Perspectives of Somali Bantu refugee women living with circumcision in the United States: A focus group approach
Introduction
Limited knowledge is available to guide healthcare providers in caring for women who have been circumcised. Somali women who have been forced to leave their country due to war and then migrated to the United States (US) as refugees are in an especially tenuous situation. These women are refugees struggling to learn a new way of life in the US and they must do so within the cultural context of the US where female circumcision (FC) is not only largely unknown, but also illegal. The purpose of this study was to explore the healthcare perspectives of Somali Bantu refugees in relation to their status as women who have been circumcised and recently resettled in the US. Questions providing focus for the study included:
- 1.
What are the Somali Bantu women's perceived healthcare needs related to circumcision?
- 2.
What culturally acceptable interventions can be developed in providing care for these women based upon their self-identified needs?
Results of this study were considered a beginning toward facilitating culturally competent, quality healthcare for this population.
Section snippets
Background
Approximately 14,000 Somali refugees entered the US during a resettlement program sponsored by the US government in 2003. By 2005, 180 Somali Bantu refugees, almost 75% under the age of 5, had arrived in the mid-sized city (population 350,000) of Pittsburgh, Pennsylvania. Once these refugees arrived in Pittsburgh they were given a 3-month rent-free apartment furnished with donated household supplies, furniture, clothes, and food. Medical assistance and food stamps were provided, but they were
Method
This qualitative study utilized focus groups to elicit the data. Focus groups were considered useful for providing a dynamic atmosphere in which participants can stimulate each other's thinking and have been successfully used with other cultural groups. In addition, focus groups have been effective when exploring sensitive topics (Speziale and Carpenter, 2003).
Institutional Review Board approval by the university was obtained before commencing the study. Informed consent was obtained from all
Results
Ages of the 23 Somali refugee participants ranged from 19 to 43 with a median age of 33 years. All of the women were married with all but one participant having children. The average number of children in each family totaled five with one women having nine children. Length of stay in the US ranged from 11 to 27 months.
The predominant theme, “Living with the Norm of Circumcision” reflected the women's worldview of FC as normality rather than an aberration. Their expressed healthcare needs
Discussion
Somali refugee women experience a plethora of issues related to healthcare in general, in addition to any concerns arising from circumcision. First, the experience of marginalization and all of its consequences requires recognition from all healthcare providers. As Somali women, they are already vulnerable in terms of appearance/dress, economic circumstances, cultural beliefs and social patterns. These Somali refugee women may strive to negotiate between their world of tradition and mainstream
Conclusion
Healthcare needs of Somali refugee women identified in this study should be considered a foundation for developing cultural competence in caring for this population of women. As a first step, providers must address the fears and concerns these women may have surrounding practices considered routine by the provider. Explaining the rationale for questions and procedures perceived as sensitive by the women may initiate a more positive interaction and help dispel uncertainties about care the women
Conflict of interest
None.
Funding source
The American Nurses’ Foundation, the National Institutes of Health through the Carlow University Office of Sponsored Programs, grant number 20-2576-8506.
Ethical approval
Ethical approval was given through the Carlow University Institutional Review Board. There is no Judgment reference number, but the approval was given on November 21, 2005.
Acknowledgements
This study was completed through the generous support of the American Nurses Foundation with all authors recognized as Julia Hardy Scholars and the National Institutes of Health through the Carlow University Office of Sponsored Programs, grant number 20-2576-8506.
References (31)
Female genital mutilation: when a cultural practice generates clinical and ethical dilemmas
Journal of Obstetric, Gynecologic, & Neonatal Nursing
(1998)Female genital mutilation (FGM) management during pregnancy, childbirth, and the postpartum period
International Journal of Gynecology & Obstetrics
(2000)Culture and Customs of Somalia
(2001)- et al.
Health care access for Somali refugees: views of patients, doctors, nurses
American Journal of Health Behavior
(1999) When tradition maims
American Journal of Nursing
(2000)- et al.
Being different and vulnerable: experience of immigrant African women who have been circumcised and sought maternity care in Sweden
Journal of Transcultural Nursing
(2006) - et al.
‘Circumcision’, culture, and health-care provision in Tower Hamlets, London
Gender and Development
(1998) - et al.
Knowledge and beliefs about health promotion and preventive care among Somali women in the United States
Health Care for Women International
(2007) - et al.
What Somali women say about giving birth in Canada
Journal of Reproductive and Infant Psychology
(2002) Female genital mutilation: consequences for midwifery
British Journal of Midwifery
(2004)
Identity, dance, and Islam among people with Bantu origins in riverine areas of Somalia
Indigenous women's voice: marginalization and health
Journal of Transcultural Nursing
Cutting the Rose: Female Genital Mutilation: The Practice and its Prevention
Somali refugee women speak out about their needs for care during pregnancy and delivery
Journal of Midwifery & Women's Health
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