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This study explored how the reproductive health care experiences of women with female genital mutilation/cutting/circumcision (FGC) were shaped. We used Institutional Ethnography, a sociological approach which allows for the study of social relations and the coordination of health care. From qualitatively interviewing eight women with FGC, we learned that they felt excluded within the Canadian health care system because they were unable to access reconstructive surgery, which was not covered by Ontarios universal health coverage (Ontario Health Insurance Plan). We then talked with seven obstetricians/gynecologists (OB/GYNs) and learned that while it was legal to perform certain genital (e.g., female genital cosmetic surgery) and reproductive (e.g., elective caesarean section) surgeries commonly requested by Western-born women, it was not legal for them to perform other genital surgeries often requested by immigrant populations (e.g., reinfibulation), nor were these covered by OHIP (e.g., clitoral reconstructive surgery). From participants comparison of clitoral reconstructive surgery and reinfibulation to female genital cosmetic and gender confirming surgeries, it became clear that the law and policies within the health care system favored surgeries elected by Western adults over those wished for by women with FGC. We found that the law had an impact on the choices that OB/GYNs and the women they treated could make, shaping their respective experiences. This created ethical dilemmas for OB/GYNs and a sense of exclusion from the health care system for women with FGC. Funding Agencies|Ontario Graduate Scholarship; Carol Mitchell and Richard Venn Fellowship in Womens Health; Canada Research Chair in Sexual and Gender Minority Health; Joyce Posluns Chair in Womens Brain Health and Aging; Posluns Family Foundation; Womens Brain Health Initiative; Canadian Institutes of Health Research; Ontario Brain Institute; Alzheimers Society of Canada; Jacqueline Ford Gender and Health Fund

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Womens engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters. Funding Agencies|Ontario Graduate ScholarshipOntario Graduate Scholarship; Carol Mitchell and Richard Venn Fellowship in Womens Health; Canada Research Chair in Sexual and Gender Minority Health; Jacqueline Ford Gender and Health Fund; Wilfred and Joyce Posluns Chair in Womens Brain Health and Aging; Posluns Family Foundation; Womens Brain Health Initiative; Canadian Institutes of Health ResearchCanadian Institutes of Health Research (CIHR); Alzheimers Society of Canada; Ontario Brain Institute

Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women’s rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women’s rights language, notably for causing violations of women’s right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women’s rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women’s rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women’s capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.

As a rite of passage to womanhood, 2 million girls undergo female genital circumcision (FGC)-the tradition of cutting, and often removing parts of the vulva-every year. The current study is the first to focus on the connection between peripheral nerve damage and chronic neuropathic pain in women with FGC. We used mixed methods-quantitative, qualitative, and physiological-to study chronic pain in Somali-Canadian women (N = 14). These women have the most extensive form of FGC, which includes removal of the glans clitoris, labia minora, medial portion of the labia majora, and stitching together the remaining parts of the labia majora. Our results indicate a multifaceted pain experience in women with FGC. Although they report good overall health and very low pain levels on the short form of the McGill Pain Questionnaire, pressure-pain quantitative sensory testing of the vulvar region applied through vulvalgesiometers shows pain thresholds consistent with those reported by women with chronic vulvar pain. Furthermore, qualitative interviews reveal a considerable amount of often debilitating pain in daily life. These results challenge the use of assessment tools offering elicited verbal pain language and highlight the importance of culturally sensitive ways of conceptualizing, measuring, and managing pain.

The way that we as researchers view and interpret our social worlds is impacted by where, when, and how we are socially located and in what society. The position from which we see the world around us impacts our research interests, how we approach the research and participants, the questions we ask, and how we interpret the data. In this article, we argue that it is not a straightforward or easy task to conceptualize and practice positionality. We have developed a Social Identity Map that researchers can use to explicitly identify and reflect on their social identity to address the difficulty that many novice critical qualitative researchers experience when trying to conceptualize their social identities and positionality. The Social Identity Map is not meant to be used as a rigid tool but rather as a flexible starting point to guide researchers to reflect and be reflexive about their social location. The map involves three tiers: the identification of social identities (Tier 1), how these positions impact our life (Tier 2), and details that may be tied to the particularities of our social identity (Tier 3). With the use of this map as a guide, we aim for researchers to be able to better identify and understand their social locations and how they may pose challenges and aspects of ease within the qualitative research process. Being explicit about our social identities allows us (as researchers) to produce reflexive research and give our readers the tools to recognize how we produced the data. Being reflexive about our social identities, particularly in comparison to the social position of our participants, helps us better understand the power relations imbued in our research, further providing an opportunity to be reflexive about how to address this in a responsible and respectful way.

Many of the Somali women who have immigrated to other countries, including Canada, have experienced Female Genital Circumcision/ Mutilation/ Cutting (FGC). While there is literature on the medical aspects of FGC, we were interested in understanding the daily life experiences and bodily sensations of Somali-Canadian women in the context of FGC. Fourteen women living in the Greater Toronto Area were interviewed. Interview data were analyzed using a phenomenological approach. We found that the memory of the ceremonial cutting was vivid but was frequently described with acceptance and resignation–as something that just is; that was normal given the particular context, familial and cultural, and their young age. Most of the women recounted experiencing pain and discomfort throughout their adult lives but were intent on not noticing or giving the pain any power; they considered themselves healthy. The following themes emerged from our interviews: Every Body Had It: Discussing FGC, I’m Normal Aren’t I?, and Feeling in My Body–all themes that work at normalizing their bodies in a society that they know views them as different. They dealt with both pain and pleasure in the context of their busy lives suggesting resilience in spite of the day-to-day difficulties of daily life.