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      The mothering experience of women with FGM/C raising ‘uncut’ daughters, in Ivory Coast and in Canada

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          Abstract

          Background

          While Female Genital Cutting (FGM/C) is a deeply entrenched cultural practice, there is now mounting evidence for a gradual decline in prevalence in a number of geographical areas in Africa and following migration to non-practicing countries. Consequently, there is now a growing number of women with FGM/C who are raising ‘uncut’ daughters. This study used a qualitative methodology to investigate the experience of women with FGM/C raising daughters who have not been subjected to the ritual. The aim of this study was to shed light on mothers’ perception of the meaning and cultural significance of the practice and to gain insight into their mothering experience of ‘uncut’ girls.

          Methods

          To this end, in-depth interviews were conducted with fifteen mothers living in Abidjan, Ivory Coast and in Montreal, Canada (8 and 7, respectively).

          Results

          Thirteen mothers intrinsically refused to perpetuate FGM/C onto their daughters and two diasporic mothers were in favour of FGM/C but forewent the practice for fear of legal repercussions. Whether the eschewing of FGM/C was deliberate or legally imposed, raising ‘uncut’ daughters had significant consequences in terms of women’s mothering experiences. Mothers faced specific challenges pertaining to community and family pressure to have daughters undergo FGM/C, and expressed concerns regarding their daughters’ sexuality. Conversely, women’s narratives were also infused with pride and hope for their daughters, and revealed an accrued dialogue between the mother-daughter dyad about cultural norms and sexuality. Interestingly, women’s mothering experience was also bolstered by the existence of informal networks of support between mothers with FGM/C whose daughters were ‘uncut’. These communities of mothers engaged in open dialogue about the consequences of FGM/C and offered reciprocal solidarity and support in their decision to forego FGM/C for their children.

          Conclusion

          Women with FGM/C who are raising ‘uncut’ daughters in their homeland and in their country of immigration vastly report a positive experience. However, they also face specific challenges related to immigration, psychosocial, and psychosexual considerations, which must be tackled from a multidisciplinary perspective.

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          Most cited references42

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          The self and social behavior in differing cultural contexts.

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            Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis

            Objective Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C. Design We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates. Results Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88). Conclusions While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C. Trial registration number This study is registered with PROSPERO, number CRD42012003321.
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              The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey.

              This paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15-54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25-2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46-6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin's cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.
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                Author and article information

                Contributors
                sophia.koukoui@mail.mcgill.ca
                ghayda.hassan@uqam.ca
                jaswant.guzder@mcgill.ca
                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central (London )
                1742-4755
                5 April 2017
                5 April 2017
                2017
                : 14
                : 51
                Affiliations
                [1 ]GRID grid.14709.3b, Psychiatry Department, , Transcultural Research and Intervention Team, McGill University, ; 7085 Hutchison, room 204.2.1, Montreal, QC H3N 1Y9 Canada
                [2 ]GRID grid.38678.32, Department of Psychology, , University of Quebec at Montreal, ; Montreal, QC Canada
                [3 ]Transcultural Research and Intervention Team, C.P. 8888 Succ. Centre-Ville. DS- 4797, Montréal, QC H3C3P8 Canada
                [4 ]McGill Faculty of Medicine, Department of Psychiatry, Center for Child Development and Mental Health, Institute of Community and Family Psychiatry, 4335 Cote St Catherine Rd., Montreal, QC H3T 1E4 Canada
                Author information
                http://orcid.org/0000-0002-4285-4173
                Article
                309
                10.1186/s12978-017-0309-2
                5382428
                28381290
                f446edc5-1c5c-4ec7-94df-8fe06d8f7b91
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 4 January 2017
                : 15 March 2017
                Funding
                Funded by: FRQSC
                Funded by: Quebec Black Medical Association
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Obstetrics & Gynecology
                female genital mutilation/cutting,qualitative research,mothers,migration,abandonment of fgm/c

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