Sara Johnsdotter

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.

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.

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

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.

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 e in a cautious way e 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.

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.

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.

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.

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.

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city's population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one's disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client's socio-economic and psychosocial needs, rather than solely follow a medical model. Enligt en kartläggning från 2005 utnyttjar befolkningen i Rosengård, en kulturellt heterogen stadsdel i Malmö, avsevärt mindre psykiatrisk vård i relation till uppskattade behov i jämförelse med övrig befolkning i Malmö. Med stöd av data från en intervjustudie bland folk som bor eller arbetar i stadsdelen klargjordes flera möjliga orsaker till den låga konsumtionen. Den främsta orsaken var synen på psykisk ohälsa; om ett mentalt tillstånd inte uppfattas som en sjukdom utan en normal livskris söker man inte medicinsk behandling för det. Syftet med artikeln är att illustrera hur underkonsumtion av psykiatrisk vård bland invandrare kan förklaras av ett annorlunda synsätt på psykisk ohälsa. Interventioner bör även inkludera människors socioekonomiska och psykosociala värld snarare än att enbart fokusera på deras mentala tillstånd.

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.

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.

In this paper, we discuss traditional Somali concepts of mental ill health. Qualitative interviews were conducted with some 20 Swedish Somali interviewees about factors causing mental ill health, traditional classification, strategies to deal with mental ill health, and attitudes to the mental health care services in Sweden. Social mobilisation and religious healing are cornerstones of traditional Somali measures to deal with mental suffering. Traditional Somali views of mental ill health stand in stark contrast to classification of mental ill health in the western biomedical model. These views deserve attention since they may have an impact on health-seeking behaviour among Somali immigrants in western countries. Yet a too strong focus on cultural aspects may over-shadow the fact that much mental suffering among Somali migrants must be understood within social, economic, and political contexts.

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

The discrepancy in societal attitudes toward female genital cosmetic surgery for European women and female genital cutting in primarily African girl children and women raises the following fundamental question. How can it be that extensive genital modifications, including reduction of labial and clitoral tissue, are considered acceptable and perfectly legal in many European countries, while those same societies have legislation making female genital cutting illegal, and the World Health Organization bans even the “pricking” of the female genitals? At present, tensions are obvious as regards the modification of female genitalia, and current legislation and medical practice show inconsistencies in relation to women of different ethnic backgrounds. As regards the right to health, it is questionable both whether genital cosmetic surgery is always free of complications and whether female genital cutting always leads to them. Activists, national policymakers and other stakeholders, including cosmetic genital surgeons, need to be aware of these inconsistencies and find ways to resolve them and adopt non-discriminatory policies. This is not necessarily an issue of either permitting or banning all forms of genital cutting, but about identifying a consistent and coherent stance in which key social values – including protection of children, bodily integrity, bodily autonomy, and equality before the law – are upheld.

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

Western countries have reported an increased risk of maternal mortality among African immigrants. This study aimed to identify cases of maternal mortality among immigrants from the Horn of Africa living in Sweden using snowball sampling, and verify whether they had been classified as maternal deaths in the Cause of Death Registry. Three "locators" contacted immigrants from Somalia, Eritrea, and Ethiopia to identify possible cases of maternal mortality. Suspected deaths were scrutinised through verbal autopsy and medical records. Confirmed instances, linked by country of birth, were compared with Registry statistics. We identified seven possible maternal deaths of which four were confirmed in medical records, yet only one case had been classified as such in the Cause of Death Registry. At least two cases, a significant number, seemed to be misclassified. The challenges of both cultural and medical competence for European midwives and obstetricians caring for non-European immigrant mothers should be given more attention, and the chain of information regarding maternal deaths should be strengthened. We propose a practice similar to the British confidential enquiry into maternal deaths. In Sweden, snowball sampling was valuable for contacting immigrant communities for research on maternal mortality; by strengthening statistical validity, it can contribute to better maternal health policy in a multi-ethnic society.

We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden.A majority of Swedish health care providers meet patients presenting with evidence of FGC performed long ago. However, very few of them have suspected recently cut patients. The results support the hypothesis that this practice is not as active among African immigrants in Sweden as in their countries of origin. If the prevalence was the same as in African countries, more pediatricians would be expected to meet current cut girls. National efforts and policy programs to prevent FGC in Sweden are recommended as effective, in accordance with current research and should especially be directed toward pediatricians.

To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors. design Qualitative in-depth interview study. Rural Guatemala. Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala. Interviews with semi-structured, thematic, open-ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications. Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants. Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them. Parameters in the referral system, such as logistics and socio-economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture-sensitive education should be included in maternal health programs.

This article intends to present the Scandinavian legislation on female genital mutilation and explore the implications of the laws. Juxtaposing trends of plastic genital surgery in the West with claims that female circumcision may be a practice generally abandoned in Scandinavia, we highlight the double morality inherent in current public discussions. Finally, we pose the question: Is the legal principle of equality before the law regarded when it comes to alterations of the female genitals?

To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome. Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth. Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden. The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance. Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as 'survival behaviours' related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.

“It is the task of scholars working on the topic of female genital cutting not only to provide perspectives to reduce ethnocentrism, but also to offer ideas for generating acceptable changes for immigrants and their new countries, informed by reasonable approaches that do not rely on inflamed rhetoric or distorted science. The work of scholars, such as those writing in this volume, is essential to engaging in a more just and thoughtful future, where human cultural behaviors can change in positive directions that ameliorate the conditions of the lives of women and girls without unjust condemnations of different ways of living.”
These words are from the keynote lecture at the 9th FOKO conference in Sweden, Female Genital Cutting: The Global North & South, which appears as a chapter in this anthology. This keynote was delivered by Professor Ellen Gruenbaum, an American anthropologist who has done research on this subject for more than four decades. The other chapters build on research papers presented at the conference, covering studies done in countries where circumcision of girls is widely practiced as well as those from European countries which host migrant communities that are affected by these practices. The collection covers a wide range of the issues that currently demand attention among Nordic researchers in the field of female genital cutting.

This book is the product of the Seminar MAP-FGM (https://mapfgm.eu, Rome, 24-25 Nov. 2017), where anthropologists, sociologists, philosophers, exponents of NGO, gynaecologists and jurists exchanged their knowledge by pursuing several aims: re-introducing the FGM/C issue inside an anthropological framework, seeking to widen the theme to body modifiability, not only women’s bodies, and proceeding from historicization and the acknowledgment of subjectivities; criticising the biomedical approaches, as other forms of criminalization, examining the connection with the other disciplines and their knowledge potential; finally, opening the issue to uncommon geographical fields, both in Africa and Asia. The main objective has been establishing the conditions for building a socio-ethno-anthropological gaze on the social gender constructions and on the biopolitics on/of the bodies, by making emerge the strengths but, most of all, the weaknesses, of the medical and regulatory gazes, which, on their part, call into question an anthropological vocabulary which does not pertain to them, and risk to produce effects opposed to the ones wished, that is the abandonment of these practices.
With contributions of: Omar Abdulcadir, Jean-Loup Amselle, Esther Ayuk, Franca Bimbi, Lucrezia Catania, Giovanna Cavatorta, Gily Coene, Ricardo Falcão, Michela Fusaschi, Irwan Hidayana, Sara Johnsdotter, Bianca Pomeranzi, Ismail Sougueh Guedi and Michela Villani.

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 reporting 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.

In discussions about sexuality in relation to circumcision, one often finds a kind of lip service, where it is declared that sexuality is multifaceted and relies on all kinds of psychological and social dimensions. Yet few authors discuss, in depth, the implications of a sexual-pleasure research approach that moves beyond the state of the genitalia. We would like to discuss exactly this: Sexual pleasure cannot be reduced to a question of genital tissue – sexuality is a more complex phenomenon than that. It is obvious that current quantitative approaches to investigating sexuality after FGC are inadequate. Generally speaking, they place too much weight on that which has been done to a woman’s genital tissue. We call such assumptions the fallacy of genital determinism (Johnsdotter 2013).
Western understandings of sex rely heavily on ideas emanating from researchers that created the model of the Human Sexual Response Cycle (Masters and Johnson 1966), which has been criticized for its simplistic focus on genitals (and not on people). Physiological aspects are thus over-emphasized at the expense of psychological, social and cultural aspects of importance for outcome.
Sexual scripting theory, introduced by sociologists in the 1970s (e.g. Gagnon and Simon 1973), highlights the cultural and social dimensions of lived sexuality, demonstrates how sexuality is embedded in social and cultural contexts and how people learn how to enact their sexuality. In addition, anthropological research on sensations (e.g. Hinton et al. 2008) suggests that culturally based learning also takes place when it comes to how we perceive bodily sensations, whether we notice bodily signals or not, and how we interpret and give meaning to sensations. Based on these findings, we will discuss possible implications of current campaigning for immigrant women and girls, who have to deal with these public expectations about erased possibilities to feel sexual pleasure after genital cutting.
In summary, we suggest that research, preventive work and rehabilitation care better take into consideration that sexuality is a complex phenomenon, and we stress the need to avoid reductionist one-track approaches that may be more harmful than helpful.

References
Gagnon, J.H. and Simon, W. (1973). Sexual conduct. The social sources of human sexuality. London: Aldine.
Hinton, D. E., Howes, D. & Kirmayer, L.J. (2008). “Toward a medical anthropology of sensations: Definitions and research agenda.” Transcultural Psychiatry, 45(2),142–162.
Johnsdotter, S. (2013). “Discourses on sexual pleasure after genital modifications: The fallacy of genital determinism (a response to J. Steven Svoboda).” Global Discourse, DOI 10.1080/23269995.2013.805530 (e-pub ahead of print).
Masters, W. H. and Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.

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.

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

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.

Assessing Cultural Anthropology is presented as a text-book of sorts. Our interest in its themes and contents led us to take it up in a graduate seminar, in which we discussed not only the different chapters but also the structure of the presentation in relation to its educa-tional goals. We ...

Innehåll Inledning 7 Sara Johnsdotter & Aje Carlbom 1. Fettpaniken 19 Marie Carlsson 2.” Damp”–debatten som spårade ur 45 Eva Kärfve 3. Nationalekonomskrået En insider-outsiderteori om den nationalekonomiska disciplinen 73 Daniel Ankarloo 4. Var Jörg Haider rasist? ...

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.