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>

Este trabalho consiste em uma leitura das diferentes formas de representação que podem ser atribuídas à personagem Tashi, protagonista do romance Possessing the Secret of Joy (1992), da escritora negra estadunidense Alice Walker. Antes desta obra, Tashi já havia aparecido em dois romances de Walker, primeiro em The Color Purple (1982), como personagem periférica, e depois como menção em The Temple of my Familiar (1989). Com Tashi, surge a temática da prática da circuncisão feminina, ritual ao qual a personagem se submete no início da idade adulta. O foco de observação do trabalho se volta para a maneira na qual a revolta da autora é transformada em um meio de representação criativa. Walker utiliza sua obra abertamente como instrumento ideológico para que o tema da “mutilação genital” (termo utilizado pela autora) receba ampla atenção da mídia e da crítica em geral. O propósito da investigação é avaliar até que ponto o engajamento social da autora contribui de uma forma positiva em seu trabalho e até que ponto o mesmo engajamento o atrapalha. Para a análise das diferentes questões relacionadas ao tema de “female genital cutting” (FGC), termo que eu utilizo no decorrer da pesquisa, os trabalhos de críticas e escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon e a egípcia Nawal El Saadawi serão consultados. Espero que esta dissertação possa contribuir como uma observação sobre como Alice Walker usa seu engajamento social na criação de seu mundo fictício. / This thesis provides a reading of the different forms of representation that can be attributed to the character Tashi, the protagonist of the novel Possessing the Secret of Joy (1992), written by the African American writer Alice Walker. Before this work Tashi had already appeared in two previous novels by Walker, first, in The Color Purple (1982) and then, as a mention, in The Temple of My Familiar (1989). With Tashi, the author introduces the issue of female circumcision, a ritual Tashi submits herself to at the beginning of her adult life. The focus of observation lies in the ways in which the author’s anger is transformed into a means of creative representation. Walker uses her novel Possessing the Secret of Joy openly as a political instrument so that the expression “female mutilation” (term used by the author) receives ample attention from the media and critics in general. The aim of this investigation is to evaluate to what extent Walker’s social engagement contributes to the development of her work and to what extent it undermines it. For the analysis of the different issues related to “female genital cutting”, the term I use in this thesis, the works of feminist critics and writers such as Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon and the Egyptian writer and doctor Nawal El Saadawi will be consulted. I hope that this thesis can contribute as an observation about Alice Walker’s use of her social engagement in the creation of her fictional world. / Este trabajo consiste en una lectura de las diferentes formas de representación que pueden ser atribuidas al personaje Tashi, protagonista de la novela Possessing the Secret of Joy (1992), de la escritora negra norte-americana Alice Walker. Antes de esta obra, Tashi ya había aparecido en dos romances de Walker, primero en The Color Purple (1982), como personaje periferica y después como mención en The Temple of My Familiar (1989). Con Tashi, surge la temática de la circuncisión femenina, ritual al cual Tashi se somete en el principio de la edad adulta. El foco de observación del trabajo se vuelca sobre las maneras en las cuales la revuelta de la autora se tranforma en un medio de creación creativa. Walker utiliza su obra abiertamente como instrumento político para que el tema de la “mutilación genital” (termino utilizado por la autora) reciba amplia atención de los medios y crítica en general. El propósito de la investigación es evaluar hasta que punto el envolvimiento social de la autora contribuye positivamente o interfiere en el desarrollo de su trabajo. Para el análisis de las diferentes cuestiones relacionadas al tema de “female genital cutting” (FGC), termino utilizado por mi en el decorrer del trabajo, las obras de las críticas y escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon y la egipcia Nawal El Saadawi serán consultadas. Deseo que el trabajo realizado pueda contribuir como una observación sobre como Alice Walker utiliza su envolvimiento social en la creación de su mundo fictício.

Este trabalho consiste em uma leitura das diferentes formas de representação que podem ser atribuídas à personagem Tashi, protagonista do romance Possessing the Secret of Joy (1992), da escritora negra estadunidense Alice Walker. Antes desta obra, Tashi já havia aparecido em dois romances de Walker, primeiro em The Color Purple (1982), como personagem periférica, e depois como menção em The Temple of my Familiar (1989). Com Tashi, surge a temática da prática da circuncisão feminina, ritual ao qual a personagem se submete no início da idade adulta. O foco de observação do trabalho se volta para a maneira na qual a revolta da autora é transformada em um meio de representação criativa. Walker utiliza sua obra abertamente como instrumento ideológico para que o tema da “mutilação genital” (termo utilizado pela autora) receba ampla atenção da mídia e da crítica em geral. O propósito da investigação é avaliar até que ponto o engajamento social da autora contribui de uma forma positiva em seu trabalho e até que ponto o mesmo engajamento o atrapalha. Para a análise das diferentes questões relacionadas ao tema de “female genital cutting” (FGC), termo que eu utilizo no decorrer da pesquisa, os trabalhos de críticas e escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon e a egípcia Nawal El Saadawi serão consultados. Espero que esta dissertação possa contribuir como uma observação sobre como Alice Walker usa seu engajamento social na criação de seu mundo fictício. / This thesis provides a reading of the different forms of representation that can be attributed to the character Tashi, the protagonist of the novel Possessing the Secret of Joy (1992), written by the African American writer Alice Walker. Before this work Tashi had already appeared in two previous novels by Walker, first, in The Color Purple (1982) and then, as a mention, in The Temple of My Familiar (1989). With Tashi, the author introduces the issue of female circumcision, a ritual Tashi submits herself to at the beginning of her adult life. The focus of observation lies in the ways in which the author’s anger is transformed into a means of creative representation. Walker uses her novel Possessing the Secret of Joy openly as a political instrument so that the expression “female mutilation” (term used by the author) receives ample attention from the media and critics in general. The aim of this investigation is to evaluate to what extent Walker’s social engagement contributes to the development of her work and to what extent it undermines it. For the analysis of the different issues related to “female genital cutting”, the term I use in this thesis, the works of feminist critics and writers such as Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon and the Egyptian writer and doctor Nawal El Saadawi will be consulted. I hope that this thesis can contribute as an observation about Alice Walker’s use of her social engagement in the creation of her fictional world. / Este trabajo consiste en una lectura de las diferentes formas de representación que pueden ser atribuidas al personaje Tashi, protagonista de la novela Possessing the Secret of Joy (1992), de la escritora negra norte-americana Alice Walker. Antes de esta obra, Tashi ya había aparecido en dos romances de Walker, primero en The Color Purple (1982), como personaje periferica y después como mención en The Temple of My Familiar (1989). Con Tashi, surge la temática de la circuncisión femenina, ritual al cual Tashi se somete en el principio de la edad adulta. El foco de observación del trabajo se vuelca sobre las maneras en las cuales la revuelta de la autora se tranforma en un medio de creación creativa. Walker utiliza su obra abiertamente como instrumento político para que el tema de la “mutilación genital” (termino utilizado por la autora) reciba amplia atención de los medios y crítica en general. El propósito de la investigación es evaluar hasta que punto el envolvimiento social de la autora contribuye positivamente o interfiere en el desarrollo de su trabajo. Para el análisis de las diferentes cuestiones relacionadas al tema de “female genital cutting” (FGC), termino utilizado por mi en el decorrer del trabajo, las obras de las críticas y escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon y la egipcia Nawal El Saadawi serán consultadas. Deseo que el trabajo realizado pueda contribuir como una observación sobre como Alice Walker utiliza su envolvimiento social en la creación de su mundo fictício.

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.

Este trabalho consiste em uma leitura das diferentes formas de representação que podem ser atribuídas à personagem Tashi, protagonista do romance Possessing the Secret of Joy (1992), da escritora negra estadunidense Alice Walker. Antes desta obra, Tashi já havia aparecido em dois romances de Walker, primeiro em The Color Purple (1982), como personagem periférica, e depois como menção em The Temple of my Familiar (1989). Com Tashi, surge a temática da prática da circuncisão feminina, ritual ao qual a personagem se submete no início da idade adulta. O foco de observação do trabalho se volta para a maneira na qual a revolta da autora é transformada em um meio de representação criativa. Walker utiliza sua obra abertamente como instrumento ideológico para que o tema da “mutilação genital” (termo utilizado pela autora) receba ampla atenção da mídia e da crítica em geral. O propósito da investigação é avaliar até que ponto o engajamento social da autora contribui de uma forma positiva em seu trabalho e até que ponto o mesmo engajamento o atrapalha. Para a análise das diferentes questões relacionadas ao tema de “female genital cutting” (FGC), termo que eu utilizo no decorrer da pesquisa, os trabalhos de críticas e escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon e a egípcia Nawal El Saadawi serão consultados. Espero que esta dissertação possa contribuir como uma observação sobre como Alice Walker usa seu engajamento social na criação de seu mundo fictício. / This thesis provides a reading of the different forms of representation that can be attributed to the character Tashi, the protagonist of the novel Possessing the Secret of Joy (1992), written by the African American writer Alice Walker. Before this work Tashi had already appeared in two previous novels by Walker, first, in The Color Purple (1982) and then, as a mention, in The Temple of My Familiar (1989). With Tashi, the author introduces the issue of female circumcision, a ritual Tashi submits herself to at the beginning of her adult life. The focus of observation lies in the ways in which the author’s anger is transformed into a means of creative representation. Walker uses her novel Possessing the Secret of Joy openly as a political instrument so that the expression “female mutilation” (term used by the author) receives ample attention from the media and critics in general. The aim of this investigation is to evaluate to what extent Walker’s social engagement contributes to the development of her work and to what extent it undermines it. For the analysis of the different issues related to “female genital cutting”, the term I use in this thesis, the works of feminist critics and writers such as Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon and the Egyptian writer and doctor Nawal El Saadawi will be consulted. I hope that this thesis can contribute as an observation about Alice Walker’s use of her social engagement in the creation of her fictional world. / Este trabajo consiste en una lectura de las diferentes formas de representación que pueden ser atribuidas al personaje Tashi, protagonista de la novela Possessing the Secret of Joy (1992), de la escritora negra norte-americana Alice Walker. Antes de esta obra, Tashi ya había aparecido en dos romances de Walker, primero en The Color Purple (1982), como personaje periferica y después como mención en The Temple of My Familiar (1989). Con Tashi, surge la temática de la circuncisión femenina, ritual al cual Tashi se somete en el principio de la edad adulta. El foco de observación del trabajo se vuelca sobre las maneras en las cuales la revuelta de la autora se tranforma en un medio de creación creativa. Walker utiliza su obra abiertamente como instrumento político para que el tema de la “mutilación genital” (termino utilizado por la autora) reciba amplia atención de los medios y crítica en general. El propósito de la investigación es evaluar hasta que punto el envolvimiento social de la autora contribuye positivamente o interfiere en el desarrollo de su trabajo. Para el análisis de las diferentes cuestiones relacionadas al tema de “female genital cutting” (FGC), termino utilizado por mi en el decorrer del trabajo, las obras de las críticas y escritoras feministas como Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon y la egipcia Nawal El Saadawi serán consultadas. Deseo que el trabajo realizado pueda contribuir como una observación sobre como Alice Walker utiliza su envolvimiento social en la creación de su mundo fictício.

Foi realizado um estudo bioquímico, morfológico e morfométrico de células epiteliais da tuba uterina de bovinos na presença e ausência de soro fetal bovino in vitro. Para determinar os efeitos dos soro fetal bovino sobre as células foram utilizados como parâmetros sua influência sobre o crescimento, a morfologia qualitativa e quantitativa, o consumo de glicose, a síntese protéica, a atividade da fosfatase láctica e da deidrogenase láctica, em diferentes dias de cultivo. Nas eletromicrografias foram analisados os seguintes componentes celulares: núcleo, grânulos de secreção, mitocôndrias, retículo endoplasmático rugoso, aparelho de Golgi e outras estruturas citoplasmáticas. A cinética de crescimento foi maior na presença de soro. A microscopia eletrônica de transmissão evidenciou inicialmente dois tipos de células, as ciliadas e as secretoras que foram gradativamente diferenciando-se durante todo o tempo de cultivo, na presença e na ausência de soro fetal bovino. Na presença de soro observou-se uma monocamada confluente no dia cinco, enquanto na ausência do mesmo não se notou monocamada confluente até o final do experimento. Um terceiro tipo celular foi observado, tratava-se de uma célula da monocamada com microvilosidades. A análise morfométrica revelou que os três tipos celulares apresentaram diferenças significativas em alguns dos parâmetros avaliados. A análise bioquímica evidenciou algumas diferenças significativas no meio de cultivo. Pode-se concluir que o soro fetal bovino não interfere nas principais características morfológicas, mas sim na formação da monocamada e de certos parâmetros morfométricos e bioquímicos, talvez por apresentar componentes desconhecidos, tais como, proteínas, ácidos graxos, fatores de crescimento, aminoácidos e/ou vitaminas, sendo que a presença e concentração destes pode variar muito entre diferentes lotes, alterando o meio de cultivo. Estudos com outros suplementos ou mesmo fatores de aderência devem ser realizados visando um modelo in vitro que auxilie na compreensão das interações das células da tuba uterina com os gametas e embriões. / The biochemistry, morphology and morphometry study were performed in bovine tuba uterina epithelial cells in vitro with and without bovine calf serum. It has been observed the effects of bovine calf serum in the cells by growth, qualitative and quantitative morphology, glucose and protein source, acid phosphatase and lactica deidrogenase in differents days. It has been analysed some cell structures, like: nuclei, Golgi regions, rough endoplasmatic reticulum, mitochondria, secretory vesicles and others by the electron microscopy. The cell growth was higher with serum. The electron microscopy has showed two cells: the secretory and ciliated, both were differentiating during the experiment. The monolayers with serum was confluent in the day 5, but it has not happened the same without serum. The structural analysis of monolayer showed a cell with microvilli. The morphometry and biochemistry have showed significant differences in both cells and in the medium. Maybe it has been happened because the serum is an effective growth-promoting supplement. Therefore, more studies are needed with others supplements or attachment factors to have in vitro model that mimic in vivo conditions most closely to study the interactions between bovine tuba uterina epithelial cells and gametes or embryos

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.