Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2007. / Titre provenant de l'écran-titre. 74 f. : ill. Bibliogr. f. 56-61.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 351-365).

Female genital mutilation (FGM) is defined by the World Health Organisation as the deliberate total or partial removal of the external female genitalia, or other deliberate injury to the female genitalia, which is carried out for non-therapeutic purposes. The practice is widely condemned. Even though the adverse effects of the practice have been well documented in many small studies and case reports, FGM is still common in many countries. The effects of this practice are also being felt in many developed countries due to substantial migration in recent years. One of the limiting factors in encouraging eradication is the availability of high quality evidence of the effects of the practice on the process of childbirth. By highlighting the effects of FGM on the process of childbirth, the objective was to encourage policy makers, in co-operation with many relevant organisations, to work together to eradicate the procedure. This original study investigates the effects of FGM on the process of childbirth using a large international epidemiological case control study involving three centres in three different countries. The inclusion criteria were strict and comprised of agreement by the woman and or her husband to participate in the study, for a normal singleton pregnancy at term with a cephalic presentation which resulted in a normal baby, for the women with and without FGM during the period of study. Women who did not fulfil these criteria were excluded. Maternal outcome measures included length of labour, obstruction to the progress of labour, operative delivery, urine retention, perineal complications, intrapartum and postpartum haemorrhage and blood loss during the process of labour. Newborn outcome measures included birth status at delivery, Apgar scores at 5 and 10 minutes, requirement for resuscitation, admission to special care unit and time taken from delivery to the first breast feed. Psychological sequelae were not assessed. The total number of participants in these three centres was 1,970 women; 526 with no FGM (control) and 1444 with different types of FGM. Every effort was taken to keep confidentiality and not to interfere with management of labour during data collection. The results indicate a highly significant difference between the two groups when comparing length of the process of labour, mode of delivery and the need for instrumental deliveries, episiotomies and tears, blood loss during and after delivery, the need for catheterisation following deliveries and duration of hospital stay following birth. Adverse effects were not confined to women and were found to have extended to the new-borns in the two groups again with highly significant difference with regard to birth trauma, requirement for resuscitation and medical attention. The time taken for the first breast contact was different in the two groups with possible effects which may be difficult to establish and require further research. The data provide clear evidence that the practice of FGM is associated with clinical adverse effects, which are not only confined to women but involve the newborn as well. It is hoped that this systematic and comprehensive collection of evidence will make a substantial contribution to the world wide effort to eradicate this harmful practice.

This qualitative research study explores female circumcision within the Canadian community perspective. / Issues examined in the literature review include: the historical background of the practice, its cultural and religious implications, its effects on health, existing social pressures to continue or discontinue the practice and the subjective constructions of majority and minority identities, perspectives and interactions in Canada's multicultural society. / For the purposes of this study majority/minority relations are explored in terms of the interactions between an immigrant community from a FC practicing country and the mainstream community in Canada. The Somali community has been chosen for this case study as the one best known to the author and as one in whose country of origin available statistics indicate a 98% prevalence rate of FC. Canadian mainstream reactions to this practice are analyzed through media reporting and statements from Somalis in Canada describing their interactions with the mainstream community on this issue. / Members of the Somali community in Montreal, Quebec and Ottawa, Ontario were interviewed in order to cover as wide an area as possible, including difference in provinces. The following six themes were chosen after data analysis: the Effects of FC on Health, the Cultural Orientation of FC, Religious Beliefs Regarding FC, Social Pressures, A Sense of Differentness and Efforts to Discourage the Practice of FC. These themes are discussed with special attention being paid to 'differentness' and the mechanisms or coping skills developed to deal with this complex social phenomenon which involves opposing values, beliefs and perceptions. / In its final section, the study examines the social work implications of the findings which address intercultural fears, anxieties and the dynamics of power involved in the way the FC issue has been addressed in Canada. / Practice, program and policy recommendations with regard to discouraging FC practice are made at the end of the thesis. / The study concludes with the observation that the debate around FC in Canada is much wider than the issue itself and that the practice has been sensationalized in a manner which has emphasized perceptions of differentness which exist in our society. No constructive dialogue will be possible around this issue until the issue of differentness is addressed, and mutual fears and anxieties evoked by the perception of differentness are dealt with in a sensitive manner, in both immigrant and mainstream communities.

No description available.

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.

<p>Between one hundred and one hundred and forty million young girls around the world have reportedly been subjected to some form of genital excision during 2005. Approximately three million young girls are at risk every year of undergoing this harmful procedure (WHO, 2008). Female genital mutilation is reported to occur, and is expected to continue occurring in twenty-eight African countries (London Safeguarding Children Board, 2007). This paper aims to firstly observe the levels of excision in Africa, and then highlight the underlying factors that encourage certain women to continue this dangerous ritual by analysing national datasets, such as the child info database, obtained form the United Nations Children&rsquo / s Fund. By calculating and comparing common indicators, the prevailing ones that dominate FGM appreciation can be further analysed. The final objective will be to suggest strategies that can be put in place to encourage the discontinuation of female genital cutting universally.</p>

<p>Between one hundred and one hundred and forty million young girls around the world have reportedly been subjected to some form of genital excision during 2005. Approximately three million young girls are at risk every year of undergoing this harmful procedure (WHO, 2008). Female genital mutilation is reported to occur, and is expected to continue occurring in twenty-eight African countries (London Safeguarding Children Board, 2007). This paper aims to firstly observe the levels of excision in Africa, and then highlight the underlying factors that encourage certain women to continue this dangerous ritual by analysing national datasets, such as the child info database, obtained form the United Nations Children&rsquo / s Fund. By calculating and comparing common indicators, the prevailing ones that dominate FGM appreciation can be further analysed. The final objective will be to suggest strategies that can be put in place to encourage the discontinuation of female genital cutting universally.</p>

Magister Philosophiae - MPhil / Between one hundred and one hundred and forty million young girls around the world have reportedly been subjected to some form of genital excision during 2005. Approximately three million young girls are at risk every year of undergoing this harmful procedure (WHO, 2008). Female genital mutilation is reported to occur, and is expected to continue occurring in twenty-eight African countries (London Safeguarding Children Board, 2007). This paper aims to firstly observe the levels of excision in Africa, and then highlight the underlying factors that encourage certain women to continue this dangerous ritual by analysing national datasets, such as the child info database, obtained form the United Nations Children's Fund. By calculating and comparing common indicators, the prevailing ones that dominate FGM appreciation can be further analysed. The final objective will be to suggest strategies that can be put in place to encourage the discontinuation of female genital cutting universally. / South Africa

Une des questions les plus débattues dans le domaine de l’éthique en ce XXIème siècle entre l’Afrique et le monde occidental concerne le respect de l’intégrité physique des femmes. Parmi les actions humaines qui touchent le plus l’intégrité corporelle, les excisions et les infibulations sont les plus dénoncées en Afrique. Longtemps considérées comme des rites d’initiation pubertaire des filles, ces pratiques sont maintenant considérées comme néfastes à la santé, et communément désignées par la communauté internationale de « mutilations sexuelles féminines ». Au cours des dernières décennies, ces pratiques ont été progressivement interdites légalement tant dans la plupart des pays d’Afrique que dans les pays occidentaux. Le Comité Inter-Africain (CIAF) contre les mutilations sexuelles demande la « tolérance zéro » par rapport à ces pratiques. La communauté internationale les combat avec des armes juridiques, en se référant aux conséquences médicales et aux droits de l’homme. Notre thèse est née d’une interrogation sur les raisons pour lesquelles ces rites se poursuivent encore en Afrique et plus spécialement au Mali, alors que dans les pays occidentaux, on élève fortement la voix pour les dénoncer comme sévices infligés aux femmes. Sur le plan international, on hésite à imposer des valeurs universelles à un phénomène perçu dans une large mesure comme une tradition conforme aux normes sociales des communautés qui les maintiennent. Afin de mieux cerner le sujet, notre questionnement a été le suivant : « Comment les pratiques culturelles des excisions et des infibulations, dans la ville de Bamako au Mali, interpellent-elles l’éthique : en quoi l’analyse de ces rites constitue-t-elle un domaine légitime d’application des principes de la bioéthique ? » Notre réflexion part du postulat que la dignité humaine est une norme à l’aune de laquelle se mesurent les défis éthiques liés à ces rites. Un proverbe Bambara dit ceci : « Une seule main ne lave pas proprement un éléphant ». La logique de cette sagesse met en évidence qu’une seule approche disciplinaire ne saurait faire ressortir les enjeux éthiques de ces pratiques. Notre analyse bioéthique se veut une démarche interdisciplinaire, qui permet d’articuler les approches philosophiques, anthropologiques, sociologiques et biomédicales de ces pratiques. Le premier chapitre, à travers la revue des écrits, présente la problématique de ces rites. Le deuxième chapitre présente le cadre théorique basé sur la notion de dignité humaine et délimite « ses contours, ses sources, ses formes et ses conséquences » afin de la rendre plus efficace et opérationnelle comme moyen de protection de l’être humain. Le troisième chapitre présente la méthodologie de la recherche basée sur la méthode qualitative et l’induction analytique et décrit le contexte de l’étude. Le quatrième chapitre présente les résultats de la recherche qui font ressortir que ces pratiques se résument essentiellement au contrôle du désir sexuel féminin. Ces pratiques sont par ailleurs déritualisées, touchent de plus en plus des enfants, comportent des risques et des conséquences sur la santé avec des coûts humains et financiers pour la société. Le cinquième chapitre analyse ces pratiques avec les principes éthiques qui démontrent qu’elles constituent un problème de santé publique malgré leur caractère culturel. Enfin, le sixième chapitre présente la portée et la limite de la thèse. Celle-ci montre qu’il est possible de mener un débat sur les excisions et les infibulations à travers une éthique de discussion. Elle offre un moyen pour y parvenir avec une vision de la notion de dignité humaine comme une « valeur éthique universelle » susceptible d’être utilisée dans toutes les actions impliquant l’être humain et dans tous les contextes socio-culturels. Notre démarche élargit ainsi le champ d’application des principes bioéthiques à des pratiques non-médicales. Par cette thèse, nous souhaitons contribuer à enrichir la réflexion éthique sur les excisions et les infibulations et inspirer les politiques de santé publique dans le respect des diversités culturelles. Nous espérons pouvoir inspirer aussi d’autres recherches en vue de rapprocher la bioéthique des pratiques culturelles traditionnelles afin de trouver des compromis raisonnables qui pourraient renforcer le rôle de protection de la dignité humaine. / One of the most debated issues in the area of ethics in the twenty first century between Africa and the Western world concerns the respect for the women’s physical integrity. Among human actions that most affect the bodily integrity of women, female circumcision and infibulation are the most denounced in Africa. Long regarded as rites of puberty and initiation of girls, these practices are now considered as exceedingly harmful to health, and commonly called "female genital mutilation" (FGM) by the international community. In recent decades, these practices have gradually been legally prohibited in most African countries as well as in Western countries. The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) demands 'zero tolerance'. The international community fights them with legal weapons, basing on the medical consequences and the infringement of human rights. Our thesis was born from a question on the reasons why these rites are still going on in Africa and more especially in Mali, while in Western countries; voices are strongly raised to denounce them as abusive to women. On the international front, we hesitate to impose universal values to a phenomenon, perceived to a large extent as a tradition in conformity with the social norms of the communities that maintain them. In order to better circumscribe the subject, our question is as follows: “How do the cultural practices of female circumcision and infibulation in the city of Bamako, Mali, challenge ethical norms : in what way does the analysis of these rites constitute a legitimate sphere of application of the principles of bioethics?” Our reflection starts from the assumption that human dignity is a standard against which measuring the ethical challenges associated with these rites. A Bambara proverb says: “One hand does not properly wash an elephant.” The logic of this wisdom highlights the fact that using only one approach from a certain discipline cannot bring out the ethical issues of these practices. Our bioethical analysis is meant to be an interdisciplinary approach that allows one to articulate the philosophical, anthropological, sociological and biomedical approaches to these practices. The first chapter, through the literature review, presents the problem associated with these rites. The second chapter presents the theoretical framework based on the concept of human dignity, and delineates its contours: its sources, its forms and its consequences in order to make it more effective and operational as means of protection of the human being. The chapter three presents the methodology of the research based on the qualitative method and analytical induction, and describes the context of the study. The chapter four presents the results of the research which highlights the fact that these practices essentially refer to the control of female sexual desire. These practices are also “deritualized” and affect more and more children, which involves risks and consequences on health with enormous human and financial costs to society. The fifth chapter analyses these practices with the ethical principles which demonstrate that these ritual practices constitute a public health problem despite their cultural character finally. The sixth chapter presents the scope and the limit of the thesis. It shows that it is possible to have a debate on female circumcision and infibulation through an ethic of discussion. It provides a way to achieve this with a vision of the concept of human dignity as a “universal ethical value” which can be used in all actions involving the human being and in all socio-cultural contexts. Our approach broadens the field of application of the bioethical principles to non-medical practices. By this thesis, we wish to contribute to the enrichment of the ethical reflection on female circumcision and infibulation and to inspire public health policies keeping in mind the respect for cultural diversity. We also hope to inspire further research in view of bringing together the bioethics of traditional cultural practices in order to find reasonable compromises which could strengthen the role of protection of human dignity.