Listening to African Voices - FPZ

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with roots in practicing groups could offer support in theform of of consultation hours.5.9. Perceptions and practices regarding health carepractices of African women immigrantsThis section is structured in two parts. The first paragraphoutlines the perceptions and practices as reported by Africanwomen immigrants. The second paragraph describes theperspectives of the gynaecologists interviewed.5.9.1. Perceptions and practices of African women immigrantsVery few women described (reproductive) health andsexual problems that they associated with FGM/C. One ofthe exceptions was a woman from Eritrea, who stated, forexample, that it was very painful for her to have a union withher husband and that she suffered from recurrent infectionsthat she believed to be associated with the FGM/C she hadundergone. A small number of women explained that theyexperienced sexual intercourse as frustrating as it did notgive them feelings of satisfaction or that the partner hadto “work hard and for a long time” to get them sexuallyaroused. A few women also described that they had little orno interest in sex which was, however, not necessarily experiencedas a negative.When asked about reproductive health care practices, all keyinformants from the African community said that they eitherconsult a gynaecologists or go to a hospital. The main reasonfor visiting a gynaecologist was pregnancy. Some also citedreasons such as bladder infections or problems conceiving.Preventive care was cited only rarely.Their experiences with reproductive health care providerswere two-fold. Some women reported satisfaction with theservices and expressed trust in their doctors. Others felt thatthe health care workers took little time to listen to them andto explain the rationale of treatments.Several women who had undergone FGM/C felt that thetopic was dealt with inappropriately. As a consequence,they changed the doctor – sometimes several times – andoften looked for gynaecologists of non-European origin. Onereason was the experience of curious or pitying reactions ofGerman health care workers. One participant of Burkinabeorigin described, for instance, that a German gynaecologist(a woman) looked at her with so much pity and irritation afterthe physical examination that she felt for the first time inher life that she was not normal. The gynaecologist did notaddress the issue of FGM/C, but the women felt that she wastreated like a victim who could not be talked to rationally.The participant decided after the treatment to abstain fromconsulting German doctors. Other women reported the lackof knowledge among German doctors about FGM/C. Theydescribed that their gynaecologists were only aware of themost extreme form of FGM/C (infibulation) and did not dealappropriately with less invasive types. A woman of Ethiopianorigin described how her gynaecologist did not see that shehad undergone FGM/C, but told her that she was lucky tohave been spared from the practice:“I want to tell you my experience in Hamburg. The gynaecologistwho is my doctor told me after her physical examinationthat I am lucky since I am not circumcised. I wassurprised but I didn’t dare tell her that I was circumcised.I think there is a misunderstanding about female circumcision.Most people know the film or the book entitledDesert Flower or Wüstenblume. I think this has misledthem. What is common in Ethiopia is not the one [form]mentioned in the book. Sewing or stitching the vagina aftercircumcision and not to let the child move for a certainnumber of days is not common in Ethiopia. I think the doctorreferred to this type of circumcision. Yes, I am lucky I didnot have such an experience.” (woman of Ethiopia origin)5.9.2. Experiences of gynaecologists with African womenimmigrantsAmong the six interviewed gynaecologists, four claimed tohave encountered few or no direct experiences with womenwho had undergone FGM/C. One of them was Dr. med CorneliaGoesmann 31 who, in collaboration with Prof. Dr. med.Heribert Kentenich, published the recommendations of theGerman Medical Association on how to treat women whohave undergone FGM/C. She reported that all efforts to gainaccess to the African community in Niedersachsen had beenwithout success and that she had never treated a womanwho had undergone FGM/C. Her conclusion was that Africanfemale immigrants from practicing countries probablyconsult their own doctors and avoid German gynaecologists.One other gynaecologist (also of German origin) had neverbeen in contact with women who had undergone FGM/Cdespite having participated in a training seminar on FGM/C.Two other gynaecologists claimed to have been consulted bya small number of affected women:• The first, a German gynaecologist, reported to have providedservices to two Ethiopian women who had undergoneFGM/C and• The second, a gynaecologist of Iranian origin, had manyAfrican patients, but had only met six women affectedby FGM/C (also mostly from Ethiopia) over more thantwo decades of practicing her profession. She had helpedone woman who suffered from complications due to aninfibulation. The other five women had undergone type Ior II and had no complications. She reported that Africanwomen rarely come for preventive care visits.Listening to African Voices 83
The two remaining gynaecologists had more substantialinformation to provide. One of them was of Eritrean origin.She had for a couple of years run an FGM/C-consultationat the University clinic of Hamburg, and had later workedas a senior physician in the delivery ward of a hospital inHamburg. She confi rmed the fact that some gynaecologistsmight not be able to recognise type I and II forms of FGM/Cdue to lack of training and the variable physics of the vagina.According to her, determining the status was more like apuzzle in which certain signs as well as the country of origincan point to a conclusion. She had assisted several womenin the scope of her FGM-consultation hour who camewith urinary tract and vaginal infections as well as sexualproblems. There were also a few cases of infi bulated womenwho were pregnant and needed to be advised on how togive birth; they either wanted to deliver with a C-section orasked to be reinfi bulated. The patient had a signifi cant needfor counselling and advice during the FGM/C consultationhour, but the offer for free consultation was terminatedafter a certain period. During her time at the delivery ward,she gathered further experience assisting women who hadundergone FGM/C, notably cases of tearing during childbirththat required closure by suture. She trained the medicalstaff in the hospital on FGM/C and prepared and advisedthe women concerned during their pregnancy.She was also contacted three times by teachers whosuspected that one of their students had been subjected toFGM/C over the holidays. All three girls were of Eritreanorigin. Control examinations revealed that the girls had notundergone FGM/C.The second gynaecologist was of German origin and employedby the Familienplannungszentrum [Family PlanningCentre], an institution providing reproductive health careto immigrants and other beneficiaries without health carecoverage. There is a strong demand for the institution’s services.It is consulted by about 350 African immigrant womenper year, of whom approximately one third have undergoneFGM/C. The women concerned are mainly from West Africancountries, e.g. Cote d’Ivoire, Togo, Nigeria, Benin, BurkinaFaso and Sierra Leone. Despite the high rate of women withFGM/C, they registered only two cases of infibulation. Mostwomen have undergone type I or type II forms and theinstitution has rarely seen complications associated with thepractice. The gynaecologist interviewed estimated that theysituations involving medical complications linked to FGM/C,such as extremely rare forms of scarification that hinder theprocess of delivery, are encountered on average once a year.She had never been informed about FGM/C being practiced31 Vice-president of the “Bundesärztekammer” [German MedicalAssociation]in Germany, though she knew there was hearsay that therewere two traditional women practitioners in Berlin.She noted that the women with unclear residence statuswere under heavy pressure to remain invisible and to gettheir lives in Germany organised. Many of them wish to havechildren. Her conclusion was that the women have otherproblems and priorities than FGM/C. She also emphasisedthat the institution had limited time for each patients.Communication problems arise from time to time due tolanguage barriers. There is not always time to build up arelationship of trust with the patients. Her impression of thetraining seminars from the Berufsverband der Frauenärzte[professional association for gynaecologists] was that thereis more focus on demonising the practice than on teachingan appropriate and sensitive approach to dealing with thefeelings and needs of the women concerned.Both gynaecologists confirmed the impression that Africanwomen immigrants usually consulted them only when theywere pregnant or when they had acute symptoms. Preventivecare visits are rare and mostly limited to women with ahigh level of education and integration.5.10. Media preferences and information networks ofimmigrant communities from Sub-Saharan Africain HamburgWe asked all key informants what means and places theAfrican immigrants use to become informed about what isgoing on and which media they use the most. Not a singlekey informant named the German media as a source ofinformation.In terms of media, the key informants stated the followingpreferences:• Internet: When using the internet for informationupdates, many immigrants consult web pages of theircountry of origin such as www.seneweb.com (Senegal),www.icilome.com (Togo), www.ghanaweb.com (Ghana) orwww.abidjan.net for immigrants from Cote d’Ivoire.• Television: Preferred television choices are internationalnews channels (BBC, Al Jazeera, TV5), African channels(e.g. Africable) or the national channels of their countriesof origin ( for example RTS for Senegal/Gambia, RTI forCote d’Ivoire).• Radio: As with television, the preferences are either forinternational channels (BBC or RFI) or for Africa-basedradio stations (Africa Nr. 1).The remaining information sources are places of public orprivate gathering. Information is mostly disseminated byword of mouth. Important meeting places are the Afro84Listening to African Voices
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Cover photo: Plan/Alf Berg - “Gir
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Within the cohort of daughters of t
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• To explore the level of awarene
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12Listening to African Voices
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• Many of them are struggling to
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1 The interviewers approached diver
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that even close friends and people
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cies. 9 The table below displays th
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4.7. FGM/C in Germany4.7.1. Estimat
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26Listening to African Voices
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illegally in Hamburg. The table is
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The largest proportions of intervie
Page 33 and 34: Reactions to the research topicThe
Page 35 and 36: A small proportion of parents annou
Page 37 and 38: Germany. Some participants reported
Page 39 and 40: In order to determine the proportio
Page 41 and 42: “I am against the practice. It ha
Page 43 and 44: Table 18: Knowledge of German law a
Page 45 and 46: gin of the immigrants (see map in a
Page 47 and 48: of the Muslims believe that practic
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Page 51 and 52: irth, their mothers come from Afric
Page 53 and 54: None of the participants named infe
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Page 61 and 62: The majority of the participants (7
Page 67 and 68: It was not an easy task to get the
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Page 71 and 72: “Female circumcision is and will
Page 73 and 74: Table 36: Proportion of women and m
Page 75 and 76: Table 37: Knowledge of German law a
Page 77 and 78: that FGM/C had been carried out in
Page 79 and 80: 5.7.1. Protective factorsThe findin
Page 81 and 82: 5.7.2.4. Low awareness and indiffer
Page 83: “The problem of female circumcisi
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Page 89 and 90: and an acceptable job, uniting the
Page 91 and 92: Daughters who were born in Africa a
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Page 97 and 98: • In order to encourage an attitu
Page 99 and 100: BEHAVIOR CHANGE MODEL: Abolition of
Page 101 and 102: Institut National de la Statistique
Page 103 and 104: 8.3. Question list for key informan
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Page 107 and 108: Evaluation of girls at riskQ214 CHE
Page 109 and 110: 8.6. Questionnaire for quantitative
Page 111 and 112: Evaluation of girls at riskQ214 CHE
Page 113 and 114: 8.7. Map of the geographical spread
Page 115 and 116: 8.9. Map of the geographical spread
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