21 22–27 28–33 34–39 40–45 46–51 52–57 58–63 Marital status Single Married Divorced Have children Yes No Education Middle school High school College Graduate school Type of FGC Type I Type II Type III Length of stay < 1 year 1–5 years 6–10 years >10 years. Almost all participants explained their intention to use or not to use FGC-related healthcare services through references to different sets of social norms and expectations pertaining to premarital and marital sexual conduct. We grouped similar subjective norms together, which eventually resulted in the formation of four different cultural scenarios These scenarios included one premarital scenario (the virgin scenario) and three marital ones (the passive sexual partner scenario, the conditioned active sexual partner scenario, and the equal sexual partner scenario). A few participants said that even though they had never engaged in premarital sexual activity, they were still very scared of failing to prove their virginity They were aware of an ongoing discussion on the presence of different types of the hymen and that not all women would bleed at the first vaginal intercourse.
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