Magister Legum - LLM / This thesis sets out to examine the practice of Female Genital Mutilation/Cutting (FGM/C) in Somalia and its impact on women. The political instability in Somalia provides an opportunity for the increase of all forms of violations of human rights. The prevalence of FGM/C in Somalia has been declared as the highest in the World, but the Somali Government has not taken any steps to address the problem. This study was motivated by the dire situation of women in Somalia. Women suffer from gender inequality in the sense that societal practices – and norms dictate that women’s sexuality be controlled with a view to suppressing their sexual desires. In this way; their rights are violated. Infibulation and sunna performed on women come with immediate and late complications including death, infection, sexual dysfunction, and exposure to HIV infection. Somalia is one of the African countries where women’s rights are almost non-existent. As Dirie notes: ‘if genital mutilation were a problem affecting men, the matter would long be settled.’ International human rights instruments help this study to investigate whether customary practices such as FGM/C are harmful to Somali women and children and whether they constitute violence against women. This practice prevents women from enjoying fundamental rights as recognized by international human rights standards. It is universally known that FGM/C constitutes a violation against women and girls’ rights because they are forced to embrace the practice. Consequently, several rights are violated such as the right to equality, the rights to freedom from all forms of torture and cruel, inhumane and degrading treatment, the right to freedom from harmful customary practices, the rights of the child, and the right to health. The persistent practice of FGM/C is mainly a result of the absence of specific legislation proscribing it as well as the political instability that creates an environment conductive to the wanton violation of the rights of citizens. A recent Somali provisional constitution has recognised FGM/C as a violation of children’s rights but the law is not enforced.Infibulation and sunna are part of Somali culture. That is why attempts to eradicate the practice create a dilemma for the authorities. This has invariably placed Universalists and cultural relativists on a collision course. Ensuing government inaction has resulted in numerous reservations being made to stall the adoption of certain instruments of human rights law such as the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of the Child (CRC). This is because cultural relativists do not consider FGM/C as a violation, but as an expression and fulfilment of Somalis’ culture as provided for in the Universal Declaration of Human Rights (UDHR) of 1948. As argued by Packer, human dignity and life represent universal values for everyone; even if FGM/C is a part of culture, certain limitations must be implemented to preserve people’s fundamental rights. This thesis agrees with the stance that FGM/C violates women’s health. This is due to the absence of proper legislation in Somalia, inadequate literacy and the collapse of the political system. Recommendations include the proposal that legal strategies to eradicate FGM/C must be accompanied by broad policies and grassroots programmes such as educational activities to explain to people the risks of this practice and how communities can remedy it without affecting their cultural tenets.

Bakgrund: Kvinnlig könsstympning innebär att av icke-medicinska skäl utföra en partiell eller total borttagning av de yttre kvinnliga könsorganen. Det finns fyra olika typer av könsstympning med olika allvarlighetsgrader. Sannolika orsaker är att kontrollera kvinnans sexliv samt kulturella strukturer. Varje år genomgår 3,9 miljoner kvinnor en könsstympning i Afrika, Mellanöstern samt Asien. Ingreppet görs oftast på flickor mellan fyra och 14 år.  Syfte: Syftet med denna litteraturöversikt var att belysa sjuksköterskans kunskap, attityd samt erfarenhet gällande kvinnlig könsstympning.  Metod: En litteraturöversikt enligt Fribergs metod som inkluderade tio vårdvetenskapliga artiklar med olika metoder, fem kvalitativa och fem kvantitativa artiklar. Databaserna som användes för att hitta artiklarna var Cinahl Complete och PubMed. Analysen gjordes med hjälp av en tematisk syntes för att identifiera olika teman.  Resultat: Resultatet presenterades i tre separata teman samt tre subteman. Kunskapsnivån gällande ingreppet varierade, olika attityder gentemot kvinnlig könsstympning identifierades och majoriteten av hälso- och sjukvårdspersonalen uttryckte svårigheter i mötet med och vårdandet av kvinnor som genomgått en könsstympning.  Diskussion: Generellt besitter sjuksköterskan låg kunskap kring kvinnlig könsstympning, där attityden till ingreppet varierar världen över. Detta kan bland annat bero på bristande utbildning, låg medvetenhet, ett icke-jämställt samhälle, kulturell påverkan och ekonomisk vinning. Madeleine Leiningers soluppgångsmodell ligger till grund för diskussionen. / Background: Female genital mutilation (FGM) involves performing, for non-medical reasons, a partial or total removal of the external female genitalia. There are four different types of female genital mutilation with varying degrees of severity. Plausible reasons are to control the woman's sex life as well as cultural structures. Every year, 3.9 million women undergo FGM in Africa, the Middle East and Asia. The practice is most often done on girls between the ages of four and 14. Aim: The aim of this literature review was to enlighten the knowledge, attitudes and experiences of female genital mutilation among nurses.  Method: A literature review according to Fribergs method that included ten articles with different methods, five qualitative and five quantitative articles. The databases used to find the articles were Cinahl Complete and PubMed. The analysis was done using thematic synthesis to identify different themes.  Results: Results were presented in three separate themes together with three subthemes. The level of knowledge regarding FGM varied, different attitudes towards female genital mutilation were identified and the majority of the health personnel expressed difficulties in caring for women with FGM.  Discussion: In general, nurses have low knowledge of FGM, where the attitude towards the practice varies worldwide. This due to, among other things, the lack of education, awareness, a non-equal society, cultural influence and financial gain. Madeleine Leininger's sunrise model forms the basis of the discussion.

Magister Public Health - MPH / This study analyses media representations of Female Genital Mutilation/Cutting (FGM/C) in two Ugandan daily English newspapers. FGM/C is recognized by the World Health Organization as an extreme form of violation of the rights, health and integrity of women and girls. In Uganda, although the overall prevalence of FGM/C is 0.3 percent of the population, FGM/C remains a harmful practice that constitutes a serious threat to the health of women and girls in communities that practice it. Despite existence of a national legal and policy framework that discourages FGM/C, progress in the eradication of the practice remains slow.

The aim of the study was to examine how advocacy workers from different governmental and non-governmental organisations work with female genital mutilation/cutting (FGM/C) and gender equality in The Gambia. We further examined their experienced difficulties and the provided support to women exposed to FGM/C. The study was based on field observations of events, meetings and educational events, as well as semi-structured and open-ended interviews with ten participants. Through a thematic analysis, findings show that counselling were the main form of support, and the most experienced difficulties was the male dominance, the cultural belief and the culture of silence. Education, traditional forums and advocacy where therefore used as informative tools regarding gender roles, power positions and the harmfulness of FGM/C. Thus, findings confirm the importance of the continuous work with the gender roles, the social exclusion of the unmutilated women and the gatekeeping roles hindering the abandonment of the harmful practice.

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.

Mondialement, plus de 200 millions de femmes et de filles vivent avec une mutilation génitale féminine/excision (MGF/E) (OMS, 2016). Les mouvements d’immigration impliquent la présence d'un nombre grandissant de femmes et de filles de pays où les MGF/E sont pratiqués dans des pays où le personnel médical et infirmier se doit de se questionner sur la façon d’aborder ce sujet d'une manière sensible et respectueuse ainsi que d'élaborer et de mettre en place des actions et lignes directrices pour assurer un suivi. Le but du mémoire-practicum est de circonscrire les pratiques médicales et infirmières, en contexte obstétrical d’un CHU, dans une perspective d’identification et d’assurer un suivi auprès de femmes ayant vécu une MGF/E. Les éléments clés concernant l’identification de la présence d’une MGF/E et d’assurer un suivi de qualité proposés dans le modèle d’Evans et al. (2019) ont servi d’assise pour ce mémoire-practicum. Une recension des écrits sur la scène internationale (n=30) ainsi qu'une revue de dossiers médicaux (n=46) ont fait émerger la difficulté de documenter cette pratique. Plus spécifiquement, des limites dans les dossiers médicaux étaient évidentes quant aux mentions concernant l’identification de la présence d’une MGF/E chez une femme d’une part et pour assurer un suivi adapté aux besoins, en contexte obstétrical, d’autre part. Les résultats confirment un besoin de formation spécifique aux expériences vécues par les femmes ainsi que l’élaboration de protocoles de soins pour soutenir la pratique médicale et infirmière et permettre une collaboration intersectorielle, notamment auprès d’organismes communautaires (Evans et al., 2019). / Globally, more than 200 million women and girls are living with female genital mutilation/cutting (FGM/C) (WHO, 2016). Immigration movements involve the presence of increasing numbers of women and girls from countries where FGM/C is practiced in countries where medical and nursing personnel need to reflect upon how to address this topic in a sensitive and respectful manner as well as develop and implement actions and guidelines for follow-up. The purpose of this report is to describe medical and nursing practices in the obstetrical context of a university hospital to identify and provide a follow up to women who have undergone FGM/C. The key elements of identifying the presence of FGM/C and ensuring quality follow-up proposed in the Evans et al. (2019) model inspired the work throughout in this report. An international literature review (n=30) as well as a medical record review (n=46) highlighted the difficulty of documenting this practice. More specifically, limitations in the medical records were evident with respect to the identification of the presence of FGM/C on the one hand, as well as ensuring coherent and sensitive follow-up in an obstetrical context, on the other. The results confirm a need for more training specific to women's experiences as well as the development of care protocols to support medical and nursing practice (Evans et al., 2019). The contribution of intersectoral collaboration, namely community-based organizations was highlighted.