Bakgrund: Över 200 miljoner kvinnor och flickor i världen uppskattas ha blivit utsatta för könsstympning. De söker vård för fysiska och psykiska besvär, som kan vara en långvarig komplikation av könsstympningen. Detta kan lätt förbises om vårdpersonalen inte har kunskap om kvinnlig könsstympning och i vilka länder det utövas. Syfte: Syftet med studien var att beskriva erfarenheter av mötet med vårdpersonal för kvinnor som har blivit utsatta för könsstympning. Metod: En litteraturstudie baserad på åtta vetenskapliga kvalitativa artiklar. Databaserna PubMed och Cinahl användes vid sökningen. Analysen genomfördes med Fribergs femstegsmodell. Resultat: Analysen gav tre kategorier, “Behov av information och rak kommunikation”, “Kvinnornas erfarenhet av vårdpersonalens kunskap och kompetens” och “Bemötande som skapar barriär eller främjar en personcentrerad vård” och sju underkategorier. Konklusion: Bristande kulturell kompentens bland vårdpersonalen och en tystnad kring kvinnlig könsstympning kan leda till att kvinnor som har blivit könsstympade inte får den vård de är i behov av och har rätt till. Vårdpersonalen behöver en kulturell förståelse för kvinnornas situation och medicinsk kompetens avseende kvinnlig könsstympning. Kvinnor som har blivit utsatta för könsstympning är i behov av empowerment och utbildning för att kunna bli mer delaktiga i sin vård. / Background: Over 200 million women and girls are estimated to have undergone female genital mutilation. They seek healthcare for physical and psychological problems, which can be a long-term complication from female genital mutilation (FGM). This can easily be overlooked by the healthcare staff if they do not have knowledge about female genital mutilation and in which countries it is practiced.  Aim: The aim of the study was to describe the experiences from the meeting with healthcare providers for women who have undergone genital mutilation.  Methods: A literature review with eight scientific qualitative studies. The databases Cinahl and PubMed were used in the literature search. The data was analyzed using Friberg’s Five-step model.  Results: The analysis gave three categories, “Need for information and direct communication”, “Women’s experiences of knowledge and competence of healthcare providers” and "Attitudes that create barriers or promote person-centered care” and seven subcategories.  Conclusion: A lack of cultural competence among healthcare providers and a silence around the topic female genital mutilation can lead to that women who have undergone female genital mutilation not receiving the care they are in need of and are entitled to. The healthcare providers need a cultural understanding of the women’s situation and medical competence regarding female genital mutilation. Women who have undergone female genital mutilation are in need of empowerment and education to be more involved in their healthcare.

Bakgrund: Kvinnlig könsstympning är en skadlig sedvänja som innebär ingrepp med avsikt att ändra eller skada kvinnans könsorgan. Traditionellt utförs det i stora delar av världen på flickor och kvinnor utan medicinska skäl. Idag beräknas cirka 200 miljoner flickor och kvinnor i världen ha utsatts för könsstympning och cirka 68 000 beräknas vara bosatta i Sverige. Syfte: Syftet var att beskriva könsstympade kvinnors upplevelse av mötet med vården. Metod: Studien är en beskrivande litteraturstudie som baserades på 13 kvalitativa originalstudier som söktes i databasen PubMed. Huvudresultat: Resultatet visade att könsstympade kvinnor i mötet med vården upplevde bristfällig kunskap hos vårdpersonal samt otillräcklig information, vilket ledde till att kvinnorna inte fick relevant vård. Kvinnor upplevde bristfällig kommunikation med vårdpersonal, delvis på grund av språksvårigheter. Kvinnor upplevde utsatthet, kände skam och användes som studieobjekt. De blev av vårdpersonal misstänkta för brott i form av att de skulle könsstympa sina döttrar. Resultatet visade även att könsstympade kvinnor hade bra upplevelser med vården där kvinnor upplevde omtänksamma och välkomnande attityder hos vårdpersonal. Slutsats: Vårdpersonalens kunskap om könsstympning var grundläggande för de könsstympade kvinnornas upplevelser av vården. Brist på kunskap, kommunikation och information ledde till skam och utsatthet för kvinnorna. Detta tyder på att könsstympning är ett ämne som bör lyftas fram då vården i nuläget riskerar att inte räcka till för denna patientgrupp. Vårdpersonal bör vara uppmärksamma och lyhörda för att främja en god upplevelse för könsstympade kvinnors möte med vården. / Background: Female genital mutilation is a harmful practice that involves procedures with the intention of changing or damaging a woman´s genitals. Traditionally, it is performed in large parts of the world on girls and women without medical reasons. Today, approximately 200 million girls and women in the world are estimated to have been subjected to female genital mutilation and approximately 68,000 are estimated to live in Sweden. Aim: The aim was to describe women with female genital mutilation´s experience of the encounter with healthcare. Method: The study is a descriptive literature review that was based on 13 qualitative primary studies searched in PubMed. Main result: The results showed that in the meeting with healthcare, women with female genital mutilation experienced deficient knowledge with healthcare personnel and received insufficient information, which led to the women not receiving relevant care. The women experienced a lack of communication in relation to the healthcare personnel, partly due to language difficulties. Women experienced vulnerability, felt shame and were used as study objects. They were suspected by healthcare personnel of crimes in form of exposing their daughters to genital mutilation. The results also showed that women with female genital mutilation had good experiences with healthcare where women experienced caring and welcoming attitudes from health care personnel. Conclusion: Healthcare personnel´s knowledge of genital mutilation was fundamental to the women exposed to female genital mutilation´s experiences of healthcare. Lack of knowledge, communication and information led to shame and vulnerability for the women. This indicates that female genital mutilation is a topic that should be highlighted as the healthcare currently risks not being sufficient for this patient group. Healthcare personnel should be attentive and responsive to promote a good experience for women exposed to female genital mutilation encounters with care.

Sammanfattning Bakgrund Fokus för studien är att uppmärksamma Socialstyrelsens vägledande information rörande könsstympning av flickor och kvinnor. Traditionen innebär total eller delvis borttagning av det kvinnliga yttre könsorganet, vilket innefattar avsiktliga skador som förändrar eller orsakar defekter på det kvinnliga könsorganet utan medicinska skäl eller grunder (WHO, 2008). Till följd av migration och befolkningsomflyttningar har traditionen kommit att uppmärksammas internationellt och även i Sverige. I Sverige har traditionen en tydlig relevans för socialt arbete eftersom könsstympning diskuteras och definieras som våld mot kvinnor/barn, förtryck, heder, brott mot mänskliga och barns rättigheter (Talle, 2008). Myndigheter i Sverige står inför en utmaning att informera, uppmärksamma, integrera och arbeta preventivt med denna målgrupp.   Syfte Syftet med studien är att beskriva och analysera hur socialstyrelsen via sin webbplattform förmedlar kunskap om könsstympning av flickor och kvinnor. Utifrån hemsidans tillgängliga texter granskas och analyseras vägledning och kunskapsstöd riktade till olika professioner, exempelvis socialtjänsten och hälso-och sjukvård. Vidare studeras hur kunskapsstöd vägleder professioner till att förstå och handla i frågor som rör könsstympning som ett arbete på samhälls-, grupp och individnivå. Utifrån det analyseras hur socialstyrelsen främja det sociala arbetet kring könsstympning.   Metod Studien bygger på en kvalitativ forskning baserad på systematisk litteraturstudie och induktiv ansats. Litteraturstudien grundades på analys och granskning av socialstyrelsen kunskapsstöd. Genom en webbaserad innehållsanalys granskades 53 publicerade dokument som direkt eller indirekt berör könsstympning av flickor och kvinnor.     Resultat I resultatdelen identifieras tilltänkta mottagare av det publicerade materialet som illustreras i form av ett diagram. Den allmängiltiga informationen representerar hälften av urvalet. De två mer framträdande grupper identifieras som Hälso-och sjukvård och den berörda målgruppen. I mindre omfattning riktas material till socialtjänst och samhälls-/hälsokommunikatörer. Resultat påvisar att Hälso-sjukvården i sitt arbete med könsstympning, har i större omfattning tillgång till praktiskt och teoretisk vägledning i jämförelse med de andra representerade mottagargrupperna.   Slutsatser Studien visar att socialstyrelsen förmedlar ett arbete mot traditionen på individ-, grupp- och samhällsnivå. Information kring könsstympning av flickor och kvinnor stämmer i stort sett överens med tidigare forskning gällande ursprung, förekomst, utformning och konsekvenser. Studien visar att Socialstyrelsen är en källa för kunskap och information kring ämnet. Det föreligger dock skillnader i den praktiska vägledningen som skapar grund för handling. Vid det konkreta arbetet på individnivå framträder skillnader beroende på om frågan aktualiseras inom hälso- och sjukvård eller socialtjänst. / Abstract Background The focus of the study is to draw attention to the National Board of Health and Welfare directory information concerning female genital mutilation (FMG). The tradition involving the total or partial removal of the female external genitalia, including intentional damage which alter or cause defects on the female genitalia without medical reasons or reasons (WHO, 2008). As a result of migration and population movements, the tradition came to be recognized internationally and in Sweden. In Sweden, the tradition has a clear relevance to social work because FGM is discussed and defined as violence against women/children, oppression, honour, violation of human and children's rights (Talle, 2008). Authorities in Sweden is facing a challenge to inform, alert, integrate and work preventively with this audience. Purpose The purpose of this study is to describe and analyse how the National Board of Health and Welfare by its web platform conveys knowledge of FGM. Based on the websites available texts examined and analysed guidance and knowledge subsidies to various professions, such as social and health care. Further studies show knowledge and support guides professionals to understand and act on issues related to FGM as a work of social, group and at a individual level. Based on the analysis of how the National Board of Health and Welfare promotes the social work of FGM. Method The study is based on a qualitative research based on a systematic literature review and inductive approach. The literature review was based on analysis and review by the National Board of Health and Welfare knowledge support. Through a web-based content analysis examined 53 published documents that directly or indirectly affects FGM. Results In the results section identified the receiver to think of the published material illustrated in the form of a diagram. The universal information represents half of the sample. The two prominent groups identified as Health and the touch target. In smaller scale material is directed to social and community -/health communicators. Results demonstrate that the health-care system in his work on FGM, has been more widely access to practical and theoretical guidance in comparison to the other receiver groups represented. Conclusions The study shows that the National Board of Health and Welfare conveys a work against the tradition of individual, group and societal level. Information about FGM are broadly in line with previous research on the origin, presence, design and impact. The study shows that the National Board of Health and Welfare is a source of knowledge and information on the subject. However, there are differences in the practical guide to creating a basis for action. In the concrete work at the individual level, disparities, depending on whether the issue arises in healthcare or social services.

The problem of vesico-vagina fistula still remains a ravaging scourge in resource-poor countries of which Nigeria is visibly prominent. A majority of the cases are attributed to prolonged complicated labour due to inaccessibility of adequate and immediate obstetric health care. Complicated labour arises as a result of narrow pelvis bones of victims due to suffering from poor nutrition. While the above factors are noted as the direct cause to the prevalent of VVF, there are other socio-cultural conditions which predispose victims to this disease. Notable among them are the following: poverty; marital age; illiteracy; hazardous traditional practices, such as female circumcision. VVF victims often live an unworthy life. Many of them have been abandoned or divorced by their husbands and become ostracised by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children. VVF victims suffer both physical and social consequences, many of them find it difficult to engage in any economic activity, surviving the hardship is very complicated and pathetic; some victims turn to street begging, while others survive through hawking of “bagged” water and selling firewood. Most studies conducted on the problem of Vesico vaginal fistula are done from the medical perspectives, often neglecting the psycho-social consequences faced by the sufferers. This study, however, discusses the socio-cultural and the psychological consequences of the disease. Locally and internationally, attempts are being made to eradicate the problem of VVF, however, if the Nigerian government does not recognise the incidence of VVF as a major public health issue, it will continue to ravage lives of Nigerian women, hence increasing maternal mortality in the country. This study proffers recommendations to help eradicate or alleviate the problem in Nigeria.

Background: Female circumcision or female genital mutilation is a tradition that is carried out mainly in Africa. The intervention refers to that part of- or all of the girl’s external genital organs are removed.  Aim: The study's purpose was to highlight the consequences of female circumcision in the encounter with western health care. Method: A systematic literature reviews was performed as a method. Twelve articles were selected for the study and these were sought in Chinal, PubMed and PsycINFO. Analysis and interpretation was done according to qualitative content analysis, inspired by Lundman and Granheim. Eriksson, Birkler, Dahlberg and Segersten’s nursing theory was used as background in the discussion. Results: The analysis process resulted in six categories: laws and guidelines, offence, communication, knowledge, vulnerability and nursing. The results showed that offence occur extensively against genitally mutilated women and the exposure of these women. The results also showed a strong need for knowledge, laws and guidelines. Conclusions: Health care professionals need to have a basic knowledge of female circumcision and clear guidelines to ensure good care. The nurse should also keep themselves updated of new research and search for knowledge to improve their care.

<p>The problem of vesico-vagina fistula still remains a ravaging scourge in resource-poor countries of which Nigeria is visibly prominent. A majority of the cases are attributed to prolonged complicated labour due to inaccessibility of adequate and immediate obstetric health care. Complicated labour arises as a result of narrow pelvis bones of victims due to suffering from poor nutrition. While the above factors are noted as the direct cause to the prevalent of VVF, there are other socio-cultural conditions which predispose victims to this disease. Notable among them are the following: poverty; marital age; illiteracy; hazardous traditional practices, such as female circumcision. VVF victims often live an unworthy life. Many of them have been abandoned or divorced by their husbands and become ostracised by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children. VVF victims suffer both physical and social consequences, many of them find it difficult to engage in any economic activity, surviving the hardship is very complicated and pathetic; some victims turn to street begging, while others survive through hawking of “bagged” water and selling firewood.</p><p>Most studies conducted on the problem of Vesico vaginal fistula are done from the medical perspectives, often neglecting the psycho-social consequences faced by the sufferers. This study, however, discusses the socio-cultural and the psychological consequences of the disease. Locally and internationally, attempts are being made to eradicate the problem of VVF, however, if the Nigerian government does not recognise the incidence of VVF as a major public health issue, it will continue to ravage lives of Nigerian women, hence increasing maternal mortality in the country. This study proffers recommendations to help eradicate or alleviate the problem in Nigeria.</p>

Kvinnlig könsstympning utförs idag i cirka 30 länder i Afrika, Asien och Sydamerika. Omkring 200 miljoner kvinnor och flickor antas idag vara könsstympade och cirka tre miljoner utsätts årligen. Proceduren innefattar alla typer av ingrepp på det kvinnliga yttre könsorganet som inte är medicinskt motiverat. Kvinnlig könsstympning ger svåra komplikationer och leder i värsta fall till döden. Skälen till varför det utförs varierar, det handlar ibland om kulturella traditioner eller religiösa ritualer och ibland enbart för att kontrollera kvinnans sexualitet. Ingreppet är i de flesta västerländska länder, däribland Sverige, olagligt. Syftet var att belysa kunskaper och attityder hos sjukvårdspersonal gentemot kvinnlig könsstympning.En litteraturöversikt enligt Friberg har utförts. Sökningarna har gjorts i databaserna Academic Search Complete, CINAHL Complete och PubMed. Elva artiklar valdes ut; fem kvantitativa, fyra kvalitativa och två med mixad metod. I resultatet framgick att det var brist på kunskaper om kvinnlig könsstympning hos sjukvårdspersonal. Attityden kring kvinnlig könsstympning skiftade men de flesta ansåg att det var mot mänskliga rättigheter. I länder där sedvänjan praktiseras upplevdes sjukvårdspersonal ambivalenta. Den globala migrationen ökar. Trots det finns det väldigt lite kunskaper om kvinnlig könsstympning hos sjukvårdspersonalen världen över. Attityden kring kvinnlig könsstympning skiftar, både i länder där det praktiseras och i länder där det inte praktiseras. Bristen på information under utbildningen uppges vara en anledning till att sjukvårdspersonalen inte vet hur de ska bemöta en kvinna som utsatts för könsstympning. Resultaten diskuteras i linje med Leiningers teori om det transkulturella omvårdandet. / Female genital mutilation is performed in about 30 countries in Africa, Asia, and South America. Nearly 200 million girls and women have undergone circumcision and annually 3 million are at risk. Female genital mutilation includes all forms of harm towards the outer female genitals without any medical indications. It results in severe complications and is even fatal. The reasons vary, sometimes they are explained as cultural traditions or religious traditions, and sometimes just to control women's' sexuality. The procedure is illegal in most western countries, Sweden included. The aim was to illuminate knowledge and attitudes among health care professionals regarding female genital mutilation. A literature review was conducted according to Friberg. Three databases were used: Academic Search Complete, CINAHL Complete and PubMed. This resulted in five quantitative articles, four qualitative articles and two with mixed method. The main findings were that there is a lack of knowledge among health care professionals. Also, attitudes differ but many of the participants agreed that it is violating human rights. In practicing countries there were often ambivalent feelings towards female genital mutilation. Even though the global migration is as high as ever, the knowledge among health care professionals is insufficient. The attitudes differ, both in countries where the tradition is practiced and in countries where it is not practiced. The lack of educational information is mentioned as a reason to why health care professionals feel unsure on how to handle meeting a mutilated woman. The results were discussed with Leininger's nursing theory as a model.

Bakgrund: Kvinnlig könsstympning är en gammal tradition där delar av könsorganet avlägsnas och ibland sys ihop. Det icke-medicinska ingreppet utförs på kulturella grunder och syftar till att kontrollera sexualiteten och omvandla flickan till kvinna. Trots att ingreppet bryter mot de mänskliga rättigheterna beräknas 140 miljoner kvinnor världen över vara könsstympade. Det är därför relevant för sjuksköterskor att införskaffa sig kunskap om de vårdbehov som kan finnas hos denna grupp kvinnor.  Syfte: Att beskriva kvinnors upplevelser efter att ha genomgått könsstympning.  Metod: Litteraturöversiktens material utgörs av tolv kvalitativa och två kvantitativa studier. Databaserna som användes var Cinahl Complete, PsykINFO och Medline.  Resultat: Resultatet delades in i fyra teman; att känna rädsla och smärta i nära relationer, att mötas med förståelse men också brist på kunskap, att känna sig påverkad själsligt och kroppsligt samt att känna utanförskap men behöva samhörighet.  Slutsats: Kvinnor som lever med könsstympning upplever sig ha blivit stigmatiserade och fråntagna bestämmanderätten över sin kropp i möten med vården. Kunskapsbrist hos vårdaren har lett till känslor av otrygghet och rädsla hos kvinnorna. Då majoriteten lever med fysiska och psykiska konsekvenser från ingreppet behöver vården ha kompetens för att möta dessa kvinnor. Upplevelser av smärta och ångest i sexuella och sociala möten med partnern tydliggör även att omvårdnaden måste omfatta hela familjen. En bredare syn på sex påverkade kvinnornas upplevelser av att ha en god sexuell hälsa. / Background: Female circumcision is an old tradition where parts of genitalia are removed and sometimes sewn together. The non-medical procedure is performed on cultural grounds and aims to control sexuality and to transform the girl into a woman. Despite the violation of human rights an estimated 140 million women worldwide are genitally mutilated. It is therefore relevant for nurses to gain knowledge about the health interventions needed for this group of women. Aim: To describe women’s experiences after genital mutilation. Method: The material in this literaturereview consists of twelve qualitative and two quantitative studies. The databases used were Cinahl Complete, PsykINFO and Medline. Results: Four themes occurred; to feel fear and pain in close relationships, to be met with understanding but also lack of knowledge, to feel affected mentally and physically and to feel exclusion but need belonging. Conclusion: Women living with genital mutilation feel stigmatized and deprived of the right to decide over their own bodies in encounters with healthcare. Lack of knowledge by the caregivers has led to feelings of insecurity and fear. As the majority live with physical and mental consequences from the procedure, the caregivers need competence to meet the womens needs. Experiences of pain and anxiety in sexual and social encounters with partners also makes it clear that the health interventions must adress the whole family. A broader view of sex affected the womens view on having a good sexual health.

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.

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