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

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      Abstract

      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.

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      Most cited references 17

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      Impact of patient communication problems on the risk of preventable adverse events in acute care settings.

      Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events. We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145,672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events. Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%-3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43-6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09-5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07-2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05). Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated.
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        "I spent nine years looking for a doctor": exploring access to health care among immigrants in Mississauga, Ontario, Canada.

        There is a growing body of research in Canada and from other countries acknowledging that immigrants face barriers in accessing health care services. As immigrants make up an increasing percentage of the population in many developed nations, a better understanding and eliminating these barriers is a major priority. This research contributes to current understandings of access among immigrant populations in Canada by exploring perceptions of access to care through focus groups with a diverse group of immigrants living in a Mississauga, Ontario neighbourhood. The results of eight focus groups reveal that immigrants face geographic, socio-cultural and economic barriers when attempting to access health care services in their community. This paper provides policy recommendations relevant to the federal, provincial and local levels for eliminating these barriers.
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          The medicalization of female "circumcision": harm reduction or promotion of a dangerous practice?

           B Shell (2001)
          In recent decades the practice of female "circumcision" has come under intense international scrutiny, often conceptualized as a violation of women's basic right to health. Although the adverse health consequences of female "circumcision" form the basis of opposition to the practice, anti-circumcision activists, as well as many international medical associations, largely oppose measures to improve its safety. The debate over medicalization of female "circumcision" has, up until now, been cast as a moral dilemma: to protect women's health at the expense of legitimating a destructive practice? Or to hasten the elimination of a dangerous practice while allowing women to die from preventable conditions? This paper seeks to re-examine this debate by conceptualizing medicalization of female "circumcision" as a harm-reduction strategy. Harm reduction is a new paradigm in the field of public health that aims to minimize the health hazards associated with risky behaviors, such as intravenous drug use and high-risk sexual behavior, by encouraging safer alternatives, including, but not limited to abstinence. Harm reduction considers a wide range of alternatives, and promotes the alternative that is culturally acceptable and bears the least amount of harm. This paper evaluates the applicability of harm reduction principles to medical interventions for female "circumcision," and draws parallels to other harm reduction programs. In this light, arguments for opposing medicalization of female "circumcision", including the assertion that it counteracts efforts to eliminate the practice, are critically evaluated, revealing that there is not sufficient evidence to support staunch opposition to medicalization. Rather, it appears that medicalization, if implemented as a harm-reduction strategy, may be a sound and compassionate approach to improving women's health in settings where abandonment of the practice of "circumcision" is not immediately attainable.
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            Author and article information

            Affiliations
            [1 ]Faculty of Nursing, Université de Montréal, PO Box 6128, Station Centre-Ville-Montréal, QC H3C 3J7, Canada
            [2 ]SHERPA Research Centre and The Research Institute of Public Health at the Université de Montréal, Montréal, Canada
            [3 ]Immigrant and Refugee Community Organization of Manitoba (IRCOM), 95 Ellen Street, Winnipeg, Manitoba R3A 1S8, Canada
            [4 ]Sexuality Education Resource Centre (SERC) Manitoba, 200- 226 Osborne Street, North Winnipeg, Manitoba R3C 1V4, Canada
            [5 ]School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal QC H3A 0G4, Canada
            Contributors
            Journal
            BMC Int Health Hum Rights
            BMC Int Health Hum Rights
            BMC International Health and Human Rights
            BioMed Central
            1472-698X
            2014
            24 April 2014
            : 14
            : 13
            24758156 4012131 1472-698X-14-13 10.1186/1472-698X-14-13
            Copyright © 2014 Vissandjée et al.; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

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            Comments

            The article addresses the very important aspect of women’s health and rights – FGC. It is interesting to see that the inhibition by law does not seem to be sufficient to eradicate the practice which highlights the importance to understand the underlying causes of FGC. More knowledge as well as ethically and culturally sensitive strategies in health service provision are needed to tackle the situation adequately. As most research about FGC is done in Africa, the focus on Western Countries offers the opportunity to learn more about how to ensure quality ethical care for migrant families.

            2015-06-11 15:01 UTC
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