In general, Somali women cover their body in veil, only revealing their face, hands and feet.
Ritual Female Genital Surgery
Ritual female genital surgery (RFGS) is common traditional practice in sub-Saharan African and West African countries. Defined by the World Health Organization (WHO) as female genital mutilation, it involves the “total or partial removal of the female external genitalia or other injuries to the female genital organs for non-medical reasons” (WHO, 2008a).
RFGS is considered a rite of “initiation;” institutionalized as a central feature of cultural African society (Shweder, 2000). The WHO estimates approximately 100 to 140 million women worldwide have had undergone some form of this procedure (WHO, 2008a).
There are 3 different types of RFGS commonly practiced (as defined by the World Health Organization) (2008a): Clitoridectomy (the partial, or total removal of the clitoris, and sometimes the surrounding fold of skin), Excision (partial or total removal of the clitoris and the labia minora, and sometimes the labia majora), and Infibulation (narrowing of the vaginal opening through the creation of a covering seal. This is formed by cutting and repositioning the inner, and sometimes outer, labia, with or without removal of the clitoris).
The most common form of RFGS in Somalia is Infibulation (Adams & Aseefi, 2002).
Organizational opposition
In 1997, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) issued a joint statement describing their intent to eliminate the practice of RFGS.
This statement was updated in 2008, to include a larger group of United Nations agencies, to support the abandonment of ritual female genital surgery worldwide.
Their rationale behind the advocacy for abandoning this practice focuses on the violation of human rights for the women undergoing this procedure. RFGS is defined by these agencies as a “painful and traumatic” experience, reflecting “deep-rooted inequality between the sexes” (WHO, 2008). The WHO also outlines the long-term health consequences that can result from the process, such as: “recurrent bladder and urinary tract infections; cysts; infertility; the need for later surgeries; an increased risk of childbirth complications and newborn deaths” (WHO, 2008a).
Maternal health
Somali women generally report dissatisfaction with maternity care and health practice in Canada (Chalmers & Omer-Hashi, 2002). In a study conducted by (Chalmers & Omer-Hashi 2002), on the birthing experience for Somali women in Canada, researchers found that many health providers lack the knowledge and cultural efficiency to assist women who have undergone RFGS. And many Somali patients pick up on the physician’s lack of experience and understanding – most stated that they would not wish to return to the same birthing hospital, or interact with the same caregivers again. Of the women in Chalmers and Omer-Hashi’s (2002) study, 87.5% reported hurtful comments made by their caregivers, regarding their RFGS, ranging from verbal expressions of surprise to sheer disgust.
Clincal care
Most of the women studied reported disconnect between what they felt their needs were and the care they were given. For instance, less than 1% wanted birth by Caesarean, although more than 50% received this procedure (Chalmers & Omer-Hashi, 2000). Also, most Somali women felt they would have preferred a female birthing companion, but were pressured into having their male partner in the room during delivery. They also noted that pain management throughout the care process was neglected, and “gentle touch” was not always used during physical examinations (Chalmers & Omer-Hashi, 2000).
References:
Adams, K. & Assefi, N. (2002). Primary care refugee medicine: General principles in the postimmigration care of Somali women. Primary Care Update for OB/GYNS, 9, (6), 210-217.
Chalmers, B. & Omer-Hashi, K. (2000). 432 women’s experiences of birth in Canada following female genital mutilation. Birth, 27, 227-234.
Chalmers, B. & Omer-Hashi, K. (2002). What Somali women say about giving birth in Canada. Journal of Reproductive and Infant Psychology, 20,4, 268-281.
Children’s Hospitals and Clinics of Minnesota. (2003). Clinics and departments: Somali culture and medical traditions. Available: http://xpedio02.childrenshc.org/stellent/groups/public/@xcp/@web/ @clinicsanddepts/documents/policyreferenceprocedure/web025020.asp.
Shweder, R. (2000). What about “female genital mutilation?” And why understanding culture matters in the first place. Daedalus, 129, 4, 209-232.
World Health Organization (2008). Eliminating female genital mutilation: an interagency statement UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO. Available: http://www.who.int/reproductive-health/publications/fgm/fgm_statement_2008.pdf.
WHO (2008a). Female genital mutilation. Fact Sheet No 241, May. Geneva, World Health Organization. Available: http://www.who.int/mediacentre/factsheets/fs241/en/index.html.
