Many attempts have been made to eradicate female genital mutilation over the past decades, yet the sustained practice continues to be a risk for women’s health and agency. In Kenya, an intervention with increasing proliferation is the alternative rites of passage. The approach has existed for some time, however little and highly contextual research has been produced around it. This thesis examines the general characteristics of an alternative rite of passage by combining primary and secondary data. Interviews were conducted with Kenyan professionals working with alternative rites of passage, as well as a systematic literature review. The findings demonstrate the balance between individual agency and social structure among the different actors usually included in the approach. In both instances, the notion of power is presented through the many perceived costs and benefits of female genital mutilation. Rather than focusing solely on the girls at risk of being cut, the alternative rite of passage is a pursuit to reframe the role of culture in targeted communities. Alternative rites of passage are often a systematic and longer process defined by communication, based on rational choice, external influences, and community validation. This thesis serves as an introduction to understanding the present alternative rites of passage in Kenya. By expanding the knowledge of an approach still at an early stage, it is possible for future research to study its effectiveness and long-term consequences on girls at risk of female genital mutilation.

MA (Psychology) / Department of Psychology

Könsstympning är en sedvänja som främst förekommer i ett trettiotal afrikanska länder och i ett antal länder i Mellanöstern och Asien. På grund av ökad migration har ämnet kommit att bli mer aktuellt i Sverige. Enligt en rapport från Nationellt Centrum för Kvinnofrid ser majoriteten av den svenska befolkningen könsstympning som en främmande företeelse. Vid frågor som är svåra för vanliga medborgare att erfara blir massmedier ofta den huvudsakliga källan till information. Syftet med studien var att ta reda på hur ämnet förmedlas i svenska tidningsmedier. Genom kritisk diskursanalys har jag undersökt artiklar om könsstympning i fem svenska nyhetstidningar under perioden 30 november 2014 – 30 november 2016. Ett antal återkommande teman har förekommit i materialet såsom att det i flera artiklar finns indikationer på att sedvänjan upprätthålls i Sverige. Analysen visar en diskurs om ingreppet som ett övergrepp och ett brott mot mänskliga rättigheter. I lite mer än en fjärdedel av artiklarna förekommer det flickor och kvinnor med egna erfarenheter av ingreppet som uttalar sig om sedvänjan. Men det är i hög grad representanter från samhällsinstitutioner som definierar problemet och presenterar åtgärdsförslag i artiklarna. Utöver diskursteori har dagordningsteorin och gestaltningsteorin varit teoretisk grund för studien. / Genital mutilation is a practice that mainly occurs in about thirty African countries and in several countries in the Middle East and Asia. The topic has become more relevant in Sweden due to the increased migration. Most of the Swedish population sees genital mutilation as an alien phenomenon according to a report from the Swedish National Center for Protection of Women. The mass media often tend to be the main source of information when issues are difficult for ordinary citizens to experience. The purpose of the study was to find out how the issue is conveyed in the Swedish newspaper media. I have analyzed articles on genital mutilation in five Swedish news magazines during the period November 30, 2014 - November 30, in 2016 using critical discourse analysis as method. Several recurring themes have appeared in the material such as frequent indications that the practice is maintained in Sweden. The analysis reveals a general view of the procedure as an abuse and a violation of human rights in the discourse. In more than a quarter of the articles there are girls and women with personal experience of the procedure who speak out about the practice. But it is mostly representatives of social institutions that define the problem and presents proposals for action in the articles. The discourse theory, the agenda-setting theory and framing theory has been the theoretical basis for the study.

Bakgrund Ungefär 200 miljoner kvinnor i 30 olika länder har blivit utsatta för könsstympning världen över. Prevalensen för ingreppet är vanligt förekommande i länder inom Afrika och Asien. På grund av den rådande globaliseringen kommer tillståndet vara något som hälso- och sjukvården i höginkomstländer kommer komma i kontakt med i allt större utsträckning. Könsstympningen delas in i fyra olika kategorier och kan ge både fysiska, psykiska och sociala efterföljder. Det är genom hälso- och sjukvården som nya fall av kvinnor som genomgått ingreppet upptäcks och det är därför viktigt att vårdpersonal har kunskap om ingreppet och dess konsekvenser. Syfte Syftet var att belysa kvinnors upplevelser av könsstympning. Metod Föreliggande studie är en icke-systematisk litteraturöversikt. De sammanslagna sökningarna resulterade i 618 träffar som gav artiklar av kvalitativ och kvantitativ studiedesign. Artiklarna söktes i databaserna PubMed och CINAHL med relevanta sökord och avgränsningar utifrån exklusions- och inklusionskriterier. Sökorden som användes var “circumcision, female”, “circumcision, female/psychology”, “female genital mutilation”, “perception”, “culture”, “universal healthcare”, “psychological trauma”, “experiences” och “beliefs”. Artiklarna analyserades i sin tur genom en integrerad analys. Resultat Resultatet visade på att kvinnorna upplever fysiska, psykologiska och sociala konsekvenser av ingreppet. De fysiska konsekvenserna var enbart negativa. De psykologiska konsekvenserna var till största delen negativa, med positiva inslag. De sociala konsekvenserna kunde vara positiva förutsatt att kvinnan var bosatt i ett land där ingreppet praktiseras. Vidare framkom att vårdpersonal uppfattas som antingen okunniga, okänsliga, eller osäkra vid vårdmötet. Slutsats De fysiska, psykologiska och sociala konsekvenser som kvinnlig könsstympning leder till är mångfaldiga och komplexa. Då kvinnans upplevelser av könsstympningen i hög grad visades variera ställs det höga krav på vårdens förmåga att anpassa bemötandet därefter. God kompetens hos sjukvårdspersonal inom behandling, kommunikation och kulturella skillnader samt kunskap om ingreppets konsekvenser är av stor vikt för att kunna bidra till ökad hälsa hos dessa kvinnor. / Background  Approximately 200 million women in 30 different countries has been subjected to female genital mutilation worldwide. The prevalence of the procedure is common in countries in Africa and Asia. Due to the current globalization, it will also be something that healthcare professionals in high-income countries will encounter to an increasing extent. The procedure is categorized into four different types which all may cause physical, psychological and social consequences. It is through health care that new cases of women who have undergone the procedure are discovered, which is why it is of high importance that healthcare staff have knowledge of the procedure and its consequences. Aim  The aim was to illustrate women´s experiences of genital mutilation. Method  The present study is a non-systematic literature review. The combined searches resulted in 618 hits that presented articles of qualitative and quantitative study design. The articles were searched in the databases PubMed and CINAHL with relevant keywords and delimitations based on exclusion and inclusion criteria. The keywords used were “circumcision, female”, “circumcision, female/psychology”, “female genital mutilation”, “perception”, “culture”, “universal healthcare”, “psychological trauma”, “experiences” and “beliefs”. The articles were analyzed through an integrated analysis. Result  The results showed that women experienced physical, psychological and social consequences of the genital mutilation. The physical consequences were only negative. The psychological consequences were mostly negative, with positive elements. The social consequences could be positive given that the women were living in a country whereas the procedure is commonly practiced. Furthermore, it emerged that care staff are perceived as either ignorant, insensitive, or insecure at the care meeting. Conclusion  The physical, psychological and social consequences which the procedure leads to are nuanced and complex. With the knowledge that women's experiences can vary greatly there is a demand on the healthcare´s ability to adapt its treatments accordingly. The treatment, communication and cultural competence of the care staff, as well as knowledge about all the consequences of the procedure, are therefore of great importance in order to be able to contribute to increased health in these women.

Bakgrund Idag beräknas 200 miljoner flickor och kvinnor världen över ha utsatts för könsstympning. Det utövas med hänvisning till kultur men fyller inget medicinskt syfte utan orsakar somatiska såväl som psykiska komplikationer och kan i värsta fall leda till död. Övergreppet står i kontrast med mänskliga rättigheter. I dagens globaliserade värld sker transkulturella möten och som sjuksköterska världen över finns en sannolikhet att möta kvinnor som utsatts för könsstympning. Större förståelse och respekt för kulturella skillnader hos sjuksköterskan skulle kunna öka upplevelsen av en god och trygg vård. Sjuksköterskan har möjlighet att uppfylla patienternas behov genom ett transkulturellt omvårdnadsperspektiv och därav finns intresse att belysa vad som har betydelse för att transkulturell omvårdnad ska kunna genomföras för kvinnor som har utsatts för könsstympning. Syfte Syftet var att belysa vad som har betydelse för att transkulturell omvårdnad ska kunna genomföras för kvinnor som har utsatts för könsstympning. Metod I förevarande studie har en icke-systematisk litteraturöversikt genomförts med sökningar i databaserna PubMed och CINAHL. De 17 artiklar som inkluderades i resultatet har kvalitetsgranskats enligt Sophiahemmets bedömningsunderlag och analyserats genom en integrerad analysprocess. Både kvantitativa och kvalitativa vetenskapliga artiklar inkluderades. Resultat Huvudfynden var att bristande kunskap förekom kring kvinnlig könsstympning och förståelse för kulturella aspekter, att relationen var ett viktigt verktyg för att kunna ge en kulturell och individanpassad omvårdnad, kommunikation behövdes för att etablera god relation och kunna identifiera omvårdnadsbehov, och delaktighet kunde bidra till att kvinnorna kände sig trygga inför omvårdnaden. Slutsats Den slutsats som kunde dras baserat på resultaten var att sjuksköterskan kan applicera studiens huvudfynd för att möjliggöra en god transkulturell omvårdnad för kvinnor som utsatts för könsstympning.

This thesis studied the representation of female circumcision by analysing 32 articles published during the 21st century in The Journal for Midwives, the union journal of the Federation of Finnish Midwives. With critical discourse analysis, through post-colonial feminist theory, the thesis researched the ways the journal is contributing to the creation of readers’ bias regarding circumcised women and their sexuality.The articles focused on multicultural healthcare, prevention of female circumcision and the most serious health detriments the practice might have. Human rights, criminal law, andgender equality were the main reasons behind the aversion of the practice. Women from the practicing communities were represented as victims of patriarchy, clueless of their position and unable to decide for themselves. Sexuality of circumcised women was widely excluded, only described through possible negative health consequences. Anthropological approach to sexuality and the role of migration was excluded and discussions about complex ethical questions, racialisation, power relations and bias of healthcare professionals were absent. Female circumcision and the practicing communities were categorised and judged based on Western understanding of sexuality and gender equality.Based on the analysis, the thesis recommends more diversity to the production of texts and to the perspectives of articles. Minorities should be included more in the production of the representation of their health issues and wider socio-cultural explanations behind the practice should be presented. Discussions about health inequalities based on ethnicity and reflections about cultural hegemony of West in relation to sexuality are also recommended subjects to be included in the journal. Most importantly, stereotypical representations of broken womanhood and positioning circumcised women as oppressed victims who need to be rescued by outsiders, should be forgotten. Instead, individual care of women and the importance of personal experiences and meanings of circumcision and sexuality should be highlighted.

Female genital mutilation (FGM) is practiced primarily in many African countries as well as some in Asia and the Arab Peninsula; however, it also takes place elsewhere around the globe among those who migrate from countries to which it is indigenous. This study was designed (a) to investigate the prevalence of FGM among the Igbo women in the Dallas-Fort Worth (DFW) area in Texas and (b) to understand the factors that support the continuation of the practice and the effects on women's sexual health. Using a quantitative approach to examine a variety of social variables aligning with the ecological framework, survey data obtained from a sample of 139 Igbo women living in the DFW area were analyzed using a multivariate analysis. Results of the study demonstrated a decreasing prevalence of FGM from maternal incidence (46%), to second generation incidence (31.3%), and future intention for FGM (25%). Nearly half of the responding participants felt the practice was required by their religion, but over 65% felt the practice should be discontinued. Results supported a high incidence of dangerous complications to women's sexual health with the continued practice of FGM. Significant social influences associated with future intention for FGM among the population were found at the micro- and exosystem ecological levels. The findings of this research provide important information on current prevalence and health effects of FGM in Igbo women living in the DFW area. Understanding the reasons behind the culture of FGM will assist public health professionals in designing appropriate culturally-specific intervention strategies that will help to eliminate inappropriate and unsafe practices associated with FGM.

Is it possible to cover an issue as a journalist to the extent that you are practically a human rights activist, and still contribute to its continuation by unconsciously upholding the values causing the issue? This study asks the question if journalists help or hinder the elimination of female genital mutilation (FGM), and puts forth the thesis that journalists as a collective in fact are affecting the development more negatively through their attitudes than positively through their actions. The study consists of a theoretical analysis connecting to patriarchy and post-colonialism, and a field study from Tanzania where journalists are interviewed. The theoretical results show a clear connection between patriarchal values and FGM, and that if a journalist upholds these values she will not be as inclined to see the victim of FGM as a subaltern, she will be more likely to generalize the groups status and characteristics and she will be caught in between traditional and modern values. If a journalist ascribes to more traditional values when it comes to the difference between the genders, her attitudes will to some extent be counterproductive to the work she does when she covers FGM with the intention to prevent it. The field study supports this by showing that awareness about gender inequality and FGM does not necessarily mean awareness of patriarchal structures and how they affect men, women and traditions. One journalist can make a significant difference, but if she is a part of a journalist collective with strong, patriarchal values her efforts might not be sufficient to help in changing the overall development of FGM.

This thesis deals with the topic of childbirth and birth delivery in Eastern Africa. The theoretical part tackles mostly the high birth rates, midwifery and hygiene habits and rituals, health system, alternative approaches in midwifery care and traditional healing methods, post-natal care as well as high maternal and infant mortality rates. It uncovers the taboo topic of female circumcision and the impact that it has on giving birth. It furthermore describes a case of an especially complicated labour of a Ugandan girl called Fatima Mirembe who gave birth in a prison hospital. The practical part of this paper consists of a research survey that, using questionnaires, aims to find out what the women from the Ugandan Nyakyera Village and the communities nearby experience during and after the delivery and what the quality of local post-natal care is. It also describes the abortion rate in the area and common causes of abortions and it also describes the knowledge of the true story of Fatima Mirembe. Keywords African women, Fatima Mirembe, childbirth, birthrate, Uganda, East Africa, health care, female circumcision

<p>Kvinnlig könsstympning uppmärksammades i västvärlden på 1970-talet då invandringen till väst från länder där könsstympning praktiseras ökade. När Waris Dirie gav ut sin självbiografiska bok En blomma i Afrikas öken 1999 kom könsstympning åter på tapeten. Eftersom könsstympning är en sedvänja som praktiserats i tusentals år världen över och fortfarande utövas i flera länder idag, väcktes ett intresse att ta reda på omständigheterna kring fenomenet. Vart, hur och varför uppstod denna till synes inhumana och irrationella sedvänja och hur kommer det sig att den lever kvar än idag? Vilka bakomliggande faktorer finns? Hur hänger könsstympning ihop med religion, kultur, genus, makt och så vidare?</p><p>Eftersom det verkade handla om ett mycket komplext fenomen togs beslutet att syftet skulle vara ganska brett och omfattande. Hypotesen var att könsstympning kunde förklaras och förstås som ett socialt fenomen och detta är det som undersöks, analyseras och framhålls genom denna uppsats. De sociologiska teorier som använts faller inom ramarna för socialpsykologi och som komplement till dessa teorier har även interkulturella perspektiv och genus- och etnicitetsperspektiv använts.</p><p>Metoden är kvalitativ datainsamling. Ett stort urval böcker, artiklar och internetkällor har använts. Dataanalysen har skett parallellt och integrerat med datainsamlingen. Centrala begrepp och teoretiska utgångspunkter har sedan kopplats samman med fenomenet könsstympning i analysen. Slutligen hålls en avslutande diskussion där personliga reflektioner och slutsatser diskuteras.</p><p>Resultatet visar på många olika möjliga sociologiska, interkulturella och genus- och etnicitetsrelaterade förklaringsmodeller av hur könsstympning kan förklaras och förstås som ett socialt fenomen. Det har även visat sig vara intressant att dra paralleller mellan den könsstympade kvinnan och den ”jämställda” västerländska kvinnan. Det finns ingen enkel förklaring till varför sedvänjan existerar än idag, det är många olika aspekter och faktorer som spelar in. Vad som är viktigt är att man förhåller sig till fenomenet med viss kulturell relativism och att man beaktar sedvänjans komplexa och multidimensionella natur.</p> / <p>Female genital mutilation (FGM) attracted much attention in the west in the 1970’s, when the immigration to the west from countries where FGM was practiced increased. When Waris Dirie published her autobiography Desert flower: the extraordinary journey of a desert nomad in 1999, the phenomenon got on the carpet again. Since FGM is a custom that has been practiced for thousands of years all over the world and is still beeing practiced in a number of countries today, an interest was awakened for examining the circumstances surrounding the phenomenon. Where, how and why did this apparently inhumane and irrational custom arise and how come it still exists today? What is at the bottom of it? How is FGM related to religion, culture, gender, power and so on?</p><p>Since it seemed to be about a very complex phenomenon a decision was made to keep the purpose of the essay quite broad and extensive. The hypothesis was that FGM could be explained and understood as a sociological phenomenon and this is what has been examined, analyzed and emphasizwd through out this essay. The sociological theories falls within the framework of social phsychology, and as a compliment to these theories there has also been a use of intercultural perspectives and gender- and ethnicity perspectives.</p><p>The method is qualitative data gathering. A large selection of books, articles and websites have been used. Data analysis has been done throughout and integrated with the data gathering process. In the analysis, theory is related and connected to the pheonomenon FMG. Finally there is a closing discussion in which personal reflections and conclusions are discussed.</p><p>The result shows many different sociological, intercultural and gender- and ethnicity related explanation models of how FGM can be explained and understood as a sociological phenomenon. It has also proved interesting to draw paralleles between the circumcised woman and the “equal” western woman. There is no simple explanation to why the custom is still beeing practiced today, there are many different aspects and factors involved. What is important though, is that you relate to the phenomenon with a certain degree of cultural relativism and that you pay regard to the customs complex and multi dimensional nature.</p>