Somali Women Research Articles

High rates of germline mutations in Somali women with ovarian cancer (2155)

High rates of germline mutations in Somali women with ovarian cancer (2155)

Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women

ObjectiveTo explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs. DesignA qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis. SettingThe study was conducted in Sweden. ParticipantsSwedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth. FindingsThe analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information. Key conclusionsMiscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns. Implications for practiceThe midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.

Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland

BackgroundWomen in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women’s reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland.MethodsSurvey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010–2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births.ResultsA total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women.ConclusionPast trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes.

CO-DESIGNING ACCEPTABLE AND INCLUSIVE APPROACHES TO PUBLIC INVOLVEMENT OF ETHNIC MINORITY COMMUNITIES IN ORTHOPAEDIC RESEARCH

AbstractIntroductionPeople from ethnic minority backgrounds are underserved in healthcare and research. We co-developed a checklist to promote good practice for inclusive community patient and public involvement (PPI).MethodsWe worked with three community groups in Bristol to develop the checklist – Dhek Bhal (South Asian community), Malcolm X Elders (African Caribbean community) and My Friday Coffee Morning (predominantly Somali women). We worked with group leaders to better understand the needs of the groups. We visited each group at least three times and used informal and open discussions tailored to how each group preferred to work. We paid for community leaders’ time, interpretation and transport where needed, as well as contributing towards activities and catering as suggested by group leaders.ResultsThe checklist covers 4 broad themes:Link building – understand the community, gauge interest in topic, build trust and relationships, visit regularly and return to updatePracticalities – visit the communities in their usual space, understand most appropriate meeting formats, consider translation and transport3. During the meeting – avoid jargon, be informal and flexible, build in social time, provide culturally preferred food4. Giving back – acknowledge the value of people's time, identify preferences for reimbursement, look for opportunities to give backTo complement the checklist, we produced a visual output in the form of an illustration created by a local artist.DiscussionWe hope this checklist will facilitate meaningful involvement of people from underserved communities in all stages of research, including identifying research priorities, co-design, research management and dissemination.

The “Transnational Business of Death” Among Somali Migrants in the Streets of Athens

Abstract Migrants risk their lives when venturing out on hazardous journeys to escape unbearable situations in their countries of origin. Some, unfortunately, lose their lives en route. When such tragedies happen, a border-crossing social network of brokers, fellow travelers, family members, and friends of the deceased engage in a “transnational business of death” involving exchanges of money, things, information, and rumors. Based on ethnographic fieldwork among Somali women and men from 2013 to 2016, this article explores how the death of one Somali woman was dealt with on a particular street in Athens, Greece. The article argues that an informal economy arises as a reaction to the lack of legal, formal support from the Greek nation-state when it comes to dealing with the deaths of loved ones among undocumented migrants.

Female Genital Mutilation: A Religio-cultural Sensitive Issue Determining Maternal Healthcare Choices among Somali Women in Dadaab Refugee Camp, Kenya

This paper focuses on Kenya’s development challenges in maternal health care, especially the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. The study identifies four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp; to establish the hospital process of providing maternal health care to mothers who have gone through FGM; to find out the level of preparedness of the midwives to handle mothers with religio-cultural concerns such as prayer and non-involvement of male nurses; and how the practice of FGM contributes to the preference of TBA by mothers. This study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. The specific support of midwives in refugee camps contexts also remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers despite the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for healthcare workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based/mother-centered skills.

The association of maternal anaemia with adverse maternal and foetal outcomes in Somali women: a prospective study

BackgroundAnaemia in pregnant women is one of the most common public health problems, especially in low- and middle-income countries, such as Somalia. This study aimed to examine the association between the severity of anaemia during pregnancy and the risk of adverse maternal and foetal outcomes in Somali women.MethodsWe prospectively enrolled pregnant women who had deliveries from May 1 to December 1, 2022, at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital. Blood haemoglobin levels were measured for each participant at admission for delivery. Anaemia was defined as a haemoglobin level of less than 11 g/dL, with mild (10 to 10.9 g/dL), moderate (7 to 9.9 g/dL), and severe (< 7 g/dL) forms. The associations between maternal anaemia and maternal-foetal outcomes were investigated.ResultsThe study included 1186 consecutive pregnant women (mean age 26.9 years, range 16–47). The incidence of maternal anaemia at delivery was 64.8%, with 33.8%, 59.8%, and 6.4% of women having mild, moderate and severe forms, respectively. Anaemia at delivery was associated with increased oxytocin administration to prompt labour (OR, 2.25, 95% CI, 1.34–3.78). Both moderate and severe anaemia were associated with increased risks for postpartum haemorrhage (moderate, OR, 4.93; severe, OR, 41.30) and the need for maternal blood transfusions (moderate, OR, 9.66; severe, OR, 301.50). In addition, severe anaemia was associated with increased risks for preterm delivery (OR, 2.50, 95% CI, 1.35–4.63), low birth weight (OR, 3.45, 95% CI, 1.87–6.35), stillbirths (OR, 4.02, 95% CI, 1.79–8.98), placental abruption (OR, 58.04,95% CI, 6.83–493.27) and maternal ICU admission (OR, 8.33, 95% CI, 3.53–19.63).ConclusionOur findings suggest that anaemia in pregnancy is associated with adverse maternal and foetal outcomes, with moderate or severe anaemia leading to increased risks for peri-, intra- and postpartum complications and that treatment of severe anaemia in pregnant women should be given particular consideration in our efforts to prevent preterm births, LBW and stillbirths.

A Cervical Cancer Screening Toolkit for Somali Women: A Pilot Randomized Controlled Trial.

This study aims to determine whether a novel cervical cancer screening toolkit will increase rates of pap test completion and HPV vaccination among Somali women living in the United States. We conducted a randomized controlled, pilot trial from June 2021 to February 2022. Somali women aged 21 to 70 were randomized to either receive a toolkit (infographic, video and an in-person health seminar) or not. Health passports confirming a completed pap test and/or HPV vaccination by clinician signature were used to measure outcomes. The primary outcome was pap test completion and the secondary outcome was HPV vaccination. We enrolled 57 participants. Patients randomized to the treatment arm were significantly more likely to have had a pap test (53.7% vs. 3.7%, p < 0.0001) and were also more likely to have received the HPV vaccine (10.7% vs. 3.7%, p = 0.6110). This toolkit increased rates of pap test completion and more participants in the intervention arm received HPV vaccination, though numbers were low. The study design may serve as a reproducible model to determine the effectiveness of patient education materials.

Hospital-based Cross-sectional Study on Demographic Aspects of Hormonal Contraception Use and its Association with Depression Among Somali Women in Mogadishu

Though hormonal contraception is known to precipitate depression in some women, it is a successful public health initiative and has numerous personal and community advantages. It contributes to reducing unsafe abortions and maternal and child mortality. The purpose of this study was to assess the prevalence of depression among women who use the hormonal contraceptive (HC) method in Mogadishu, which at times led to circumstances for discontinuation of the contraceptives. A hospital-based cross-sectional study was conducted among women who use HCs and attend a tertiary Benadir mother-and-child hospital and a Somali-Sudanese hospital in Mogadishu, Somalia, from August 2022 to December 2022. The data were collected using Patient Health Questionnaire-9 (PHQ-9). Data were analysed in both descriptive and inferential statistics such as percentage, t-test, analysis of variance, and binary as well as multiple logistic regression. On the HC usage characteristics, 43.6% of the participants have been on Jadelle Implants (a levonorgestrel-releasing implant), with a significance, while only 18.1% use pills (progestin and oestrogen), and the rest used Norplant capsules. In evaluating the physiological side effect incurred by respective HC, 39.6% of respondents were taking anti-depression therapy with a comparative significance, 78.9 were in overall good health, while 21.1% of participants were in poor health. Based on PHQ-9 majority of the respondents (26.9%) had moderate depression, and thirteen (13.1%) had minimal depression, fifty (22.0%) had mild depression. Yet, 43 (18.9%) experienced moderate depression, while another 43 (18.9%) had severe depression. Female housewives were 1.91 times more at risk of any form of depressive disorder than those who are employed. Respondents who had more than $600 were 0.45 times less likely to develop depression compared to those who had less than $600. However, women who used implants (Jadelle) and pills were more likely to develop depression with a p-value of 2.4x10-2 and 1.40x10-2, respectively, than those who used Norplant, respectively. In addition, women who use HCs for one year and more/over are less likely to develop depression compared to those who use HCs for more than 3 months and 6 months, respectively. In conclusion, housewives, low-income level, type of HC, and long duration of HCs were the determinants of depression. As a result, women should be aware of the Hormonal Contraceptives' side effects related to depression and seek the advice of doctors or other medical professionals.

The Utilization of Antenatal Care Services among the Pregnant Women in Somalia: A Scoping Review

Background: Women in Somalia suffer from one of the highest maternal mortality rates in the world. The good utilization of antenatal care (ANC) services significantly minimizes maternal and child mortality. The study aimed to identify the utilization of antenatal care services among pregnant women in Somalia. Methodology: We performed a scoping review based on the York methodology. This methodology entails a thorough search of published academic articles, conference proceedings, and grey literature via PubMed, Scopus, Google, and Google Scholar, focusing on English-language material. Results: Findings revealed that a significant number of Somali pregnant women utilize the ANC services, though not to the required number of visits as recommended by the WHO. Financial constraints, poor attitude of the healthcare providers, partner's attitude toward ANC services, lack of accessibility due to ANC services being far away, long waiting times, family matters, lack of awareness or media exposure, gravida, parity, and a good number of them believing that ANC is not necessary for their health were among the reasons given for an inadequate visit or non-utilization of the ANC services. Conclusion: The motivation to utilize ANC services, the initiation of visits within the early stages of pregnancy, and the completion of the required number of visits during pregnancy are crucial in preventing pregnancy-related issues and reducing maternal mortality. This must be encouraged among Somali women.

Barriers and facilitators to physical activity and healthy eating: A qualitative study among Somali women in Oslo, Norway

Barriers and facilitators to physical activity and healthy eating: A qualitative study among Somali women in Oslo, Norway

Abstract P650: Addressing Cardiovascular Disease Inequities: Qualitative Process Evaluation From a Co-Investigation With Im/Migrants Exploring How to Sustain a Community-Driven, Social Network Intervention Using a Racism-Conscious Approach

Introduction: Health promotion programs focused on cardiovascular disease are underutilized with im/migrants. The one-time referral to group-based interventions model ignores (1) the complex sociocultural influences on behavior change and (2) the socio-historical context of migration, racialization of immigrants and refugees, and the roles these play in differential social integration of refugees. One solution may be to apply community-based participatory research (CBPR) and Public Health Critical Race Praxis (PHCRP) to social network interventions with opinion leaders. Yet, these interventions are challenging to scale. There is a critical need to understand how to scale community-driven social network interventions to effectively address cardiovascular disease inequities resulting from systemic racism experienced by im/migrant populations. Developed using CBPR and informed by PHCRP, this work builds upon Healthy Immigrant Community (HIC), a collaborative effort between Latinx and Somali im/migrant partners and Rochester Healthy Community Partnership. Our aim is to explore opinion leader recruitment, their characteristics, and expectations for HIC scale-up. Qualitative Hypothesis: Learning more about the opinion leaders’ background and experience in the Healthy Immigrant Community social network intervention will prepare us for a future efficacy study. Methods: We conducted a process evaluation by: (1) interviewing community partners who recruited opinion leaders (n=8) and (2) conducting three pre-intervention focus groups with opinion leaders (Latinx n=4; Somali women n=8; Somali men n=8). We used PHCRP to deductively form codes yet allowed for new ideas that arose from the data by inductively generating additional codes. Results: Interview participants described their decision-making process, qualities considered, recruitment strategies, and expectations for an implementation study. Focus group participants discussed their personal motivations for participation, how they hoped the study would help their community, and the barriers to health they experience because of structural determinism (macro-level forces that sustain inequities). Conclusions: This work will enhance our ability to translate HIC to other communities by expanding our knowledge of opinion leader characteristics that are important in a community-driven, social network intervention. Because social network interventions have been demonstrated to cause positive behavior change, further adapting these interventions in a community setting would be expected to provide a more effective approach compared to individually targeted behavior change strategies. Additionally, selecting OLs is neither time nor resource intensive and could enhance organizational strategies for implementing health promotion programming.

Trend and factors associated with anemia among women reproductive age in Ethiopia: A multivariate decomposition analysis of Ethiopian Demographic and Health Survey.

In developing countries like Ethiopia, anemia is a public health problem. Unfortunately, the progress of anemia reduction has been slow. Although the issue of anemia has received considerable critical attention nowadays, trends and factors associated with anemia among women of reproductive age have not been explored in Ethiopia. This study aimed to determine trends and factors associated with anemia among women of reproductive age in Ethiopia from 2005 to 2016. Data from three consecutive Ethiopian Demographic and Health Survey (EDHS) from 2005-2016 were analyzed in this study. EDHS is a two-stage cluster sampling survey. Data were weighted to correct sampling bias in all surveys. A total of 46,268 samples were analyzed using a fixed effect model. For a measure of proportion, differences and slopes were computed. Bivariate and multivariable logistic regression analyses were done to identify predictors of the trend of anemia among women. Adjusted odds ratio (AOR) with a 95% Confidence Interval(CI) was computed, and the p-value < 0.05 is considered significant. Prevalence of anemia among women was 68%, 20.3%, and 27.3% in 2005, 2011 and 2016, respectively. The trend of anemia was reduced by 47.7 percentage points from 2005 to 2011; however, it increased by 7% points again from 2011 in 2016. Lack of mobile phones (AOR = 1.4, 95%CI, 1.2,1.6), Afar women (AOR = 1.5, 95%CI, 1.1,2.3) and Somali women (AOR = 1.5, 95%CI, 1.1,1.9) were associated with anaemia among women. On the contrary, the history of heavy menstruation in the last six months (AOR = 0.9; 95%CI, 0.85,0.98) was a factor negatively associated with anemia in 2005. In 2011, single women (AOR = 0.8,95%CI,0.7,0.9), watching TV less than once per wk (AOR = 0.9,95%CI,0.7,0.95), watching TV at least once per week (AOR = 0.8,95%CI,0.7,0.98) were variables associated with anemia. On the contrary, widowed women (AOR = 1.7,95%CI,1.4,2.0) were affected by anemia. In 2016, the richest women (AOR = 0.7, 95%CI, 0.6,0.8) and single (AOR = 0.8, 95%CI, 0.7,0.9) were affected little by anemia. Women of traditional belief followers (AOR = 2.2,95%CI,1.6,2.9) were more highly influenced by anemia than their counterparts. The prevalence of anemia declined rapidly from 2005 to 2011, and increased from 2011 to 2016. Stakeholders should develop policies and programs to enhance the socio-demographic status of women and basic infrastructure for the community. Furthermore, they should design strategies for extensive media coverage of the prevention of anemia. The federal government should balance the proportion of anemia among regions by ensuring health equality.

Re-learning to be a woman: virtual space and post-migration womanhood in the Somali diaspora

ABSTRACT Upon migrating, gender ideologies, performances, and relationships are transformed. However, little work has examined how information and communication technologies facilitate this transformation for immigrant women. In this article, drawing on observations of a Somali women created and led phone line and interviews with founders, moderators, and participants on this space, I consider how Somali immigrant women utilise virtuality to create a unique diasporic space in which they learn and practice the new identity of ‘immigrant woman’, distinct from the womanhood of their homeland or hostland. I argue that the reconfiguration of their womanhood post-migration is actively developed and negotiated communally through innovative community building and highlight how women specifically benefit from the scale and scope of a decentralised and virtual diaspora. Focusing on the domain of motherhood, I show how virtual space allows for a communal learning and negotiation of arising tensions. These findings illuminate the process underlying gendered immigrant integration.

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

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

The impact of parity on sexual function in Somali women: A prospective study

The impact of parity on sexual function in Somali women: A prospective study

Determine knowledge and belief of Somalian young women about breast cancer and breast self-examination with champion health belief model: a cross-sectional study

Breast cancer (BC) is an important reason for mortality rates in Somalian women. In Somalia, many women are late in applying to the hospital for the diagnosis of BC. Breast self-examination (BSE) is considered an important early detection method for BC in encouraging women to learn to practice BSE, especially for women in developing countries. This study purposed to determine knowledge, and belief of BC and BSE and BSE practice among women in Mogadishu, Somalia using the champion health belief model (CHBM). This cross-sectional study was conducted on 413 women who were between 18 and 49 years of age. The data were collected by using sociodemographic variables (age, marital status, education level, income status), Champion's Health Belief Model Scale (CHBMS), and an introductory questionnaire with questions about BC and BSE and between October 2020 and January 2021 in Mogadishu, Somalia. Further descriptive statistics, the Mann-Whitney U test, and Kruskal-Wallis analysis test were used to assess data that were not normally distributed. Average age of participants was 22 ± 11.21 years. Only 35.4% of participants had information about BC, 37.8% had heard about BSE before, 25.2% knew BSE, and only 17.2% had done it. Income status, marital status, and age of first birth family were significantly associated with perceived sensitivity, health motivation, convenience, perceived benefits, and self-efficacy for BSE. Overall, the total scores of CHBMS were significantly higher among those who had heard and knowledge about BSE and practiced clinical breast examination (CBE). For the sub-dimensions of perceived sensitivity, health motivation, perceived benefits, barrier, and self-efficacy BSE with hearing about BSE, practicing BSE, knowing to practice BSE, knowing early detection methods of BC and practice CBE significant differences were observed (P < 0.005). This study showed that BSE practice among Somalian women was very low, and they don't have sufficient knowledge about BSE and BC. Furthermore, this study revealed that many CHBMS significantly related to BSE practice in Somalian women, suggesting that BSE health education programs with CHBMS.

Knowledge, attitudes and practices concerning breast cancer, cervical cancer and screening among healthcare professionals and students in Mogadishu, Somalia: a cross-sectional study.

Somali women face exceptionally high mortality and incidence rates from both breast cancer (BC) and cervical cancer (CC). They experience the highest age-standardised BC mortality rate in Africa and an age-standardised BC incidence rate of 41.7 per 100,000 women. Somalia's second-highest cancer-related mortality and incidence rates are due to CC, both behind BC. It is critical to identify the underlying factors that may influence healthcare workers' management of both cancers. At present, there is a lack of evidence regarding providers' knowledge of these two cancers and their screening in Somalia. A cross-sectional questionnaire was administered with a purposive sampling strategy to 469 healthcare professionals and students and was completed by 405 (86%). Healthcare workers were recruited from Mogadishu-based hospitals. One hundred and ninety-seven healthcare professionals and 207 students completed the survey and were included in the analysis. 89% and 73% of respondents demonstrated good knowledge of BC and CC, respectively. Only 46% knew that a vaccine could prevent CC, and 89% of healthcare professionals disagreed that human papillomavirus (HPV) vaccines were available to their patients. Attitudes towards cancer screening, in addition to breast self-examination (BSE), were overwhelmingly positive. For both BC and CC, 24% reported having treated a patient and 30% reported having conducted a screen for either disease. Overall, while knowledge of both diseases and screening was good, there remain areas for clear educational targeting such as HPV vaccine availability and BC preventability. Attitudes to screening for both diseases were exceedingly positive but, with the exception of BSE, failed to translate into practice due to inadequate resources and patient refusal. Future investments into Somalia's chronic care management should prioritise technology necessary to conduct screenings for both diseases, expanding HPV vaccine access and understanding patients' potential motivations for refusing screening.

Group antenatal care (gANC) for Somali-speaking women in Sweden – a process evaluation

BackgroundLanguage supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo (“mother” in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors.MethodsA process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8).ResultsLanguage-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC.ConclusionsThe Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided.Trial registrationThe study was registered in ClinicalTrials.gov (Identifier: NCT03879200).

Somalian women with female genital mutilation had increased risk of female sexual dysfunction: a cross-sectional observational study

Studies regarding the impact of female genital mutilation/cutting (FGM/C) on sexual function are scarce. This study is the first to explore the rate of female sexual dysfunction (FSD) among Somalian women who underwent FGM and its association with different FGM types. This study was carried out among women with a history of FGM who visited our clinic for a medical check-up. It relied on data including socio-demographic features, type of FGM determined by an examination, and the Female Sexual Function Index (FSFI) scores. Overall, 255 women were included. While 43.9% (n = 112) of the respondents had a history of Type 3 FGM, 32.2% had Type 2 (n = 82), and 23.9% had Type 1 (n = 61) FGM. Among all patients, 223 had FSD (87.6%). There was a significant association between the FGM type and FSD (p < 0.001). The mean total FSFI score for the patients with Type 1, 2, and 3 FGM was 22.5, 19.7, and 17.3, respectively, all indicating FSD. The FSD is prevalent among mutilated Somalian women. Patients with Type 3 FGM had the lowest mean total FSFI scores indicating that the impact on sexual function was correlated with the extent of tissue damage during FGM.