Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences

BMC International Health and Human Rights

Jodi Proctor³  Paula Migliardi⁴  Shereen Denetto¹  Bilkis Vissandjée² 

[1] Immigrant and Refugee Community Organization of Manitoba (IRCOM), 95 Ellen Street, Winnipeg, Manitoba R3A 1S8, Canada;SHERPA Research Centre and The Research Institute of Public Health at the Université de Montréal, Montréal, Canada;School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal QC H3A 0G4, Canada;Sexuality Education Resource Centre (SERC) Manitoba, 200- 226 Osborne Street, North Winnipeg, Manitoba R3C 1V4, Canada

关键词: Cultural sensitivity;    Community engagement;    Harm reduction;    Ethics;    Public health;    Migration;    Traditional practices;    Female genital mutilation;    Female genital cutting;   

Others  :  854997
DOI  :  10.1186/1472-698X-14-13

 received in 2013-05-13, accepted in 2014-04-14,  发布年份 2014

【 摘 要 】

Background

Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented.

FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada.

Discussion

The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC.

Summary

Working partnerships between the public health sector and community based organisations with a true involvement of women and men from practicing communities will allow for more sensitive and congruent clinical guidelines. In order to honour the fundamental principles and values of medical ethics, such as compassion, beneficence, non-malfeasance, respect, and justice and accountability, socio-cultural interactions at the interface of health and migration will continue to require proper attention. It entails a commitment to recognise the intrinsic value and dignity of girls’ and women’s context.

【 授权许可】

   
2014 Vissandjée et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Abdulcadir J, Margairaz C, Boulvain M, Irion O: Care of women with female genital mutilation/cutting. Swiss Med Wkly Eur J Med Sci 2011, 140:1-8.
• [2]Jirovsky E: Views of women and men in Bobo-Dioulasso, Burkina Faso, on three forms of female genital modification. Reprod Health Matters 2010, 18:84-93.
• [3]Rogo K, Subayi T, Toubia N: Female Genital Cutting, Women’s Health, and Development: The Role of the World Bank. Washington, D.C: The International Bank for Reconstruction and Development/The World Bank; 2007.
• [4]Society of Obstetricians and Gynaecologists of Canada (SOGC) 2013. [http://www.sogc.org/guidelines/documents/gui272PS1202E.pdf webcite]
• [5]World Health Organization (WHO) [http://www.who.int/mediacentre/factsheets/fs241/en/ webcite]
• [6]American Academy of Pediatricians (AAP) [http://pediatrics.aappublications.org/content/125/5/1088.full.pdf webcite]
• [7]Vissandjée B, Kantiébo M, Levine A, N’Dejuru R: The cultural context of gender, identity: female genital circumcision, excision and infibulation. Health Care Women Int 2003, 24:115-124.
• [8]Heger Boyle E, Cotton Corl A: Law and culture in a global context: Interventions to eradicate female genital cutting. Annu Rev Law Soc Sci 2010, 6:195-215.
• [9]Abusharaf RM: Female Circumcision: Multicultural Perspectives. Philadelphia: University of Pennsylvania Press; 2006.
• [10]Chalmers B, Omer-Hashi K: What Somali women say about giving birth in Canada. J Reprod Infant Psychol 2002, 20:268-282.
• [11]Krasà K: Human rights for women: the ethical and legal discussion about female genital mutilation in Germany in comparison with other Western European countries. Med Healthc Philos 2010, 13:269-278.
• [12]Boddy J: Gender Crusades: The Female Circumcision Controversy in Cultural Perspective. In Transcultural Bodies: Female Genital Cutting in Global Context. Edited by Hernlund Y, Shell-Duncan B. New Brunswick, New Jersey, and London: Rutgers University Press; 2007:1-45.
• [13]Shell-Duncan B: The medicalization of female “circumcision”: harm reduction or promotion of a dangerous practice? Soc Sci Med 2001, 52:1013-1028.
• [14]Cook R, Dickens B: Special commentary on the issue of reinfibulation. Int J Gynaecol Obstet 2010, 109:97-99.
• [15]Cook R, Dickens B, Fathalla M: Female genital cutting (mutilation/circumcision): ethical and legal dimensions. Int J Gynaecol Obstet 2002, 79:281-287.
• [16]Davis DS: Ritual genital cutting of female minors. Pediatrics 2010, 125:1088-1093.
• [17]Thierfelder C, Tanner M, Bodiang CMK: Female genital mutilation in the context of migration: experience of African women with the Swiss health care system. Eur J Public Health 2005, 15:86-90.
• [18]Turillazzi E, Fineschi V: Female genital mutilation: the ethical impact of the new Italian law. J Med Ethics 2007, 33:98-101.
• [19]Canadian Medical Association (CMA) [http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf webcite]
• [20]Macklin A: The Double-Edged Sword. In Female Circumcision: Multicultural Perspectives. Edited by Mustafa Abusharaf RA. Philadelphia: University of Pennsylvania Press; 2006:207-223.
• [21]Anantnarayan L: American Academy of Pediatrics (AAP) is Advocating For U.S. Pediatricians to Perform Certain Types of Female Genital Mutilation (FGM). [http://www.equalitynow.org/american-academy-pediatrics-aap-advocating-us-pediatricians-perform-certain-types-female-genital-mut webcite]
• [22]Equality now. female genital mutilation in the U.S. Factsheet. US. 2013 http://www.equalitynow.org/FGM_in_US_FAQ webcite
• [23]Hernlund Y, Shell-Duncan B: Transcultural Bodies: Female Genital Cutting in Global Context. New Brunswick, New Jersey, and London: Rutgers University Press; 2007:1-45.
• [24]Kulish N: German ruling against circumcising boys draws criticism. [http://www.nytimes.com/2012/06/27/world/europe/german-court-rules-against-circumcising-boys.html?_r=0 webcite]
• [25]Snyder D: Circumcision to remain legal in Germany. 2012. NBC News December 12. Accessed February 10th 2014 http://worldnews.nbcnews.com/_news/2012/12/12/15869347-circumcision-to-remain-legal-ingermany?lite webcite
• [26]Adler P: Is circumcision legal? Richmond J Law Public Interest 2013, 16:439-486.
• [27]Johnsdotter S, Essén B: Genitals and ethnicity: the politics of genital modifications. Reprod Health Matters 2010, 18:29-37.
• [28]Udin J: Indonesia: female genital mutilation regulations mistaken as endorsement, experts fear. [http://www.irinnews.org/Report/93628/INDONESIA-FGM-C-regulations-mistaken-as-endorsement-experts-fear webcite]
• [29]Vissandjée B, Battaglini A: Santé des Femmes: A la Croisée des Questions de Genre, Ethnicité et Migration. In Santé et Services Sociaux de Première Ligne en Milieu Pluriethnique. Edited by Battaglini A. Québec: Éditions Rémi Saint Martin; 2010.
• [30]Asanin J, Wilson K: “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Soc Sci Med 2008, 66:1271-1283.
• [31]Bartlett G, Blais R, Tamblyn R, Clermont R, MacGibbon B: Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Can Med Assoc J 2008, 178:1555-1562.
• [32]Padilla Y, Villalobos G: Cultural responses to health among Mexican American women and their families. Family Commun Health 2007, 30:524-533.
• [33]Carnevale F, Vissandjée B, Nyland A, Vinet-Bonin A: I don’t understand what you need: Ethical Nursing in Cross-linguistic Clinical Care. Nurs Ethics 2009, 16(6):1-10.
• [34]Serour GI: The issue of reinfibulation. Int J Gynecol Obstet 2010, 109:93-96.
• [35]Battaglini A: Santé et services sociaux de première ligne en milieu pluriethnique. Éditions Rémi Saint Martin: Québec; 2010.
• [36]Einstein G: Situated Neuroscience: Exploring a Biology of Diversity. In Neurofeminism: Issues at the Intersection of Feminist Theory and Cognitive Science. Edited by Bluhm R, Maibom H, Jacobson AJ. London, England: Palgrave McMillan; 2011.
• [37]Collinet P, Stien L, Vinatier D, Leroy JL: Management of female genital mutilation in Djibouti: the Peltier General hospital experience. Embase Acta Obstet Gynecol Scand 2002, 81:1074-1077.
• [38]Delbon P, Conti A: Female genital mutilation in Europe: ethical and legal considerations. Riv Ital Med Adolesc 2008, 6:28-36.
• [39]MacKay T, Tavares T: Building hope: appropriate programming for adolescent and young adult newcomers of war-affected backgrounds and Manitoba schools: a preliminary report for consultation and discussion. [http://www.edu.gov.mb.ca/k12/cur/eal/building_hope.html webcite]
• [40]World Health Organization (WHO) [http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/ webcite]
• [41]Ormond M: Harm reduction: considered and applied. [http://library.catie.ca/PDF/P14/21308.pdf webcite]
• [42]Sexuality Education Resource Centre Manitoba (SERC): Our Selves Our Daughters: Women, Men, and Youth’s Perspectives of Female Genital Cutting and Change. Winnipeg: SERC; 2011a.
• [43]Sexuality Education Resource Centre Manitoba (SERC): Our Selves, Our Daughters: Community-Based Education and Engagement Addressing Female Genital Cutting (FGC) with Refugee and Immigrant African Women in Winnipeg 2010–2011. Winnipeg: SERC; 2011b.
• [44]Sexuality Education Resource Centre Manitoba (SERC): Our Selves Our Daughters: Community-Based Education and Engagement Addressing Female Genital Cutting (FGC) with Refugee and Immigrant African Women in Winnipeg 2011–2012. Winnipeg: SERC; 2012.
• [45]Tharao W, Cornwell L: Feminist Leadership and Female Genital Mutilation in Canada. In Theorising Empowerment: Canadian Perspectives on Black Feminist Thought. Edited by Massaquoi N, Wane N. Toronto: Inanna Publications; 2007.
• [46]Migration und Gesundheit: Tough Decision. Switzerland: Federal Office of Public Health; 2012.