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.

In The Democratic Contradictions of Multiculturalism, Jens-Martin Eriksen and Frederik Stjernfelt elaborate on the concept of “culturalism.” In Telos 163 (Summer 2013), Eriksen continues to analyze its intricacies under the heading “Culturalism: When the Culture becomes Political Ideology.”2 Horizontal class divisions are out, vertical cultural barriers are in. Seemingly, culture has squeezed out all other concepts. The present essay shall broaden this discussion by asking the question: What is the relation between the Counter-Enlightenment of the early nineteenth century and today's culturalism?

Children living with a parent with a mental illness can face difficulties. Parentalmental illness may influence the parents’ ability to cope with family life, where theparents’ awareness of their illness plays an important role. Family interventionsprovided by psychiatric and children’s social care services can be a way to supportthese children, making them feel less burdened, and improving the relationshipswithin the family. The aim of this thesis was to illuminate how children infamilies with a parent with a mental illness are supported in psychiatric and socialservices, especially by means of family interventions, and how families experiencethe support. Study I explored how professionals in adult psychiatric outpatient servicesdeal with children and families when a parent has a mental illness. The findingsshowed that professionals balanced between establishing, and maintaining,a relationship with the patient and fulfilling the legal obligations towards thepatient’s children. Asking the patient about their children could be experiencedas intrusive, and involving the patient’s family in the treatment could be seen asa dilemma, in relation to the patient. Efforts were made to enhance the familyperspective, and when the patient’s family and children joined the treatment thisrequired flexibility from the professional. Study II examined how professionals in children’s social care services experienceworking with children and families when a parent has a mental illness. The socialworkers’ objective was to identify the needs of the children. No specific attentionwas paid to families with parental mental illness; they were supported in thesame way as other families. When the parental mental illness became difficult tohandle both for the parent and the social worker, the latter had to set the child’sneeds aside in order to support the parent. Interagency collaboration seemed likea successful way to support these families, but difficult to achieve. Study III investigated if patients in psychiatric services that are also parentsof underage children, are provided with child-focused interventions or involvedin interagency collaboration between psychiatric and social services and childand adolescent psychiatry. The findings showed that only 12.9% of the patientsregistered as parents in Psykiatri Skåne had registered children under the ageof 18 years. One fourth of these patients had been provided with child-focusedinterventions in psychiatric service, and 13% of them were involved in interagencycollaboration. If a patient received child-focused interventions from the psychiatricservices, the likelihood of being involved in interagency collaboration was fivetimes greater as compared to patients receiving no child-focused intervention.Study IV explored how parents and their underage children who were supportedwith family interventions experienced these interventions. The results showedthat parents experiencing mental illness were eager to find support in explainingto and talking with their children about their mental illness, although the supportfrom the psychiatric service varied. Both children and other family membersappreciated being invited to family interventions. After such an intervention, theyexperienced the atmosphere in the family as less strained and found it easier tocommunicate with each other about difficulties. Unfortunately, the participatingpartners felt that they were left without support specifically targeted at them. The thesis showed that there is a gap between how professionals deal withquestions concerning these families and their support, and the parents’ and thefamilies’ needs to receive support in handling the parental mental illness in thefamily. The psychiatric and social services need to expand their approach andwork with the whole family, in order to meet the needs of the child and otherfamily members involved.

The aim of this study is to describe the experiences of children’s social workers in Sweden who work with families in which a parent suffers from serious mental illness, and how a child in such a family receives support. Data were collected through individual interviews and focus groups discussions with 13 professionals in 2 minor municipalities in southern Sweden. Interviewees stated that parental serious mental illness was not a main focus for children’s social workers. When parental serious mental illness became a barrier to caring for their children, the children’s social workers sought to collaborate with psychiatric services, but in many cases it did not turn out well. Providing support to the parent was one way of aiding the family, although at the price of setting the child’s perspective aside. Being faced with responsibility for the parent and the child left children’s social workers feeling they were the last outpost for the families. Children’s social workers require greater knowledge of how to handle parental serious mental illness, and more interagency collaboration with psychiatric services is needed to adequately support children of parents with a serious mental illness. Keywords: children of parents with serious mental illness; parental serious mental illness; children’s social workers; psychiatric services

Abstract Background: Children of parents with a mental illness need support from adult psychiatric services. Efforts have been made to enhance the knowledge of practitioners in this field so that they may work in a more family- oriented manner and to include children in the therapeutic services they provide. Aim: This study investigates how adult psychiatry services works with families and children when a parent has a mental illness. Method: Twenty-four Swedish professional care providers were interviewed individually or in focus groups. Data was analyzed using an inductive content method. Results: Although the professionals knew that their patients had minor children, they still prioritized the individual relationship they had with the parent. Few efforts were made to include both children and families in the treatment offered, and when this happened it was done at the professional’s own discretion. Conclusion: Despite the mandatory Swedish obligation to pay attention to a patient’s children, our study showed that professionals tend to fall short in this regard. Adult psychiatry services needs to strengthen family -oriented work in order to provide support to such children. Keywords: Minor children; Parents with mental illness; Adult psychiatric services; Family therapy

Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.

Denna studie avser att undersöka den mening som mediciner skapar, och hur de påverkar människors vardagliga erfarenheter och identitetsskapande. Medicineringens relation till kroppsliga tecken och symptom påvisar den spänning som finns i synen på läkemedlet; mediciner som något farligt och riskfyllt men samtidigt med förmåga att förebygga och bota. Mediciners farlighet tycks delvis kunna motverkas genom den domesticering som sker i skapandet av rutiner kring läkemedlen. Resultatet påvisar en ambivalens i individens relation och interaktion med läkemedlen; en ständigt pågående balansgång mellan medicinen som vana eller fara.

Ageing and old age has become a phase of life occupied with new, often medical, devices; for instances blood pressure meters, medication, hearing aids, dentures and walking aids. These material objects are intended for surveillance, as well as to compensate or replace parts of the ageing body and its altered abilities. This article examines the material culture of growing old, using a phenomenological perspective as a point of departure and comprehending materiality as permeated with cultural norms and ideas that affect identity and agency. The article is based on two studies consisting of interviews and participant observation with persons between 66 and 93 years. The analysis focuses on how to understand the process that occurs when older people are faced with new objects associated with a certain age and with certain health conditions, how the medical materiality of old age is accepted, internalized, questioned or resisted, and how these medical objects fit in with everyday life.

This article traces a genealogy of serial monogamy in Swedish policy documents (SOU) during the twentieth century. Analyses of renegotiations of marital morality, introduction of more liberal divorce laws, and the introduction of regulations of unmarried cohabitation show that societal norms as well as legal reforms have normalized serial monogamy as state regulation and social practice. The role of marriage as a societal stabilizer has increasingly been taken over by the idea of family, but interestingly durability and stability are concepts invoked during the process of decline of the ideal of lifelong marriage.

Recension av Jens Rydström, Odd couples: a history of gay marriage in Scandinavia. (2011).

The concept of love was introduced into a Swedish policy context in the early 1980s as regulations of same-sex cohabitation were proposed. The same-sex cohabitation legislation was presented as a tool in the battle against discrimination of lesbian women and gay men in the government commissioned reports, and offered an inclusion of same-sex couples based on the idea of same-sex love and heterosexual love as fundamentally the same. The article demonstrates how this governing of same-sex relationships rested heavily on authenticity and inclusion/exclusion of wanted/unwanted non-heterosexual subjects. By creating a concept of gay identity based on an essentialist notion of orientation, love was used as a sign of normality indicating authentic homosexual orientation' and restricting this authenticity to individuals in monogamous and stable same-sex relationships. Nevertheless, the act only recognized a selected few and created new lines of division between different non-heterosexual subjectivities.

The article explores the introduction of the concept of love in government commissioned reports in the 1980s as it was used for portraying same-sex relationships as normal and comparable to heterosexual relationships. The article is a discourse analysis focusing on the uses of love and constructions of homosexuality and the normal couple in governmental inquiries. Following international studies on love as a political technology, the article concludes, on the one hand, that the concept of love in the Swedish case creates sameness and makes possible an inclusion of same-sex relationships in the regulations of intimacy. On the other hand, the article concludes that the inclusion of same-sex relationships in the regulations of intimacy is conditioned on constructions of normality and on same-sex couples living up to expectations of coupledom and stability. Temporality is central for this process of normalization as it points to discursive constructions of historical and contemporary Sweden as tolerant and modern.

Theorists point to late modernity as a time of new intimacies where individualism and self-knowledge are central components (Giddens, 1992; Beck & Beck-Gernsheim, 1995). According to Plummer (1995), one of the major shifts in intimacy and sexuality the last decades of the 20th century is the constitution of the family. Previous ideas of nuclear family and traditional values has shifted to how family members are chosen rather than biologically given. One of the kinds of relationships and families that represent this move away from the heterosexual nuclear family with biological children is the family with more than two parents, for example one based on a polyamorous relationship. Polyamory means that more than two people are involved in an intimate and/or sexual relationship with one another. Polyamory as a relationship practice bears many similarities with how late modern intimacy is described, and could, according to Barker (2005), be seen as part of a wider transformation of intimacy in postmodern society. Preliminary results from analysis of media representations of polyamorous families show that explicit strategies are deemed necessary for handling the legal vulnerability of the families, but that these strategies depend on the families having both social and economic resources to draw from. Contacts with school and health institutions are reported as both positive and negative, but there is a recurring theme of invisibility that the families perceive – the system is generally designed for coupled parents. Lastly, there are also stories of the importance of community and thus how geography and place are central for offering contact with other families in a similar situation. These conclusions point to the need for further studies of the legal situation for non-coupled families – how are the families faring that do not have the social or economic resources to navigate the legal vulnerability, and how are invisibility and lack of community affecting families outside norms of coupledom?

Recension av Malmquist, A. Pride and Prejudice: Lesbian Families in Contemporary Sweden (diss.). Linköpings universitet: Institutionen för beteendevetenskap och lärande 2015 (106 sidor)

BACKGROUND: In Sweden expectant fathers are now assumed to be active participants in pregnancy and birth, but few studies have focused on fathers' expectations of antenatal care. Knowledge of expectant fathers' views about what is important in antenatal care will enable the design of care that is more inclusive and meets the expectant fathers' needs. OBJECTIVES: To identify expectant fathers' expectations regarding the content of antenatal care during pregnancy and to examine associations between expectations and social factors. METHODS: The current study uses data from a quasi-experimental trial that took place from 2009 to 2010, in which 627 expectant fathers were recruited from different parts of Sweden. RESULTS: Checking the health of the baby (85.3%) and the mother (80.8%) were rated highest in importance by expectant fathers, whereas attending parent classes (14.9%), becoming acquainted with other expectant parents (7.0%) and paying attention to their own emotional well-being (6.9%) were rated lowest. Furthermore, less than half of the expectant fathers had a very high expectation of being treated in a way that made them feel involved (38.5%).First-time fathers, young fathers and fathers with very good emotional health had higher expectations about most aspects of antenatal care. CONCLUSION: Expectant fathers had low expectations of receiving support or of meeting other parents as they thought that antenatal care should have a medical focus. First-time fathers, young fathers and fathers with very good emotional health had higher expectations of antenatal care in most areas. Copyright © 2016 Elsevier B.V. All rights reserved. KEYWORDS: Antenatal care; Content of care; Expectant father; Expectation

Detta dokument är tänkt att belysa hur innovationskultur kan förstås samt att ge stöd i förändringsarbete, och också stimulera medarbetare och chefer i detsamma. Förhoppningen är även att detta dokument kan ge politiker och andra aktörer en bild av hur det är att arbeta med verksamhetsnära projekt. Dokumentet belyser erfarenheter från en kunskapscirkel som genomförts inom ramen för projekt Testbed för äldreomsorgen, vilket inbegriper samverkan Malmö stad och Mötesplats Social Innovation (MSI) vid Malmö Högskola. Detta dokuments tillkomst hade inte varit möjlig utan medverkan av deltagarna i kunskapscirklarna, chefer, övriga medarbetare och förtroendevalda. Varmt tack till alla. Tack också till Vinnova som varit medfinansiär till Testbed för äldreomsorgen. Kunskapscirkeln planerades och genomfördes av detta dokuments författare. Malmö stad har etablerat en testbädd i nära samarbete med Mötesplats Social Innovation, Malmö högskola och Medeon AB med finansiellt stöd av VINNOVA. Det har skett inom ramen för projektet – ”Testbed för äldreomsorgen i Malmö stad”, juni 2013-oktober 2016. Sedan november 2016 ingår testbädden i ordinarie verksamhet. Testbed för äldreomsorgen erbjuder innovatörer att utveckla och testa behovsdrivna idéer och lösningar i praktiken, i reell miljö. Idéerna och lösningarna ska svara mot behov hos kvinnor och män som är 65 år eller äldre och som bor i ordinärt boende. Lösningarna ska bidra till att öka kvaliteten i vård och omsorg (Mötesplats Social innovation, 2016; Malmö Stad, 2017). En central del av Testbed för äldreomsorgen har varit att försöka skapa grundförutsättningar för en innovationskultur inom Malmö stads vård- och omsorgsverksamhet. Med innovationskultur avses i dokumentet en kultur där personalen har möjlighet att ta initiativ till och vidareutveckla idéer och lösningar som på olika sätt kan förbättra den dagliga verksamheten.

Entering adult life consists of several transitions that are related to finding a source of income, establishing an independent household and creating new family formations. This stage of ‘becoming’ entails a move from needing others to living as an autonomous and economically independent citizen (France, 2008; Smeeding and Philips, 2002). This key life stage, where several major transitions and life-course events take place concurrently (Anxo et al., 2010; Müller and Gangl, 2003), results in increasing vulnerability to poverty (Moore, 2005). In the Nordic countries (Finland, Sweden and Norway), economic autonomy has become quite difficult to obtain for many young people; continued financial support from either parents or social assistance is a reality for many. Poverty is central in understanding if and how young people can transition effectively into adulthood. Within the populations of the Nordic countries today, young people are among those most likely to be economically vulnerable.1 Despite being relatively affluent compared with young people in many eastern and southern European countries, it is evident that this life phase is associated with increasing vulnerability in the Nordic countries. 

Syftet med denna studie är att fördjupa förståelsen och handlingsutrymmet för att lokalt minska barnfamiljers ekonomiska utsatthet. De senaste årens ökade uppmärksamhet kring barnfattigdom i ett materiellt överflödssamhälle som Sverige visar på nödvändigheten av förnyade fördelningspolitiska strategier för att klara de åtaganden om barns rättigheter som bl.a. FN:s barnkonvention anger. Barns rätt till en skälig levnadsstandard (artikel 27) är en förpliktigande utfästelse såväl för samhället i stort men givetvis också för deras föräldrar och närstående. Utan att bortse från andra aktörers och nivåers betydelse och ansvar riktar denna studie sin uppmärksamhet på den lokala kommunala nivåns möjligheter att bidra till fattigdomsbekämpande insatser.

The purpose of this chapter is to shed light on the ontological assumptions that underlie the idea of a contract in Academic Capitalism. Far from being “simply a metaphor”, there are now concrete examples of real contracts in Swedish universities, which we here designate “academic contracts”. In investigating the perceived function of academic contracts, we will try to answer this fundamental question: For which problem, in what conception, is signing a contract between a student and an academic teacher a solution? By analysing four existing academic contracts from Swedish universities through the lens of a very influential economic theory of the nature and function of contracts, New Institutional Economics (NIE), we will argue that the implementation of academic contracts is totally at odds with the Humboldtian tradition and the classic university. Our contention is that the introduction of academic contracts does not facilitate, but rather undermines, the academic teaching and learning process.

People with disabilities are in many cases only present in everyday life through stereotypical representations in media. Those stereotypes matter: they influence everyday social interactions as well as political guidelines and measures and they can legitimize discrimination and social oppression. The purpose of this on-going research project is to identify and problematize activist strategies that are used to change restricting cultural representations in the contemporary Swedish society. The focus is on activist cultural representations made within performing arts in a broad sense, in different types of media and in public spaces. The sociologist Stuart Hall’s (2003) representation theory and feminist theory on intersectionality, body, (dis)ability and the stare create a theoretical framework (see f.ex. Campbell 2012; de los Reyes & Mulinari 2005; Garland-Thomson 2009). In this paper preliminary results from the first case study will be discussed: The Gothenburg Collective for Independent Living (Göteborgskooperativet för Independent Living, GIL) and their campaigns for making the Swedish society less discriminatory and more accessible and equal.

Previous research shows that disabled pupils that are included in mainstream schools often have negative experiences of physical education (PE). The PE teachers, on the other hand, feel that they lack education in, knowledge about and experience of teaching these pupils. This paper presents results from a research project in which a document analysis is made of course literature about physical education of disabled pupils, used in PE teacher training in grade 7-9 at four Swedish universities. The aim is to explore the assumptions made about bodies, gender and (dis)ability. The project draws from the work of sociologist Dorothy Smith, who regards texts as factual, human practices, that constitute bridges between a ruling apparatus (in this case PE teacher training) and people’s everyday lives (the PE teachers’ and, finally, the pupils’). These texts regulate, co-ordinate and interfere in people’s local practices. Text should here be understood in a broader sense: pictures, blurbs, list of contents etc. are included in the empirical material. The amount of literature that deals with questions of disabilities differs a lot. While one university devotes 7.5 credits to the subject, others pay little or none attention to these questions. Furthermore, it is an able-bodied ”we” that educates and leads those who are disabled. Some texts only discuss how to adapt the teaching and physical environment, while others bring up teachers’ and classmates’ attitudes too. Gender is absent in most texts, in one example, however, gender stereotypes are reproduced. Only one text has a norm critical perspective on gender and ability. The course literature offers resources of differing types, quantity and quality. It influences the teachers’ and pupils’ experiences of PE as well as of their own bodies. A combination of theoretical research based and practically oriented course literature would be desirable, and can contribute to a more inclusive education for all pupils.

This path-breaking book analyses the experiences of young sporting women with physical impairments. Taking phenomenology as a point of departure, Elisabet Apelmo explores how the young women handle living with a body which, on the one hand, is viewed as deviant – the disabled body – and on the other hand is viewed as accomplished – the sporting body. A polarization is apparent between the weak, which is manifested through the expression of belonging as "we", and the strong individual. The subject position as strong, positive and capable – as a reaction towards the weak, the negative – is one of the few positions that are available to them. Furthermore, the book demonstrates the strategies of resistance the young women develop against the marginalisation, stereotyping and othering they experience in their everyday lives. Finally, the author discusses the paradox of gender. Disabled bodies are often seen as non-gendered, however, these young women’s experiences are structured by both the gender regimes within sports and the larger gender order of the society.

The aim of this article was to explore how young, sporting women with physical impairments experience physical education (PE), drawing on research on PE as well as on disability studies. Phenomenology provides a theoretical framework that includes the body. Semi-structural interviews were conducted and video diaries were kept of the women, aged 15 to 28, and living in Sweden. The stigmatization the young women experienced in their everyday life resulted in a polarization between the weak, which was expressed through the expression of belonging as ‘we’, and the strong individual. The subject position as positive and capable – as a reaction towards the weak, the negative – was one of the few positions that were available to them. With the positive and strong attitude, the consequence was the difficulty, not only to complain but also to express pain or discomfort in one’s everyday life. However, as regards the issue of PE, the participants discussed problems dealing with experiences of exclusion and special treatment. It appeared to be difficult for teachers to see these women as the sports interested youths that they were. The young women used different strategies of resistance. While a pair of them did not participate in some of the aspects, another woman had chosen not to participate in PE at all. One participant made use of a strategy which has the potential for changing the view as regards disabled pupils: she showed her teacher medals she had won in the Swedish national swimming championship, as a way to receive a higher grade. When the women finally described the stigmatization that they had been subjected to, they avoided positioning themselves as victims, by minimizing the seriousness of the situation or by using in the interview the word ‘we’ instead of ‘I’, thus describing the incident in collective terms.

The aim of this paper was to explore how young, sporting women with physical impairments experience physical education (PE), drawing on research on PE as well as on critical disability studies. Phenomenology (Ahmed 2006; de Beauvoir 1949/2011; Merleau-Ponty 1945/2013) provides a sociological theoretical framework that includes the body. Ten semi-structured interviews were done with women ages 15 to 28, living in Sweden. Most of interviews took about an hour. In order to grasp the experience of disability from the view points of the young women themselves, three participants were asked to keep video diaries: they were lent a camcorder and a tripod for two months. The diaries were between 85 to 110 minutes long. The stigmatization the young women experienced in their everyday life resulted in a polarization between the weak, which was expressed through the expression of belonging as ‘we’, and the strong individual. The subject position as positive and capable – as a reaction towards the weak, the negative – was one of the few positions that were available to them. With the positive and strong attitude, the consequence was the difficulty, not only to complain but also to express pain or discomfort in one’s everyday life. However, as regards the issue of PE, the participants discussed problems dealing with experiences of exclusion, being singled out, and special treatment. It appeared to be difficult for teachers to see these women as the sports interested youths that they were. The young women used different strategies of resistance. While a pair of them did not participate in some of the aspects, another woman had chosen not to participate in PE at all. Refusing to be physically active is, according to Larsson et. al. a common form of resistance among girls (with or without impairments) and is interpreted by teachers as lack of interest (2005). An important difference is, however, that in this study the young women were very physically active in their leisure time. One participant made use of a strategy which has the potential for changing the view as regards disabled pupils: she showed her teacher medals she had won in the Swedish national swimming championship, as a way to receive a higher grade. When the women finally described the stigmatization that they had been subjected to, they avoided positioning themselves as victims, by minimizing the seriousness of the situation or by using in the interview the word ‘we’ instead of ‘I’, thus describing the incident in collective terms.

Det är vanligt att betona betydelsen av att väga in kulturella och religiösa idéer i forskningen om sexuell och reproduktiv hälsa. I den här genomgången av litteratur på området visar författarna att beläggen för argumentet är svaga då det i hög utsträckning saknas kunskap kring hur muslimska patienter själva resonerar i de här frågorna. Vad som tycks vara betydelsefullt är att anpassa vården till religiös heterogenitet och variation och till de subjektiva och intersubjektiva religiösa förhandlingar som muslimska patienter själva är inblandade i.

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.

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.

Background: Varying patterns of policy and cultural disadvantage among sexual minorities have recently been pointed to as implicated in their poorer health outcomes, relative to the heterosexual majority. We examined the precursors of internalised homonegativity (IH) within a macro-meso-micro framework, using various data sources, to help disentangle the complex influences perpetuating homonegative internalisations among European MSM. Methods: EMIS is a collaborative study across 38 countries which during summer 2010 recruited over 180,000 MSM via Internet sites. The survey included a culturally stable form of the IH scale and various beliefs and behavioural variables. Additionally, to broaden the view of macro and meso environment at the level of individual men with respect to IH, we combined country-level data from the World Economic Forum, LGB status list, and European Values Survey. Results: The analyses included 38 countries and 144,177 MSM with a valid IH score, which varied across Europe, with the highest scores found in Southeast Europe. In multivariate analyses, at the societal structure of rule-systems, higher IH was predicted by the absence of legal rights (b.37 to .42). At the meso-level, IH was predicted by cultural values regarding homosexuality (b.16). At the individual level, greater homonegative internalisation was found among those men who perceived they could not access PEP and HIV and STI testing in their country (b.21 to .22). Higher IH, in turn, was associated with not testing for HIV and STIs (b.70 to .57). Conclusion: As possibly the first multi-level study, EMIS shows that a homonegative structural and social climate appears to have pervasive effects on MSM’s evaluation of the self, and greater IH in turn affected men’s levels of HIV precautionary behaviours. In addition to the human rights aspect, the EMIS results suggest that improved affirmative policy environments will have positive health impacts on MSM populations.

The objective of this article is to examine internalized homonegativity (IH) in relation to aspects of well-being and several measures of clinical importance among men-who-have-sex-with-men (MSM) in 38 countries. The data were collected as part of the EMIS project. The multivariable regression analysis identified independent associations with IH for nongay identity, younger age, being closeted, limited gay social affiliation, and sexual unhappiness. IH was also positively associated with loneliness, inability to decline unwanted sex, and being less knowledgeable about HIV and HIV testing. These results provide evidence that homonegative internalization merits consideration as a predisposing factor in several aspects of ill health. There are also several clinical implications of this project, including: (1) Treatment of lesbian, gay, and bisexual (LGB) persons should address gay self-acceptance, as internalized homonegativity seems to be a predisposing factor in several aspects of ill health among this population, and (2) therapy that is used to help LGB persons accept and integrate a gay or lesbian identity seems particularly important for younger, nongay identified persons.

We discuss “love” as a rhetorical strategy in the Swedish gay press, 1969–86, in relation to shifting meanings of sex and love. During this period, meanings of homosexual subjectivity were rapidly changing at several societal levels. New ideals of openness and monogamous love became more dominant and tended to exclude expressions of sexual practices based primarily on pleasure. Using the analytical terms unconditioned versus conditioned, we discern a shifting relative strength between discursive constructions of unconditioned sex/sex conditioned on love, and love for love's sake/love conditioned on coupledom.

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.