In this chapter, we discuss how cultural expertise can be used to neutralize stereotyped images of minority cultures in court in female genital mutilation/cutting–related cases because, wisely employed, it may counteract possible negative effects of typification and judicial stereotyping.

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.

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.

“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.

“Sex as self-injury” is a well-established concept within Swedish society and is a new label for categorizing sexual risk-taking. The phenomenon has been discussed in Sweden since 2008, and about a decade later the concept appeared for the first time in Swedish scientific literature. “Sex as self-injury” is not yet an idea accepted by the international research field, but it can be assumed that it will eventually reach the international arena: the discourse about “self-destructive sex” has the potential to be established as a new diagnostic category of sexual dysfunction through “concept creep.” In this article, based on an analysis of media material from Sweden, we argue that the burgeoning discourse around “sex as self-injury” leads to a further strengthening of the normative division between “good” and “bad” sexualities, as described in Gayle Rubin’s work on a sex hierarchy.

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.

En 2008, un couple somalien, réfugié en Suisse, a été condamné pour la clitoridectomie de leur fille de deux ans. L’intervention avait été effectuée douze ans plus tôt par un médecin somalien dans l’appartement familial à Zurich. Les parents ont par la suite abandonné la pratique de l’excision, renonçant à la perpétuer sur leurs filles cadettes, et la mère a milité contre cette pratique lors de réunions de femmes somaliennes. Or, les médias ont omis de mentionner le changement d’attitude opéré chez ce couple de parents. Ce faisant, la couverture médiatique de ce procès a fait naître la crainte que l’excision soit une réalité contemporaine sur le sol suisse. Pourtant, il s’agit du premier et seul cas connu à ce jour d’excision pratiquée sur le territoire national. Afin de déconstruire cette « panique morale », cet article entreprend une analyse critique des représentations médiatiques de l’excision en examinant l’arrêt du tribunal concernant cette affaire. Nous discuterons des divergences observées entre la couverture médiatique et les faits relatés dans l’arrêt, et proposerons une réflexion sur les effets de ces représentations médiatiques sur le débat plus global de l’intégration des étrangers en Suisse.

When activism to combat «female circumcision» gained momentum in the 1980s, a discursive gap was created that persists until today. On the one hand, campaigners, activists, governments and some scholars promoted a discourse that focused on these practices as mutilations; on the other hand, not all scholars were willing to adopt the new term (FGM, «female genital mutilation») or to drop the perspective that these practices must be described within their wider contexts, with the full variations in different settings. Starting from this gap, this article discusses «reconstructive clitoral surgery», or «clitoris repair», as a cultural phenomenon growing out of the first discursive stream. Using Ian Hacking’s concepts «interactive kinds» and «looping effect», I argue that the increasing demand for reconstructive clitoral surgery in European countries needs to be understood in relation to the dominant anti-FGM discourse. While many interdisciplinary teams around Europe strive toward providing a holistic and respectful care for women requesting the surgery, I contend that the ubiquitous anti-FGM discourse has negative effects for both circumcised women who opt for surgery and those who do not.

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.

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.

This chapter discusses adjudication, expertise, and cultural difference as it appears in criminal court cases concerning female genital cutting (FGM) in the EU, as reported in a 2015 comparative overview. It begins with the distinction between typical and atypical FGM cases; a distinction that connects court cases to the cultural realities of the practicing communities, suggesting that the lack of cultural knowledge can cause unnecessary suffering to families and/or individuals who wrongly undergo prosecution in alleged FGM cases. A contrario, the intervention of experts in FGM court cases could be a positive approach to assessing the legitimacy of public intervention in certain cases.

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.

In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis' post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.

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.

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.

BACKGROUND: The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. METHODS: In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants' approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala's B-statistic and Welch's t-test were used. RESULTS: We found a substantial agreement between an individual's own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis-and especially other Swedish Somali women-approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3-27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4-9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%). CONCLUSIONS: Swedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC.

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

Avvägningar mellan den biologiska moderns och barnets intressen: En kvalitativ studie av svenska familjerättsekreterares erfarenheter av transnationellt surrogatmoderskap

Det finns få studier om hur socialarbetare handlägger ärenden som berör transnationellt surrogatmoderskap. Vår studie har för avsikt att bidra till att fylla detta tomrum. I Sverige är det inte tillåtet för sjukvården att utföra assisterad befruktning vid surrogatmoderskap. Detta har gjort att människor vänt sig utomlands för denna reproduktionsmetod, främst till Indien. Det finns inga lagar som reglerar surrogatmoderskap i Sverige, vilket har lett till svårigheter vid fastställande av rättsligt föräldraskap när föräldrarna återvänt med barnet. Denna kvalitativa intervjustudie med familjerättssekreterare har funnit att det finns rättslig osäkerhet och etiska frågeställningar som påverkar deras hantering av ärendet. Hur föräldraskap konstrueras i nuläget beror till stor del på enskilda familjerättssekreterares uppfattning om hur man bäst väger surrogatmammans intressen mot vad som är bäst för barnet. Avsaknad av riktlinjer och de etiska frågeställningarna har lett till osäker och olika hantering av ärendena, och en reglering behövs för att bättre skydda de inblandade och öka rättssäkerheten i handläggningen.

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.

Purpose of review: The purpose of this review was to explore current research on the impact of migration on issues related to female genital cutting and sexuality. Recent findings: There is growing evidence that migration results in a broad opposition to female genital cutting among concerned migrant groups in western countries. In addition, after migration, affected women live in the midst of a dominant discourse categorizing them as “mutilated” and sexually disfigured. There is also, in contrast to what is shown by most research, a public discourse saying that female genital cutting (FGC) leads to lost capacity to enjoy sex. Concurrently, a vast body of research demonstrates a strong correlation between a negative body image or body shame and sexual dysfunction. Summary: Care for women with FGC needs to be holistic and, while offering medical care when needed, the health care providers should avoid feeding into self-depreciatory body images and notions about lost ability to enjoy sexual life.

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.

Objectives: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. Setting: Sweden. Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years). Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. Trial registration number NCT02335697; Pre-results.

Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis. Results: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44–20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46–5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25–13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. Conclusions: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values.

Media often report about circumcision of girls, or ‘female genital mutilation’ (FGM), in ways that present this practice as a burning social problem, albeit secretively performed among African immigrants in Europe. In this paper we discuss the construction of FGM as a widespread social problem in Europe. We contrast the public discourse on FGM with empirical data on FGM criminal court cases in Europe in order to see to what extent the public discourse agrees with evidence. We conclude that there is a discrepancy between public discourse and media representations, on one hand, and empirical evidence, on the other. We suggest that the scarcity of criminal court cases in Europe to a large extent can be explained by processes of cultural change after migration. Further, we emphasise the importance of access to context-specific knowledge during court proceedings in FGM cases.

Introduction: Sweden legislated against FGM in 1982. Since then, nearly 90 suspected cases have reached the police and prosecutor. A few of the reports were alerts from healthcare professionals, but the bulk of them originated from daycare and social services sectors. Healthcare providers play a prominent role as experts in forensic investigations. Methods: Cases of suspected FGM originating from healthcare providers who have reported suspected, performed, or planned FGM were analylzed to determine the role of healthcare providers as experts in assessing whether FGM has been performed, and, if so, to what extent. Results: Very few cases analyzed had sufficient indictable evidence; two cases during 35 years were brought to court. The review revealed inconsistencies in the medical assessment processes during which medical experts reached divergent conclusions about FGM status. Conclusion: Variations in normal anatomy and also in cutting procedures make genital assessments by healthcare providers very difficult. It is of utmost importance that appropriate medical experts are summoned in FGM criminal investigations, since these processes often involve radical measures from the police and prosecutor, such as detention of legal custodians and compulsory medical genital examinations of young girls in order to obtain a legally valid medical certificate for an eventual court proceeding.

Utgångspunkten är en presentation av sex forskare, knutna till Centrum för sexologi och sexualitetsstudier, som berättar om sina respektive forskningsfält. Utställningen består också av en tidslinje med nedslag i den svenska sexualitetshistorien, ett tittskåp med kuriosa och en samling litteratur. I en brevlåda kan besökaren kommentera eller ställa frågor till forskarna, svaren projiceras på väggen. Två offentliga samtal arrangeras och filmas; Sex och makt och Tema erotisk litteratur. I samband med utställningen visas konstprojektet "Kyss" där prästen och konstnären Kent Wisti och författaren Maria Küchen i bild och text tolkat Höga visan.

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.

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.

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.

Introduction: The demand for the surgical technique of clitoral reconstructive surgery introduced by Pierre Foldès is increasing globally despite lack of evidence of its benefits weighed against its potential harms. Methods: In an ongoing study, we use nexus analysis to study the introduction of the surgery in Sweden. In nexus analysis, one simultaneously reviews current discourses, actors and settings to understand a particular phenomenon. In this analysis we seek to determine who is promoting the surgery, in what settings, and what discourses are offered to interpret the phenomenon. Results: Preliminary results, in line with other studies from social science literature, suggest that reconstructive clitoral surgery as a biomedical practice is a response to Western discourses on ‘female genital mutilation’: discourses that label cut women as ‘mutilated’, sexually deprived and less feminine than uncut women. These discourses in themselves are harmful to women and may cause them to seek a surgical solution that may not actually lead to improved outcomes. Conclusion: A new biomedical surgical procedure has been introduced and is generally praised, despite the lack of evidence to prove beneficial outcomes. This surgery is embedded in a powerful discourse that may negatively affect far more women than those who opt for surgery. The negative effects of female genital cutting should be carefully addressed in campaigning in order not to stigmatize already cut women further.

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 paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the ‘Pharaonic’ type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using – in a cautious way – the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.

Transnationella familjer utmanar västerländska samhällen, eftersom dessa länder tillämpar en lagstiftning som utgår ifrån antagandet att familjer är kärnfamiljer som vistas inom gränserna för en nationalstat. I artikeln jämförs den transnationella somaliska familjeformen med den västerländska kärnfamiljsmodellen för att påvisa de grundläggande skillnaderna mellan modellerna. Hur barn är mobila i den somaliska familjemodellen diskuteras i relation till socialtjänstinsatser i Europa. Kulturell variation i hur familjer organiseras behöver diskuteras mer i samhällen som säger sig vara mångkulturella. Interventioner för barns bästa kommer i slutändan att präglas av huruvida samhällen anser att universalistiska eller kulturrelativistiska värden ska väga tyngst.

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5-6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital's CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have.

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 report was prepared for the European Commission. The terminology used is theirs. This study develops a comparative overview of recent FGM (Female Genital Mutilation) court cases within the EU, as well as an exploratory survey of transnational movement in relation to FGM. The legal aspects of 20 recent criminal court cases in Europe are analysed, and evidence about transnational movement to have FGM performed is assessed. The report is based on data collected by country experts in eleven European countries. Data include court decisions, migration background of groups from FGM-practising countries in the host countries, the process of FGM-reporting, and stakeholders’ proposals and opinions regarding FGM. The report addresses the general legal context or framework to fight FGM in the eleven countries, and it briefly analyses the impact that the embracing of the due diligence standard could have, as a consequence of the signature of the Istanbul Convention by all the countries in the report. A finding of our study is the fact that the responses given by different countries to FGM are modelled by disparities of public prosecution systems in Europe. Calling upon state parties to apply the Istanbul Convention and accordingly modify existing provisions that limit their jurisdiction over FGM cases (art. 44) could have an impact on such procedural disparities, although further research is needed in this area. The review of existing court cases shows the legal concepts of ‘error of prohibition’ and ‘neglect of care’ as novel approaches for both prosecution and prevention of FGM in Europe. As a consequence, the report points out that these aspects (due diligence, neglect of care, and error of prohibition) ought to be further explored in future discussions, not primarily for their potential to result in more criminal court cases of conviction, but because of their potential power as preventive tools. In the analysis of collected data, we distinguish between ‘typical’ and ‘atypical’ cases, provide examples of those categories, and discuss what the criminal court cases tell us about the geography of illegal FGM activities among migrants in European countries. A strong tendency in the data is that rumours about a transnational movement to have FGM carried out state that girls are brought to their countries of origin to undergo FGM. This situation is reflected in court cases: although FGM has been carried out in France, Italy, Switzerland, and possibly in Spain, a majority of criminal court cases regard FGM performed in African countries. As for the process of reporting suspicious, pending, or performed FGM cases, most countries establish for professionals a duty to report. However, there are conflicting interpretations of such duties between legal operators and lay people, provoking practical difficulties and ethical dilemmas. Country experts collected possible reasons for the scarcity of reported suspected cases within the EU. Amongst the reasons stated by stakeholders in the different countries, the two more important were lack of first-hand information and fear of disproportional measures (such as parents under arrest and institutionalisation of children). Children at risk of FGM are not in abusive environments, but the system responds as if that were the case. As for the policy suggested, the report briefly discusses the legal and ethical implications of some of the stakeholders’ suggestions. For instance, a valuable suggestion is the idea of creating incentives to report by offering better service provisions for affected women and girls. This suggestion tries to counterbalance the idea many professionals have that reporting will only make things worse for the affected family, as special services and provisions are not in place. Access to services or rights would not rely on the willingness of victims themselves to cooperate or report but on the establishment of a system of services that professionals can use when re- porting such cases. A stronger emphasis in awareness-raising campaigns among professionals and communities, on medical and social support for affected girls and women would possibly strengthen as well the incentive to report. The report identifies several areas where further research is needed. One such area is processes of social and cultural change as regards views and practice of FGM among immigrants from FGM-practising countries. A future key question is how legislation, policies, and preventive efforts can speed up the processes of abandonment of FGM among immigrant communities in Europe.

This book expands the notion of sexual fantasies from the field of psychology into the realms of cultural studies, anthropology, philosophy, and sociology. So far, much research on sexual fantasies has dealt with issues of gender differences, the effect of sexual fantasies on people’s lives, or how problematic fantasies can be treated in therapy. In this volume contributors from different academic disciplines explore sexual fantasies at the convergence of the cultural and the individual, taking into account that fantasies are paradoxical: highly individualised and private, and at the same time dependent on a world that supplies structures, images, symbols, and narratives.

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

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.

Objective: in light of the rising caesarean section rates in many developing countries, we sought to explore women's and caregivers' experiences, perceptions, attitudes, and beliefs in relation to caesarean section. Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis. Setting: a public university hospital in Dar es Salaam, Tanzania. Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each Women had undergone a caesarean section within two months preceding the interview and were interviewed in their homes. Caregivers were consultants, specialists, residents, and midwives. Findings: both women and caregivers preferred vaginal birth, but caregivers also had a favourable attitude towards caesarean section. While caregivers emphasised their efforts to counsel women on caesarean section, women had often reacted with fear and shock to the caesarean section decision and perceived that there was a lack of indications. Although caesarean section was perceived as involving higher maternal risks than vaginal birth, both women and caregivers justified these risks by the need to 'secure' a healthy baby. Religious beliefs and community members seemed to influence women's caesarean section attitudes, which often made caregivers frustrated as it diminished their role as decision makers Undergoing caesarean section had negative socio-economic consequences for women and their families; however, caregivers seldom took these factors into account when making decisions. Key conclusions and implications for practice: we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness. (C) 2015 The Authors. Published by Elsevier Ltd.

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

Modern biomedicine excels in discoveries in areas such as identification of pathogens and biochemical pathways, and the unveiling of genetic information. This remarkable development had its starting point back in the 19th century with the discovery of how microorganisms were related to disease. Until this point in time physicians primarily had had to rely on patients’ subjective illness experiences and social behavior in deciding diagnosis and treatment. When illness and disease moved into the laboratories the role of social and cultural factors for bodily processes was almost totally discarded. During the last decades it has become increasingly clear that an all-encompassing understanding of physiology and pathology requires that social and cultural factors be taken into consideration. The high placebo effect obtained during clinical trials is evidence of this. The pathways of the placebo effect are slowly being uncovered and this research testifies to the importance of factors not traditionally pertaining to biochemistry. Among the studies investigating into the interface between biochemical activity and social life, there are those showing associations between emotions and production of cytokines in inflammatory reactions, and how psychosocial stress might induce both depression and inflammation through activation of the nervous system. Consequently, future research needs to be multidisciplinary in order to reveal and identify areas of biomedicine so far missed. Collaboration between biomedical researchers and scholars from the social sciences and the humanities has a potential to capture more complex relations in the field of health and disease, and, in the end, make scientific contributions that better mirror the intricate conditions of human life.

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’.