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Navigating Conflicting Norms on Body and Sexuality: Exploring Swedish-Somali Women's and Swedish Welfare Workers' Perceptions of Female Genital Cutting
Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).ORCID iD: 0000-0003-0126-5265
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Female genital cutting (FGC), sometimes referred to as female genital mutilation, is the subject of intense debate, exposing tensions between varying cultural values about bodies and sexuality. In Sweden, FGC is framed as a social problem designed to control female sexuality, and national efforts have long aimed to prevent it from being perpetuated. Welfare workers have a key role in interpreting and implementing FGC politics, making the welfare encounter a site where sometimes divergent cultural understandings about FGC, bodies, and sexuality converge.

In this thesis, I explore how sexuality and sexual health are constructed in relation to FGC through welfare work and from the perspectives of different generations of Somali women in the Swedish setting of immigration. Based on individual interviews (16) and focus groups (3) with welfare workers (24) in social care, healthcare, and education, I investigate how FGC, sexuality, and sexual health, is approached in counseling and information targeting young women potentially affected by FGC. Through individual interviews (12) and focus groups (9) with Swedish-Somali women of different generations (53), I examine how women relate to and make sense of their own FGC experiences in light of changing social norms and discourse of FGC post-migration to Sweden. I discuss how concepts of FGC, body, sexuality, and sexual health are navigated and negotiated by investigating meanings ascribed to FGC by the various actors. I also consider the ways in which the understandings of these notions are changing depending on a complex interchange between individual experience, social interaction, and global discourse on FGC.

The thesis consists of four papers. The first two papers explore the complexity of how to counsel and address FGC in welfare encounters while having a difficult dual role – working to protect future generations from the practice, while simultaneously encouraging and empowering those for whom it has already been done, without undermining body image or sense of sexual capacity. The first paper found that a key problem is the over-reliance on medical models of sexuality that tend to result in a reductionist focus on the genitals for sexual function, perhaps under-emphasizing the role of the mind, emotions, and sociocultural factors. This approach often led welfare workers to conclude that FGC inevitably negatively interferes with sexuality and sexual health. It was also primarily within a biomedical discourse that solutions and strategies to promote young women’s sexual wellbeing were sought.

The second paper investigate how welfare workers understand and respond to health discourse about FGC, using counseling on menstrual pain as an empirical example. The study found that welfare workers navigate their various sources of knowledge, where acquired FGC-knowledge worked as a lens through which young women’s situations were understood. Medical discourse, and menstrual pain in particular, was also used as a starting point for discussing drawbacks of FGC, in order to deter young women from forwarding the practices to future generations.

The third paper highlights how women navigate dominating discourse of FGC in their efforts to make sense of their experiences. The study found that imageries and dominant framings of FGC affect how women are perceived by others, or how they expect others to perceive them, also affecting women’s selfunderstanding. Women “talked back” to and talked through expected categorizations and elements of dominant discourse that put women with FGC in a stigmatized position. Doing this, they reinforced categorizations of the most extensive form of FGC (type III, pharaonic cutting) as stigmatized and harmful, while less extensive forms of FGC (type I-II, IV, sunna cutting) were disconnected from some of the stigma attached to FGC.

The fourth paper examines subjective experiences and perceptions of sexuality in relation to FGC. The study found that while FGC has been seen as a means to mold a tempered female sexuality in line with cultural standards for proper gendered behavior, both gender standards and means to achieve them have changed under influence of migration and global FGC politics. The findings suggest that while premarital virginity remains as an important value, the external regulation of sexuality through FGC to protect female chastity has been replaced by increased emphasis on inner control and self-discipline. Women disqualified previous rationales for the practice by unsettling the connection of FGC to reduced sexual responsiveness. Many described sexual responsiveness as inherent and not necessarily adversely affected by FGC, although experiences varied. While most expressed positive expectations on sexual desire and pleasure, emerging was also more mixed understandings among some older and younger women. These were associated with notions of the clitoris as significant for sexual responsiveness, causing women to question their bodily and sexual adequacy. Such understandings shall be seen in light of previous cultural ideas about FGC as contributing to reduced sexual responsiveness, which is reinforced in the Swedish context which emphasizes the negative impact of FGC on sexuality.

In conclusion, this thesis sheds light on the complex nature of FGC in a context of immigration, particularly highlighting FGC in relation to individual care and counseling in welfare encounters. In Sweden, FGC is framed as a social problem, shaping how women with FGC are perceived and understand themselves. Welfare workers predominantly address FGC from a health perspective, often adopting a genital reductionist approach. Medical discourse plays a dual role: empowering women through knowledge while also exerting control over their bodies, drawing boundaries of some bodies as normal, and others as pathological. Interviews with Somali women shed light on their interactions with FGCconstructs in the Swedish context, illustrating a complex interplay of sociocultural, individual, and global influences.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2024. , p. 128
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2024:6
Keywords [en]
female genital cutting, female genital mutilation, migration, discourse, Sweden, welfare work, qualitative research
National Category
Social Work
Identifiers
URN: urn:nbn:se:mau:diva-66479DOI: 10.24834/isbn.9789178774722ISBN: 978-91-7877-471-5 (print)ISBN: 978-91-7877-472-2 (electronic)OAI: oai:DiVA.org:mau-66479DiVA, id: diva2:1846924
Public defence
2024-04-19, Niagara hörsal C, NI:C0E11, Nordenskiöldsgatan 1, Malmö, 10:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 2015-03546
Note

Paper IV in dissertation as manuscript

Available from: 2024-03-29 Created: 2024-03-26 Last updated: 2024-04-02Bibliographically approved
List of papers
1. Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind–body dualism affecting social and health care professionals’ perspectives
Open this publication in new window or tab >>Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind–body dualism affecting social and health care professionals’ perspectives
2019 (English)In: Sexual and Reproductive Health Matters, ISSN 2641-0397, Vol. 27, no 1, article id 1615364Article in journal (Refereed) Published
Abstract [en]

Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called “the FGM standard tale”. The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia’s role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual’s body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
female genital cutting, female genital mutilation, sexual health counselling, discourses, migration, youth, Sweden, sexuality, body
National Category
Social Sciences
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-4496 (URN)10.1080/26410397.2019.1615364 (DOI)000514155600020 ()31533573 (PubMedID)2-s2.0-85072378123 (Scopus ID)30418 (Local ID)30418 (Archive number)30418 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-26Bibliographically approved
2. Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals' Approach to Menstrual Pain as an Empirical Example
Open this publication in new window or tab >>Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals' Approach to Menstrual Pain as an Empirical Example
Show others...
2022 (English)In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, Vol. 26, p. 1-25Article in journal (Refereed) Published
Abstract [en]

In Sweden, as well as in an international context, professionals are urged to acquire knowledge about possible health effects of female genital cutting (FGC) in order to tackle prevention and care in relation to the practice. While professionals are guided by policies and interventions focusing on medical effects of FGC, some scholars have cautioned that many popular beliefs about health risks rest on inconclusive evidence. The way professionals understand and respond to health information about FGC has in this context largely been left unexamined. This article aims to provide a qualitative exploration of how professionals in Sweden approach adolescent sexual and reproductive healthcare encounters in relation to acquired knowledge about FGC, using menstrual pain as an empirical example. The analysis shows that there was a tendency in counselling to differentiate young migrant women's menstrual complaints from ordinary menstrual pain, with professionals understanding pain complaints either in terms of FGC or as culturally influenced. The study shows how professionals navigated their various sources of knowledge where FGC awareness worked as a lens through which young women's health complaints were understood. Biomedical knowledge and culture-specific expectations and assumptions regarding menstrual pain also informed counselling. Finally, the article discusses how FGC awareness about health risks was used constructively as a tool to establish rapport and take a history on both menstrual pain and FGC. The analysis also recognises potential pitfalls of the approaches used, if not based in well-informed policies and interventions in the first place.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Female genital cutting, Sexual and reproductive health counselling, Menstrual pain, Migration, Youth, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-44875 (URN)10.1007/s12119-021-09895-w (DOI)000673518600001 ()2-s2.0-85122382469 (Scopus ID)
Available from: 2021-08-17 Created: 2021-08-17 Last updated: 2024-03-26Bibliographically approved
3. The relationship between dominant Western discourse and personal narratives of female genital cutting: exploring storytelling among Swedish-Somali girls and women
Open this publication in new window or tab >>The relationship between dominant Western discourse and personal narratives of female genital cutting: exploring storytelling among Swedish-Somali girls and women
2023 (English)In: Frontiers in Sociology, E-ISSN 2297-7775, Vol. 8, article id 1188097Article in journal (Refereed) Published
Abstract [en]

Introduction: A dominant narrative, referred to as “the standard tale,” prevails in popular representations about female genital cutting (FGC) that often contrast with how cut women traditionally narrate their FGC experience as meaningful in contexts where FGC is customary. However, scholarship has increasingly highlighted how global eradication campaigns and migration to countries where FGC is stigmatized provide women with new frames of understanding which may lead to a reformulation of previous experiences. This article subjects the storytelling itself to analysis and explores how participants narrate and make sense of their FGC experience in a post-migration setting where FGC is stigmatized.

Methods: Semi-structured focus groups (9) and individual interviews (12) with Swedish-Somali girls and women (53) were conducted.

Results: The article highlights how the participants navigate their storying in relation to "the standard tale" of FGC in their efforts to make sense of their experiences. Navigation was conducted both at an intrapersonal level through continuous identity work, and in relation to the social context in interpersonal encounters, i.e., with service providers and others, among whom the standard tale has become a truth.

Discussion: The article places the analysis within broader discussions about anti-FGC work and considers the implications in relation to efforts to end FGC.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
female genital cutting, female genital mutilation, anti-FGM discourse, migration, storytelling, qualitative research
National Category
Social Work
Identifiers
urn:nbn:se:mau:diva-61891 (URN)10.3389/fsoc.2023.1188097 (DOI)001032417000001 ()37497100 (PubMedID)2-s2.0-85165699987 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2024-03-26Bibliographically approved
4. Sexuality constructions in relation to female genital cutting: young and older Swedish-Somali women on sexual responsiveness
Open this publication in new window or tab >>Sexuality constructions in relation to female genital cutting: young and older Swedish-Somali women on sexual responsiveness
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Through focus groups (9) and individual interviews (12), this study explores subjective experiences of sexual responsiveness in relation to female genital cutting (FGC) among Somali women and youths living in Sweden. FGC in Somalia is traditionally associated with the creation of a restrained sexuality inaccordance with gendered sexual norms. In efforts to end the practice, however, it is continuously stressed that FGC aims at depriving women of their sexual capacity. Specifically, this study seeks to examine how contradictory sexuality constructions are navigated and negotiated among women of different generations post-migration to Sweden. In contrast to what has been suggested in former literature, younger women seemed less influenced by condemnatory discourses in terms of their sexual self-understanding while the opposite was the case among the older women. The article discusses how this can be understood and possible implications.

Keywords
female genital cutting, female genital mutilation, discourse, sexuality, qualitative research
National Category
Social Work
Identifiers
urn:nbn:se:mau:diva-66480 (URN)
Available from: 2024-03-26 Created: 2024-03-26 Last updated: 2024-03-27Bibliographically approved

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