Starting in the early 1980s, media coverage of customary African genital surgeries for females has been problematic and overly reliant on sources from within a global activist and advocacy movement opposed to the practice, variously described as female genital mutilation, female genital cutting, or female circumcision. Here, we use the more neutral expression female genital surgery. In their passion to end the practice, anti-mutilation advocacy organizations often make claims about female genital surgeries in Africa that are inaccurate or overgeneralized or that don't apply to most cases. The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little-known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented.

Background: Sweden stands out as an interesting example of potential cross-cultural tensions in reproductive healthcare. On the one hand, most people agree that gender equality between men and women should apply to everyone. On the other hand, people in Sweden report a high level of respect for cultural diversity, emphasising people’s ‘right to be different’. The aim of this study was to explore how midwives communicate gender equality perspectives in encounters with non-Western patients, many of whom have migrated from countries expressing less support for gender equality. Methods: Semi-structured individual interviews as well as focus group interviews were conducted in Denmark and Sweden between 2013 and 2016. Carol Bacchi’s ‘What’s the Problem Represented to be’ approach guided the analysis. Findings: We found that it is difficult for health care providers who are ideologically motivated to promote gender equality in clinical encounters, to simultaneously value and tolerate traditions that are considered to uphold gender-unequal structures. The gender equality standard is thus one example of a liberal, egalitarian value that health care providers appeared to give priority to at the expense of others. Conclusions: That the gender equality ideology is given priority is not necessarily undesirable but nevertheless appears to generate unintended consequences. We argue that a high level of ideological persuasion upon female patients may negatively influence their experience of the encounter, and negatively influence women’s possibilities to obtain adequate support in relation to their individual needs. Main messages: Healthcare providers are also part of cultural systems of norms — such as pertinence to gender equality — although these are seldom problematized ‘Reflexivity’ as a working tool can assist healthcare providers to reflect upon how gender equality norms influence clinical encounters.

The abortion discourse in Sweden is marked by historically liberal ideals about women's inviolable right to make autonomous reproductive decisions. However, to respond to the increase in cultural and religious pluralism building up over several decades, religious organizations have been given opportunities to provide so-called spiritual care in affiliation with Swedish hospitals since the 1980s. In this study we asked: in what ways do religious counsellors, affiliated with Swedish hospitals, construct their ideas on abortion, and how well do their ideas comply with Sweden's 'women-friendly' abortion policies? Through interviews with Protestant, Catholic, Muslim, and Buddhist religious counsellors, we wanted to empirically test the presumption underlying the decisions to grant space to religious actors in Swedish healthcare, i.e., that religious counselling serves to complement existing services. We found that it cannot be expected that religious advice on abortion will always comply with Swedish abortion law and with the women-friendly abortion policy that the Swedish state seeks to impose. When policy-makers open up possibilities for diverse norms on abortion to manifest in close affiliation with healthcare institutions, they must be aware that some religious counsellors argue that only God-and not the woman herself-can decide whether a woman can terminate a pregnancy. We argue that the findings in this study speaks to what researchers have referred to as the "diversity-equality paradox", which highlights the tension between the promotion of religious ideas on abortion on the one hand and the promotion of liberal ideas about women's reproductive freedom on the other.

Background: ‘Low socioeconomic status’ and ‘religious barriers’ have been presented as nearly universal explanatory reasons for why minority women are less likely than majority women in Scandinavian countries to use contraception. Recent studies have warned against giving such statistically ‘objective’ theories undue importance in the formulation of clinical recommendations. Drawing on this recent critique, the aim of this study was to qualitatively explore how ‘low socioeconomic status’ and ‘religiousness’ intersect with Muslim minority women’s contraceptive decisions. Methods: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. Data analysis was inspired by naturalistic inquiry. Findings: We found that a low level of education and low income were not necessarily obstacles for women’s use of contraception, but strong imperatives for women to wait having children until their life circumstances were more stable. Arguments grounded in Islamic dictates on contraception became powerful reasons for women to decide it was religiously correct to postpone having children, in case the financial and emotional resources were not yet at hand. Conclusions: We have shown that the dominant theory about that ‘low socioeconomic status’ and ‘religiousness’ are paramount barriers to minority women’s use of contraception must be challenged. When formulating suggestions for how to provide contraceptive counselling to minority women in Denmark and Sweden, one must also take into account factors such as low financial security as well as religious convictions which can be strong imperatives for women to use contraception. Main messages: The use of broad group-categorisations for understanding individuals’ contraceptive behaviours should be challenged The validity of initiating ‘targeted interventions’ towards large heterogeneous minority groups in Scandinavian contraceptive counselling should be critically discussed

Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions. Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established. Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception. Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling. (C) 2019 The Authors. Published by Elsevier Ltd.

In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers’ ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women’s possibilities to obtain adequate support. At the end of the article, we suggest how health care providers’ reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.

This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process of parenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additional couples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish system contradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved a complex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood make people feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequences of an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers’ conflicting views on how to best meet the surrogate mother’s interest and the best interest of the child. Regulation is thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.

Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

Background: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers. Objective: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy. Methods: In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam. Results: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services. Conclusions: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.

In 2008, a Somali couple, refugees in Switzerland, were convicted of the clitoridectomy of their 2-year-old daughter. The procedure had been carried out by a Somali physician in the family’s apartment in Zurich twelve years earlier. Subsequently, the parents abandoned the practice and did not perform it on their younger daughters, and the mother campaigned against it during meetings of Somali women. Obscuring the change in attitude of the prosecuted parents, the media coverage of this trial resulted in an upsurge of fear that female circumcision would be a contemporary reality on Swiss soil, albeit this case is the first and only case known to date of a female circumcision performed in the national territory. In order to deconstruct this «moral panic», this paper aims at providing critical analysis of media representations of female circumcision by examining the court report of this case. We will discuss discrepancies between the media coverage and what can be known from legal documents, and reflect on the effects of such media representations on the broader debate of immigrants’ integration in Switzerland.

Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.

Objective: to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth. Design: a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling. Setting:a diasporic context among participants living in six urban centres across Sweden. Participants: successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants). Findings: within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support. Implications for practice: to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.

This study focuses on communication and conceptions of obstetric care to address the postulates that immigrant women experience sensitive care through the use of an ethnically congruent interpreter and that such women prefer to meet health providers of the same ethnic and gender profile when in a multiethnic obstetrics care setting. During 2005–2006, we conducted in-depth interviews in Greater London with immigrant women of Somali and Ghanaian descent and with White British women, as well as with obstetric care providers representing a variety of ethnic profiles. Questions focused on communication and conceptions of maternity care, and they were analyzed using qualitative techniques inspired by naturalistic inquiry. Women and providers across all informant groups encountered difficulties in health communication. The women found professionalism and competence far more important than meeting providers from one's own ethnic group, while language congruence was considered a comfort. Despite length of time in the study setting, Somali women experienced miscommunication as a result of language barriers more than did other informants. An importance of the interpreter's role in health communication was acknowledged by all groups; however, interpreter use was limited by issues of quality, trust, and accessibility. The interpreter service seems to operate in a suboptimal way and has potential for improvement.

Unskilled traditional healers are widely blamed for complications to male circumcision performed in low- and middle-income settings. However, attributions of culpability are mostly anecdotal. We identify self-circumcision in adults that was performed during adolescence, hereby termed retrospective self-circumcision, and unexpectedly discovered during interviews with Somali men in Sweden in 2010. This study explores the phenomenon with the aim to increase our understanding about the health needs of this group. Two focus group discussions (six and seven participants), one informal discussion with three participants, and 27 individual interviews were conducted in 2010 and 2011 with Somali-Swedish fathers, guided by a hermeneutic, comparative natural inquiry method. Eight participants had performed retrospective self-circumcision while living in rural Somalia. Actions were justified according to strong faith in Islam. Genital physiology was described as adequate for producing children, but physical sensation or characteristics were implied as less than optimal. Few had heard about penile reconstruction. There was hesitation to openly discuss concerns, but men nevertheless encouraged each other to seek care options. Presently no medical platform is available for retrospective self-circumcision. Further systematic exploration is recommended in sexual, reproductive and urological health to increase interest in this phenomenon. Our findings suggest approachability if health communication is enabled within an Islamic context.

In recent years, the dominant Western discourse on "female genital mutilation" (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called "the standard tale" of FGM (also termed "female genital cutting" [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO's terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.

Introduction Since the 1980s, refugees have come to Sweden from the Horn of Africa, where the majority of women have undergone Female Genital Cutting (FGC). Sweden was the first country in the West to outlaw the practice in 1982, later it became illegal for a Swedish resident to perform FGC abroad. The Swedish government has allocated research funding and has put a lot of effort into prevention and management by means of writing guidelines and organized professional training activities for best practices of persons with FGMC. Methods We have explored to what extent empirical data from the international research field is used in professional education and policy documents from Swedish health authorities since the 1990s. We performed a systematic review of scientific papers, books, guidelines and grey literature reports from Sweden. We focus on outcomes related to maternity care (maternal, perinatal mortality) and youth health counselling (menstruation disorders, sexuality). Results The evidence-based knowledge from perinatal and maternal death audits had not been used in an appropriate way, basic medical knowledge on dysmenorrhea was neglected, and qualitative data on sexual health among women with FGC was not acknowledged in the documents. Conclusion Swedish authorities have worked to improve the health outcomes among women with FGC. However, evidence-based knowledge has been underused, thereby increasing the risk for harm in spite of good intentions.

Comment on Informed consent in medical decision-making in commercial gestational surrogacy: a mixed methods study in New Delhi, India.

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semistructured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

An important determinant of family honour in many cultures is the chastity of women, with much importance attributed to virginity until marriage. The traditional proof of virginity is bleeding from the ruptured hymen, which has led some women to request genital surgery to “restore” virginity, or hymen repair. The aim of this study was to investigate whether Swedish health care providers have had experience of patients requesting this surgery. Questionnaires were sent to 1,086 gynaecologists, midwives, youth welfare and social officers, and school nurses and doctors in four Swedish cities. Of the 507 who returned the questionnaire, 271 had seen patients seeking virginity-related care. Of these, 14 had turned the patients away; 221 had made 429 referrals, mostly to a welfare officer or a gynaecologist; and 26 had referred patients to a plastic surgeon. Nine gynaecologists had carried out such surgery themselves. Swedish authorities have to date focused on this issue primarily from a social and legal perspective. No guidelines exist on how health professionals should deal with requests for surgery to restore virginity. Further research is needed on how best to meet the needs of this group of patients in a multi-ethnic society and how to address requests for hymen repair. Without this, medical practitioners and counsellors will remain uncertain and ambivalent, and a variety of approaches will persist.

BACKGROUND: : The literature concerning interpretation in research primarily concentrates on rigorous techniques to eliminate bias. This article analyses other significant issues that arise when interpreters participate in research. MATERIAL: : Empirical examples are drawn from a research project concerning mental ill health in a multicultural neighbourhood. DISCUSSION: : Interpreters influence interview data in ways commonly unnoticed by researchers. One often-overlooked factor is that languages are dynamic and interpreters are not instruments. CONCLUSION: : Research conducted with an interpreter is a complex undertaking. Solely relying on checklists to improve methodological rigour can result in a false sense of the material's validity.

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city’s population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one’s disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client’s socio-economic and psychosocial needs, rather than solely follow a medical model.

Det finns ingen undersökt brottsplats, ingen vet säkert när brottet begicks, vittnesmålen är motsägelsefulla och det är en vårdnadstvist i botten. Ändå döms Ali Elmi till fängelse för att han ska ha låtit könsstympa sin dotter i Somalias huvudstad Mogadishu något år tidigare. Han fälls av tingsrätten i Göteborg i juni 2006, därefter av Göta hovrätt i oktober samma år. En granskning av fallet avslöjar anmärkningsvärda brister i den juridiska processen, men också rättsväsendets oförmåga att hantera kulturella skillnader. Vad händer när det svenska rättsväsendet ska bedöma vad som är ”rimliga” och ”sannolika” händelser i en grupp med en helt annan kulturell bakgrund? Kan människor med invandrarbakgrund lita på att rättssäkerheten gäller alla? Sara Johnsdotter diskuterar fallet Ali utifrån förundersökningsprotokoll, berättelser och vittnesmål från rättegångarna, intervjuer med Ali och forskning om kvinnlig könsstympning. Sara Johnsdotter är filosofie doktor i socialantropologi och forskare vid Malmö högskola. Hon disputerade vid Lunds universitet 2002 på en avhandling om hur synen på traditionen att omskära flickor har förändrats i den somaliska gruppen efter migration till Sverige.

Background: Despite the risk of essentialising, there is reason to highlight the fact that certain syndromes and health strategies are to some extent culture-specific. “Culture” as a theoretical concept is needed if we are to understand differences between ethnic groups. Aim: To discuss how certain notions of mental health and disease, and views and expectations of the Swedish health care system, may affect health seeking behaviour. Method: Qualitative interviews with Swedish Somalis in Malmö, some of them with a formal diagnosis of mental ill-health. Basic interview questions were, ‘What is mental ill-health?’ and ‘How can it be dealt with?’ Result: Interviewees highlighted themes such as shame and the importance of social networks. Various expressions of mental ill-health were classified along a continuum including both mild ailments and “madness”. Culture-specific strategies to deal with mental ill-health were identified. Views of the Swedish health care system were positive, but turning to mental health care was generally seen as a last resort. Conclusion: Suffering and mental ill-health are universal phenomena. But our ways to categorise symptoms and classify ill-health are culture-specific. Cultural aspects of mental ill-health ought not be over-emphasized at the expense of social and biological dimensions. However, awareness of culture-specific expressions of mental ill-health and local strategies to deal with them may be of value in the health care sector in a multicultural society.

In this paper I discuss discourses about sexual pleasure after genital modifications, and how medical statements about effects on sexual pleasure are associated with politics, especially regarding male and female circumcision. Further, I argue that current discussions on sexual effects of genital modifications are reductionist due to widespread assumptions about the role of genitalia in sexuality – what might be characterised as ‘genital determinism’.

Originally published in Global Discourse, volume 3, issue 2 (June 2013) pp. 237-255

In 1982 Sweden legislated against ‘female genital mutilation’ (FGM) and was the first Western country to do so. Compared to many other countries in Europe, Sweden shows a high level of alertness when it comes to suspected cases of FGM; knowledge about legislation banning FGM is generally high and there is additionally a long history of guidelines for various professional groups. The emphasis on identifying illegal cases of FGM is supported by the mass media, which repeatedly gives this issue attention. Since the law came into effect in 1982, about twenty reports on suspected FGM have reached the police. Two cases have been taken to court and ended up in custodial sentences. Both will be briefly described in this report. In some of the cases representing suspicion of FGM in Sweden, compulsory genital examinations of minors have taken place. None of these cases has shown that FGM was performed. These cases will be in focus in this report. Particularly noteworthy is the present dichotomy within Swedish society: there is a strong political will to have effective enforcement of the FGM legislation, while at the same time contiguous anti-discrimination legislation exists, as well as a social movement working against the stigmatization of immigrants. An important question to be addressed here is to ask, ‘What happens when such aims clash?’ The report is a result of a multi-country project with researchers from Belgium, the UK, France, Spain, and Sweden: the EC Daphne project "Towards an improved enforcement of FGM legislation in Europe: Dissemination of lessons learned and capacity building of actors in legal and paralegal fields."

This chapter focuses on cultural variation regarding sexual activities and erotic practices. First, there is a presentation of how research data on these questions have been collected historically, acknowledging scientific and moral shortcomings of such compilations. Then, an empirical example—heterosexual intercourse—is used to show that there is wide cultural variation even in “dominant” sexual practices around the world. Sexual script theory is presented to introduce the overarching theoretical lens, social constructionism, that most scholars in the social sciences and humanities use to understand and describe sexuality. Cultural variation in views of acceptable sexual expressions may create challenges in multicultural societies, and this is discussed with respect to the fraught issue of sexuality and children. The chapter ends with a discussion of cultural change and globalization, pointing to current and future directions in anthropological approaches to understanding human sexuality.

Transnational familyhood is a challenge to western societies, whose implementation of legislation generally works with the assumption that families are nuclear and situated within a nation state. In the present case study Somali transnational family organisation is juxtaposed to the western nuclear family model to illustrate basic differences between the models. The mobility of children in the Somali family system is discussed in relation to child protection in European societies. Cultural variation in family organisation needs to be further discussed in societies that claim to be multicultural. The nature of child protection interventions by social workers will depend on whether society declares universalist or cultural-relativist values as more important.

Female genital cutting, or female circumcision, is primarily practiced in about 30 African countries. It is labeled “female genital mutilation” by the WHO. Motives vary considerably between groups. Various theoretical explanations behind the origin and continued practice of female circumcision have been offered. The radical feminist view has gained much public attention. The practice is criminalized in many parts of the world and there are campaigns against it on a global level. Female circumcision results in immediate medical consequences, although whether there are considerable long-term adverse effects for health and sexuality has been contested. In recent years female circumcision has been compared to practices of genital alterations that are accepted in the United States and European countries.

This chapter discusses whether female circumcision can be seen as violence in the name of religion. The concept of 'violence' in relation to female circumcision is problematized, and the fact that there are many forms of the practice is emphasized.

“Female genital mutilation” (FGM) or “female genital cutting” (often FGM/C) are the most widespread terms to designate nonmedical practices that alter or affect the external female genitalia. Medical consequences are often classified into immediate and long-term complications. FGM/C in some form is practiced in more than 30 countries, primarily in Africa and Asia, and there is vast variation as regards motives and age of the girls who undergo the procedure. FGM/C is illegal in Europe, North America, and Australia, and in most high-prevalence countries in Africa. Few cases of illegal FGM/C procedures have reached criminal courts in the west. A growing body of research demonstrates that cultural change regarding FGM/C attitudes and practices among migrant communities may be an important explanatory factor. Current contested issues include how the prevalent zero-tolerance approach to FGM/C is in line with the general acceptance of male circumcision, intersex surgery, and cosmetic female genital surgeries.

This paper starts with a discussion about the symmetrical aspects of circumcision of girls and circumcision of boys. In a brief overview of historical changes in the discourses on circumcision, especially regarding girls, we can see how a conceptual asymmetry was created through the activist claim, introduced in the early 1980s and prominent since then, that one of the phenomena, in whatever form, was to be labelled ‘mutilation’, the other ‘harmless’. The paper will further discuss later developments in the form of an activist movement (the genital integrity movement, intactivists) contending that also boys without decision-making capacity need to have legal protection against non-medical procedures that irreversibly change their genitals. Examples from the academic, medical, and political-legal fields in Europe will demonstrate a general trend in which the symmetries between circumcision of girls and boys are again being brought out, now within a children’s rights perspective.

Somali young women in Sweden, some of them circumcised, have to deal with national campaigns condemning ‘female genital mutilation’ and the public message that they are ‘sexually mutilated’ and deprived of their ability to enjoy sex and experience orgasm. Some of these young women arrived in Sweden already circumcised and the public view of how FGC has had a devastating effect on their sexuality is their only source of information. Thus, these young Swedish Somali women have to make their sexual débuts in lack of knowledge about the potential of their own sexuality. A previous study among Eritreans and Ethiopians in Sweden showed that many women are firmly convinced that female circumcision – generally clitoridectomy – had ruined their possibilities to have a truly enjoyable sexual life, despite the fact that they reported being orgasmic and had prior to migration classified their sexual life as ‘normal’. These feelings of loss and distress seemed to stem from anti-FGM-campaigns in Sweden. Here I want to discuss the implications of unfounded allegations of deprived sexual abilities used in the moral crusade to abolish FGM, especially in the light of recent research showing that orgasmic pleasure and satisfaction are related more to cognitive and affective than sensory aspects.

Kapitlet utgör en diskussion om kvinnlig omskärelse i Sverige. Det finns en tydlig diskrepans mellan den offentliga diskursen om mörkertal och vad faktiska tillgängliga data pekar på vad gäller kulturell förändring: en stor majoritet invandrare från länder där omskärelse av flickor praktiseras tycks välja att avstå från traditionen i Sverige. Detta strider mot samhälleliga förväntningar på en upprätthållen tradition. Vidare diskuteras möjliga motiv bakom dessa antaganden om stora mörkertal.

In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, girls. The discussion is based on data from 122 police files, including criminal investigations regarding suspected “female genital mutilation” (FGM). A growing body of research in European countries indicates that processes of cultural change are occurring among immigrant communities from areas where traditionally girls are subjected to what is construed as “circumcision”. Many studies show growing opposition to these practices among people who have migrated to Europe, and there is little evidence to support the assertion that large-scale illegal activities are prevalent. Yet there is a dominant discourse stating that FGM is secretively practised on a large scale among some immigrant groups in Europe, and policies encourage the detection of cases to charge in criminal court. I describe the current situation in Sweden and highlight some of the drawbacks of a very harsh, although well-intended, policy to check for FGM in Europe. While the ultimate aim is to protect girls at risk for FGM, current policies have ramifications that are invasive and sometimes even traumatising for the girls involved. This paper offers an empirical example of how politics in western multicultural societies may negatively influence the sexual health and rights of a target group, in this case, girls and young women whose families originate from countries where circumcision of girls is practiced.

We tend to view medical statements as empirically objective, while in reality they are politically determined: - Statements about sexual sensitivity after clitoris cutting vary in history with time-bound theories about female sexuality and also political agendas. - Prevalent inconsistencies become clear comparing medical statements about maintained or lost ability to enjoy sex after current surgeries involving the clitoris: compare for instance operations in intersexed persons and ‘designer vaginas’ in western medical settings vs. female circumcision in Africa. We need to be aware of how these authoritative statements are politically positioned and tinted by implicit ideas about morality and ethnicity.

In 2006-2007 (from District Court to the Supreme Court), the Swedish citizen Ali Elmi Hayow was sentenced to prison for female genital mutilation of his daughter. In this paper I argue that the popular understanding of FGC, seeing African men as the true actors and stakeholders in the upholding of FGC, rendered it impossible for this man to get a fair trial. The facts presented during court proceedings were interpreted within a radical feminist framework, and the political will to sentence a male for FGM made it possible to overlook this citizen’s legal rights. The case is presented and discussed in relation to the social context of this specific case. Further it is discussed in relation to the wider social and political context of FGC in Sweden. I try to show that this case cannot be fully understood without knowledge of some cultural traits among Somalis and that the court members, rather than aiming for a well-grounded understanding of the case, leaned toward popular and stereotyped notions of FGC as well as of Somali men and women. Ethnocentric ideas of family organisation were also important for the outcome of the court proceedings. With less twisted and more realistic preconceptions of the Somali practice of FGC and gender relations, I argue, Ali Elmi Hayow would have walked free.

In 2006–2007, the Swedish citizen Ali Elmi Hayow was sentenced to prison for the female genital mutilation of his daughter. In this paper I argue that the popular understanding of FGC, seeing African men as the true perpetrators, rendered it impossible for this man to get a fair trial. The facts presented during court proceedings were interpreted within a radical feminist framework, and the political will to sentence a male for FGC made it possible to overlook this citizen’s legal rights. The case is discussed in its specific social context and in relation to the wider social and political context of FGC in Sweden. I try to show that this case cannot be fully understood without the knowledge of Somali culture and that the court members, rather than aiming for a well-grounded understanding of the case, leaned toward popular and stereotyped notions of FGC as well as of Somali men and women. Ethnocentric ideas of family organisation also affected the outcome of the court proceedings. With more realistic preconceptions of the Somali practice of female circumcision among Somalis, Ali Elmi would have walked free.

Current public debate on “female genital mutilation” often renders the impression that it is possible to draw an unambiguous line between acceptable and condemnable practices of female genital cutting. In this paper, the cultural histories of cutting of the female genitalia are presented and discussed. Available historical accounts of female circumcision practices in Africa reflect Western, mainly European, ideas and ideologies at certain points in time. In a sense, these descriptions have more to say about “us” than “them”. Further, the historical descriptions of female circumcision in Africa are intertwined with time-bound notions and cutting practices in Western countries in different epochs. Through retrospective reflections, it is possible to see how current commonsensical standpoints, among them the hegemony of a “zero tolerance” attitude regarding cutting of the female genitalia among Africans, are a product of a recently introduced perspective, and also how this generally accepted perspective may render it more difficult to present multi-faceted ethnographic accounts of lived experiences today.

Den här rapporten bygger på en uppföljning av 28 projekt som fick bidrag från Allmänna arvsfonden under 1995–2008 för verksamheter som vänder sig till somalier i Sverige. I de 28 projekt som uppföljningen sett närmare på har 'link work' och arbetet med mentorer och förebilder varit viktiga strategier för att förbättra levnadsvillkoren för svensksomaliska barn och ungdomar. Det arbete som förebilder och mentorer utför, och genom att många föreningar hela tiden arbetar överbryggande, gör skillnad i enskilda människors liv.

In the spring of 2003 the Swedish mass media highlighted a phenomenon that came to be labelled “dumped children”. The cases concern Swedish Somali children who are brought to Somalia by their legal guardians, and who wish to return to Sweden. In this paper the global Somali clan structure, the Somali family concept and ideas on upbringing of children will be discussed. For a comparison, there will also be a brief discussion on the western nuclear family model and the kind of relations between parents and children which are seen as ideal in the West. Emotionality in both systems is discussed. Further, there is a description of the phenomenon that Somali children are generally seen as mobile – they migrate between relatives within national borders, but transnationally as well. In a family system based on a concept of segmented parenthood (in this case that all adult relatives are potential parents), children’s mobility may work as a system to optimise children’s future prospects. The Swedish Somali parental generation experiences a loss of authority in relation to the younger generation. The encounter with Swedish welfare institutions is often experienced as a threat to the Somali families. Conclusions when it comes to so called “dumping” of children in Somalia include: - This is a phenomenon which is a small part of a much bigger picture. It is common that children and young people migrate between relatives all over the world. Somalia is one among several countries where children are sent. - Somalia is chosen in some cases for being a Muslim country, and a country void of alcohol and (heavy) drugs. - Somali children and young people migrate within the scope of a continuum which include voluntary and willing moving as one extreme and reluctant and forced moving as another. The children highlighted in the Swedish mass media are some of those who were brought to Somalia against their own will. - The phenomenon described as “dumping” in the Swedish mass media is often about “returning” a foster child, when the custodians in Sweden have lost control of the socialisation process and no longer dare to be responsible for the child’s future.