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2020-11-23 Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology

Werunga, Jane Nasipwondi

Werunga, J. N. (2020). Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology (Unpublished doctoral thesis). University of Calgary, Calgary, AB. http://hdl.handle.net/1880/112782 doctoral thesis

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Female Genital Cutting and African Women's Migration to Canada: Toward a

Postcolonial Feminist Decolonizing Methodology

by

Jane Nasipwondi Werunga

A THESIS

SUBMITTED TO THE FACULTY OF GRADUATE STUDIES

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE

DEGREE OF DOCTOR OF PHILOSOPHY

GRADUATE PROGRAM IN NURSING

CALGARY, ALBERTA

NOVEMBER, 2020

© Jane Nasipwondi Werunga 2020

Abstract

The discourse on the cultural practice of FGC has captured a lot of attention over the last several decades, and with international migration propelling what was once a private cultural practice onto the global stage, FGC has become a fixture in the international human rights and global health arenas. FGC is a sensitive topic and the debates around it remain politically and culturally contentious. A lot of resources have been poured into eradication endeavors with multiple multinational organizations including the WHO spearheading the effort, the non-negotiable endpoint being the wellbeing, safety, and security of young girls and women.

The purpose of this qualitative interpretive description study informed by decolonizing perspectives was to critically examine how immigrant and refugee women who have experienced FGC make sense of and explain the practice for themselves and for younger generations; and to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women including their perceptions of as well as interactions with health services in diasporic locations. Participants’ understandings and agency-in-practice were analyzed through the themes of Experiencing, Explaining,

Migrating, and Mitigating FGC. A decolonizing interpretation of research findings surfaced the intersections of social, political, economic, and cultural barriers manifesting through racialized and gendered axes of exclusion and marginalization to affect the health and wellbeing of FGC-affected immigrant and refugee women in a globalized milieu.

This study highlights the importance of historical and cultural contexts in understanding and researching FGC-affected women as well as the relevance of decolonizing universal norms including in research, in order to effectively do this. This study offers an

ii alternative way of conceptualizing FGC in a transnational setting and has implications for nursing research, health services, nursing education, as well as leadership and policy.

Immigrant and refugee women affected by FGC deserve equitable, socially just, culturally responsive, and trauma-informed health services. This is in keeping with the nursing mandate of fostering health equity and social justice for all individuals. This study opens avenues for considering alternative ways of conceptualizing FGC and in doing so lives up to the interpretive description design logic.

Keywords: female genital mutilation/cutting, FGM/C, migration, African, immigrant women, refugees.

iii Acknowledgements

I would like to convey my gratitude to everyone who supported and guided me throughout this process. It did take a village. I am eternally grateful to the African women who selflessly volunteered to share their stories with me for this study. I applaud your bravery and resilience. I hear you. I see you. You deserve to tell your own stories and to be heard.

Words cannot adequately express the gratitude I have for my thesis advisor and supervisory committee members. Dr. Carol Ewashen, my chair, thank you for your gentle guidance and positive outlook, for your faith in me even during times when I could not find any reason to believe in myself, for your patience with me through challenges and frustrations, for the engaging critical conversations and book club discussions, for the uplifting talks, for sticking it out with me. For all that and more, I thank you. Dr. Sheryl

Reimer-Kirkham, your presence on my supervisory committee has been invaluable.

Thank you for seeing the potential in me, for nurturing my interest in critical theories through the guided study methodology course, for pushing me to think outside the box.

Your methodological expertise has been invaluable to my work. In addition to helping with the formulation of this thesis, you have also helped guide my research interests – I am eternally grateful to you. Dr. Andrew Estefan, I cannot thank you enough for your continuous involvement with my work, your gentle yet critical analytical feedback has helped me to be a better, more careful researcher. Thank you for valuing my work, and for your editorial feedback.

My heartfelt thanks go to my family. To my mom – Mayi, I have felt your love and prayers through the years and want to thank you for being our family’s anchor and our

iv home. Thank you for sharing your stories and the stories of our ancestors with me. To my brother Martin for your love and unwavering support through the years, asante mwenetu.

To my sister Dr. Robai who quite literally refused to let me quit, thank you for being a positive role model for me, for being my sounding board, and for being an all-around awesome big sis – asante sana. To my brilliant nephews Collins, Mitchell, Jeffrey, and

Martin Jr, I love you guys, you are going places. To my niece Nabwire, go get them little mama! The future is female!

Special thanks to my friends in Canada and the USA who were there for me and believed in me. Dr. Dada and family, thank you for your support and prayers and for being my family in Canada. Barikiwa sana. To everyone at the University of Calgary who made this process a little easier for me, thank you. I appreciate the scholarships and awards that

I received through the Nursing Faculty and the Faculty of Graduate Studies at the

University of Calgary.

v Dedication

To my mom, Khakasa Werunga ~ Thank you Mayi, for everything. I honour you along with Mayi Wakhalakwa, and all the kukhus who eternally watch over us.

And to my late dad, Musamali Werunga (Prof) ~ Orioo sana papa. You did good baba. I know that somewhere out there, you are smiling.

vi Table of Contents

Abstract ...... ii Acknowledgements ...... iv Dedication ...... vi Table of Contents ...... vii List of Tables ...... xi List of Figures ...... xii List of Abbreviations ...... xiii Epigraph ...... xiv

Chapter 1 Introduction ...... 1 Orienting to the Research ...... 3 Research Questions ...... 6 Clarifying the Theoretical Forestructure ...... 6 Critical Theoretical Perspectives for Researching FGC ...... 7 Postcolonialism ...... 8 Postcolonial Feminism ...... 9 Africana Feminism ...... 10 Black Feminism ...... 11 Womanism ...... 11 Africana Womanism ...... 12 African Feminism ...... 12 Situating Self in the Study ...... 14 Overview of Thesis Chapters ...... 16

Chapter 2: Literature Review on FGC in a Global Context ...... 17 FGC Background and Scope ...... 18 A Brief History of FGC ...... 21 Classifications of FGC and the Related Challenges ...... 23 Immediate and Long-Term Health Risks of FGC ...... 26 FGC and Terminology ...... 29 Factors Perpetuating FGC ...... 31 FGC as a Violation of Universal Human Rights ...... 34 FGC as a Violation of the Convention of the Rights of the Child ...... 34 FGC Problematic and Universalism ...... 36 FGC in Global North Countries ...... 38 FGC in Canada ...... 41 Global North Attitudes Towards FGC ...... 44 Healthcare for Women Affected by FGC ...... 45

Chapter Summary ...... 46

Chapter 3 Interpretive Description Research Design Informed by Decolonizing Perspectives ...... 48 Situating the Researcher ...... 49 Research Questions ...... 50

vii Ethics Approval ...... 51 Ethics approval was obtained from the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary (Appendix A)...... 51 Informed and ongoing consent...... 51 Confidentiality and Anonymity...... 52 Sampling Approach ...... 53 Purposive Sampling...... 53 Snowball sampling...... 53 Entering the Field: Recruitment and Selection ...... 54 Participant Demographics ...... 57 Qualitative Interviewing: Data Collection ...... 58 Semi-Structured Interviewing ...... 60 Participants’ Back Stories ...... 62 Group Interview ...... 68 Making Sense of Participant Interviews ...... 71 Data management and initial coding ...... 74 Thematic Data Analysis in Process ...... 76 Enhancing Study Credibility and Rigour ...... 78 Decolonizing Interpretation ...... 82

Chapter 4 Experiencing and Explaining FGC ...... 84 Black Womanhood as Agency ...... 85 The Agency-Structure Dialectic ...... 87 Re-presenting Black Women’s Experiences: Shards of Glass ...... 89 Experiencing FGC ...... 91 Health ...... 92 Grieving ...... 95 Recurring/Re-experiencing confusion and pain ...... 95 A time of uncertainty ...... 98 Frustrations of new understandings ...... 99 A peace-finding process ...... 102 Trauma ...... 104 Explaining FGC ...... 109 The confluence of religion and culture in justifying FGC ...... 111 Hive Mind Phenomenon and the normalizing of FGC ...... 117 The Social Dynamics Sustaining FGC ...... 121 Gender and Patriarchy ...... 122 Class and Rurality ...... 125

Chapter Summary ...... 127

Chapter 5 Migrating and Mitigating FGC ...... 128 Migrating FGC ...... 128 Displacement (Leaving home) ...... 129 Straddling Cultures ...... 133 “All eyes on you”: Racialization, Folding in, Silencing, Islamophobia ...... 137 FGC, a Dying Tradition? ...... 143

viii Mitigating FGC ...... 144 Access to Culturally Responsive Care – Gender and Generational ...... 145 Access to Trauma-Informed Care in the Context of FGC ...... 148 Relational Practice - Dos and Don’ts ...... 150

Chapter Summary ...... 157

Chapter 6 Decolonizing Interpretation ...... 159 Situating Self ...... 164 It is Tricky: Fractured Understandings of FGC ...... 170 Who Hurt You? FGC and the Blame Game ...... 171 Who Gets Viewed as Doer? African Women at Work ...... 173 Who is Speaking for Whom? Lost in Translation ...... 177 Where Does it Hurt? Intersections of Trauma ...... 183 Exits, Re-routings, and Border Crossings: Intersectionalities of Influence ...... 187 Who am I? Cultural Fragmentations and New Understandings ...... 188 Representation Matters ...... 192 Folding in: Religion as a safe space ...... 193 Mothering and Daughtering, Then and Now: Intergenerational perspectives on FGC ...... 195 Conversation ...... 197 Let’s Talk about FGC: Hybrid Spaces and Intergenerational Views ...... 199 Agency Revisited ...... 202

Chapter Summary ...... 205

Chapter 7 Conclusion ...... 206 Main Findings and Issues Arising ...... 208 What are the effects of FGC on the lives of affected African immigrant and refugee women (younger and older)? ...... 209 How has migration to Canada shaped how African women (younger and older) view FGC, including how views evolve across generations and geographies? ...211 What happens when affected African women (younger and older) interact with various health services? ...... 212 What implications for healthcare services do the understandings of FGC have for affected women (younger and older)? ...... 215 Policy Implications ...... 218 Research Implications ...... 221 Study Strengths ...... 223 Critical Reflexivity and Relationality in Decolonizing Research ...... 224 Interpretive Description Design Logic ...... 225 Study Limitations ...... 225 Disseminating Study Findings/Knowledge Translation ...... 226

Chapter Summary ...... 227

References ...... 230

ix Appendix A: ETHICS CERTIFICATE ...... 264

Appendix B: CONSENT FORM ...... 265

Appendix C: VERBAL CONSENT SCRIPT ...... 270

Appendix D: RECRUITMENT POSTER ...... 271

Appendix E: INTERVIEW GUIDE ...... 272

Appendix F: RECRUITMENT EMAIL ...... 273

x List of Tables

Table 1: FGC Classification ...... 24

Table 2: Participant Demographics for Individual Interviews ...... 67

Table 3: Participant Demographics for Group Interview ...... 71

Table 4: Evaluative Criteria and Associated Techniques ...... 79

xi List of Figures

Figure 1: Experiencing and Explaining FGC ...... 85

Figure 2: Migrating FGC and Mitigating FGC ...... 128

Figure 3: It is Tricky: Fractured Understandings of FGC ...... 171

Figure 4: Exits, Reroutings and Border Crossings: Intersectionalities of Influence ..... 188

Figure 5: Mothering and Daughtering, Then and Now: Intergenerational Perspectives on FGC ...... 197

xii List of Abbreviations

CEDAW Committee on the Elimination of Discrimination against Women FGC Female Genital Cutting FGM Female Genital Mutilation FIDA Federation of Women Lawyers (Kenya) NGO Non-Governmental Organization OHCHR Office of the High Commissioner for Human Rights UDHR Universal Declaration of Human Rights UK United Kingdom UN United Nations UNDP United Nations Development Programme UNECA United Nations Economic Commission for Africa UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations International Children’s Emergency Fund USA United States of America WHO World Health Organization

xiii Epigraph

We are victims of our history and our present. They place too many obstacles in the way of love. And we cannot enjoy even our differences in peace ~ Ama Ata Aidoo, Our Sister

Killjoy (1977).

xiv 1

Chapter 1 Introduction

The cultural practice of female genital cutting (FGC) transcends cultures and is said to predate religion (Bashir, 1995; Kelly & Hillard, 2005). According to World

Health Organization (WHO) estimates, more than 200 million women and girls are affected worldwide, predominantly in 28 African countries as well as in several countries in Europe and Asia (UNICEF, 2016; WHO, 2008). Recent estimates by the United

Nations International Children's Emergency Fund (UNICEF) point to increasing prevalence in Indonesia, a country previously not thought to have high FGC incidences

(https://data.unicef.org/resources/female-genital-mutilation-cutting-country-profiles/).

FGC is also often referred to as female genital mutilation (FGM) or female circumcision

(Njeri & Askew, 2004; Ogunsiji, Wilkes, & Jackson, 2007). Such varied terminology reflects the strife surrounding the practice between those who completely oppose the practice and others who argue for a more neutral stance aimed at inviting debate around genital cutting rather than alienating practicing communities, over terminology.1

The topic of FGC attracts much debates both within practising communities, and internationally. The debates are often contentious and tend to pit those who support the practice against those who oppose it. Central to these debates is the presumption of harm as evidenced by choice of terminology, for example with words like “ genital mutilation” and “scarring,” as well as claims of the “violation” of women’s human rights2 by anti-

1 I offer a more detailed discussion of terminology in Chapter 2. 2 A substantive discussion of FGC and human rights is presented in Chapter 2

2

FGC advocates including the WHO (Elamin & Mason-Jones, 2020; Werunga, Reimer-

Kirkham, & Ewashen, 2016; WHO, 2008).

FGC is, however, more complex than represented by a reductionist view that embeds it as a universally harmful violence against women. FGC can be deeply symbolic and meaningful for those who engage in it. For many of these communities, FGC is an essential and even beneficial practice and is by no means intended to intentionally inflict harm on women and girls (Abdulcadir, Margairaz, Boulvain, & Irion, 2011; Vissandjee,

Denetto, Migliardi, & Proctor, 2014). In fact, foregoing FGC can be detrimental to the welfare of women in these communities (Vissandjee et al., 2014). The complexity of

FGC is further compounded when viewed in the context of immigration and migration with research showing a growing influx of immigrants from countries with high FGC prevalence rates to non-practising countries in the Global North3 including Canada.

While the documented health effects of FGC are undeniable, the fact that the practice continues is testament to its endurance despite eradication endeavors, including the almost global criminalization of FGC (Jefferson, 2015; Macklin, 2006; Utz-Billing &

Kentenich, 2008). The geographic spread of the practice along with the diversity of cultures that engage in FGC signify the need for critical understanding and contextual analysis to better situate FGC within the many milieus which practicing communities and affected individuals inhabit. Any harmful cultural practice has social justice ramifications, but it is not enough for people to merely express their displeasure; rather, as Wangila (2007)

3 “Global North” is used with reference to economically developed countries located primarily in the northern hemisphere as designated by the United Nations (UN). On the other hand, “Global South” refers to developing countries located primarily in the southern hemisphere.

3 asserted, “there are universal norms that can make intercultural communication possible”

(p. 64). In other words, while there is a case, based on health outcomes, to be made for the eradication of FGC, there are cultural justifications for its continuation from the perspectives of communities who engage in it. At the heart of this debate is the health and welfare of women and girls.

Orienting to the Research

FGC has been extensively studied for decades with most studies oriented toward the reduction of harm. Scholars, policy makers, women’s groups, governments, and anti-

FGC organizations have all weighed in on this topic of stopping the practice. Multiple differing points of view have been debated including humanist, feminist, cultural relativist, and moral-ethical (Werunga et al., 2016). My interest in an interpretive description research design incorporating a decolonizing methodology arose out of the realization that the complexity and polarity of FGC requires a new understanding; one that seeks to respect the integrity and cultural values of communities which have engaged in the practice for centuries, while at the same time ensuring that the health and welfare of women and girls are respected and upheld. I was interested in learning about the ways in which affected women navigate socioeconomic structures in new cultural milieus while faced with often conflicting messages regarding a practice held as sacred by some and vilified by others.

The following headlines from print media in Canada and the United Kingdom (UK) illustrate the conflicting messages regarding FGC:

“Vagina surgery sought by girls as young as nine” (Mackenzie,

2017)

“Embodying Barbie: Cosmetic gynecology on the rise in Canada” (Zeidler, 2017).

4

These headlines, referring to the growing popularity of cosmetic gynecological procedures, are telling, particularly considering the WHO definition of FGC as the practice of injuring or cutting away all or part of the female genitalia for nontherapeutic reasons (WHO, 2008).

While there are many documented health effects attributable to FGC, the WHO, along with many countries including Canada, have criminalized all forms of FGC while allowing procedures like the ones in the quoted headlines to be carried out on women and girls in the Global North. Herein lies the conundrum, particularly when one starts to analyze cultural perceptions with regards to female genitalia.

In my interpretive description research study informed by decolonizing4 perspectives, I initially sought to interpret and describe African immigrant and refugee women’s experiences of FGC (Chapters 4 and 5), followed by a decolonizing interpretation

(Chapter 6). I sought to analyze the historical trajectory of the FGC problematic to understand how the health of affected African immigrant women continues to be shaped by this punitive colonizing history. I acknowledge the multiple contributions that have been made in efforts to better understand the practice and to work toward its eradication but as researcher, I argue that conceptual and knowledge gaps still exist particularly in the tracing of the historical trajectory of the FGC problematic, and exploring how this complex history manifests itself in affected women’s lives particularly in the context of contemporary migration. For my study, I focused on the FGC experiences of African immigrant and refugee women, which I contend cannot be fully comprehended outside their individual

4 I use the term “decolonizing” in line with Smith’s (1999) usage as a way of countering Western Colonial ways of producing knowledge especially with regards to indigenous and other marginalized communities.

5 and communal cultural histories and migratory trajectories. I also argue that women’s experiences cannot be understood in preclusion of an African feminist perspective, a traditionally marginalized critical perspective which has been shaped by colonial history

(Werunga et al., 2016).

The purpose of my research was twofold: (a) to critically examine how immigrant and refugee women who have undergone Female Genital Cutting (FGC) make sense of, and explain the practice, both for themselves and for younger generations; and (b) to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women, including their perceptions of and interactions with various health services in Canada. I sought to explore how affected women’s understandings of their FGC experiences had or had not changed over space and time, and how various matrices of domination (Collins, 2000) had manifested within intersecting structural systems of gender, race, class, ethnicity, nationality, and migration to construct the healthcare identities of these women in Canada and the United States of America (U.S.A).

I also sought to offer a critical understanding of how multiple intersecting systems of power shape the experiences of immigrant and refugee women affected by FGC, and how these systems influence women’s ability to gain access to healthcare delivery programs that offer culturally safe, socially just, timely and equitable nursing and other health care services in

Canada.

I initially recruited African immigrant and refugee women in a Western Canadian city but due to a low number of volunteer participants, I expanded recruitment to include immigrant and refugee women from across Canada. I also had one participant from the U.S

6 whom I recruited in line with the snowball sampling design utilized and with the approval of the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary.

Research Questions

For my study, I sought answers to the following research questions:

1) What are the effects of FGC on the lives of affected African immigrant and

refugee women (younger and older)?

2) How has migration to Canada shaped how African women (younger and older)

view FGC, including how views evolve across generations and geographies?

3) What happens when affected African women (younger and older) interact with

various health services?

4) What implications for healthcare services do the understandings of FGC have for

affected women (younger and older)?

Clarifying the Theoretical Forestructure

The interpretive description research design informed by decolonizing perspectives was guided by the interpretive description theory and method of Sally Thorne (2016) and by critical theoretical perspectives including postcolonialism, postcolonial and African feminism, and intersectionality. Interpretive description studies require that researchers in applied health disciplines ask questions that derive from the discipline, and that make sense of, and can provide practical answers for clinical settings (Thorne, 2016). As a nurse, I am tasked with utilizing theoretical knowledge to alleviate health issues and improve the well- being of individuals and populations. FGC has impact upon the health of affected immigrant women and their families, and the questions I sought answers to needed to not

7 only make sense to these women, but to also influence theirs and their families’ health and well-being.

My choice of the interpretive description research design informed by decolonizing perspectives reflects my standpoint, which is that there are many forces at play when it comes to FGC as seen in the never-ending debates surrounding the practice, and that no one perspective can sufficiently capture this complexity. Interpretive description allows for an emancipatory methodological logic model (Thorne, 2008, 2011, 2016; Thorne,

Kirkham, & O’Flynn-Magee, 2004) in which the research question drives the design, fieldwork, and eventual organization and analysis of data in a clear manner in an effort to

“deconstruct” what may already be known and arrive at some new “truth claims” that might help explain why things are the way they are (Thorne, 2016). The process is systematic and allows for interpretations within contexts that might otherwise be deemed too subjective and complex (Thorne, 2016); interpretations that can have actual practice implications for marginalized populations and communities (Thorne, 2011). The complexity of the FGC lends itself to this kind of research design. I detail the critical theoretical perspectives which informed my decolonizing methodology in the next section.

Critical Theoretical Perspectives for Researching FGC

Critical inquiry is a genre that incorporates theories that analyze discourses on social justice, advocacy, and power dynamics within social and cultural institutions, and have their roots in the Frankfurt school of thought (Reimer-Kirkham & Anderson, 2010;

Werunga et al., 2016). My choice of critical perspectives was in keeping with the purpose of my study, which was to explore the interlocking mechanisms of oppression and

8 exclusion (Collins, 2000) that structure the everyday health experiences of African immigrant and refugee women in diaspora.

Critical theories that informed my decolonizing methodology included postcolonialism, postcolonial feminism, Africana feminism, Black feminism, Womanism,

Africana Womanism, and African Feminism. These theories had a cumulative effect in the way they impacted my approach to this research on the experiences of African immigrant and refugee women who have experienced FGC. Next, I offer brief discussions of each of the critical theories.

Postcolonialism

Postcolonial theories span multiple discursive spaces and continue to spark debates, given the different meanings that scholars ascribe to the term postcolonial

(Loomba, 2015; Khan et al., 2007). In the very basic sense of the word, colonialism refers to the conquests exerted by European empires. Oyěwùmí (1997) referred to the three Cs of empire, namely colonialism, Christianization, and civilization as the root causes of much of the cultural strife that exists globally in former colonies as well as in neocolonial diasporic spaces. Some African scholars have argued that the civilizing mission of colonialism led to the construction of the FGC problematic (Njambi, 2004). Tracing the historical trajectory of postcolonialism reveals an attempt by both colonizers and the colonized to reckon with the always present manifestations of empire (Loomba, 2015;

Khan et al., 2007). Khan et al (2007) summed up the basic premise of the postcolonial theory which is that it helps to generate different discourses that question established mainstream discourses by “giving voice to those who have been marginalized by history and viewed as other” (p. 231).

9

For my research, I drew on the colonial works of Fanon (1963, 1967), Thiong'o

(1994), Said (1979), and Bhabha (1994). Fanon and Thiong’o called attention to the indignities that were visited upon colonized subjects and the resulting psychological manipulation (Werunga et al., 2016). Evidence of these indignities exists in the form of neocolonial hegemonic practices that serve to define the norm based on standards of

Whiteness while alienating the nonconforming “other.” In his earlier writings, Thiong'o

(1994) attempted to “decolonize” African minds by urging Africans to reclaim their native languages particularly in rewriting their history. Fanon’s approach was more militaristic, especially with his call to the black man to resist white domination by any requisite means (Fanon, 1963). For his part, Said (1979) set in motion an era of theorizing difference differently by questioning the flawed nature of the knowledge that was produced by the West about non-western colonized people (Khan et al., 2007; Kirkham

& Anderson, 2002; Werunga et al., 2016). This questioning of hegemonic knowledge projects endures to date with the growing fields of critical inquiry, decolonizing methodologies (Smith, 1999, 2013), and intersectional inquiry (Crenshaw, 1991) which I utilized in this research.

Postcolonial Feminism

Postcolonial feminism can be said to have arisen out of necessity through integration of the postcolonial and black feminist theories (Khan et al., 2007). Black feminism emerged during the third wave of feminism as a response to the postmodernist and poststructuralist theories which, although well intentioned, were still seen to be operating from the white-dominated centre and ignoring those on the margins (hooks,

1984; Kirkham & Anderson, 2002). Research in the postcolonial tradition can be said to

10 be emancipatory and social justice oriented (Reimer-Kirkham & Anderson, 2010) given its focus on the inclusion of silenced others in knowledge production and its emphasis on analyzing historical relations that still serve to marginalize and create inequalities based on multiple axes of exclusion (Collins, 2000; Norwood, 2013) including gender, race, ethnicity, class, and for many, location and culture (Reimer-Kirkham & Anderson, 2010;

Werunga et al., 2016).

Africana Feminism

I refer to Africana feminism in this research as an all-encompassing movement which addresses the experiences of women in different locations around the globe who have endured the conditions of colonialism, patriarchy, slavery, along with other multiplicative systems of oppression (Norwood, 2013). I, however, remained aware that all knowledge is situated (Haraway, 1988) and contextual, particularly within the critical theoretical traditions in which I embedded my decolonizing research. Concurrently, I remained committed to tapping into the similarities inherent in the colonial and gendered realities of women in Africa, as explicated by Africana feminists (Carastathis, 2013,

2014; Norwood, 2013). Africana feminism includes the feminisms in Africa, the

Caribbean, and North America, all of which continue to operate within colonized

(neocolonial) spaces. Norwood (2013) effectively summed up this dynamic when she described Africana feminists as “inherently rebellious and unapologetically anti- imperialist, antiracist, anti-sexist, and (recently, since the third wave), anti-homophobic”

(pg. 226). Africana feminism includes the aforementioned black feminism, womanism, and Africana womanism (Blay, 2008). I will now briefly discuss each of these strands.

11

Black Feminism

Patricia Hill Collins is credited with originating this line of thought. In her book

Black Feminist thought: Consciousness, and the Politics of Empowerment (Collins,

1990), she theorized the global “matrix of domination” that black women experience.

Collins referenced the exploitation of what she terms women of color transnationally along the axes of gender, class, and sexuality as a unifying factor for this particular sisterhood (emphasis mine). While Collins emphasized the multiplicative nature of oppressions, she was nevertheless doing it from a black American standpoint, which can be said to be privileged given its situatedness in the Global North. Nevertheless, black feminism helped to influence the decolonial thinking that I aligned with given the diasporic location of the immigrant and refugee women in this study.

Womanism

Alice Walker is credited with originating this form of inquiry. Like Collins,

Walker (1983) also refers to women of color and black feminists in defining her notion of womanism, a reference to the gendered and raced identities of Black Americans. She also referenced Black culture within which Black people can liberate themselves. However,

Walker’s Global Northern location became apparent when she spoke about FGC, opting to call it “mutilation” instead of circumcision or cutting that were the more preferred terms in the 1970s and 80s. Walker’s theorizing is relevant to my research on FGC not only for her privileging of Black experiences but also for the critical scrutiny that her theory invites for researchers interested in this line of thinking.

12

Africana Womanism

As with the aforementioned theories, Africana womanism is embedded in African culture with Hudson-Weems (2000) as the major proponent. This theory differs from

Walker’s (1983) womanism in that it problematizes the privileging of gender over other intersections including racism. Hudson-Weems used the language of “sisterhood” and

“male compatible” among the attributes that a woman should possess. As with the rest of the Africana feminist strands, this theorizing is situated and partial (Harraway,1988;

Collins, 2000) but adds to the body of knowledge in the decolonizing tradition.

African Feminism

African feminism is perhaps the most marginalized of feminist theory. Organizing and activism by women have existed in African communities for millennia. In contemporary Africa, African women risk their lives daily to organize and theorize about mainstream as well as subjects that are considered taboo within the general African context that affect women, girls, children as well as men (Oloka-Onyango & Tamale,

1995; Salo, 2013; Tamale, 2011). And yet one would be hard pressed to find works by

African feminists within mainstream diasporic discursive spaces. An exemplar of this is with my discussions on Africana feminism above where black feminists and womanists invoke the notions of a sisterhood and African culture without giving mention to how black theorists outside the North American milieu have contributed. African feminists centre context in theorizations of Africa and its peoples (Oyewumi, 1997; Salo, 2013,

Tamale, 2008, 2011).

Along with the centring of cultural experiences, African feminism oppose the universalization of Western notions of gender that are not congruent with African

13 realities; for example, the invention of the categories “gender” and “woman” which were non-existent in some African cultures before colonization and empire (Oyewumi, 1997).

This tendency to universalize is particularly applicable to FGC given the global gaze that this topic has elicited for decades. It is perhaps easy to default to universalization relating to FGC in diasporic cultural spaces, but as Blay (2008) reminds us, Africa does not cease to exist when persons cross oceans. Additionally, as Wangila (2007) asserted, African women do not “throw stones” (p. 145), a reference to the ambivalence that some African women face when it comes to cultural practices like FGC, particularly assessing it as harmful and illegal. Researchers need to consider the complexity of African cultures when researching African women in any given location.

For me, African feminism cannot be precluded from research on issues that affect

African immigrant and refugee women and girls. Doing so would propagate the erasure and silencing that Africans have endured in global discursive spaces for millennia

(Oyewumi, 1997). Transformational change can only occur within inclusive and decolonized discursive spaces where knowledge production involves all the consumers of knowledge, particularly racialized, gendered, classed, and marginalized groupings around the world (Werunga et al., 2016). As Lorde (1984) argued, discussions within the feminist tradition that are not representative of all women are essentially flawed. If flawed research produces flawed results, then it follows that the utility of such knowledge becomes questionable when it is applied in practice.

With regards to FGC, research efforts have existed for decades and even predate the construction of the FGC problematic. While there has been much progress in terms of meeting the needs of girls and women as well as efforts to eradicate the practice, it is

14 evident that FGC is not going away anytime soon. The upward revision of worldwide

FGC prevalence statistics according to a report published by the UNICEF5 in 2016 (from

120 to 140 million women and girls to 200 million) highlights the magnitude of the problem.

Taken together, the critical theories discussed previously, all served to inform my research study and in particular the decolonizing methodology. I view these critical perspectives as having a significant effect in how they related to and influenced my understanding of the experiences of African immigrant and refugee women who have experienced FGC.

Situating Self in the Study

My role as a critically reflexive decolonizing researcher required that I bring to this research awareness of my personal assumptions, values, and biases so that I could be more mindful of how my pre-understandings might impinge on the process including the interviewing and analysis of research data. I, however, remained aware that I could not entirely separate myself from my research as in interpretative description research, the researcher serves as a filter for participants’ stories, constructions, as well as for the truth claims that emerge from the data. Lather and Smithies (1997) referred to this researcher experience as “both getting out of the way and getting in the way” (p. xiv) with the researcher in actuality writing themselves into the participants’ stories (Evans-Winters,

2019). This reflexivity is also in line with decolonizing work (Bhattacharya, 2007).

5https://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf

15

My perceptions of FGC are shaped by my personal experiences. I was born and raised in Kenya, one of 28 African countries where FGC is practiced. In my younger years, I viewed FGC as one of many cultural practices that different tribal groupings engaged in, and did not pay much attention to it, especially since my tribe did not practice it. In my teenage years, I started hearing about the eradication narrative, mostly through foreign-funded but locally based nongovernmental organizations (NGOs), which were advocating for the rights of the African girl-child at the time. The local narrative back then was measured and respectful, particularly in the usage of language describing the practice but this started changing over time with more NGOs and anti-FGC activists referring to cutting as FGM. It was also around this time that I learned through snippets of information from my mom that she had also undergone FGC, having run away from home with other teenage girls to get it done in a neighboring village against my grandparents’ wishes.

I became more aware of the practice when I moved to North America and especially when I became a Registered Nurse and recognized my unique cultural location as an African immigrant and health professional. My interest in this research topic certainly stemmed from this unique cultural space, and as a researcher, interpretive description calls on me to continually interrogate aspects within my “spaces” that I might unknowingly reproduce in this study (Thorne, 2016). I had to continually remind myself that I am but a learner who can aid the process of translating this unique knowledge through what Moosa-Mitha (2005) referred to as an attitude of “empathic imagination” along with self-reflexivity, while honouring the agency of the subaltern; the women who have actually lived through FGC.

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Overview of Thesis Chapters

In this introductory chapter, I provided relevant background information on the

FGC problematic, introduced the significance of my study for understanding FGC experiences of African immigrant and refugee women, clarified the interpretive description research design and offered a brief description of the critical theories which informed my decolonizing methodology. Additionally, I outlined the research questions for the study and situated myself as researcher. In Chapter 2, I review and synthesize the

FGC literature including a review of terminology used to describe the practice of FGC. In

Chapter 3, I discuss the interpretive description research design informed by decolonizing perspectives. In Chapters 4 and 5, I present the study findings as constructed through thematic analysis using interpretive description. In Chapter 6, I discuss a deeper decolonizing interpretation of the study findings. In Chapter 7, the final chapter of this dissertation, main study findings and issues arising are discussed including strengths and limitations of the study, and recommendations for future nursing practice, policy, and research.

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Chapter 2: Literature Review on FGC in a Global Context

In interpretive descriptive studies, a review of the literature is one of two elements that Thorne (2016) sees as crucial to the “scaffolding of a study,” that is, the laying down of the structural foundation from which a study emanates. In conducting a review of the literature, a researcher is able to examine a proposed clinical problem in view of what has already been studied and concluded about the topic in order to determine if the topic is worth studying, and if so, what new insights the new study adds to the science (Thorne,

2016). The other element of the scaffold according to Thorne is the clarification of the theoretical forestructure and locating oneself as researcher within the study, aspects of which I have covered in Chapter 1. Thorne contends that a solid scaffold with all constituent parts ensures a solid research product.

The topic of FGC has garnered a lot of attention around the globe and has subsequently been extensively studied both in individual practising countries in Africa,

Asia, and the Middle East as well as in global diasporic locations which attract immigrants from FGC source countries (Gharib, 2019). The more I dove into the literature on FGC, the more I realized that this is a cultural practice that has been studied ad infinitum making it a virtual impossibility to effectively represent all of the information and studies in one dissertation. For my purposes, I focused on the literature which I deemed to be relevant to my research purpose. I focused on reviewing background literature on the FGC problematic as a preview to the globalized context of

FGC. I also reviewed literature on FGC within a globalized post-migration context in order to assess the current state of knowledge on FGC and healthcare in diaspora. I retrieved information from various sources including the academic search engines

18

CINAHL, Medline, Web of Science, Google Scholar, ERIC, EBSCOhost, ProQuest,

ResearchGate, internet websites, and some grey literature. Additionally, I reviewed FGC information from organizational websites including the WHO and UNICEF.

I conducted my search using the following keywords which I used individually and in combination: female genital cutting, female genital mutilation, FGC, FGM,

FGM/C, circumcision, African immigrant women, African refugee women, African women, African immigrants, immigrant women, FGC and migration, Canada. I included published research studies, the majority of which ranged from 2000 to 2020 in order to capture the progression of FGC knowledge over the last two decades for purposes of understanding trends, particularly in the context of migration. I also included literature to capture the historical colonial-cultural nexus of FGC. In the next section, I offer a discussion of this literature while paying attention to gaps as well as emerging questions.

FGC Background and Scope

The WHO defines FGC as comprising “... all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.”6 It is worth noting that the WHO uses the designation female genital mutilation (FGM) with the word “mutilation” used to emphasize the gravity of an act which it deems as harmful to women and girls WHO (2008). To “mutilate” according to the Oxford dictionary, is to “inflict a violent and disfiguring injury on someone or to inflict serious damage on something.”7 I discuss FGC terminology and its usage in more

6 World Health Organization: http://www.who.int/topics/female_genital_mutilation/en/ Accessed August 24, 2020 7 Oxford online dictionary: http://www.askoxford.com/?view=uk Accessed August 24, 2020

19 detail later in this chapter. The UNICEF (2016) maintains a database of FGC statistics based on availability of this information from countries around the world. Consequently actual statistics on FGC globally are not known as not all countries maintain these data, but based on the available data, the WHO estimates that over 200 million girls and women worldwide have been subjected to FGC including 91.5 million girls and women above nine years old in Africa and over three million girls at risk of being subjected to

FGC each year.8 FGC is said to be practised widely in the western, eastern, and north- eastern regions of Africa, in a few countries in Asia and the Middle East, among certain ethnic groups in South and Central America and among some immigrant communities in

North America and Europe,9 (Mulongo, McAndrew, & Hollins Martin, 2014; Raya,

2010; Berg & Denison, 2013).

The practice of FGC leaves in its wake immense human and financial costs in terms of direct health effects on affected women and girls as well as the burdens to healthcare systems in countries where cut women and girls reside owing to these associated complications (El-shawarby & Rymer, 2008; Rymer, 2003., WHO, 2008;

Yoder, Noureddine, & Zhuzhuni, 2004). As a result of these complications and given the dispersion of the FGC problematic around the globe, multinational agencies have come up with various ways to try and counteract the problem while attending to women and girls. For instance, the WHO (2008) along with other agencies have come up with

8 WHO 2008; https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation Accessed August 24, 2020 9 Ibid

20 publications aimed at managing the complications of FGC,10 guiding the provision of care for women and girls affected by FGC,11 curbing the medicalization of FGC,12 as well as the interagency statement for the elimination of FGC.13 While these documents target global stakeholders, and while societies around the world have historically engaged in genital cutting and other ways of modifying human bodies14 (Crossley, 2005;

Featherstone, 1999), the FGC problematic focus on Africa and within the African diaspora makes it so that global efforts toward tackling FGC often amount to a collective global gaze, a frowning upon Africa, and an indictment of a cultural practice born out of the continent and for which the continent is denigrated. I once shared with my thesis supervisor how frustrating it was to try and have a productive discussion on FGC with academic and industry peers when there were so many preconceptions about it, and when most people were generally disgusted by it. This was after I had attended and presented my research on FGC in the context of migration at a few academic conferences in Canada and witnessed the expressions of pity and disgust firsthand. It is worth acknowledging however, that perceptions about FGC are rooted in individual belief systems and cultural conditioning (Csordas, 1999) which in turn guide people’s responses to the practice. In

10 https://www.who.int/publications/i/item/who-guidelines-on-themanagement-of-healthcomplications- fromfemale-genital-mutilation Accessed August 24, 2020 11 https://www.who.int/publications/i/item/care-of-girls-and-women-living-with-female-genital-mutilation Accessed August 24, 2020 12 https://www.who.int/publications/i/item/global-strategy-to-stop-health-care-providers-from-performing- female-genital-mutilation Accessed August 24, 2020 13 https://www.who.int/publications/i/item/eliminating-female-genital-mutilation-an-interagency-statement- --ohchr-unaids-undp-uneca-unesco-unfpa-unhcr-unicef-unifem-who Accessed August 24, 2020 14 This study does not allow for a full exploration of the practice of human body modifications although it has been studied across various disciplines

21 the next section, I discuss the historical origins of FGC to offer a contextual understanding of how it came to capture the intrigue of the entire globe as a problematic.

A Brief History of FGC

While FGC is primarily seen as analogous with Africa (Mulongo, McAndrew, &

Hollins Martin, 2014), its existence for reasons such as health, beauty, and religion has been reported in multiple locales across the globe (Hellsten, 2004; Johnsdotter & Essen

2010) including in the USA and the UK where it is said to have been performed by physicians in the 20th Century (Toubia, 1994) to “treat hysteria, lesbianism, masturbation, and other so called female deviancies” (p. 225). The origins of FGC are not expressly known but the practice is said to predate all religions including Judaism, Christianity, and

Islam and is said to have been practiced within all these religions (Gharib, 2019;

Gruenbaum 2001; White, 2001). The earliest tracings of the practice in Africa can be linked back to its adoption by ancient Egyptian Pharaohs (Gharib, 2019; White, 2001) but others have argued that FGC has historically existed in African contexts as an important rite of passage from childhood to puberty and adulthood (Dorkenoo & Elworthy, 1992;

Dorkenoo, 1994; Njambi, 2004).

Origins notwithstanding, FGC has become contentious and political with discourse on the practice framed in terms of sexual, reproductive, and human rights

(Ford, 2006; Mulongo, McAndrew, & Hollins Martin, 2014; Shell‐Duncan, 2008; WHO,

2006, 2008, 2013, 2016, 2018) as well as migration and issues of asylum (Gallagher,

2005). Along with discourse on eradication and attending to health consequences (WHO,

2008, 2013), and because of global migration of African immigrants and refugees to

Western countries (Werunga et. al., 2016), a once localized cultural practice has now

22 become entrenched as an issue of global health concern (Abusharaf, 2006; Berg &

Denison, 2013).

FGC was not always viewed as problematic by practising communities in Africa but was instead revered by many practising communities (Abusharaf, 2006). The vilification of the practice along with the advent of, and the reification of Western perceptions of symbolically unmutilated bodies (Johnsdotter & Essen, 2010; Njambi,

2004; Werunga et. al., 2016) can be traced back to colonialism and the civilizing presumptions of the colonizers with perceptions that were rooted in views of the primitivity of African cultures as well as the presence of “docile” and “unnatural” bodies in need of fixing (Abusharaf, 2006; Comaroff, 1993; Njambi, 2004, 2007, 2011). An understanding of the invention of the FGC problematic cannot, therefore, be delinked from the politics of empire that still play a central role in current FGC discourse, a politics which is rooted in the three Cs of empire: colonialism, Christianity, and civilization (Abusharaf, 2006; Njambi, 2004; Thiong’o, 1986; Werunga et. al., 2016).

FGC eradication endeavours in Africa can be traced back to activities by the

British empire in their then colonial protectorates of Kenya and Sudan in the early 19th

Century (Gruenbaum, 2001; Njambi, 2007; Thomas, 2000). Historical accounts point to the apparent cultural shock and horror experienced by British colonial administrators on encountering FGC in the Sudan, and the resultant enactment of prohibitive laws as an attempt at rescuing Sudanese women and girls from the practice in contravention of cultural and social norms (Abusharaf, 2006). Similarly in Kenya, presumably mortified

23

British administrators attempted to use the spread of Christianity15 as an FGC deterrent among practising tribes including the Kikuyu, Maasai, and the Kisii tribes in attempts to reconcile their colonizing agendas and their religious agendas (Comaroff, 1993; KDHS16

2008-9; Njambi, 2007; Thomas, 2000). While these early punitive, norm-flouting attempts by the British colonial administrators did not succeed in eradicating FGC largely due to resistance from practising communities (Wangila, 2007), they served as precursors to the present-day global FGC discourse with some of the same tactics including criminalization and punitive naming practices, still at play (Abusharaf, 2006; El Bashir,

2006; Njambi, 2007).

Classifications of FGC and the Related Challenges

The WHO (2008) classifies FGC into four typologies for ease of distinction

(Table 1) but it is worth noting that these distinctions do not fully capture the diversity in cutting technique and the inherent heterogeneity of the practice within and between cultures (Njambi, 2011; Nnaemeka, 2005). According to the WHO (1996b), classifying

FGC in this way helps in a number of ways including facilitating research and data comparison; monitoring prevalence and trends around the world; managing health consequences of FGC; interpreting legal statutes relating to FGC; as well as the management of reviews, consultations, and evaluations regarding FGC. The WHO classification system shows a trend in severity of FGC ranging from a relatively benign

Type I to the more severe Type III (infibulation) with a general understanding that

15 There is extensive interdisciplinary literature on FGC and colonialism in Kenya and other African countries including the role of resistance movements. 16 Kenya Demographic and Health Survey

24 severity is based on the amount of tissue that is cut off from the female genitalia. But while the severity of genital tissue cutting tends to increase from Type I to III, the WHO

(2008, 2013) cautions that there are exceptions therein based on different factors including the age at which FGC is performed which may impact healing times and severity. So for example Type II which involves the removal of the labia majora is deemed to be more severe than Type III which involves only the removal of

Table 1

FGC Classification

Typology Definition

Type I Partial or total removal of the clitoral glans and/or the prepuce/clitoral

hood.

Type II Partial or total removal of the clitoral glans and the labia minora, with or

without excision of the labia majora

Type III Narrowing of the vaginal orifice with creation of a covering seal by

cutting and repositioning the labia minora or the labia majora, with or

without excision of the clitoris (infibulation).

Type IV All other harmful procedures to the female genitalia for non-medical

purposes, for example: pricking, piercing, incising, scraping and

cauterizing the genital area

Note Adapted from WHO (2008). Female Genital Mutilation Factsheet the labia minora. Additionally, the notion of severity depends on the effect of FGC on women meaning that for example, women who see FGC as having impacted their sexual

25 function due to the removal of the clitoris would rate Type I as more severe than some forms of Type III which leave the clitoris intact (WHO, 2008).

Based on the WHO nomenclature, the first two types of FGC make up 80% of all

FGC cases in Africa while Type III, which is prevalent in the Sudan and Somalia, accounts for 15% of total African cases (World Bank & UNFPA, 2004). However, variations exist even within each typology suggesting that the WHO nomenclature, at best, serves as a placeholder for multiple, heterogenous FGCs (Abusharaf, 2006;

Gruenbaum, 2001; Obermeyer, 1999). As Klouman, Manongi, & Klepp (2005) and

Msuya et al (2002) noted, many studies fail to specify the type of FGC performed on women and instead only mention that a woman has been cut. Other studies show that while women might report having had a particular type of FGC, assessments by medical professionals familiar with the practice and typologies might refute these self-reports

(Elmusharaf, Elhadi, & Almroth, 2006) further casting doubt on the WHO nomenclature.

For instance, according to Gordon et al (2007), women who had visited a London clinic to have their infibulation reversed were found to have intact clitorises although they were classified as Type III FGC which includes the removal of the clitoris as a criterion. This points to the ongoing challenges with classifying FGC.

Additionally, there is no common agreement on the amount of tissue removal that coincides with a specific typology of FGC meaning that different health professionals can define FGC differently and this has implications for the type of harm that is then attributed to the type of cutting. For example, some studies describe Type I as involving the removal of the prepuce (Thabet & Thabet, 2003) while others see it as involving the removal of both the clitoris and the prepuce (Satti, Elmusharaf, Bedri, Idris, Hashim,

26

Suliman, & Almroth, 2006). Type II is even more confusing as it may involve the cutting of the clitoris alone; the cutting of both the clitoris and the prepuce or the cutting of the prepuce while leaving the clitoris intact (Almroth, Elmusharaf, El Hadi, Obeid, El

Sheikh, & Elfadil, 2005). Type III is also challenging in that while the clitoris may be cut or left intact, there are variations in the extent to which the vaginal opening is sealed

(Almroth et al., 2005).

Type IV is even more complicated when one considers its all-encompassing definition (Table 1) and as some earlier researchers noted, technically, piercing, pricking, and incising do not involve modification of the genitalia and were therefore viewed as questionable as FGC (Obiora, 1996. Nevertheless, the WHO chose to proceed with this classification in anticipation of its potential exploitation by those intending to use it as justification for the performance of more severe forms of FGC (WHO Somalia, 2002).

Additionally, retaining FGC under the Type IV category would also have helped in the campaign against FGC as well as acting as a deterrent for those who would take advantage of any loopholes to perform FGC on young women and girls due to social and cultural pressures.17

Immediate and Long-Term Health Risks of FGC

While FGC has no known health benefits, it results in immediate and long-term health risks and complications. According to the WHO (2008), the immediate complications include severe pain, shock, haemorrhage, infections, urinary retention, open

17WHO 2008; Eliminating Female Genital Mutilation; Inter Agency Statement:http://www.unfpa.org/upload/lib_pub_file/756_filename_fgm.pdf Accessed August 25, 2020

27 sores in the genital region and injury to nearby genital tissue.16 Long-term complications include recurrent bladder and urinary tract infections, development of cysts, infertility, increased risk of pregnancy complications and newborn deaths, and the need for later surgeries as in the case of infibulation and defibulation.18

In terms of immediate health effects, study findings show that FGC which is often carried out without anaesthesia can cause severe pain and trauma (Almroth et al., 2001;

Bikoo, 2007; Catania., Abdulcadir, O., Puppo, V., Verde, J. B., Abdulcadir, J., &

Abdulcadir, D. 2007; Chalmers & Hashi, 2000; Gharib, 2019; WHO, 2008, 2013). Other study findings indicate that the use of force and physical restraint can cause lasting trauma for women and girls (Dare et al., 2004). A study by El-Defrawi et al (2001) found that some girls and women who had undergone FGC reported having difficulties with passing urine and sometimes faeces due to edema, swelling and pain. Still other studies found that

FGC often involved the use of crude, unhygienic and unsterilized tools which were often reused and in certain cases caused the spread of infections (Morison et al., 2004).

In terms of long-term health effects, studies have showed that FGC can lead to recurrent infections through the lifespan for some women (Gharib, 2019; Kaplan-Marcusan et al., 2009; Kaplan, Forbes, Bonhoure, Utzet, Martín, Manneh, & Ceesay, 2013; Kaplan,

A, Hechavarría, Bernal, & Bonhoure, 2013; Kaplan, Hechavarría, Martín, & Bonhoure,

2011; Thierfelder, Tanner, & Bodiang, 2005; WHO, 2008). These include genital ulcers, abscesses and cysts; chronic pelvic and back pain; and, keloids, genital herpes and the

18 WHO; Female Genital Mutilation, Key facts; http://www.who.int/mediacentre/factsheets/fs241/en/index.html Accessed August 25, 2020

28 infections of the reproductive and urinary tract which could result in septicaemia, kidney failure and even death. Some studies also associate FGC with chronic adverse pregnancy- related outcomes (Banks et al., 2006; Gharib, 2019). One collaborative prospective on FGC and obstetric outcomes carried out by the WHO in six countries in the Horn of Africa and

West Africa involving 28, 393 participants, found that FGC is associated with multiple adverse obstetric outcomes including complicated caesarean section, chronic bleeding, necessity for episiotomies at childbirth, urinary tract infections, extended hospital stays, genital infections, resuscitation of the infant, still births, perineal injury, prolonged and obstructed labour, and postnatal maternal and infant deaths (Banks et al., 2006; WHO,

2006). The findings from this WHO study led to multiple health initiatives and subsequent research aimed at safeguarding the lives of pregnant women affected by FGC along with their unborn babies (Balfour, Abdulcadir, Say, & Hindin, 2016; WHO, 2011; Wuest et al.,

2009; Liao & Creighton, 2007). A study by Njue & Askew (2004) indicated that infibulation, which involves partial sealing of the vaginal opening, interferes with urinary and menstrual flows which may require surgical interventions. Other studies have found that FGC can cause painful sexual intercourse (Gruenbaum, 2006) and decreased sexual sensitivity (Elnashar & Abdelhady, 2007) which have implications for quality of sexual life. FGC is also associated with infertility (Almroth et al., 2005) and often leads to defibulation (Berggren et al., 2006) These immediate and long-term health effects attributable to FGC provide ample justification for the attention that the FGC problematic draws across the globe and for the multiple strategic efforts and interventions, including by healthcare practitioners (Braddy & Files, 2007) to treat FGC-affected girls and to eliminate

FGC.

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FGC and Terminology

Often within practising communities, FGC is considered a part of everyday life and culture (Njambi, 2004) therefore the idea of harming or “mutilating” women and children is as foreign to practising communities as FGC is for some people in the Global

North (Shell-Duncan & Herlund, 2006, 2008). Fran Hosken, a radical feminist, is credited with coining the term FGM, a term which was taken up by the WHO and other global organizations19 as well as by anti-FGC activists in both the Global South and the

Global North. The term FGM is generally used by those who are against the cutting of any part of the female genital organ (Ogunsiji, Wilkes, & Jackson, 2007), as well as in anti-FGM discourse (Njambi, 2004). Those who oppose this terminology argue that FGM is more typical of Global North societies and can be considered a reflection of Global

North values. However, in societies where the cutting of some parts of female genitalia is considered a cultural norm, terminology such as female circumcision, surgery, or cutting are more typical (Ogunsiji et al., 2007; Shell-Duncan & Hernlund, 2006, 2008). Other traditional names for FGC include halalays and qodiin (Somalia), kutairi (Kenya), megrez (Ethiopia), niaka (Gambia), thara (Egypt), and sunna (Nigeria and Sierra Leone)

(Terry & Harris, 2013). The term circumcision often fails to capture the specificity of nuance within particular cultural groupings (Njambi, 2011). In most cultures, the choice

19 The Term FGM is used in all international declarations and consensus documents, human rights conventions, international agencies and the U.N. General Assembly statements and documents. This is also the language used on most legal documents in African countries which have criminalized FGC as well as The Inter-African Committee on Harmful Traditional Practices (IAC), which has chapters in all African countries where FGC is practiced.

30 of name reflects the meaning attached to the practice (Ogunsiji, Wilkes, & Jackson, 2007) for example, tahara means purification for Arabic speakers (Abusharaf, 2006), while for the Kikuyu tribe in Kenya, irua means initiation which captures the processes of becoming adult women inherent to the practice of FGC (Njambi, 2011).

The issue of language with regards to FGC dates back to the very first encounters between practicing communities in Africa and European colonizers (Njambi, 2004) but remains polarising particularly in the global fight against FGC. Some scholars like

Njambi (2004, 2011) blame the usage of what they deem as polarizing terminology for the resistance to change by some practising communities. It is, however, worth noting that various African organizations including the Federation of Women Lawyers (FIDA)20 also use the term FGM in grassroots eradication efforts having adapted the messaging of some of their development partners. The variety of terminology can present challenges for researchers particularly during fieldwork as some practicing communities take offense at the use of the term ‘mutilation’ and consider it disrespectful (Ogunsiji et al., 2007). It was with this critical understanding of the effect of language that I opted to use the more neutral FGC in my research study except when referencing global and anti-FGM literature or at the request of study participants. While the term FGM is still widely used, the WHO (2006) opted to compromise and use FGM/C to show respect for practising communities while still emphasizing the gravity of the topic, with the exception of particular declarations and documents where FGM is still used.

20FIDA. http://fidakenya.org Retrieved on August 31, 2020

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Factors Perpetuating FGC

The WHO (2008) describes the causes of FGC as a mix of cultural, religious and social factors within families and communities. These include social conventions, social pressure, rite of passage to adulthood and marriage, prevention of premarital sex, preservation of virginity and marital fidelity; cleanliness, beauty, femininity and modesty; religious reasons; local structures of power and authority; acculturation; assimilation; and new immigrants.21 A 2005 study by UNICEF22 showed that social and economic inequality have disempowered women from actively participating in matters that affect their life with many women in FGC-prevalent countries relying on infibulation as a gateway to marriage and economic stability. Gruenbaum (2006) noted that systems of patriarchy serve to deny women equal opportunities for self-determination and instead subject them to a life of dependency first on their parents and later on their husbands.

Decisions about FGC often involve members of the extended family as well as the immediate community in which FGC is practiced (Njambi, 2004; WHO, 2008), therefore, in many ways, women’s ability to make their own decisions is curtailed and remains at the whim of their community’s social conventions. Hence, any intervention to end the practice requires community consultations. Additionally FGC is deemed as an important rite of passage from childhood to adulthood which contributes to its perpetuation (Bikoo, 2007;

Catania et al., 2007; Njambi, 2004). This view is echoed by Ahmadu (2000) who observed that un-infibulated girls may not be allowed to participate in community activities, special

21 World Health Organization: http://www.who.int/mediacentre/factsheets/fs241/en/index.html Accessed August 25, 2020 22 https://www.unicef.org/publications/files/FGM-C_final_10_October.pdf Accessed September 2, 2020

32 women roles, or get married before undergoing FGC in communities where the practice is considered normal and any deviating from it as abnormal.

While social pressure and societal norms contribute to FGC (Momoh, 2004), some girls make personal decisions to go through with it, sometimes against their parents’ wishes, as they fail to visualize living without having the cut especially if their peers are cut (Behrendt, 2005). Studies show that noncompliance may lead to ostracism, punishment, scorn, shaming, rejection, stigma, and harassment while compliance is met with social acceptance, recognition and status in the community (UNICEF, 2005a). In some practising communities, FGC is seen as a source of pride and identity and is associated with more rewards than harms (Njambi, 2004). Kenyatta (1938) wrote about girls from his Kikuyu tribe bringing their own razors and participating in mass circumcision following the introduction of anti-FGM legislation by British colonial administrators in Kenya in 1954.

For the Kikuyu tribe, FGC was meaningful to both men and women as induction into their riika (age group or generation) with full advantages including the ability to make decisions and own property (Njambi, 2004).

Some studies indicate that purity and virginity of girls before marriage are held with high regard in communities where FGC is practiced (Hernlund, 2003) and in some of these communities, FGC has been used as a mechanism to limit sexual desire and ensure that virginity is preserved until marriage (Abusharaf, 2006). Other studies have found that FGC is performed to ensure cleanliness, modesty and beauty among girls

(Gruenbaum, 2006), and to enhance men’s sexual desire (Almroth et al., 2005). In certain communities FGC is practised for religious reasons (Clarence-Smith, 2007) even though research shows that Islam does not sanction the practice (Gharib, 2019; Berg & Denison,

33

2013). FGC is also perpetuated by religious groups or movements that push for the preservation of their cultural identities in the face of social changes (Dembour, 2001;

Nypan, 1991). A case in point is the Mungiki group, a militant spiritual group among the

Kikuyu tribe of Central Kenya which has been known to use coercion to enforce FGC and other traditional practices (Karanja, 2003; Muthoga, 2014). Powerful individuals, including religious leaders in practising communities who fear the dilution of their cultural values and identity play an important role in perpetuating FGC (Toubia &

Sharief, 2003). Studies also indicate that FGC can be introduced through the intermingling of cultures for instance through relocation by certain tribes into new areas

(Abusharaf, 2006) leading to symbiotic assimilation, acculturation, and adoption of new practices (Finke, 2006). This is closely related to intermarriage as a contributing factor for FGC perpetuation (Shell-Duncan & Hernlund, 2008). Other studies have highlighted factors which hinder FGC including illegality, negative health and personal experiences, lack of religious justification, pressure from family members, and inability to justify the physical importance of the practice (Berg & Denison, 2013). While FGC prevalence rates have been found to be very high in Africa, especially in Muslim-majority African countries such as Somalia, Sudan, and Egypt (Berg & Denison, 2013), most women who identify as Muslim do not engage in FGC (Von der Osten-Sacken & Uwer, 2007), and

Islam does not sanction FGC (Rouzi, 2013). Also, increasingly, diasporic Muslim communities are shunning FGC as they view it as being in violation of Quranic values

(Abusharaf 2006; Johnsdotter 2007). Taken together, these factors constitute vital starting points in global efforts aimed at eliminating FGC as strategic interventions can and often target these root factors (Berggren, 2005; WHO, 2011, 2013).

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FGC as a Violation of Universal Human Rights

A major reason why FGC elicits the global attention that it does is because it contravenes various Articles of the Universal Declaration of Human Rights (UDHR) as entrenched in resolution 217 A (III) by the General Assembly of the United Nations of

December 10, 1948.23 Since FGC is understood to interfere with the healthy genitalia of women, have no legitimate medical rationale, and leads to long term physical and psychological consequences; it is a practice that contravenes several UDHR Articles including women’s basic right to (a) a standard of living adequate for health and well-being

(Article 25), (b) life, liberty and security of person (Articles 3 and 22), and (c) protection against their subjection to torture, cruelty, inhuman or degrading treatment or punishment

(Article 5). The FGC practice is also understood to perpetuate gender inequality and discrimination against women due to the decision-making power imbalances which curtail women’s right to dignity and freedom of opinion and expression as entrenched in Articles

1, 2, 6, 7 and 19. In many cases FGC is performed to prepare young girls for marriage thus denying them a chance to go to school, violating their right to education (Article 26). These numerous human rights violations are at the core of global efforts to eradicate FGC

(Behrendt, 2005; WHO, 2008).

FGC as a Violation of the Convention of the Rights of the Child

FGC is understood to violate various Articles of the Convention of the Rights of the Child as adopted by the United Nations General Assembly resolution 44/25 of

23 United Nations General Assembly Resolution 217 A III: http://www.ohchr.org/EN/UDHR/Pages/Introduction.aspx Accessed August 25, 2020

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November 20, 1989.24 Article 1 defines a child as every human being below the age of eighteen years and FGC is carried out on young girls including infants (Dare et al., 2004).

The trauma and pain accompanying FGC contravenes Article 2 which warns against all forms of discrimination or punishment as well as Article 37 which warns against subjection to torture, cruelty, inhuman or degrading treatment or punishment. FGC often involves unilateral decision making by the family or the community thus denying children their right to make and express their own views (Article 12). Also, the FGC decision often involves social pressure and coercion hence violating the child’s right to freedom of expression and freedom of thought. This constitutes arbitrary or unlawful interference with the child’s privacy and/or an unlawful attack on the child’s honour and reputation (Articles 13, 14, and 16). FGC as a rite of passage and as a gateway to marriage for girls under the age of

18, violates Article 32 which recognizes the right of the child against economic exploitation. Moreover, while Article 28 recognizes the right of the child to education, FGC in preparing girls for marriage at very young ages in effect, could be understood to deny them education, self-determination, and condemn them to lifelong dependence on spouses and family members.

FGC can also interfere with the healthy development of genitalia in children resulting in permanent modification and harmful health consequences. This contravenes the right to shield children against physical and mental violence, injury, and maltreatment

(Article 19), the right of the child to the enjoyment of the highest attainable standard of

24 Convention of the rights of the child: http://www2.ohchr.org/english/law/crc.htm Accessed August 25, 2020

36 health (Article 24); and the right of every child to a standard of living adequate for the child's mental, physical, moral, spiritual, and social development (Article 27). In the case of death of the child, Article 6 would be violated, the right to life for every child. Given the extent of harm, trauma and suffering that FGC could, and indeed often does cause for young girls and women, it becomes important to understand what causes FGC to persist, and how health professionals could intervene more effectively to ameliorate distress while honoring girls and women.

FGC Problematic and Universalism

The globalization of the FGC problematic owing to the UDHR violations discussed in the previous section has led to campaigns on a global scale to eradicate FGC, campaigns which, according to Shell-Duncan (2008), often promote an essentialized

Global North derived view of FGC as unacceptable. This definition captures the clash of cultures that began during the colonial scramble for Africa and the establishment of colonial protectorates (Njambi, 2004; Oyewumi, 1997). Tensions have therefore existed for as long as the Global South has been in contact with the Global North. At the core of the contentious history of eradicating FGC is the issue of framing, how FGC is framed and who does the framing, which also can reflect the exercising of power by colonizers who most Africans viewed as intrusive (Shell-Duncan, 2008).

To summarize, in the 1950s and 1960s in colonized Africa, colonial administrators did not shy away from framing FGC eradication endeavours in terms of what they perceived to be the barbarism of the practice from their cultural standpoint, but this narrative morphed somewhat to include the issue of harm in the 1970s and 1980s and then onto the focus on FGC from a global health framing (Hernlund & Shell-Duncan,

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2007). Gradually, the health argument fell out of favor as multiple studies pointed out that the universal ascription of health risks and harm to all forms of FGC was erroneous

(Hernlund & Shell-Duncan, 2007; Njambi, 2004) leading to a major reversal by the

WHO in its joint statement with other UN agencies in 199725 conceding that the health risks argument was flawed and likely unhelpful. This action by the WHO necessitated a paradigm shift which led to the modern-day framing of the FGC global health discourse in terms of human rights violations (Hernlund & Shell-Duncan, 2007; Nnaemeka, 2005).

It is however important to note that opponents of framing FGC as a human rights violation point to the fractured colonial history of eradication including the overexaggerating of harm, the denigration of African cultures, and the failure to contextualize the experiences and contexts of communities who engage in FGC

(Ahmadu, 2000; Shell-Duncan, 2006, 2008). In the context of this research study, the global health discourse on FGC is especially relevant given the diasporic locations inhabited by research participants and the ongoing disagreements regarding the universalization/generalization of FGC harm (Magoha & Magoha 2000; WHO 2008).

The issue of universality26 and framing FGC within universal norms will remain contentious as long as the norms reflect a Global North standpoint while seemingly targeting those in the Global South who lack the power to counteract the dominant, albeit, sometimes flawed ideological narrative on FGC (Johnsdotter & Essen, 2010; Obermeyer,

25 https://apps.who.int/iris/bitstream/handle/10665/41903/9241561866.pdf?sequence=1&isAllowed=y Retrieved on August 31, 2020 26 The discussion on universalism here is meant to highlight the history of FGC eradication and is not meant to fully capture the extensive multidisciplinary discourse which exists on the topic including notions of individuality vis a vis cultural relativism.

38

1999). A Global North framing often touts universality but concurrently fails to question

Global North genital modification surgeries which fall under the WHO (2008) nomenclature including labial, vulval, and clitoral enhancement surgeries (Braun, 2005;

Goodman, 2009; Liao & Creighton, 2007; Njambi 2004), as well as vaginoplasties

(Conroy, 2006). This is a not-so-subtle cultural double standard particularly with some researchers noting that age and consent for these procedures are not always taken into consideration in the Global North (Zuckerman & Abraham, 2008).

FGC in Global North Countries

Global migration has propelled what was once a private cultural practice of FGC onto the global stage to become a fixture in the international rights and global health arenas (Berg & Denison, 2013). Some of the major drivers of this migratory trend for

Africans include economic and political strife as well as wars and displacement (Sundby,

2003). This South-to-North migration has led to a steady influx of African immigrants and refugees into countries in Europe, Australia, New Zealand and countless other countries including Canada (Gharib, 2019; Vissandjée et al., 2014). Many of these immigrants come from countries with high FGC-prevalence rates and bring their cultural practices with them (Catania et al., 2007) meaning that Global North governments have to reckon with accommodating these differences including in the provision of healthcare to women and girls affected by FGC (Alradie-Mohamed, Kabir, & Arafat, 2020;

Vissandjée et al., 2014).

As has been stated previously, FGC is now considered a violation of the human rights of girls and women (WHO, 2008). The WHO declared FGC a public health concern in Global North countries including Australia, the United States, and Canada as

39 early as 1994 owing to migratory trends at the time (Bashir, 1995; Williams-Breault,

2018). However, prevalence statistics in host nations still remain elusive because of the private and secretive nature of the practice among immigrant communities, and with each country keeping its own statistic, some countries do a better job of it than others (WHO,

2008). Studies carried out in various Global North countries including Canada, the United

Kingdom (UK), Spain, Sweden, Australia, and the United States (USA) reflect increasing numbers of “cut” women (Chalmers & Omer- Hashi, 2002; Finke, 2006; Kaplan et al.,

2009; Nour, 2004; Ogunsiji, Wilkes, & Jackson, 2007; Wright, 1996; Thierfelder,

Tanner, & Bodiang, 2005). Further evidence of the FGC problematic in Global North countries is its wholesale denunciation and the enactment of laws criminalizing FGC either within specific countries’ borders or if performed outside a country’s border by its citizens (Kelly & Hillard, 2005; WHO, 2008, 2016, 2018).

The bulk of research studies on FGC in Global North countries has tended to focus on minimizing harm and preventing complications particularly those related to pregnancy and childbirth (Terry & Harris, 2013; UNICEF, 2016; WHO, 2006, 2016,

2018). Some studies have focused on the perceived sexual health effects of the practice as well as surgical procedures to reconstruct the genitals (Brady, Connor, Chaisson, &

Mohamed, 2019; Catania et al., 2007) while others have examined perceptions of FGC among immigrant women (Jacobson et al., 2018; Omorodion, 2020), encounters with healthcare providers in Global North countries (Kawous, Allwood, Norbart, & van den

Muijsenbergh, 2020), as well as issues relating to FGC and Global North politics and morality (MacNamara, Mackle, Pierson, & Bloomer, 2020; Earp, in press) and perceptions of African women’s bodies in the Global North (Johnson-Agbakwu, &

40

Manin, 2020). In a 2013 literature review of FGC studies completed in host countries and published between 2000 and 2012, Terry and Harris found that there was very little research involving the nursing care of affected women and girls. Some predominant themes in the studies included the prevalence of FGC, attitudes of health care practitioners towards FGC, personal experiences of affected women, and to a limited extent, the nursing care of affected women and girls in migrant diasporic communities.

While the WHO (2008, 2016, 2018) and the UNICEF (2016) provide most of the statistics on FGC prevalence, some countries have made great strides in an effort to document and quantify incidences. In the UK for instance, health care practitioners are now required to document visits by affected women in a health service registry

(Macfarlane & Dorkenoo, 2015). In 2013, the European Institute for Gender Equality

(EIGE) obtained prevalence data on FGC through reviewing research studies from eight

European Union (EU) states, in addition to using a variety of other sources including case laws, questionnaires, and other publicly available data in an effort to try and formulate guidelines for handling FGC cases. Findings indicated that 50% of female asylum seekers in the UK in 2011 were potentially affected by FGC, and that there were variations in data across Europe. Enormous obstacles were encountered in trying to identify cases due to the private nature of FGC and the unwillingness by communities to talk about it

(Bikoo, 2007). A systematic review conducted in the UK by Alradie-Mohamed, Kabir, &

Arafat (2020) used narrative analysis to understand FGC decision-making processes within affected families and found that fathers, mothers, and grandmothers were the main decision-makers and that there were regional variations in how decisions were made. The authors recommended the involvement of fathers in FGC issues to offload the pressure

41 from only mothers and grandmothers making FGC decisions. They saw this as potentially valuable in mitigating and eradicating FGC. There have been recent fervent efforts in the

USA and the UK to publicize what they have labeled as widespread FGC practice (in both countries) through mass media campaigns27 and the signing of petitions to support grassroots eradication endeavors.

FGC in Canada

In May of 1997, the Canadian federal government amended the Criminal Code and included the performance of FGC as aggravated assault under section 268(3). Under the Criminal Code, any person who commits an aggravated assault is guilty of an indictable offence and is liable to imprisonment for a term not exceeding 14 years. A parent who performs FGC on their child may be charged with aggravated assault. Where the parent does not commit the act but agrees to have it performed by another party, the parent can be convicted as a party to the offence under section 21(1) of the Criminal

Code.28

Canadian immigration trends point to an increase in numbers of immigrants from developing countries (Jacobson, Glazer, Mason, Duplessis, Blom, Du Mont, Jassal, &

Einstein, 2018; Vissandjée et al., 2014). Citizenship and Immigration Canada (CIC) statistics show that in 2011 alone, almost 59,000 women from Africa and the Middle East became Canadian permanent residents. Many of these women were from countries considered by the WHO to have high prevalence rates for would most probably have

27 http://www.theguardian.com/end-fgm 28 http://www.ohrc.on.ca/en/policy-female-genital-mutilation-fgm/4-fgm- Canada.

42 been cut. According to the 2011 National Household Survey, the City of Calgary was the third ethnically diverse city in Canada behind Toronto and Vancouver in terms of visible minorities (National Household Survey, Statistics Calgary, 2011). The 2014 City of

Calgary Census showed that approximately 22.2% of the almost 1.2 million population of

Calgary were classified as visible minorities, and that about 8.9% of this group self- identified as African with about half of them being women (City of Calgary Census,

2014). Overall, the total number of Africans in Calgary is almost 27,000 (City of Calgary

Census, 2014). According to Statistics Canada,29 participants in this study were from six

African countries including Kenya, Nigeria, Somalia, Sudan, Democratic Republic of the

Congo (DRC), and Burundi. Some of these countries have been shown to have very high

FGC prevalence rates for women between the ages of 15-49. For example, in the year

2003 in Kenya, 32.2% of the women in that age group had experienced FGC while 19% of women from Nigeria in the same age group had been cut (Gharib, 2019; WHO, 2008).

In 2000, 90% of women between the ages of 15-49 in Sudan had undergone FGC while in 2005, 97.9% of Somali women in the same age group had undergone FGC (Gharib,

2019; WHO, 2008). Canada continues to receive immigrants and refugees from all of these countries in addition to other high-prevalence countries (Gharib, 2019).

Terry and Harris (2013) found that in the UK, FGC is primarily carried out among immigrant ethnic groups from Egypt, Eritrea, Ethiopia, Gambia, Iraq, Kenya, Kurdistan,

Liberia, Mali, Nigeria, North Sudan, Sierra Leone and Somalia, and that many were

29 https://www150.statcan.gc.ca/n1/pub/89-657-x/89-657-x2019002-eng.htm

43 recent immigrants who had little exposure to Western culture. While statistics on FGC in

Canada are limited, and while Canada may not have a long immigration history compared to other Western countries including the UK and the USA, the trends in other Global

North countries offer a reflection of the Canadian situation, Canada being home to thousands of immigrants and refugees from the countries listed above.

Additionally, political and health care trends point to an increasing concern by stakeholders in these areas over the presence of, and effects of FGC on populations within Canada. For instance, the College of Physicians and Surgeons of Ontario (CPSO) has set up guidelines to guide physician conduct with regards to people affected by

FGC.30 FGC is also listed as a harmful cultural practice in the Canadian citizenship guide and there was debate and a petition in 2016 by Michelle Rempel, the member of parliament for Calgary Nose Hill, over the apparent removal of this designation from the guide by the current Liberal government.31 There is no national strategy to address FGC in Canada and no official prevalence statistics, so the scope of FGC is unknown. Rates are based on UNICEF prevalence statistics in countries of origin as well as on informal analyses (see for example Poisson, 2017; Portenier, 2019). Additionally, point of care

FGC data does not exist for Canadian provinces.

Global North Attitudes Towards FGC

While it is now widely understood that FGC is a violation of the human rights of girls and women (WHO, 2008, UNICEF, 2016), the criminalization of the practice has in

30 http://www.cpso.on.ca/Policies-Publications/Policy/Female-Genital-Cutting-(Mutilation) Accessed on August 31, 2020 31 https://www.cbc.ca/news/politics/female-genital-mutilation-citizenship-hussen-1.4502068 Accessed August 31, 2020

44 no way lessened FGC prevalence rates for source and host nations. This is because criminalization and/or threats of legal repercussions have never been, and cannot be the solution (Bashir, 1995). A study by Norman, Hemmings, Hussein, and Otoo-Oyortey

(2009) found that FGC is conducted secretly in the UK even though it has been illegal there for almost two decades. Morison, Dirir, Elmi, Warsame, and Dirir (2004) in a survey of young Somalis living in London, found that age on arrival in Britain affected participants’ attitudes towards abandonment of the practice. Although FGC is criminalized in Canada, and even though Canada receives large numbers of immigrants from FGC-prevalent African countries (Vissandjée et al., 2014) there are relatively few studies on FGC compared to other Global North countries (see for example, Elamin &

Mason-Jones, 2020). Additionally, while prosecution is a sensitive topic with regards to

FGC, Canada is yet to prosecute any FGC-related cases or to enact modalities for combating FGC outside of prosecution (Packer, Runnels, & Labonté, 2015). Yet as evidenced by the global interest in the topic, the dearth of research does not indicate absence of FGC in Canada. Studies in European and other Global North countries offer a template for similar endeavors within Canada. More research within Canada would help explore attitudes towards FGC as well as the complexity of encounters with health service providers.

Healthcare for Women Affected by FGC

Most studies on the experiences of immigrant women affected by FGC have found that women often report negative effects on their overall wellbeing including emotional distress, anxiety and fear (Andersson, Rymer, Joyce, Momoh, & Gayle., 2012;

Norman et al., 2009; Oguntoye, Otoo-Oyortey, Hemmings, Norman, & Hussein, 2009).

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Although psychological issues were frequently mentioned in studies, women reported no access to, or consideration of any form of psychological support (Oguntoye et al., 2009).

A 2001 survey of health care practitioners in Spain by Kaplan- Marcusan, Torán-

Monserrat, Moreno-Navarro, Fàbregas, and Muñoz-Ortiz (2009) to evaluate their knowledge and attitudes towards FGC found that practitioners were not adequately prepared, and that they lacked resources to adequately care for affected women. The authors concluded that professionals needed to be adequately equipped with knowledge in order to properly address FGC cases. They identified a need to develop practice guidelines and concluded that a profound lack of knowledge of FGM in healthcare delivery bordered on cultural incompetence (Kaplan- Marcusan et al., 2009, 2013). The

UK has made some strides in terms of developing referral services for pregnant women

(Momoh, 2004) but in Canada, more needs to be done to sensitize nurses and other health care practitioners on how to engage with affected women and girls (Norman et al., 2009;

Oguntoye et al., 2009; Chalmers and Omer-Hashi., 2002).

These studies foreground the complexity of the experiences of FGC for affected women as well as for health care practitioners in host nations. That these issues continue to plague countries that have a considerable head start compared to Canada in terms of understanding and caring for women affected by FGC should be a wakeup call for

Canada. My research arose out of the realization of this deficiency and a need to explore better ways of understanding the complexity of FGC in the context of migration in

Canada.

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Chapter Summary

Multiple local and multinational organizations exist around the globe and are all working individually as well as in collaboration to eradicate FGC and provide care for affected women and girls. Numerous resources have been poured into eradication endeavors with influential global agencies like the UN, the WHO, and the World Bank at the helm of these global efforts. Eradication campaigns have existed for decades with a focus on upholding universal human rights and children’s rights, and yet as stated in

Chapter 1, FGC still endures, the UNICEF’s global FGC prevalence numbers having been revised upward in 2016 (UNICEF, 2016).

Much of the research on FGC reported in the literature has been undertaken in countries other than Canada, particularly the United Kingdom and Australia.

Additionally, while the studies provide a starting point for understanding FGC and treating affected women, most do so from a Global North understanding of the practice.

Too often, the practice is not historicized and contextualized in order to critically engage with it in non-traditional settings. For me, this is a huge knowledge gap, the addressing of which might help explain why the practice endures despite decades of fervent eradication endeavors in host nations. I argue that an understanding of FGC and the subsequent provision of equitable nursing and health care cannot preclude an African viewpoint.

I also hold that FGC can best be understood within a colonial historical framing as well as within individual cultural contexts. Additionally, with regards to affected women, it is relevant to consider the various social contexts that shape their understandings, and to situate their meanings within the larger discourse of the provision of equity-oriented health care. In reviewing the literature on FGC, I did not find any studies which applied a

47 decolonizing lens to understanding the experiences of FGC in diasporic locations. My interpretive description research study informed by decolonizing perspectives builds on existing research by considering how history, context, location, and societal factors have all been complicit in the construction of the FGC problematic. The incorporation of critical reflexivity in consideration of how micro and macro structures work in tandem to affect the experiences of immigrant and refugee women affected by FGC holds potential to offer alternate ways of engaging with FGC practice in Canada, working towards more equity-oriented nursing and health services for women affected by FGC.

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Chapter 3 Interpretive Description Research Design Informed by Decolonizing

Perspectives

For this study, I utilized an interpretive description research design informed by decolonizing perspectives to make sense of the ways in which FGC manifests itself in the lives of affected immigrant and refugee women. I came into the research knowing that my decolonizing methodology was in and of itself, a complex of theories that I was attempting to assemble into a somewhat coherent whole. As interpretive description is grounded in theory (Thorne, 2016), it is therefore congruent with my use of multiple critical theories to inform decolonizing interpretations. In Chapter 1, I detailed the critical theories that informed my decolonizing design including postcolonialism, postcolonial feminism, Africana feminism, Black feminism, Womanism, Africana Womanism, and

African Feminism. My aim throughout analysis was to capture thematically the meanings of women’s stories in context while acknowledging the entangled relationship between myself as researcher and interpreter, and the women who in line with this research tradition, are viewed as co-creators of the research product in all its entanglements and contradictions (Teodoro, Rebouças. Thorne, Souza, Brito, & Alencar; 2018; Thorne et al.,

2004; Thorne, 2016). Interpretive description allows for the utilization of data collection and analytic methods that align themselves with the overall purpose of any given study, and that can be justified as such (Thorne, 2016). Inherent in this research design is an understanding that human experiences are unique, but that there are nonetheless realities that are shared between individuals; and that experiences are constructed within given contexts (Thorne, 2016; Thorne, Kirkham, & MacDonald-Emes, 1997).

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Situating the Researcher

The methodological underpinnings of interpretive description align with my views on how to carry out FGC research with immigrant and refugee women in the context of migration. According to Thorne (2016), studies in the tradition of interpretive description:

• View subjective and experiential knowledge as key sources of clinical judgment

• Recognize that an element of human experience is socially constructed and cannot

be separated from its essence

• Are respectful of the rights, ethics, and comfort of participants, and are contextual

• Recognize that while there are some shared common human experiences, there

exist variations, even in similar foci areas

• See the relationship between the “knower” and the “known” as inseparable

• Appreciate the fact that “reality” involves multiple constructed realities which can

be contradictory

• Attend to context and time while embracing issues that are not bound by time and

context (p.74)

Since a key assumption of interpretive description is the social construction of certain aspects of the phenomenon under study, it follows that researcher reflexivity is called on, in order to actively acknowledge personal preconceptions that might impinge on the research (Thorne, 2016).

The multi-theoretical framing of my study which incorporated decolonizing perspectives is grounded in what Moosa-Mitha (2005) would term “anti-oppressive theories” which aim to resist and liberate. I suggest that knowledge is “situated,

50 subjugated, and subaltern” (Moosa-Mitha, 2005, pp.88-89) which for this research means that women affected by FGC possess unique knowledge that reflects their “lived circumstances” within the complexity of their social, spatial and often oppressive systems. According to Moosa-Mitha (2005), subjugated groups own this knowledge, and it therefore has to be translated in order for others to understand it. As researcher, I attempted to actively listen to the participants’ stories, as well as to analyze and interpret conversations while remaining aware of the theoretical and experiential knowledge that I brought to the study. This included my inherent being as an African immigrant researcher in a diasporic milieu, who is not entirely divorced from the totality of my own lived experiences. I strove to strike maintaining a respectful understanding of the participants’ inherent agency, and by staying close to their actual narrations, the stories that they chose to share. So then, I became the vessel that holds their stories, but not an empty vessel. In fact, as a conduit for those stories, and as a loaded vessel, I relate them through the lens of my own complex experiences and understandings. To reiterate, the purpose of my research was twofold: (a) to critically examine how immigrant and refugee women who have undergone Female Genital Cutting (FGC) make sense of, and explain the practice, both for themselves and for younger generations; and (b) to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women, including their perceptions of and interactions with various health services in

Canada.

Research Questions

For my study, I sought answers to the following research questions:

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1) What are the effects of FGC on the lives of affected African immigrant and refugee

women (younger and older)?

2) How has migration to Canada shaped how African women (younger and older)

view FGC, including how views evolve across generations and geographies?

3) What happens when affected African women (younger and older) interact with

various health services?

4) What implications for healthcare services do the understandings of FGC have for

affected women (younger and older)?

Ethics Approval

Ethics approval was obtained from the Conjoint Health Research Ethics Board

(CHREB) at the University of Calgary (Appendix A).

Informed and ongoing consent.

The importance of ethical considerations in qualitative research cannot be overstated as researchers are obligated to respect desires, needs, and values of participants. Informed consent was especially significant for my study given the contentious and sensitive nature of the topic, and the legal implications of FGC for participants. FGC is a hidden phenomenon in most source countries due to laws that have been enacted in the last decade or so to curtail the practice. It is hidden in the sense that individuals and communities that continue to practice FGC do so away from the public eye in order to avoid any associated legal implications (Johansen, 2019; Sauer &

Neubauer, 2014). But it is also hidden in the sense that it is considered a taboo subject even within practicing communities as are most discussions about female genitalia

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(Barrett, 2017; Wheeler, 2004). This silence makes studying FGC within diasporic immigrant communities particularly daunting, as was the case in my research.

Following ethics approval, and after recruiting potential participants and explaining my research to them and addressing questions and concerns, I asked each to sign a consent form (Appendix B). In addition to having participants sign consent forms,

I also asked them to verbally confirm their consent before conducting any interviews.

While most of the interviews were in-person, I held one interview over the phone and in this case I obtained approval from the CHREB for a verbal consent script (Appendix C). I told participants that they would be free to ask questions about individual aspects of the study at any point during interviews, and that they had the option to stop an interview and to voluntarily withdraw from the study at any time without prejudice.

Confidentiality and Anonymity.

I assured participants of strict confidentiality of their information at all times including before, during, and after the study in accordance with CHREB. I gave each participant a copy of the consent form and retained signed copies for recordkeeping. The criminalization of FGC in Canada as well as in most of my study participants’ countries of origin rendered my study participants particularly vulnerable even without taking into account the sensitivity and very private nature of FGC. Prior to conducting interviews, I made it clear to each study participant that I would make every effort to maintain their confidentiality but that given the recruitment strategy of snowball sampling where I was asking them to help link me with other study participants, complete anonymity might not be entirely possible. I however assured them that all conversations before, during and after interviews would remain confidential and anonymous, and that I would use

53 pseudonyms in place of their actual names and anonymize all collected data. Only information deemed to be directly related to the study would be disclosed in the final write-up of the study. I also let them know that backup documents would be locked in a cabinet in a secured office and that digital and electronic records would be encrypted and password protected.

Sampling Approach

Sampling approaches in interpretive description studies are undertaken based on researcher aims, the event(s) being studied, as well as any specific guidelines based on theoretical leanings (Thorne, 2016). Research projects in this research tradition have utilized sample sizes ranging from 5-30 participants with decisions left to the discretion of researchers as long as sample sizes align with the overall study intent (Teodoro et al.,

2018; Thorne, 2016). A sample size of 20 participants was utilized in this interpretive description study informed by decolonizing perspectives.

Purposive Sampling.

Purposive sampling is a non-random sampling technique in which participants are selected on purpose from research settings that represent the phenomenon under study.

This was my chosen sampling technique.

Snowball sampling.

This is a non-conventional type of purposive sampling which has been found to be effective in the recruitment of study participants from hard-to-reach, hidden, or marginalized groups (Atkinson & Flint, 2001; Browne, 2005). Researchers identify initial participants who then refer the researcher to subsequent participants.

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The private nature, complexity, and the cultural specificity of FGC made for particularly tricky recruitment from this very hidden population of immigrant women. I had initially proposed the use of snowball sampling to maximize the potential for achieving an initial sample size of six to eight younger women (ages 18-35) and six to eight older women (age 36 and above).

Entering the Field: Recruitment and Selection

I started recruitment by focusing on social services agencies offering services to

African immigrant populations and communities. One such agency had a constituent department that targeted social services for the Somali community in a Western Canadian city. I approached independent third parties within the agency and used them as conduits to access Somali women. These third-party individuals had worked with women in

Somali immigrant communities and had garnered the trust of community members. I made appointments to meet with these third-party contacts who then introduced me to the management team within the agency and in doing so gave me the opportunity to pitch my research to the management team and to brainstorm ways of identifying and contacting potential participants while adhering to agency rules of conduct and terms of engagement, and respecting individual privacy rights.

Given the sensitivity of the topic of FGC, we all agreed that the best initial step would be for me to utilize a recruitment poster containing study details as well as my contact information. The third-party agency contacts would email the poster to Somali women who they identified on the agency listserv as meeting my inclusion criteria

(Appendix F - Recruitment Email). The women would then independently contact me via email or by phone. In this way, I was able to recruit a few women and set up my initial

55 interviews. In addition to recruiting via agency email listserv, the contacts also suggested that I attend some community functions for women where I would talk about my research and ask anyone interested in participating to contact me privately. This strategy fell through as there were no activities scheduled during the Muslim holy month of Ramadan in the summer of 2017, and then in the fall of the same year, the group’s funding was discontinued and I lost the opportunity to recruit through community agency-funded community functions.

Although I had initially proposed to recruit women by placing flyers in public locations such as African businesses and social halls, I subsequently decided against this recruitment strategy, following suggestions from some of the women who I met through the human services agency. The primary reasons they gave me for this were the preservation of the dignity of potential participants as well as avoidance of any undue discomfort for them. I ended up conducting all of my recruitment and data collection without publicly situated flyers.

Another avenue for recruitment was the utilization of my own personal networks, especially after program funding ended for the Somali group within the human services agency. Since “snowballs” begin with the researcher (Browne, 2005), and since my identity as a female African immigrant availed me some insider status, I dialed into my personal networks including friends and acquaintances, to help me locate potential gatekeepers within target communities. In doing so, I was able to successfully locate a few key people who helped me to identify potential participants through informal immigrant groupings which I was previously unaware of. According to Browne (2005), personal networks can serve as effective recruitment channels in snowball sampling, and

56 since such channels can include individuals who do not meet the sample criteria such as men or women who have not undergone FGC but who may be familiar with the practice, they can help with avoiding the static categorization that comes with more homogenous groupings such as with the agency where my recruitment commenced.

I recognize that snowball sampling has limitations, as do most recruitment procedures. One such limitation is the issue of inclusion and exclusion, as well as the potential for further alienation and silencing of entities within target communities

(Browne, 2005). Browne (2005) stated, “…where snowballs begin can be significant to the formation of the sample creating particular exclusions and boundaries” (p. 52). What this means is that it is entirely possible to focus on recruiting within a very homogenous entity in a target population and perhaps silencing the less visible members of the chosen population like women, who for economic, religious or familial reasons cannot attend social functions.

The criteria for inclusion as cited in the recruitment poster (Appendix D) were:

• Women who have experienced cutting

• Women who may not have been cut but have parents, grandparents, friends, or

other family members who are cut

• 18 years of age or older

• From an African community where women experience cutting

• Live in Canada or the USA

• English-speaking32

32 One interview with a group of women was conducted in Kiswahili and translated into English

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The diversity of participants allowed for rich personal stories that helped make sense of my research questions. Interpretive description studies are not meant to be exhaustive. I consider my research to be partial in that it can only represent the views of the participants therein, and yet in keeping with interpretive description, those views have the potential to effect change in clinical practice with FGC-affected diasporic populations.

A feature of interpretive description studies is the utilization of small samples to capture meaningful stories that can help generate knowledge that is steeped in experience

(Thorne, Stephens, & Truant, 2016). Previous FGC studies have utilized varied sample sizes ranging from five participants for qualitative studies to as many as 492 participants in quantitative surveys which require a higher sample power (Berg & Denison, 2013;

Chalmers & Hashi, 2000; Mitike & Deressa, 2009; Morison, Dirir, Elmi, Warsame, &

Dirir, 2004; Thierfelder, Tanner, & Bodiang, 2005). My decision to include younger and older women in this study was meant to capture intergenerational understandings and nuances, the better to enrich the participants’ stories and honor their experiences fully. As stated earlier, the sample size of 20 was in line with previous interpretive description research, but most significantly, it was procedurally and financially feasible, and capable of providing sufficient rich data to provide answers to the questions that I was posing.

Participant Demographics

Participants included three mother-daughter sets, one set of whom had all experienced cutting. The other two sets included a mother and two daughters who had a family member who was cut but had not experienced cutting themselves, and a mother- daughter set who had only heard about FGC while living as refugees in a country where

FGC happened traditionally. Among the participants in the group conversation were a

58 mother, her daughter, and her mother-in-law. Three of the women who had experienced

FGC as children also self-identified as having engaged in anti-FGC activism and advocacy work. Participants’ length of stay in Canada varied from two months to 28 years, six of the participants having come to Canada as immigrants while the rest stated that they had arrived as refugees33.

Ages ranged from 18-68 and included three teenagers, five women in their 20s, five women in their 30s, five women in their 40s, and two women in their 60s.

Participants’ countries of origin included Kenya, North Sudan, Somalia, The Democratic

Republic of the Congo, Nigeria, Burundi, Rwanda, and Tanzania. Among these participants, 10 women had been cut, three had family members who were cut but had not experienced FGC themselves, and seven of the women had neither experienced cutting nor had family members who were cut but knew of, and about FGC on account of having lived in countries in the horn of Africa where cutting happens. The last group of women were displaced from their own countries as a result of war and had sought refuge in FGC-prevalent countries before ultimately relocating to Canada.

Qualitative Interviewing: Data Collection

I conducted a qualitative individual and/or group interview with each participant.

I allocated 1-2 hours for each interview but held open the possibility for longer or shorter interviews depending on interview flow, amount of information shared, and if expressly requested by participants. I also asked participants (and all consented) for their

33 The Merriam-Webster Dictionary defines an immigrant as a person who comes to a country to take up permanent residence and a refugee as a person who flees to a foreign country or power to escape danger or persecution.

59 permission to contact them following the interview, if any questions or clarifications were required. Although interviews were semi-structured, I still had an interview guide

(Appendix E) which helped me stay organized and to steer conversations as needed.

Interviewing is commonly used in qualitative research (Creswell & Poth, 2006).

Unlike other formal data collection strategies, qualitative interviewing can help explore values and attitudes that would otherwise remain hidden (Byrne, 2004). Rubin and Rubin

(2011) highlighted some key features of qualitative interviewing, particularly in-depth interviews including that:

• It can enable researchers to reconstruct and make accessible unique information

about complicated processes in participants’ lives;

• It can help portray information about ongoing social processes in participants’

lives;

• It can help bridge the gap between older and younger participants by fostering

more understanding through the retelling of oral history and lore;

• It can help capture change for example through interviewing participants of

varying ages about the same phenomenon;

• It is a good tool for exploring highly sensitive issues in order to capture differing

points of view and counterarguments; and,

• It can allow researchers to study “invisible” processes and hidden populations (p.

3-5).

These six features of in-depth qualitative interviewing are especially relevant to the topic of FGC and to the research participants who generously shared their stories.

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Semi-Structured Interviewing

Since my study was partially informed by postcolonial and Africana feminist perspectives, I chose semi-structured interviewing, which allowed for open-ended questions that actively engaged research participants in the construction of their life stories (Reinharz & Davidman, 1992). With this kind of interviewing, I utilized what

Rubin and Rubin (2011) referred to as responsive interviewing which involves choosing knowledgeable informants, paying attention to what they have to say, and then devising and asking follow-up questions based on the answers provided (Rubin & Rubin, 2011). I adapted my interviewing style to accommodate study participants as partners in the conversation while respecting their views, opinions, and constructions of their life experiences in an effort to build a trusting relationship (Rubin & Rubin, 2011). Semi- structured interviewing can allow researchers to delineate differences among seemingly homogenous study participants (Reinharz & Davidman, 1992). This was certainly the case for my research as I was able to capture varying viewpoints from participants who seemingly shared linguistic, geographical, and other characteristics.

Interviews began in July 2017 with the last interview in April 2018. In keeping with the interpretive description research design, data collection remained open for the duration of the study with the option of further interviews to fill in knowledge gaps, as well as for member checking for corrections and clarifications. I digitally recorded all of interviews and transcribed them verbatim. I also kept a notebook in which I wrote descriptions and reflections relating to particular interviews. This was especially useful when I started NVivo™ coding and in identifying emerging themes and subthemes.

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All of the interviews were conducted face to face except for one, which was conducted via a telephone call. Prior to conducting interviews, I asked participants to choose a location and time for interviews, and also obtained their permission to audiotape interviews for transcription. I used a semi-structured interview guide for all interviews although I also relied on the participants’ responses to further guide questioning. The interview guide (Appendix E) included the following questions:

1. Would you tell me about your experience with cutting?

2. How has cutting affected your life?

3. How has cutting affected your health? (Physical, mental, sexual)

4. How has cutting affected your generation?

5. Have your views about cutting changed since moving to Canada? How?

6. What kinds of experiences have you had with health services here in Canada?

7. If you could, what would you change? (Perceptions within and outside

community)

8. Are you receiving adequate health care with regards to your experiences with

cutting?

9. Is there anything else you would like to share about your experiences with

cutting?

It is worth noting that in many instances, participants immediately delved into their personal stories of FGC and were keen to share them in their own way. In these instances,

I respectfully and attentively listened, only interjecting when it seemed relevant, like to clarify points made. I learned that simply listening was effective in the sense that

62 participants were able to tell their stories in their own terms and I was still able to amass rich understandings which were in line with my research questions.

I completed 13 interviews with a total of 20 participants from six African countries;12 were individual interviews and one was a conversational group interview with eight women. I conducted the conversational group interview at the request of the women, and with the approval of CHREB. I had scheduled 1-2 hours for each interview while remaining open to the fact that participants would ultimately determine interview length. One of the interviews with a teenage participant lasted only 33 minutes, and two other interviews lasted about 45 minutes. Four interviews lasted about an hour, and the rest of the interviews, including the group conversation, lasted between one and a half to two hours. One interviewee participated in an individual interview (Table 2) as well as the group interview (Table 3).

Participants’ Back Stories

In this section, I offer a short account of each participant who I view as the knowledge co-creators in this research study. This is in keeping with decolonizing knowledge projects where researchers conduct studies “with” participants, and not “on” study subjects (Bhattacharya, 2009). Learning about participants humanizes them and helps to contextualize their stories. I begin with individual interview participants.

Asha (individual interview)

Asha was a 44-year-old mother of four who came to Canada with her family as refugees fleeing war in their home country of Somalia. She experienced cutting at the age of eight or nine years (she could not remember the exact age) and moved to Canada in her late teenage years. Asha described her cutting as circumcision and stated that when

63 she was circumcised, both her parents were away from home and she, along with her siblings had been left in the care of her grandmother who authorized and oversaw the cutting. Asha was very active in her diasporic community and had engaged in anti-FGC advocacy work back in Africa subsequent to her settling in Canada. Asha was multilingual and fluent in English.

Malala (individual interview)

Malala, a 36-year-old married mother of an infant baby boy was born in Somalia, but her family moved to Canada as refugees when she was around 10 years old. Malala was college-educated, multilingual, and had worked in different provinces in Canada including with refugee and human services agencies. She stated that she had a lot of extended family in Canada and the United States and that several female members of her extended family had also been cut. Malala was very knowledgeable about FGC in the global context.

Chali (individual interview)

At the time of the interview, Chali was 18 years old and lived with her mother and

21-year-old sister, Didi. The family immigrated to Canada from Kenya when Chali was eight. Chali’s father had passed away unexpectedly when she was 12, and her mother had been taking care of the girls by herself since. Chali, her sister, and their mother were not cut but her grandmother had been circumcised as a young girl according to Chali’s mother. When Chali’s mother volunteered to be a research participant, she stated that she thought her daughters would want to participate too and talked to them about it. Both

Chali and her sister volunteered to participate in the study; they were both articulate but very shy.

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Didi (individual interview)

Chali’s sister Didi was 21 years of age. Didi was very thoughtful with her answers and credited her mother with taking good care of her and Chali after their father’s death.

Didi stated that her mother had very strong views on different issues including women’s empowerment and would never have subject her and Chali to FGC. At the time of the interview, Didi was a college student mulling over her options after graduation.

Binti (individual interview)

Binti was 47 years of age and mother to Didi and Chali. Her family had emigrated to Canada from Kenya over a decade ago in search of better economic opportunities. As a widow, she was the sole provider for her two daughters. She grew up in a middle-class family, was college educated, and multilingual. Binti stated that her mother had undergone FGC but that it was not something that was openly discussed in her family.

She stated, however, that she was very open with both her daughters on all matters including sexuality. Didi and Chali agreed but stated that they had not discussed FGC because it was not prominent in their day-to-day lives.

The interviews with Binti and her daughters were very illuminating for me perhaps because I initially thought of them as outliers given their lack of what I would describe as firsthand knowledge of FGC. On reflection however, this was very telling especially in the context of an interpretive description; outliers can serve as signifiers for knowledge that would otherwise remain hidden, and this is how I ended up approaching these three interviews when attempting to make sense of study data.

Shala (individual interview)

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Shala was a 42-year-old mother of two daughters and a son. She moved to the

United States from Kenya over 15 years ago. Shala was very eager to share her story and described herself as an anti-FGM activist. She experienced cutting as a young girl and considered it her life’s mission to work as hard as she could to put an end to the practice, particularly among her tribal community back in Kenya. Shala had very strong views on terminology and stated multiple times that she thought the practice was “barbaric” and was, in her opinion, “mutilation” and nothing less. Shala was college-educated and very knowledgeable about FGC, which she referred to as FGM.

Teso (individual interview)

Teso was a 48-year-old mother of two daughters (Tamu and Diya). Teso and her family moved to Canada from Kenya about a decade ago. She stated that she experienced cutting at a young age as did both of her daughters. Teso participated in the group interview and also offered to be interviewed individually. She stated that her views on

FGC were evolving based on what she was learning personally but also from her two daughters. She shared that she had recently had a brief talk on FGC with her daughters after they had accidentally seen a news item about the topic on television. She seemed eager to know what her daughters thought about the practice and what had been done to them. Teso offered to speak with her daughters about volunteering for the study, which they both did.

Tamu (individual interview)

Teso’s oldest daughter, Tamu, was 26 years of age when we met. Tamu was college educated, very confident, and articulate. Like her mother and sister, she experienced cutting at a young age and was eager to share her views on the topic. Her

66 views were markedly different from her mother’s and helped illuminate generational differences in perceptions and opinions about social and body practices including FGC.

Diya (individual interview)

Diya was Teso’s 18-year-old daughter and a college student at the time of interviewing. Like her sister, she was very articulate and confident and was also eager to share her FGC experiences as well as her views on cutting. Diya had been cut in Kenya before her family moved to Canada and stated that although she was “a child of two worlds,” she felt more Canadian than Kenyan. Like her sister, Diya’s views were markedly different from her mother’s and were informed by what she described as all that she had learned about FGC up until that time.

Samia (individual interview)

Samia was 22 years of age and had only been in Canada for two months at the time of the interview, having arrived as a refugee from the Republic of the Sudan. She was multilingual, had a college degree, and was fluent in English. She stated that she had experienced cutting as a young girl back home. She also stated that she had done some anti-FGC advocacy work back in The Sudan and seemed to have a good grasp of the topic. She shared her story along with what she understood to be the historical genesis of the practice in her culture and stated that she hoped to see the practice disappear for good.

Zemi (individual interview)

34-year-old Zemi was born in Somalia. She stated that her family had left Somalia after war broke out and had sought refuge in several different countries in Africa, the

Middle East, and Europe before finally landing in Canada as refugees. She experienced cutting at the age of 6 or 7 and was 10 years of age when her family first arrived in

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Canada. Zemi had several family members throughout Canada and the United states and said that most of her female relatives had also experienced FGC. Zemi was college- educated and very knowledgeable and articulate. She described herself as a feminist and shared her views on aspects of culture, women, and sexuality within a global context.

Doria (individual interview)

At 68, Doria was the oldest participant in this study. She was born in Nigeria and moved to Canada over 25 years ago. She experienced cutting as a toddler and stated that she had one grown daughter who was also cut. Doria’s story was a contrast to a lot of the stories that the other participants told. She was largely unfamiliar with the current global anti-FGC initiatives and saw nothing wrong with the continuation of what she considered a deeply meaningful cultural practice.

Table 2 Participant Demographics for Individual Interviews Name Country of Age Religion FGC Status Origin Asha Somalia 44 Muslim Cut

Malala Somalia 36 Muslim Cut

Chali Kenya 18 Christian Uncut

Didi Kenya 21 Christian Uncut

Binti Kenya 47 Christian Uncut

Shala Kenya 42 Undisclosed Cut

Teso Kenya 48 Muslim Cut

Tamu Kenya 26 Muslim Cut

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Diya Kenya 18 Muslim Cut

Samia Sudan 22 Muslim Cut

Zemi Somalia 34 Muslim Cut

Doria Nigeria 68 Christian Cut

Group Interview

I held the group interview at the request of several participants who after volunteering to participate brought along family members and friends and requested to be interviewed together. A total of eight women from four countries and ranging in age from

18 to 66 years old participated in the group interview. One group participant, Teso, also participated in an individual interview. The group interview provided a perspective which

I might otherwise have missed in that it showcased a call and response kind of camaraderie with participants playfully interjecting and asking each other questions for clarification or to playfully crack a joke about a sentiment expressed. This is a dynamic inherent in traditional African story-telling. Witnessing these interactions was quite illuminating for me; I mostly sat back and listened and only interjected to steer the conversation back to the topic at hand. One notation that I made following this interview was that it felt like a traditional fireside chat among family and friends. Worth noting is that this group interview was conducted in Kiswahili, a common language among the participants and myself. While all the participants spoke Kiswahili, I learned that they had varied expressive and comprehension levels, and I noted that a participant would stop and explain a word or sentence to another participant who might have asked what it meant. Sometimes this meant using another language like Lingala or French, and then

69 reemphasizing the Kiswahili meaning. I translated and transcribed this interview in

English. Unfortunately, due to time limitations, I was not able to get as detailed background information from participants although some shared more than others in discussions on FGC. Following is a brief demographic summary of the group interview participants:

Mrembo

A 23-year-old mother to an infant daughter, Mrembo was born in the Democratic

Republic of the Congo (DRC) but fled to Tanzania with her family as a refugee following the war in the DRC. At the time of the interview, she had been in Canada for just over a year. She stated that she had learned about FGC in Tanzania where it is traditionally practiced among some tribal groups.

Bela

At 28 years of age, Bela was also born in the DRC but moved to Burundi to escape the war. She had subsequently moved to Canada just six months prior to the interview and was currently taking English language classes.

Mtoto

Mtoto was 18 years old and was born in Burundi to parents who had fled the

DRC. Her family had been in Canada less than a year at the time of the interview. She was shy and contributed to the interview only when asked directly. Some of the women teased her about it and encouraged her to speak up.

Lindi

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Lindi was 39 years old and mother to Mtoto. She was currently doing volunteer work at an agency and taking English classes.

Nana

The oldest participant in the group interview, Nana was the 66-year-old mother- in-law to Lindi, and Mtoto’s grandmother. The participants respectfully referred to Nana as nyanya, the Swahili word for grandmother. Participants also tended to defer to Nana when they could not remember historical or traditional information.

Teso

A 48-year-old mother of two grown daughters, Teso was born in Kenya but relocated to Canada with her husband and daughters in search of better opportunities.

Both Teso and her daughters underwent FGC prior to immigrating to Canada. Teso was willing and eager to share her story outside of the group conversation, and she also offered to speak to her daughters about the possibility of participating in my research, which they agreed to.

Mimi

At 33 years of age, Mimi was born in the DRC and fled to Tanzania with her husband and two young children. Mimi had been in Canada for just over a year at the time of the interview.

Asali

36 years of age, Asali was also born in the DRC. Asali and her family fled to

Tanzania before relocating to Canada a little over 6 months prior to the interview.

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Table 3 Participant Demographics for Group Interview Name Country of Age Religion FGC Status Origin Mrembo DRC 23 Muslim Uncut Bela DRC 28 Christian Uncut Mtoto Burundi 18 Undisclosed Uncut Lindi DRC 39 Christian Uncut Nana DRC 66 Undisclosed Uncut Teso Kenya 48 Muslim Cut Mimi DRC 33 Christian Uncut Asali DRC 36 Muslim Uncut Note. DRC denotes the Democratic Republic of the Congo

Making Sense of Participant Interviews

The process of making sense of my research interviews was daunting, to say the least. As I began to work with participants’ interview transcriptions, I asked myself many questions: how was I, a novice researcher, going to honour the complex stories entrusted to me by women, many of whom were sharing their stories for the very first time? How would I best tell their stories without compromising their meanings, their cultural pride, and their stoicism in the face of hardships? Most importantly, I wondered how I could analyze, interpret and write this information to advance knowledge and avoid setting off what one of the women described as a “pity party” of foreigners? These were questions that I grappled with for months as I read and reread my interview transcripts and began

NVivo™ coding of the data.

The process of analyzing data in interpretive description involves an understanding of what the data are telling you, what you are asking of the data, and an

72 understanding of how these two questions work in tandem to help you answer your research questions. Interpretive description studies require that researchers in applied health disciplines ask questions that derive from the discipline, and that make sense of, and can provide practical answers for clinical settings (Thorne, 2016). As a nurse, I am tasked with utilizing theoretical knowledge to alleviate health issues and improve the well-being of individuals and populations. FGC has impact upon affected immigrant women and their families, and the questions to which I sought answers had to not only make sense to these women, but to also influence theirs and their families’ health and well-being.

Analysis of interpretive description data is inductive (Thorne et al., 2008) and is meant to “provide(s) direction in the creation of an interpretive account that is generated on the basis of informed questioning, using techniques of reflective, critical examination, and which ultimately guide and inform disciplinary thought in some manner” (p.6). The overall interpretive description research process including question generation, theoretical scaffolding, framing the design, and fieldwork, all contribute to what Thorne et al (2004) referred to as the preliminary analytic stage. My collaboration with the human services agencies for my initial data collection provided a conduit for knowledge translation through accountability to this and other agencies which seek to improve the lives of immigrant communities. This accountability might take the form of sharing my research findings with them and giving presentations relating to the health and welfare of target communities as appropriate.

During an interpretive description preconference workshop at a the 22nd Annual

Qualitative Health Research Conference in Kelowna British Columbia in October 2016,

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Sally Thorne described coding as “putting a tag on something for later retrieval in an attempt to create order out of chaos.” This order creation is aimed at systematically conceptualizing findings with the objective of creating a thematic summary or even a conceptual description aimed at generating an idea for inductive reasoning (Thorne 2016).

Conceptualization of findings in an interpretive description entails navigating the flow of information to showcase description of the data (see what I see) to analysis (know what I know) to interpretation (understand what I understand) (Thorne, 2016).

In conceptualizing interpretive description research findings, Thorne (2016) cautioned against committing too early to formal labels which she noted could limit one’s ability to explore new angles of data comprehension and serve to stifle creativity. This was true for my research because initial codes only served as placeholders with final thematic categories materializing from a better engagement with and understanding of research data.

Attempting to make sense of my research data via coding was no easy task particularly while trying to avoid committing too early to certain lines of reasoning based on theoretical preconceptions. I agonized over how to intelligibly connect the pieces and make them comprehensible to readers while linking to theory, but not overly so. Additionally, I agonized over how I would do this while understanding that meanings do not magically emerge from the data but are strategically created by knowing actors (Thorne, 2016;

Thorne, Kirkham, & O’Flynn-Magee, 2004). In the next section, I discuss the process of making sense of the research data.

In keeping with interpretive description, I began immersing in data immediately following the first interview. Transcribing the interviews myself allowed me to grasp nuances in participants’ words as well as any tonal variations used when describing their

74 experiences. This is an important aspect of interpretive description in rendering an interpretation beyond what is said, a reading between the lines so to speak. As Thorne

(2016) stated, words, sounds, and silent spaces can offer important insights when properly utilized. I brought a notebook to all of the interviews into which I wrote down insights based on interview proceedings. Given the sensitive nature of the topic, and out of respect for the participants, it was not always possible to write down more than key words during the actual interviews. Following the interview, during transcription or even in reviewing my field notations, I developed more comprehensive notes and/or questions. The field notes and reflections served as the bedrock of initial data coding.

Data management and initial coding

Management of data in interpretive description involves the arrangement, organization, and sorting of field information into an accessible and usable format (Thorne,

2016). For this study, I utilized the NVivoTM data management software for initial data coding because of its ability to support multiple data formats including audio and text.

Coding with NVivoTM also allowed me to immerse myself within the data thereby maintaining control over the process of analysis (Thorne, 2016).

All interview transcripts were uploaded into the NVivo™ software for organization, coding and initial sense-making. I used the text format which helped organize the data through classifying and developing nodes I was able to create as many nodes as necessary when I first started reading and rereading my transcripts and coding sentence by sentence. Creation of multiple nodes allowed me to describe minute details and to start making connections between data bits while staying close to participants’ stories, using embedded quotes, which NVivoTM refers to as references. Like most data

75 management tools, NVivoTM does not analyze and interpret data thereby that remains the researcher responsibility.

Next, I constructed a nodes list into with relevant and related embedded quotes.

Labeling nodes was a particularly daunting task that followed the initial pattern identification. Thorne (2016) recommended identifying an organizing structure for coding but guarding against predetermining its significance in the context of the overall research project. In attempting to determine associations between codes, I started shelving and assigning labels. During the multiple readings, I started looking for trends in keeping with my postcolonial feminist decolonizing theoretical leanings. It therefore made sense to start coding with these leanings in mind. I shared my initial NVivoTM codebook with my supervisor and dissertation committee members to elicit feedback on the coding process.

Initial codes were derived from a rereading of my transcripts by trying to plug theory into data and back again, over and over, while keeping my research questions in mind. With the NVivoTM software, I was able to immerse in the data and begin to make associations between emerging data pieces based on initial line-by-line reading for content. With these associations, I was able to develop multiple related nodes, which formed the template from which I began making associations and organizing data. Initial organization was based upon the comparisons and contrasts that began surfacing from readings of multiple transcripts.

Some of the comparisons that I made were based on participant characteristics including their ages and whether they were cut or not, whether they were mothers, grandmothers, or children as well as whether they viewed themselves as immigrants or

76 refugees. Interviewing intergenerationally added an extra level of comprehensiveness through repeated readings of the data while listening for similarities, differences, and tensions. During the initial stages of interviewing and coding of data, I was able go back and modify my interview guide to better reflect the context of my research questions.

These modifications were largely based on feedback after debriefings with my supervisor and served to clarify issues from previous interviews and also allowed me to grow as a qualitative interviewer and active listener.

I also used my field notebook and memos to supplement some of the broad themes and patterns. Additionally, this form of coding allowed for concurrent data collection, analysis, and self-reflection that aligned with the interpretive description study design. With NVivoTM, I was able to concurrently code, annotate, and memo, all while immersing in my data. The ease of access to participant experiences of FGC helped ensure that I had ready data to support the next phase of data analysis using interpretive description.

Thematic Data Analysis in Process

Actual data analysis requires of the researcher to be present and to actively

“drive” and “take ownership” of the interpretation in an effort to arrive at “truth claims” which are capable of withstanding scrutiny from persons with prior knowledge of the research field and the phenomenon under study; truth claims that would enhance the defensibility and therefore credibility of the analytic process as well as the overall research project (Thorne, Kirkham, & O’Flynn-Magee, 2004). In interpretive description studies, this “intellectual exercise” is more amenable especially when researching complex topics as was the case in this research, instead of using common qualitative

77 analytic maneuvers like the enumeration of themes (Thorne, 2016). With this knowledge in mind, I started coding my data with an understanding that any thematic nodes that I came up with would be based on participants’ narrations, colored with my understanding of those narrations, and based on the theoretical lens that I brought to the study along with my own preconceptions as an African immigrant woman conducting decolonizing resesarch in a diasporic setting. Which is to say that I read my research transcripts alongside my awareness of being a product of my culture, education, and socialization.

The thematizing and meaning-making that I embarked on was, therefore, a process informed by many understandings including my own.

Data analysis flowed from pieces to patterns and then from patterns to relationships, which could then be harnessed to surface truth claims about the phenomenon under study (Thorne, 2016). After initial coding, I read and reread my transcripts and started refining the categories, looking at overarching patterns that I then used to formulate larger labels. Through this process of constant comparative analysis, I was able to expand the associations between different data groupings and codes and come up with four main thematic categories.

In interpretive description studies, labels are understood as conveyors of conceptual meanings and are reflected within the theoretical scaffold that the researcher chooses to anchor their research in (Thorne, 2016). Ideally, the scaffold is determined prior to writing up findings. In other words, Thorne (2016) recommends constructing an outline, a table of contents, before embarking on the write-up of findings. The conceptual themes that I derived from data were all interrelated and together helped to weave multiple stories into one coherent story, a reflection of different experiences with blurred

78 lines between them. Data analysis surfaced four major themes with corresponding subthemes. The four main themes are: Experiencing FGC, Explaining FGC, Migrating

FGC, and Mitigating FGC. These themes with their respective subthemes are presented in detail in Chapters 4 and 5.

Enhancing Study Credibility and Rigour

With regards to credibility and rigour in interpretive descriptive studies, Thorne

(2016) cautions against the potential pitfall of strict adherence to traditional methodological evaluative standards which might not fit with the moral obligation and practice mandate of qualitative health research noting that “checklists and guidelines do little to ensure the excellence of any specific qualitative product” (p. 237). For instance,

Thorne (2008) warns against the common practice of member checking where a researcher revisits research participants to confirm whether the research findings accurately represent the truth of what the participants said and meant. Depending on the type of study, member checking may not fit as in my study design, interpretive description informed by decolonizing perspectives. Methodologically, a basic assumption was that the data were “partial, incomplete, and always in a process of re-telling and re- membering” (Jackson & Mazzei, 2012). As a critically reflexive decolonizing researcher,

I was in a continual process of questioning the data, what and how I heard. This also included questioning how my history as an African immigrant woman and my position of privilege and authority as researcher influenced interpretation of data.

Thorne (2016) does however offer some evaluative criteria and techniques to enhance credibility and rigour in interpretive descriptive studies based on general principles similar across various qualitative methodological affiliations. In Table 4 the

79 evaluative criteria along with associated techniques specific to my study are summarized.

Furthermore, in addressing what counts as validity in value-based research where issues such as social justice and equity are examined, Lather (1986) argues for catalytic validity to achieving study credibility and rigor. Catalytic validity “refers to the degree to which the research process re-orients, focusses, and energizes participants in what Freire (1973) terms ‘conscientization’” (p. 67). In other words, for value-based research, credibility and rigor include not only researcher self-reflexivity and understanding but also ideally more conscious awareness, understanding and even action for participants as well. For Lather

(1986) specific techniques include “some documentation that the research process has led to insight and, ideally, activism on the part of the respondents” (p.78). As an example, in my study, several study participants decried, among other things, the double standards with regards to the decriminalization of genital cosmetic procedures in Global North countries as well as the “folding in” that happens for them as a result of experiencing racial discrimination and Islamophobia in Canada. Notably, some study participants were already engaged in FGC activism and advocacy work.

Table 4

Evaluative Criteria and Associated Techniques

Evaluative Criteria Techniques Steps Taken in this Research Epistemological Integrity Assumptions about the -Extensive supervisor nature of knowledge are guidance and supervision justifiable, and the chosen -Guided study course on method matches the critical and decolonizing research questions methodologies -Theoretical triangulation to capture complexity

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-Workshops by Dr. Sally Thorne on interpretive description methodology -Publication on methodology (Werunga et. al., 2016) in a peer- reviewed journal -Conference presentations, national and international including at a qualitative health research conference.

Representative Credibility Theoretical claims are -Triangulation of data congruent with the sources by including sampling technique individual and group interviews, sampling across generations and geographical origins, interviewing cut and uncut women to capture diversity of views within cultures

Analytic Logic Reasoning is explicit -Extensive use of participant quotes in interpretive descriptive analysis -Detailed analysis chapters to showcase design and analytic logic

Interpretive Authority Interpretation of data is -Verbatim transcription of trustworthy interviews -Immersion in data analysis with continuous input from supervisor and supervisory committee - Researcher reflexivity with decolonizing interpretation (deep analysis) -Use of NVivoTM data management software as an organizational tool

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Moral Defensibility Claims made are -Relevant and timely topic convincing; potential that remains understudied benefits are accounted for in nursing in Canada especially when sensitive -Sensitive to, and topics or vulnerable groups respectful involved acknowledgement of women’s participation and their stories -Problematized the harm narrative of FGC and offered an alternative decolonizing interpretation focussed on black woman agency, resilience, and coping.

Disciplinary Relevance Extends knowledge of the -Research questions nursing discipline relevant to nursing and health care. -Recommendations for nursing education, leadership, research, policy, and practice

Pragmatic Obligation Considers findings as to -Focus on health and applicability in practice wellbeing of African and whether potential for immigrant and refugee harm women - Focus on equity and accessing culturally responsive trauma- informed care - Identification of structural inequities and conditions of exclusion/marginalization

Contextual Awareness Understands and -Consistent self-reflexivity recognizes linkage between and acknowledgment of the researcher perspectives to inseparability of researcher personal histories and from the research context disciplinary contexts; the -Acknowledgement of dynamism of individual intersecting sociopolitical and shared constructions of and economic structures understandings and the and how they manifest in women’s lives

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likelihood of reproducing -Recognition of harm intergenerational variations in FGC understandings and the evolution of African cultures in diasporic milieus and how these factors come into play in sustaining, disrupting, and countering FGC

Probable Truth Flexible in recognizing that -Consistency in critical any truth claims are not reflexivity absolute and that what is -Situating findings in true now may not be true decolonial literature when new information -Assume data as partial, becomes available incomplete, and situated -Critical interrogation of sociopolitical structures

Decolonizing Interpretation

For the decolonizing interpretation (Chapter 6), I shifted from a micro level to a macro level of analysis, situating participants’ stories within larger sociopolitical structural contexts to critically interrogate how these structures played into participants’ constructions of their lived experiences. This decolonizing process involved a back and forth movement between theory and data, between question and conversation, listening for nuances, intersections, the unsaid, and tension points, in an effort to surface new truths about how women make sense of FGC in colonized transnational spaces.

As discussed in Chapter 1, selected critical theories informed the decolonizing methodology used in this research. These critical theories included postcolonialism, postcolonial feminism, Africana feminism, Black feminism, Womanism, Africana

Womanism, and African Feminism. Guided by these theories, the supporting literature,

83 intersectionality, and the thematic findings of this study, I posed the following questions to help focus analysis:

• What are the fractured understandings of FGC?

• How does (neo)colonization affect gender constructions (e.g. global colonization

of bodies and minds)?

• What intersecting factors affect participants’ transnational and hybrid experiences

of FGC?

• How does migration impact intergenerational attitudes on FGC?

My aim with this interpretation was to go beyond what is known about FGC theorizing and tease out some truth claims that could, at the very least, shed some light on why decades of debates have been unsuccessful in deconstructing FGC within traditionally practicing locales as well as within practising diasporic communities. In Chapter 6, I offer my decolonizing interpretation extending analysis to situate participant stories within decolonial literature. With this critically reflexive re-examination of initial findings, my hope was to situate participants experiences of FGC “in the larger scheme of things” (Thorne, 2008, p. 193) in order to capture the effect of socioeconomic structures on the experiences of immigrant and refugee women affected by FGC.

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Chapter 4 Experiencing and Explaining FGC

“People always say that I didn’t give up my seat because I was tired, but that isn’t true. I was not tired physically … no, the only tired I was, was tired of giving in.”- Rosa Parks

I begin my analysis by discussing agency, an overarching theme that weaves its way through participants’ stories as narrated by them as well as through my interpretation of these stories. My interpretations are steeped in literature by contemporary black women diasporic thinkers who explore ways in which black women exhibit agency through the performance of mundane everyday activities that end up constituting resilience and resistance. The above quote by Rosa Parks is especially relevant here because she did not set out to trigger a movement, and yet she did. Rosa Parks was sitting in the “colored” section at the back of the bus at the end of a long day of work and simply wanted to get home. By refusing to cede her legally sanctioned black space yet again, she inadvertently set in motion events that gave rise to the civil rights movement in the

United States. It appeared that had not the white bus conductor pressed the issue, had he left Rosa Parks alone, the relegation of Black Americans in the USA south would have continued for much longer than it did. A tired black woman’s seemingly mundane act of resistance set in motion a historic movement.

With regards to analysis of data on black women’s experiences, Evans-Winters

(2019) recommends reflexive engagement with such stories on the part of black women researchers because the re-told stories reflect the larger accounts of black women’s ways of coping, resisting, and surviving on the margins of society. In this chapter, I do so, starting with a presentation of the overarching theme of agency (in dialectical tension with structure), followed by inductive analysis of the two themes of experiencing and

85 explaining FGC. In Chapter 5, the third and fourth themes of migrating and mitigating

FCG are presented. The following thematic diagram (Figure 1) shows the sequencing of the themes Experiencing FGC and Explaining FGC along with associated subthemes and sub-subthemes.

Figure 1: Experiencing and Explaining FGC

Agency/Structure

Experiencing FGC Explaining FGC

The confluence of Hive Mind The Social Religion and Phenomenon and Health Trauma Grieving Dynamics Culture in the Normalizing of Sustaining FGC Justifying FGC FGC

Recurring/re- Frustrations of Gender and experienciencing A time of new Patriarchy as confusion and uncertainty A peace-finding Class and Rurality understandings Perpetuating FGC pain process as Sustaining FGC

Black Womanhood as Agency

African immigrant women who have experienced FGC have powerful and complex stories to tell. This complexity is made even more apparent when one considers the positionality of these women as global citizens, residing far away from their ancestral homes, and having to negotiate complex foreign sociopolitical structures not only for themselves but also their families. For this research study, I interviewed women who identified as mothers, daughters, siblings, grandparents, and friends. I view the experiences shared by study participants in their navigation of these sociopolitical

86 structures as akin to what Ringrose (2007) saw as an intuitive series of twists and turns across different situations to establish a space for themselves. I view this navigation as agency-in-practice in the many ways in which the women were able to resist, survive, and find new ways of coping. Ringrose (2007) sought to differentiate between agency and choice noting that the two cannot be synonymous since agency, unlike choice, is not always comprised of intention but rather is subjective with individuals evolving and transforming, sometimes in surprising ways in an effort to liberate themselves and make sense of situations they find themselves in. I aligned with this view of agency-in-practice as integral to black womanhood in attempting to make sense of participants’ stories. As a researcher, then, the challenge for me was in finding a way to effectively relay participants’ stories without overly emphasizing ways in which they were oppressed and marginalized but also showing how they resisted, persisted, and triumphed in the face of challenges.

McGee, Love, Waters, and Evans-Winters (2019) understood Black women as possessing multiple agencies spanning time and space and viewed agency as inseparable from identity. Therefore, black womanhood was intimately tied to agency and this agency was made manifest in various aspects of black women’s everyday lives in intentional and unintentional ways. Evans-Winters (2019) spoke to the process of analyzing and sharing data about experiences of black women in research studies as a process of unmasking, a pulling back of layers in an effort to expose hidden experiences and stories using analytical techniques which center and honor these experiences while enabling others to discern and be sensitive to the ways in which black women, both researchers and

87 participants, exist within structures which are expressly constructed to embellish their stories and render them invisible.

In sharing their FGC experiences, women in this study were able to speak to ways in which they found the practice of FGC within their cultures to be problematic and even outdated and yet they still found ways to honor their mothers, grandmothers, and others within their communities who had played a role in their cutting. I found this to be in contradiction to the blanket condemnation of FGC, particularly in global contexts, as barbaric but also as illegal mutilation and abuse against women and girls (WHO, 2008;

Werunga et al., 2016) sometimes without consideration for ongoing efforts within specific cultures to address this centuries-old tradition and respectfully find ways to replace it with practices that are less harmful. Participants spoke about the reckoning happening at individual, family, and community levels within their cultures with regards to FGC; a reckoning necessitated by grassroots efforts by women and men within these communities who continually question the viability of a practice which many community members deem to be harmful to the girls and women who have to endure it.

The Agency-Structure Dialectic

My understanding of participants’ agency in this study was in line with McGee et al’s (2019) view of the complexity and variation of manifestations of Black womanhood across space, time, nations, generations, as well as sociopolitical structures within a transnational milieu. I therefore assumed that study participants did not exist in a vacuum, rather they were part of formal and informal social, political, economic, and cultural structures which helped shape how they viewed themselves and the larger society in which they lived. The stories shared by women in this study were stories situated

88 within the aforementioned structures and spanned geographical space and time.

Additionally, these stories happened within unequal sociopolitical relations of power and included what Evans-Winters (2019) and Collins (2000) saw as a legacy of survival where black women constantly mediate how society sees them versus how they see themselves. This survival instinct and the ability to negotiate identities across time and space, oftentimes unsuccessfully, can nevertheless be transformative and liberative

(McGee et al., 2019). Also reflected was the inseparability of black womanhood and agency, in other words, to be a black woman is to embody agency as a part of identity, oftentimes in unknowable ways. This, for me, is agency-in-practice; a dialectical interplay that, of necessity, is situated within sociopolitical structures which black women must navigate from the margins and yet often, as Evans-Winters (2019) noted, continually exhibit remarkable agentic practices of coping, resistance, and resilience.

This understanding of agency reflects what Evans-Winters (2019) saw as a shared unconscious, that is, a collective of ways in which black women cope, resist, and persist against enormous odds. However, it does not mean that black women are a monolith or that they employ similar tactics in their navigation of everyday structures. Black women employ varied tactics to fight different battles in shared wars. For instance, del

Guadalupe (2017) explored the differences between perceptions of younger versus older black feminists with regards to the sexualization of black female bodies in contemporary mass media whereupon she found that younger black feminists were more receptive of such images and seized upon the opportunity to relay a positive narrative of the images instead of focusing on the negative, overly sexualized media spin. This view of black feminist agency as temporal was echoed by Evans-Winters (2019) and other

89 contemporary minority thinkers and aligns with the analytical lens which I bring to my data in the sense that the apparent reciprocity and dynamism between individuals and structures (Archer, 2005; Hubbard, 2000) denotes a fluidity and complexity which calls for the adaptation of a more complex, dynamic, and adaptive black feminist agency, one that reflects the changing times. In my research study, there were generational differences in how participants viewed, expressed, and performed agency and I detail these differences in Chapter 5 when I discuss the subthemes of migrating and mitigating FGC.

Re-presenting Black Women’s Experiences: Shards of Glass

In positioning as a critically reflexive decolonizing researcher, one of the main reasons I was drawn to the interpretive descriptive methodology was the promise of a qualitative methodology that would afford me a level of intellectual freedom and allow me to disrupt the status quo by particularizing and centring the experiences of black women as well as disrupt and raise my consciousness of my personal experiences as a black woman researcher. My conversations with African immigrant and refugee women affected by FGC were reliant on an unspoken covenant, a sisterhood of sorts, as if the women innately knew that I would “do right” by them in terms of how I chose to share and interpret what I viewed as their sacred revelations. So then, it was incumbent on me to choose stories that I could relate without compromising participants’ dignities as well as the dignity of their communities. In a way, I viewed some of the more sensitive information that participants chose to share with me as secrets bound by a sisterhood, and

I agonized over how to best share them, or even if I ought to share them at all in this research. In discussing this dilemma in her own research work, Bhattacharya (2007)

90 likened the re-presentation of participants’ experiences to seeing through a broken looking glass stating thus:

Very rarely does a looking glass reflect what we hope to see. The re-presentation

from such messiness inhabits mirrored spaces that are not only fractured and

refracted but also shattered into shards, leaving it to the writer and the reader to

piece them together to tell tales with indistinct ends, beginnings, and middle, with

a temporary composure that is fraught with contradictions. (pg. 1106)

In the next two chapters, Chapter 4 and Chapter 5, I re-present participants’ experiences while staying as close to their own telling of them as possible, while showcasing the many ways they exhibit multiple agencies knowingly and unknowingly as they navigate and attempt to survive a transnational existence. In Chapter 4, I present participants’ understandings of how they experience and explain FGC to themselves and to others. I do this by exploring the subthemes of “health” and “trauma” to show how participants enact and perform health and healing practices across dynamic socio- politico-cultural, economic, gendered, and raced structural landscapes. In Chapter 5, I lay out the migration experiences of women affected by FGC and ways in which they confront it in diasporic settings while trying to mitigate the effects. I present participants’ views of their healthcare encounters as well as ways in which they speak to the practice across different generations including how they take up the narrative on FGC in an attempt to reclaim and redirect it to reflect their ownership of it; a re-telling of the story on their own terms.

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Experiencing FGC

When I first started conducting interviews with the women in this study, I agonized over how to effectively and respectfully break the ice so that I could seamlessly transition into a meaningful conversation with women given the sensitivity of the research topic. However, I quickly discovered that it was best to allow participants to determine the starting point for the narration of their FGC stories. It was then that I started to notice a trend in where the telling started, with most of the women initially sharing details about the actual day that they were cut, including details of events leading up to the cutting as well as the aftermath of the cutting. Participants shared details about where the cutting happened, who was involved, who called the shots, as well as their pain and fears. Given that most of the participants stated that they had been cut around the age of seven, I surmised that the choice of talking about that day, which one of the participants described as the worst day of her life, as the starting point for sharing these stories held some significance for the women. I likewise chose to begin the re-telling of participants stories with their experiences of FGC and how their memories of the actual act served as a springboard for women’s subsequent FGC experiences across different countries and cultures because, as one participant stated, the memories of the actual cutting were forever etched in her psyche. I hold that one cannot fully appreciate the complexity of FGC without first understanding how participants remember and relate their experiences.

In order to offer a more nuanced view of participants’ understandings of the impact of FGC on their health and overall wellbeing, I subdivided the theme

Experiencing FGC into three subthemes: health, grieving, and trauma.

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Health

The view of FGC as a problematic cultural practice with proven health consequences has captured global headlines for decades and remains a fixture within global health contexts and human rights discourses. A global health perspective has as its focus issues that affect individuals’ health and wellbeing directly or indirectly and that can transcend borders and boundaries (Koplan et al., 2009). Participants in this study were immigrant or refugee women with complex transnational identities who now had to navigate their FGC experiences within a new cultural and healthcare dispensation.

In speaking with study participants, a common experience that weaved its way through most of their stories was how undergoing FGC had affected their lives. I used the subtheme of health to encompass the multiplicity of physical and psychosocial disruptions to participants’ sense of wellbeing as understood by them, to try and capture the ways in which they enacted coping mechanisms pre- and post-migration.

FGC is associated with multiple health effects (WHO, 2006, 2008, 2011, 2013,

2016) and participants in this study corroborated this in describing their life experiences.

For this subtheme, I wanted to go beyond the well-documented physical health effects of

FGC, which some participants admitted to also having experienced, to other modalities of healing from FGC-induced ill-health which participants may have adopted as they navigated their transnational experiences. Additionally, I wanted to highlight psychosocial health effects of FGC as described by participants. Many participants spoke about the difficulties they experienced in speaking about the non-physical health effects of FGC, the ones that left no visible scars. Here is what Samia said when I asked her if she ever discussed FGC consequences with her siblings:

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Samia: With my sisters we never talked about it because usually if you don't have

a problem, you don't talk, and most of the people who talk about FGM (sic) or the

circumcision, they do have some kind of consequences that happened to them.

Interviewer: Could you tell me more about that?

Samia: Like the emotional psychological trauma or shock, I think it is there in

every girl that had (sic) been through it but they choose not to talk about it unless

there is really a problem that is kind of a physical problem. So you just didn’t said

(sic) anything if you had nothing to show that is physical. (Samia, individual

interview, age range 21-30)

Participants spoke of having to live with FGC effects as a lifelong endeavor requiring adaptations as they went through various life stages. They expressed frustrations about the focus on physiological health effects at the expense of the invisible scars which most of them have to live with forever. This quote by Malala further elucidates this:

… because you know, trauma … if someone was raped, they can get help, if

someone was abused as a child and has trauma, they can get help, but someone

who experienced cutting … it is almost like a cultural mob, hive-mind, and it’s

like a secret or taboo, how do you get help, you know? And to admit to even your

parents that something is wrong with me, their first thought is not, oh it is the

cutting or what happened to her, you know?... they are just like, we will take you

to the doctor … and they don’t know what’s wrong with her. I know what’s wrong

with her; she’s been cut. (Malala, individual interview, age range 31-40).

Given participants’ frustrations with the health practices at their disposal, it is fair to surmise that the traditional frame for understanding health and coping tends to be quite

94 static and limited in its primary focus on physical symptoms. It is therefore lacking when it comes to the provision of healthcare for women affected by FGC as these women often endure trauma and other psychosocial health issues. Most women just wanted to be helped to cope and manage the natural progression of complex bodily experiences. Some young participants spoke about their fears regarding intimacy when they eventually got married or entered a sexual relationship. One participant, Diya, shared that she was not sure how she would go about revealing to a partner that she had been cut and that she likely looked different “down there.” To these women, ongoing complex bodily experiences and changing health practices regarding body positivity and body image were more important than any associated physical symptoms. So then, coping mechanisms as health practices would be more apropos particularly if expressly situated in sociopolitical, economic, gendered, and even raced transnational milieus to reflect the experiences of participants in this study. In other words, participants would benefit from culturally safe healthcare practices focusing on their psychosocial health, and offered in judgment-free, respectful environments.

Worth noting is the fact that although participants spoke about initial physical effects of FGC, most denied experiencing any ongoing physiological health issues.

Instead, most alluded to past and ongoing psychosocial health challenges. To this end, I focused on those challenges and participants’ performance of agency in the face of many other life events including wars, displacement, and challenges brought on by their migration and settlement experiences in new countries and cultures. In listening to the participants’ stories about their FGC experiences I began to see a trend in how they enacted coping mechanisms from a young age all the way to their resettlement in the

95 diaspora. I refer to this as grieving, not because participants described a tidy linear process of coping and triumphing, but rather, they described a messy process made up of trial and error and yet reflecting courage, persistence, resistance, and agency. I discuss this process in the next section.

Grieving

Participants spoke about navigating the FGC experience starting from the initial shock of undergoing the practice at a young age to accepting and living with it as adults.

In reviewing participants’ stories, I noticed a pattern in how they had arrived at their current state of being where they seemed to have a good understanding of how FGC had impacted their lives. I then formulated the sub-subthemes of recurring/ re-experiencing confusion and pain, a time of uncertainty, frustrations of new understandings, and a peace-finding process to reflect these meaning-making stages across their lifespan. The linearity of these phases reflects participants’ progression through their physical and psychosocial growth and development. I chose the notation of “grieving” to reflect the loss of a body part and to signify participants’ efforts to cope with, and come to terms with that loss, as well as their willingness to regain a sense of wellbeing in spite of it; their inherent agency. In expounding on these sub-subthemes, I also discuss how the psychosocial health and wellbeing of participants was affected.

Recurring/Re-experiencing confusion and pain

Most participants spoke about experiencing trauma later in life with most attributing it to memories of the actual act of cutting happening to them at a young age.

Here, I focus on participants’ initial reactions to their cutting experiences. Participants spoke about being misled about cutting with most describing a party-like atmosphere

96 leading up to the cutting, and then getting bribed with gifts before being led somewhere private, held down, and forcefully cut, amid their protestations. Malala describes her cutting experience thus:

… It’s mixed feelings…. of that fight or flight … fear, and I tried to run away a

lot, especially, like they lied to me when they told me where we were going … so,

you know, if they had told me ahead of time where we were going I think I would

have run away, you know. So um, they lied to me en route and then once we got

there and um, they couldn’t do anything about the order of who gets cut first so

my cousin went ahead of me and she had the full one done where they take

everything out and they only leave a little bit … no anaesthesia by the way, and

they sew everything together and they leave a little pea-sized hole for you to pee

out of. So listening to her blood-curdling screams told me I am in a butchery, I am

somewhere where someone’s being butchered vaginally and it’s gonna happen to

me too. They did the Sunna one to me which is where they cut a piece of the

clitoris and they make you bleed and they sew under your clitoris, the part that

they cut, and I didn’t know…like it was very quick, you know, …it could have

been at least like a minute and half when he did it but it felt, um, like agony and it

felt like forever … and I was running around um, the table that he was, you know

um, the… and my aunt caught me… um, with him helping and they threw me on

there and they restrained me. She had a … my aunt had a shoe, you know, like a

sandal and she was just whipping my face the whole time while I was crying …so

it was like to me … it was like no consent, you know, most girls had I think a lot

better experiences where you know, they were having a party for them and where

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they were celebrating but like my mom wasn’t there, I didn’t have anyone with

me, my, you know, father wasn’t there. So I didn’t have like my support system,

like that comforting feeling… being only 6 or 7 it’s like what’s going on. So I just

remember being in the car and like just having pangs (of pain) after that. So what

ended up happening afterwards is I guess, as I got older, I ended with having

trauma and anxiety and um, having my hips feeling tighter than normal ‘cause

when I got home they had to um, wrap my legs for 2 weeks where I couldn’t even

move, so my hips locked. So I had to do a lot of physiotherapy, massage and so

on. (Malala, individual interview, age range 31-40).

This lengthy quote by Malala was all encompassing in the way it captured the sentiments of most of the participants who identified as having undergone FGC, albeit with more nuance. It is worth noting again that given the sensitive nature of FGC, I had notified participants of the voluntary nature of the interviews and made available to them, the contacts of trained professionals in case they needed to speak with someone about any issues brought on by their sharing about what many deemed to be a deeply traumatic experience. Malala, along with the rest of the participants did not express the need to speak with someone about what they chose to share for this study. While Malala’s description of her experience was extremely detailed, she also seemed eager to speak about it, and while other participants did not go into as much detail, they echoed her sentiments.

The level of confusion and pain experienced by participants during their cutting experiences seemed to be proportionate to their descriptions of subsequent “grief” which they had to work through and overcome later in life. So for instance, participants who

98 described a more organized, perhaps more sanitized cutting experience where trained health professionals used medications and sterilized tools, tended to describe “less traumatic” yet still haunting and “unforgettable” experiences. To this end, the cutting experiences as described by participants seemed to signal the genesis of myriads of enduring psychosocial health issues attributable to FGC. For most participants, pain was the main catalyst for the ensuing traumatic recall.

A time of uncertainty

Participants described a time of uncertainty in their lives, the period between being cut, usually before the age of 10, and the onset of puberty. For most participants, this period was where memories were repressed and nothing much happened with regards to their cutting experiences. Many of the participants below the age of 40 stated that this was the time when their families relocated to Canada from their home countries and got busy with adjusting to a new life and culture. They spoke about the adjustment processes and the challenges therein, but for some participants, the thought of having been cut was always just below the surface. Here is how Zemi described this coming of age:

We moved to Canada when I was 11. Knowing my body was never going to be the

same as other girls my age was kind of just at the back of my mind and I just put it

at the back and ignored it because I was playing sports and I was busy and I

really didn’t think about. (Zemi, individual interview, age range 31-40).

Zemi described the enduring psychosocial health impact of FGC, despite the silence and erasure that can occur. Other participants spoke about completely forgetting or perhaps blocking out the experience throughout this time period. For instance, Diya spoke about only having learnt about her own cutting experience after seeing a news item on the

99 television and questioning her mother about it. She stated that she started remembering details of her own cutting after that. Diya’s experience shows that suppression is often just momentary and that memories of FGC are wont to resurface in the face of triggers.

This period of uncertainty by participants was yet another phase in the FGC grieving period, and whereas participants may have presented as healthy, I view it as a period of repressed, unresolved FGC-related health concerns.

Frustrations of new understandings

Participants described the onset of puberty as not only a time of discovery but also a period filled with frustrations attributable to a better understanding of what had happened to them and for some, the onset of some health issues related to their FGC experiences. Samia best captured this sense of snapping back to reality thus:

… they try to make it good for you by giving you the presents, by doing those

stuffs (sic), and for a while it works, you know, you heal and stuff, and life goes

on, you like forget …like before puberty, you just forget about it, you don't think

about that a lot. And if you've got the really worst type, the Pharaonic one

(Infibulation), at this time of period it’s really hard for girls, it’s really where

infections start, where a lot of misery starts. And then when you get to know your

… like because we know that in the human development, there is a time of

puberty, then you acknowledge, and you try to get to know your genitalia … your

sexuality and stuff. So, it’s really a hard time, it is really hard especially for the

worse (sic) kind of circumcision. (Samia, individual interview, age range 21-30)

And here is Zemi:

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Then for a while it was like nothing, so I was okay. I didn't have like any

infections, or puberty problems with my period or stuff. But once I went to

university, because I didn’t have knowledge about what exactly the anatomy of

the female genitalia was until I got to university, can you believe that? So at

university was actually when we studied anatomy and I think it was the first year,

the second semester of the first year that we did anatomy and I was like looking

through the pages. I remember that quite well, I was studying the female genitalia

and I was like I saw this picture … I was like, I should have the same thing, but I

don’t feel that it’s the same. (Zemi, individual interview, age range 31-30).

Participants expressed surprise and also described feeling frustrated about not having adequate knowledge about FGC and being fearful about the future given the inadequacy of their preparation for the discoveries they were making about their FGC experiences and their altered genitalia. Most participants described the added pressure of grappling with FGC-related issues while already attempting to fit into a new culture where they were automatically deemed as “other” on account of their migration status. Some of the struggles shared by participants included body image, sexual health, as well as self- esteem issues. To this end, some participants spoke about attempting to obtain genital reconstruction surgeries while others spoke about their unease with sex. Here is an excerpt of Zemi talking about sexuality:

When it comes to like sexual activity, it takes me longer to be stimulated as a

female, but I can't speak for other females …for me, the way that it has affected

my life is that for the longest time I was never comfortable with sexuality.

Culturally we never talked about sexuality, sex is a taboo subject. I was

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explaining to someone that in the African community you can’t even have

discussions about safe sex. People don't even want to acknowledge how kids are

made but imagine when you're in a conservative Muslim household on top that,

right? So, for the longest time it was just nothing was discussed about it. So, as an

adult woman you discover things on your own and as I got older I realized like

I'm glad that I still have sensation because some women don't have sensation and

will never have that sensation because it's damaged and it's gone. And my heart

breaks for them because sex just becomes procreation. Two of my siblings are not

married and they don't ever want to be married and I'm pretty sure one of the

reasons why is because of that practice, that horrendous practice, because when

you’re raised in a place where you are taught from a young age that you’re with a

partner because you need to procreate and nothing else … sex is not supposed to

be enjoyable, right? So then when you are educated and you know how the female

body works, then it becomes like what's the point? (Zemi, individual interview,

age range 31-40).

Zemi went even further and attributed the discoveries about sexual health to her siblings’ life-changing decisions regarding marriage. Diya echoed Zemi’s sentiments and also spoke about her own FGC-related frustrations:

… now I'm kind of in a situation where I am like, I don't know what to do, I don't

know what to think, I don't know how to go about this. And even to bring this

topic up to myself has really been difficult because I'm like now I have to think

about the future. I have to think about how I'm going to deal with this, you know?

I have to think about if I want to go talk to a doctor, how am I going to tell him?

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Sometimes like you get doctors who are like, “What is that? I've never heard of

that before.” So, you have to explain and the explaining part of it is even harder

because everyone is like, what? How could you allow that? What are you going to

do now?” So much shock is associated with it and everyone's like, Oh, my God

like, Are you okay? (Diya, individual interview, age 18).

Participants’ frustrations during this stage highlighted a perceived disruption to their sense of wellbeing and overall health but also showed how their perception of health was of necessity interwoven with events in their lives at any given time, events which manifested within sociopolitical, economic and social structures.

A peace-finding process

Participants described learning to cope and even transcending their FGC experiences. In a sense, in telling their stories and sharing their experiences, participants demonstrated their ability to rise above their circumstances and create a new normal for themselves and their families. I interpreted this as a peace-finding process, as a coming to terms with and learning to live with the consequences of FGC This creation of a new normal reflects the embodied enactment of agency by participants through this messy grieving process and speaks to the ways in which black women’s identities are intimately tied to agency. While most participants stated that they likely would never forget their

FGC experiences, many described finding a renewed purpose in life as a result of those experiences. Samia spoke about moving beyond her anger at her mother for having put her through FGC:

… we had like a lot of arguments with my mom about it. And then the anger and

the frustration just went away. I’m trying to kind of find peace with it because it

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happened but I’m never going to do it, so that made me feel like I’m okay because

now I know. I know a lot about it, so I will work on this area and never, never

ever do it to my children. (Samia, individual interview, age range 21-30).

As part of her peace finding process, Samia was actively engaged in being a change agent in her home country and as a new refugee to Canada was already engaged in multiple volunteer initiatives in her community. She was also in the process of enrolling in school because as she said, she was determined to “let nothing hold me back”. Like Samia, Shala was engaged in anti-FGC activism and spoke about her life purpose as a result of having experienced FGC:

If it’s going to empower someone who desperately needs it done, like someone

who has gone through mutilation and she can really benefit by me explaining how

it has helped me, that’s my passion, that’s my vision. That’s my purpose to be in

this world. I truly believe that. I’m a Christian; I truly believe God let me go

through FGM (sic) because he knew I will help people. He knew I will stand up

and talk to women and help them about it. (Shala, individual interview, age range

41-50).

Other participants spoke about concrete plans to handle any FGC-related challenges, a reflection of their newfound confidence and agency. Diya spoke about plans to speak with a health professional in the future to help her assess any potential reproductive health issues. For Doria, the oldest participant in this study, acceptance manifested a little differently. Here is what she shared about her views on perceived FGC effects on her life, including her sexuality:

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I have never noticed anything (health effects). We women we have sex, sex is no

good (sic). You get to a certain age that we don’t even feel like having it. All you

just focus is if you are working, you just work. Life is hectic, do some exercise and

move on with your life at a certain age. So, like me now my husband is not here, I

am here. I'll go home maybe in another few months … every year I go home. So, I

don't really think of it (FGC). (Doria, individual interview, age range 61-70).

For Doria, FGC was largely blameless, and she readily accepted any perceived ill effects of the practice as part of a cultural norm. While some participants spoke about having sought past professional help for FGC-related issues or potentially seeking help in the future, their collective awareness of their situations as well as the fact that most of them were living what they deemed to be well-adjusted lives in a new cultural location was what I interpreted as having somewhat transcended their FGC-related grief experiences.

And yet, participants spoke about the triggering and ongoing effects of FGC-related trauma even while they had figured out ways to function with in spite of this ever-present phenomenon. In the next section, I delve into a discussion of trauma, an ongoing struggle as expressed by participants in this study

Trauma

A common subtheme that seemed to weave its way through participant stories was the notion of FGC as a very traumatic act, the remnants of which were almost always present. For me as researcher, this was perhaps the most daunting and emotional aspect of the interview process. While I had mechanisms in place for providing participants with professional resources in anticipation of any triggers related to the retelling of FGC experiences, the real challenge was in respectfully allowing participants to express

105 themselves fully in a safe, caring, and neutral space. Part of this process was the awareness of the fine balance between discussing available resources, which I mostly did during the pre-interview consent form review, and offering up those resources when not expressly requested, like during particularly emotional or tearful narrations by participants. Understanding and enacting this process was a growth exercise for me throughout the process of collecting data. I learned that participants had in many ways developed coping mechanisms, learned to recognize triggers, and some had even established processes around coming to terms with their traumatic experiences. I also learned that most participants wanted to share those experiences and processes without the expectation of professional intervention. While learning to engage with participants in this way will no doubt be an ongoing learning process for me, I did learn to listen keenly and allow participants to share this part of their FGC experiences however they saw fit.

None of the participants asked for professional help or expressed distress after sharing their stories. Shala, a social worker by profession, stated that she chose to speak about

FGC, not to look for pity or to be victimized further, but in order “to gain change makers” which she explained as a collection of allies who would help in her attempts to eradicate the practice in her home country and to help girls and women to cope with consequences. Shala’s actions reflect agency as a Black woman.

Participants pointed to the actual cutting experience when discussing trauma with most of them using the actual term, trauma, to describe their cutting story as in the following data excerpts:

Shala: …for those who have gone through it, it’s a lifelong trauma because FGM

affects every woman differently. I have women who don’t talk about it, they don’t

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even want to know how it affects them, and they want to keep silent with their

struggle.

And Tamu;

Just because the experience is really traumatizing. It is very traumatizing. It stays

with you and you never forget it. There are millions of things that I’ve forgotten

from when I was seven, eight, nine, ten years old, but this I haven’t forgotten just

because it was so traumatizing. I don’t know if I would want to put my grandkids

through it. If she (daughter) decides that she wants to do it, that’s her choice, but

I wouldn’t make that decision for her because it’s not my decision to make.

Some aspects of the process that participants associated with their trauma included not knowing in advance what was going to happen to them; subsequently attempting to fight during the cutting and then being forcefully held down; the pain during and after the cutting; and for some participants, the absence of support systems in close family members with some participants having been cut while parents were away.

Participants also spoke about learning to cope with trauma triggers as adults and coming up with workable coping mechanisms. Here is how Shala described some of her triggers and how she handled them:

It really depends on the situation, like four weeks ago a friend of mine called me

and she told me that one of the girls that I do assist in my anti-FGM services, they

have a safe house and a dormitory for girls in Kenya … that one of the girls has

been taken by her father to go and get circumcised and they cannot find her. Then

I remembered the conversation we had with this kid and why she doesn’t want to

go for FGM and how she was scared, and it triggered me. It took me back to the

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same place where I was when I was telling my parents, “Please, spare me, please

spare my sister.” And that bothered me. So, I do a couple of things, I have gone

through trauma therapy for years and I have learned ways of coping. Personally,

I start thinking about how many people I have saved from going through FGM. I

start reminding myself that I have saved my oldest daughter; she’s not going

through it, I have saved my second born, she’s not going through it. But yes, I was

so traumatized and for a couple of weeks I didn’t want to talk about FGM, I

didn’t want to talk about anything, I was angry. It just took me to that dark

moment. (Shala, individual interview, age range 41-50)

Shala highlighted the notion of trauma as always present, as always hidden just below the surface. She also showed how she, like many other participants, had found ways to cope in order to lessen the impact; actions which I view as agentic. For Shala, this included affirmations of the positive changes she was making in her eradication efforts and the acknowledgment of, and channelling of her anger at what had been done to her, into a call to action; agency in practice.

Other participants spoke about compartmentalizing trauma and coping with it in their own way. Teso spoke about growing up with a mother who had epilepsy and experienced frequent seizures. She compared the trauma of her mother’s situation with her cutting experience while discussing how her youngest daughter had brought up the issue of FGC-related trauma:

Like when she (daughter) said it was so traumatic and she looked at me and she

said, “Mom, don't you think so?” and I said, “I agree with you.” And that's when

I reflected. You know when someone talks to you, that’s when you reflect back. So

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that’s when I reflected, it was a dark room etc. (sic). Yes, it was traumatic but as

an individual I would say because I have seen a lot of things in my life, I don’t

find anything traumatic anymore. I am not numb to it necessarily. I deal with it. I

say, what can I do, and I start thinking. I am a person of solutions. I am a very

positive person not a negative person … So, I see the way I’ve had a difficult life,

and I wonder if by crying and by sulking am I going to get anywhere. So I start

thinking like that rationally, this is the situation, what do we need to do next? I

think when saturation stage has been reached nothing moves you. I can also say

that I lost my father and there was no emotion at all. Everything was dead. He is

no more; it sinks in later on but not at that moment as you’ve got to be strong.

Because from the time of childhood, I can tell you this much, circumcision was

not that traumatic the way my mother’s epilepsy was traumatic, it doesn't leave

me till today (sic) … up to now, because her epilepsy was extreme. Up to now I

get up at night like so scared that she is getting her epilepsy attack. That trauma

is not going to leave me for life, the circumcision trauma can leave, I can think

about it and then move on, but the epilepsy trauma will not leave me for life. I

don’t think it’s going to leave me. For me that’s what I call trauma. (Teso,

individual interview, age range 41-50).

Teso’s description of her coping strategies appeared to fall into the category of what another participant, Zemi described as an African propensity for “folding in”, a crumpling up of certain uncomfortable issues and tossing them into the corner in the hope that they will be forgotten. It also fits in with an experiential framing of healthcare practices where situations or happenings in one’s life dictate the mechanism(s) chosen to

109 address the issues at hand including how to cope at any given time. It would therefore appear that participants, even the most adjusted women, were engaged in a complex process of re-negotiating their incomplete grief and trauma experiences even as they simultaneously attempted to adjust and settle into their new lives in a new country. I viewed this juggling act as a reflection of agency-in-practice and black womanhood as agency.

In this next section, I discuss the theme of explaining FGC.

Explaining FGC

In addition to sharing their FGC experiences, participants also spoke about their understandings of the presence of FGC within their cultures and its persistence across generations therein. While women in this study held varied opinions about the utility of

FGC in their communities, they nevertheless found ways to speak about it without vilifying their elders and others within their communities who held sway with regards to the continuation of FGC. With this theme I discuss participants’ understandings of various justifications given within their communities for the existence and continuation of FGC. These include a discussion of the confluence of culture and religion as well as the gender dynamics at play within communities both in the actual cutting process as well as in the sustenance of FGC across generations.

I believe that FGC cannot be fully comprehended without also having an understanding of the cultures within which the practice is embedded. In reviewing interview transcripts, it became apparent that culture was at the centre of participants’ discussions about FGC. Arizpe (2004) described culture as,

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…a flow of meanings that human beings create, blend, and exchange. Cultures

are philosophies of life that hold together all the social practices that build and

maintain a capable, creative human being. Such practices also hold together well

functioning, balanced societies. In this sense, cultures function as primarily

regulating systems that help to keep people’s feelings and actions within the

bounds of institutionally acceptable behavior. (pp. 164).

For purposes of this research, I align with the above definition along with the view that human beings do not passively ascribe to cultural norms but instead play an active role in perpetuating practices within their cultural milieus. Furthermore, I hold that individuals’ participation in culture takes many different forms including the questioning of, reinvention, and even complete denunciation of certain aspects of their cultures that they may deem problematic. This means that individuals possessing agency are social actors either individually, for instance by questioning why girls should be cut at all, or collectively within defined socio-politico-cultural structures. In other words, as members of a community, individuals exercise agency but within ascribed cultural definitions because in a way, the two cannot be divorced, particularly with regards to an embedded cultural practice like FGC.

Questioning cultural norms was evident with participants in this study, most of whom viewed FGC as a negative cultural practice that needed to be eradicated or replaced. One participant spoke about her objection to the practice even while growing up in what she described as a conservative Muslim household. When I asked Zemi about what prompted her opposition, she described being the only one among her many siblings to respectfully question things and refuse to take things at face value. Zemi credited

111 exposure to other cultural groups’ ways of doing things as having equipped her to reject an embedded cultural practice. She spoke about the dislocation of her family from her home country of Somalia as a blessing because it allowed her to immerse in, and learn about other cultures, a process which she said allowed her to intimately engage with and question her own culture. Zemi personifies a woman who refuses to be a passive receptacle of culture (Arizpe, 2004) but instead questions and engages with it.

To better understand participants’ views, I subdivided the subtheme of culture into three sub-subthemes: the confluence of religion and culture in justifying FGC, Hive

Mind and the normalization of FGC within cultures, and the social dynamics of FGC

(including gender, class, rurality, and patriarchy).

The confluence of religion and culture in justifying FGC

Participants in this study spoke about reasons given for engaging in FGC within their communities as either religious or sociocultural but also spoke about the conflation of the two. Some participants who identified as Muslim (see table 2 and 3) seemed to agree that Islam, the religion which is usually associated with FGC, did not specifically sanction the practice but that the religious excuse had somehow been passed down generations and become embedded within cultures whereupon people now regarded it as an important part of their cultures. Here’s how Samia described the FGC situation in her home country of Sudan:

So, if we are talking about FGM (sic) in Sudan as a whole, like North Sudan

especially, it has many points of view. It is a cultural thing, it is a religious thing,

and it is kind of a social thing. So why I am saying it is cultural and social is

because they are still doing it and celebrate it like kind of a ceremony or

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something. So like people are doing it and they are actually happy about it … and

a religious view is that they relate it to the holy Quran, like for Muslims, that they

should get the FGM for women and circumcision for men. You know it has been

proven by many religious men that this FGM has no relation to Islam at all… a

cultural thing is that I have been asking some women about it like, why do you do

FGM? because you know about the consequences … some of them have lived with

the consequences and they have done it to their daughters as well. So why you do

that? (sic). And they will say that because it is a requirement, or it is good for

your sexual life or with your husband. I don't know, it’s kind of pleasurable thing

for the men, I guess. (Samia, individual interview, age range 21-30).

This quote by Samia shows the interconnectedness of religion, culture, social standing, and relationships in understanding FGC. Samia alluded to some of the reasons given to justify FGC including marriageability (in order to pleasure men) on top of the disputed religious reasons. She spoke about the difficulty in convincing people to dissociate from a practice that has been passed down generationally. Many participants echoed this difficulty with some specifically describing religion as a smokescreen used to apply pressure on community members to conform to a practice which they might otherwise oppose, or face ridicule. Diya described her grandmother as being very religious and as having likely used that religious excuse to convince Diya’s mother and aunt to circumcise their own children against their better judgment:

Like my aunt definitely didn't agree with it and I don't think that my mom agreed

with it too (sic), but I think what happened was that … you know pressure is one

of the biggest things … is that my grandma is very religious. Back home it's like if

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you haven't gotten it done, you are a sinner. Like you are a bad girl, that's kind of

what it is … they might not want to do but they have really no choice in that

situation. (Diya, individual interview, age 18).

Diya described the pressure imposed on people to conform to the practice or face ostracization. She saw this as a violation of their rights to choose without facing repercussions. She went on to describe her understanding of Islam’s view on FGC as only a guide meant to allow people to decide if they wanted to circumcise girls along with boys but that this had been twisted to make it look like a requirement in order to appeal to the cultural need to defer to religious interpretations favouring cutting at all costs. This conflation of religion and culture was problematic in Diya’s view because as she stated, it took away community members’ moral imperative to refuse to participate in a practice which was “illegal just about everywhere” thus driving them to break the law as was the case in a news story which she had been following and which she shared, about a physician from her community who was facing prosecution in the United States for covertly performing FGC. Like Diya, Zemi also saw religion as a ruse to justify what she described as a barbaric practice:

… and it was a historical practice that is one of the cultural practices in Somalia.

It’s not religious but it was just pretty much to ensure that the female stayed

virtuous, that she was only sexually active when she was married, but there's

nothing in the Quran; nothing in the hadith, which is the way that prophet

Muhammad, peace upon him, lived. The hypocrisy of it is that it’s against the

scripture, like they’re practicing something that's against the scripture because

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you are not supposed to inflict pain on anybody let alone on a child. (Zemi,

individual interview, age range 31-40).

Several participants spoke about this blurring of religious and cultural lines, and I also noticed some generational differences in how participants viewed this confluence. For instance, Diya’s mother, Teso, differed with her daughter about the role of religion in

FGC. Here is a discussion about the role of religion in FGC that occurred during the group interview between Teso and two other participants:

Teso: For us Muslims, that (FGC) is what is required of us. It is our custom … an

Islamic custom … both men and women. For the men, it is usually at birth, they

will mostly do it when a baby boy is born right at birth so that they do not

experience the pain, but for the women, there is a set age…when they get to the

age of seven, that is when they are supposed to be circumcised.

Mimi: Ah, I see. I did not know that. So, are you saying that your Islamic culture

is also your traditional culture?

Teso: It is not because anyone says go and do it. You see, my own mother did it,

my grandmother did it, and women before them also, so that it has been passed

down to us and we do not question it. We do it in honouring our culture as I

imagine you also honour your own culture. To honour the grandmothers before

us…especially since cutting is part of sharia and therefore has to be done by

people who believe in it. For us, it is a very bad thing to not cut your daughters,

and that is why women do it unfailingly when girls reach seven years of age. They

don’t have a choice in the matter. My grandmother used to say that one would be

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a burden to their lineage if they failed to do it. It is a decree of Islamic sharia. No

choice in the matter.

Mrembo: Still, I would like to know from you (Teso), did you circumcise your

daughters because you thought it was a good thing or because it is the culture

and you had to do it?

Teso: I did it because it was the culture and a religious requirement. Honestly,

even now, I can’t say for sure if it is good or bad. I am learning more about it and

will hopefully decide someday. (Group interview, participant ages 18-66).

This discussion is interesting on two levels: first, the religion-culture dialectic and second, the moral imperative in the honouring of customs. Teso appeared to view religion as a part of her culture by referring to it as “our custom” and offered as a justification the notion of honouring “our culture and the grandmothers before us” and the idea of having no choice in the matter. And second, there was the generational divide in understanding this dialectic. This was interesting when viewed alongside her daughter’s understanding of the religious view of FGC as only a suggestion for adherents, not a must-do. There appeared to be a generational difference in perception of, and interpretation of the culture-religion influence on FGC. I view the religion-culture dialectic as open to interpretation and likely generationally influenced. With regards to the moral imperative,

Teso appeared to be open to learning more, perhaps a signal to the influence of intergenerational learning, migration, and settlement (which is discussed further in

Chapter 5).

It did appear that although there were compelling sociocultural reasons for engaging in FGC, religion (Islam) was a catalyst in practising Muslim communities. In

116 general, apart from religion, participants from both Muslim and non-Muslim backgrounds gave fairly comparable reasons for the continuation of FGC in their communities including the promotion of chastity, economic reasons in the sense that a cut girl was more desirable for marriage and therefore more economically viable for her family, and as a cultural milestone in the form of the continuation of a centuries old rite of passage.

For non-Muslim participants however, FGC was mainly seen as a cultural milestone, a rite of passage from childhood to adulthood. And yet even without the added religious pressure, some participants still saw FGC as an important and necessary part of their culture. Here is how the oldest cut participant described her understanding of the practice:

Naturally, African people mainly (in) my country Nigeria, we do that because it is

very good. Why they did do it when they are born is because it prevents them from

having infection and also it prevents them from having sex with anybody because

when they go into a certain age without doing that, it makes them having sex (sic)

with anybody … they cannot control themselves when regarding to sex if they do

not do the circumcision (sic), so it is very important when a child is born in any

home. (Doria, individual interview, age range 61-70).

In some ways, Doria was an outlier with regards to her views on FGC as she was the only participant who shared that she had not been exposed to any information about FGC being problematic, and she seemed quite surprised that anyone would view it as such.

However, she, like many other participants in the study, was for cultural preservation, particularly in diaspora, in terms of passing on African culture to younger generations. To her, this included FGC.

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Participants from non-Muslim backgrounds viewed decisions about performing

FGC as mostly falling on families rather than whole communities, although repercussions were felt within the community. One participant described a conversation she had with her parents as a pre-teen facing FGC where she said she had begged them to spare her from the cut to no avail because she said, they were concerned for her social well-being as well as their social standing within her community. Shala seemed to suggest that perceptions within her Maasai community were more important to her parents when it came to making the decision about whether to have their daughters cut. So, while religion and culture were used in conjunction to justify the continuation of FGC, participants felt that it was much more difficult to abandon the practice in communities where forms of religious authoritarianism or fundamentalism were employed.

Hive Mind Phenomenon and the normalizing of FGC

I use Hive Mind here to refer to decision-making on FGC issues that results from collective thinking regardless of health effects and legal consequences. I borrowed this term from a participant who used it to lament the state of FGC in her Somali community although other participants described variations of Hive Mind. Participants decried a groupthink mentality, which they saw as permeating attitudes towards FGC in their communities. Many blamed collective community attitudes and perceptions for the continuation of, and silence surrounding the practice; an attitude of “if we all know and understand what it is then there is no need to discuss or explain it.” Participants struggled to reconcile their experiences of FGC, which many referred to as horrendous, barbaric, and even “stupid” with the knowledge that whole communities overlooked the associated health effects and continued to engage in it.

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Malala spoke of the weight of the expectation to unquestionably to go through

FGC that was placed on small children by adults who in her opinion ought to have known better:

There are cultural milestones that they put upon you as a child that you like, in

the end, you are like this was traumatic, this was painful but hey, look how

everyone is acknowledging me and treating me almost as an equal, an adult,

especially if you are a girl that is kind of developed physically… it is almost like

this Hive Mind, this group mind where to refuse it you are socially out casting

(sic) your daughter, you know? Because if other women find out that your child

hasn’t been cut, they are gonna treat her less respectfully. I was always baffled by

that.

Malala described a situation, which under different circumstances would have been irrational and even questionable, that is, placing the burden of social expectation on a child with parents expecting their daughter to persevere through FGC for their perceived social standing and reputation. She was baffled by what she saw as normalized groupthink within her community. Other participants in this study expressed similar sentiments. For the participants, the Hive Mind was a persuasive and powerful collective decision-making mentality, which shaped choices related to FGC even when families were removed from the culture in which it was sustained and supported. In questioning

Hive Mind, Malala was voicing her displeasure at the status quo and questioning embedded cultural understandings that had been transmitted intergenerationally. Her attempts to disrupt this way of thinking were agentic and reflected a generational change for her as compared to her parents and community.

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Another participant, Zemi, went on to express her frustration with people, especially women in her own community, who went along with FGC without questioning it, even when they had, according to her, been told from a young age that sex was not supposed to be enjoyable and that being cut would ensure that they would not be able to enjoy it at all. So again, women were making choices to be cut which negatively impacted their lives based on collective ‘Hive Mind’ thinking and out of fear of repercussions for nonconformity. Zemi saw this Hive Mind mentality as an inherently

African way of dealing with all manner of hardships. Here is how she summed it up:

To be honest with you I think it is mortal survival; it’s like an African mentality,

it’s like you just move on. It's like when we were in the war and we lived through

a civil war (in Somalia) before we were able to flee for seven months and it was

like every morning you woke up and the building next to you or behind you was

half gone. Your mind goes to, “Well, it wasn't me, it wasn’t my house. So, let’s

just keep going.” So, for them it’s like one foot after the other and there is not

even a thought of “this is not part of scripture, but I am going to go against the

scripture.” For them it's like an automatic thing like if you wake up in the

morning and you brush your teeth, you use the bathroom, and then you eat, it’s

the same things as that normalized automated behaviour. So, when you're a

woman and you have a child it's like, “Well, this is part of a culture. (Zemi,

individual interview, age range 31-40).

Cultures, being dynamic in the definition of meanings of social practices and in the regulation of these practices, allow for a certain level of dissent as long as dissenters are willing to face the consequences of dissent which according to participants included

120 loss of social standing and ostracization. Hive Mind served to regulate and discipline members to stay within the bounds of institutionally acceptable behaviour, “normalized automated behaviours” that could fortify members in the face of traumatic events. Hive

Mind appeared to play a significant role in cultural preservation of such practices as

FGC. Some participants even blamed this Hive Mind mentality for the minimization of the severity of the effects of FGC by referring to it by what they deemed respectable terminology instead of calling it what it really is; mutilation. Shala described the community and family backlash she faced for being outspoken, for publicly telling her story, and for using words such as “clitoris” and “mutilation.” She stated that not only did she hear from members of her wider community, but also her own brothers asked her to tone it down because she was embarrassing them. She refused to do that, however, because she equated silence to shame which she said she no longer felt and would not be silenced on account of her “educated brothers” sense of shame. I asked Shala about the discomfort that affected women might feel about some of the terminology, she said:

It’s harsh to them because they’re still feeling shameful, they’re still living with

the stigma, they make it about themselves. So, it’s almost like someone’s calling

you out, that’s how it feels to them. It’s like someone calling you out and pointing

it out and putting you in a different category. Someone is trying to minimize you,

it’s like when we say us and them, that’s what they fear, and nobody wants to be

called that … it hurts when somebody calls them out, and you want to be accepted

for who you are and that’s why you’re scared of saying, “I am a survivor”

because people are going to look at you different (sic). I have people that look at

me differently but for me I don’t care as long as I can have relationships with

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men. There are African men who will never want to date me because I have told

the world that I am a survivor of FGM. (Shala, individual interview, age range

41-50).

Shala pointed to shame and fear as some of the drivers of Hive Mind in sustaining FGC practices and seemed to suggest that moving beyond those sentiments would help in addressing FGC-related issues. Shala exhibited agency and bravery in defying her brothers and her wider community and moving beyond fear and shame in an attempt to heal from her trauma and disrupt FGC cultural understandings and practices.

The Social Dynamics Sustaining FGC

Participants in this study spoke about the complex social dynamics that form the scaffold that holds the practice of FGC together in various cultural contexts. In telling their stories, participants were able to highlight the contradictions and nuances inherent in

FGC and in some ways to disrupt some commonly held beliefs about the practice including the role of gender and patriarchy in FGC continuation. Participants also spoke about social class and economics in sustaining FGC. I discuss these dynamics in this next section.

Gender and Patriarchy

Participants perceived most of post-independence Africa as patriarchal and that men made decisions on issues affecting women. With regards to FGC, participants described situations where men would indirectly pressure women to be cut. Participants seemed to point to men as the probable originators of cutting based on the aforementioned patriarchy. Here is what Binti had to say about gender dynamics within her tribal community in her native Kenya:

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It was possibly a man’s idea. Some man somewhere thought it was a good idea

and the idea was probably to suppress the women from expressing themselves. I

don’t know if that’s where it started, I’m speculating here but obviously they

perpetuated it by coming up with … I don’t know if they’re the ones who came up

with these derogatory names for women who had not gone through the process or

having women who had not gone through it considered undesirable as wives, I

don’t know. (Binti, individual interview, age range 41-50).

Binti and her two daughters were uncut, but she shared that her mother and many other women in her family had been cut. Although Binti stated that the circumcizers were women, she spoke about the patriarchy in her Kenyan Kikuyu tribe, especially when it came to ownership and inheritance of property. In the above quote, she implicates men in the continuation of FGC since they are the ones who made decisions about the desirability and marriageability of women, and FGC was an indicator of both. On her part, Samia stated that she had heard about men within her community who refused to marry uncut women thereby forcing mothers to have their daughters cut out of fear for their future marriage prospects.

Although participants implicated men in originating the cutting, most also blamed women who they saw as the primary orchestrators of cutting. The following data excerpts illustrate this:

I think to this day my dad regrets what happened to me and he is against it, and

most of the men also from my mother’s side of the family are against it … it was

one of those things that the women know that everyone is against it, but still did it

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because, you know, they are just continuing tradition. (Malala, individual

interview, age range 31-40)

Participants shared stories about how their fathers had been against FGC but their mothers, grandmothers, and other women within their families had gone ahead and done it anyway. Samia spoke about how angered her father had been when he came back home from a work trip and found that her mother had subjected her and her sister to FGC. She said that her mother was able to convince her father that she had only allowed the type one clitoridectomy which she described as harmless, to be performed on her daughters.

Samia also shared that she had harbored anger toward her mother for many years as result of this.

Some participants thought that women, specifically mothers, had sufficient power, even within embedded patriarchal structures, to stop the performance of FGC on their daughters, but chose not to exercise it. Zemi spoke about resenting her mother who she described as the one who wore the pants in the house, for having allowed her cutting.

When I asked Zemi if her father would have been on board had her mother said no to her cutting, she said:

If my mom said no, my dad wouldn’t have been able to say do it. If she wants to

be strong, she is strong-willed; she is very strong-willed, she is stubborn even, but

a lot of the times it was the culture. But if she strongly felt the way that I feel

about what I went through, I know heaven or hell would not have made her go

through with it for her daughters to experience that. I can't speak for other

families. I just speak from my experience and seeing her stand her ground on

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certain things with my dad. If she was against it, like nothing, I mean nothing

would have stood in the way.

It would therefore seem that gender dynamics around the practice of FGC are very complicated. Participants described patriarchal communities where men held sway in matters such as economics and ownership of property but where some women, with regards to FGC, had a certain level of power to say no to it, a power which some nevertheless chose not to exercise, perhaps given the tie-in with socio-economic and marriageability indices along with the aforementioned Hive Mind. The gender dynamics of patriarchy position women to be complicit in sustaining social practices such as FGC where women end up being the overseers and sustainers of the practice by policing and disciplining young women’s bodies to fulfill cultural, societal, and patriarchal expectations.

Participants also spoke about war, migration and relocation as having upended the gender dynamics vis a vis FGC within their communities. So, for instance, men would leave home for extended periods of time to fight in wars leaving women to make family decisions including those relating to FGC. In Chapter 5, I further discuss migration and relocation and the resultant upending of gender roles, under the theme “migrating FGC.”

Class and Rurality

In addition to gender, participants spoke about class and socioeconomic dynamics affecting the practice of FGC. Some participants spoke about FGC as happening only among uneducated rural inhabitants in their tribal communities. Binti spoke about cutting in her native Kenya as mostly happening among uneducated rural folk and stated that

125 most people from her generation were educated and better informed and therefore opposed to it. I asked Binti why she thought cutting was confined to rural areas:

Because only people who grew up in the village, people who were not educated

would be going through those kinds of things. I think socioeconomic factors play

into it for sure and if you are educated, if you live in the city, if you’ve gone to

school, you likely won’t be doing that. (Binti, individual interview, age range 41-

50).

Binti’s views were echoed by her two daughters, also uncut, who stated that they had only heard about “FGM” on television and other media, and thought it only happened in rural areas.

Participants who did not see FGC as only happening in rural areas nevertheless spoke of cutting as more crude and less modern when performed in rural settings. Shala spoke about how her experience was perhaps less painful because her father was a clinical officer in the community and helped ensure that anesthesia was used during his daughters’ cutting experience and that everything was sterilized. Participants stated that even though their own FGC experiences were distressing, worse things happened to women who experienced FGC in rural settings which they perceived as dirtier and poorly equipped to handle such procedures. This class difference was referenced by Malala in my conversation with her:

Malala: And it was done by a well-known doctor in the city, and he was someone

that did it for all of the women in my family, like he was kind of an older guy and I

think he also did it for my older aunties, and I am not sure but my mom's maybe

could have been with him too. So, they took us to someone that was trusted, and it

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is not how it is depicted on the TV, and that happens too, this is more like a

modern thing.

Interviewer: How is it depicted on TV?

Malala: Oh, like some dirty, backward act with rusty razor blades and such.

Maybe that happens somewhere, but it most certainly wasn't my experience.

(Malala, individual interview, age range 31-40).

Participants seemed to link a person’s economic standing in society with the likelihood that they would engage in FGC. They also linked location, in terms of whether one resided in a rural versus urban setting, to socioeconomic standing and perceived level of education. So if one resided in an urban setting, they would likely be more educated and exposed to media such as television, and therefore be less likely to participate in cutting, and if they did participate in cutting, they would have access to health professionals who would do the cutting under more hygienic conditions. In this way, participants linked urban living with better outcomes for FGC both in terms of likelihood of engaging in it (low) and quality of associated healthcare and outcomes for those who chose to engage in FGC while residing in urban settings. Participants’ views seemed to echo trends in studies on FGC prevalence in Africa (Banks et al., 2006; WHO, 2008) where even in communities that have seen a fizzling out of the practice, pockets of rural participating communities tend to hold on to the practice much longer.

Chapter Summary

In this chapter, I discussed participants’ shared stories of their experiences of, and understandings of FGC as a cultural practice. Through an examination of participants’ navigation of their health and FGC-related trauma along with their views on culture,

127 religion, and the social dynamics of FGC, I laid out the ways in which participants were able to navigate cultural, religious, sociopolitical and gendered barriers in their attempts to resist and even rise above embedded cultural understandings of FGC. In this way, I highlighted ways in which participants not only exhibited agency but also how they performed agency knowingly and unknowingly through their stories of trauma and healing, agency being a part of their black womanhood. In the next chapter, I discuss the themes of Migrating FGC and Mitigating FGC.

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Chapter 5 Migrating and Mitigating FGC

Migration is an expression of the human aspiration for dignity, safety and a better future.

It is part of the social fabric, part of our very make-up as a human family ~ Ban Ki-moon

In this chapter, I introduce the themes of Migrating FGC and Mitigating FGC. In

Migrating FGC, I discuss the subthemes: displacement (leaving home), straddling cultures, all eyes on you, and FGC as a dying tradition? In Mitigating FGC, I discuss healthcare in the diaspora focusing on the subthemes: access to culturally responsive healthcare — gender and generational, access to trauma-informed care in the context of

FGC, and relational practice – dos and don’ts. The following Figure 2 outlines the subthemes for Migrating FGC and Mitigating FGC.

Figure 2: Migrating FGC and Mitigating FGC

Agency/Structure

Migrating FGC Mitigating FGC

Access to Culturally Access to Trauma- Displacement (Leaving FGC, A Dying Responsive Care - Relational Practice - Straddling Cultures All Eyes on You Informed Care in the Home) Tradition? gender and Dos and Don'ts Context of FGC generational

Migrating FGC

Migrating FGC was a major theme I identified in reviewing interview transcripts.

This study’s focus on immigrant and refugee women meant that participants’ FGC stories were interwoven with stories of displacement, translocation, migration, and resettlement

129 in new locations. Furthermore, migration created new levels of complexity with regards to views on FGC in new cultural and legal contexts. Participants shared stories about cultural shifts resulting from displacement, settlement issues away from home including

FGC legalities, and matters of identity and feelings of alienation, silencing, and racialization. Additionally, most participants viewed FGC as a dying tradition within their diasporic communities.

Displacement (Leaving home)

Most of the participants in this study identified as refugees, having been forced from their home countries by wars and other forms of strife. Participants viewed this displacement as both a curse and a blessing; a curse because they were forced to leave their homes and cultures and embark on unknown encounters which for most, were filled with disappointment, pain, loss, and uncertainty. One participant spoke about how her family had been forced to leave a comfortable upper-class life in her home country of

Somalia and had unsuccessfully attempted to seek refuge in four countries in Africa, the

Middle East, and Europe. They had finally ended up in Canada, the only country which would take them in. The participant said that, by that point, most family members were traumatized by what they had been through, which included witnessing war-related atrocities in Somalia before fleeing the country. Still, other participants viewed displacement as a blessing for having allowed them to start new lives in a new country far away from the aforementioned atrocities. Some participants even credited migration for having slowed down incidents of FGC through the disruption of generational cycles including planned ritual cutting of girls. Zemi spoke about how prior to migration she had

130 envied the girls whose families had left Somalia and referred to them as lucky for having avoided the cut on account of those moves. She said:

Like that circle of my mom's friends, they have all subjected their daughters to the

same practices that they went through. The ones that survived and were able not

to be cut (sic) are the ones that were abroad. If you were raised in the Middle

East, if you were in North America, if you were raised in any other part of Asia,

because there’s people who were all over the world even before the war happened

with their families, that used to visit back and forth, those are the ones that really

were saved in a way, if you really think about it. I have cousins that are the same

age, one year younger, one is the same age as I am, and they were not

circumcised. They didn't because they were living in the Middle East at the time

and their mom was like, I'm not subjecting them to this practice. (Zemi, individual

interview, age range 31-40)

Moving to other countries became not just the saving grace for some girls with regards to undergoing FGC but participants also spoke about a shift in gender dynamics related to war and displacement with women enjoying more power in diaspora which translated to the ability to contribute to important family decisions including decisions on cutting daughters. And yet this dynamic did not always translate to a refusal to cut their daughters because as one participant stated, there were still generational factors at play within families, for instance there were grandmothers imposing their will on mothers to cut their daughters either by pressuring them directly if they had migrated along with families or indirectly through communication with families back home. So then, while migration might have added a layer of complexity to generational transmission of FGC,

131 families still lived within the confines of their cultures post-migration and therefore any efforts to disallow FGC was in opposition to established cultural norms, an opposition which still held consequences, albeit less severe than they would be in their home countries. One participant, Shala spoke about her decision not to circumcise her daughters and noted that although members of her own family and some in her wider

Maasai community including those in diaspora frowned upon what she referred to as her hard-headedness, she was confident that her daughters would thrive in their new country and could marry whomever they wanted without cultural limitations.

Participants noted that grandmothers and other elders were generally respected and most of their decisions were unquestioned and that this respect did not vanish just because families migrated to the West. I witnessed this generational respect firsthand during the group discussion with women from six different countries in the horn of

Africa. During the discussion, participants referred to the oldest participant, a 65-year-old woman from The Democratic Republic of the Congo, as grandma even though most had just met her for the very first time. Participants would also defer to grandma when it came to certain questions about African customs although they were from different countries and cultures. Additionally, whey would listen keenly without interrupting when she spoke and then thank her before offering any contrary opinions. On her part, the oldest participant, being uncut, was keen to hear the younger women’s stories and opinions on FGC, perhaps a recognition that she too had a lot to learn in a new country and culture. In this way, leaving home had provided an avenue for perhaps a more robust intergenerational communication.

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Participants spoke about hearing stories of mothers in diasporic locations sending their children back home to be cut and linked proximity to home as aiding this phenomenon. A conversation I had with Malala highlighted the complexity of decision- making regarding cutting even when families moved away from their primary cultures and settled in diasporic locations:

Interviewer: What did the war mean for cutting?

Malala: I think it slowed things a little. There were so many complexities

happening, many moms, many families couldn’t afford to send their kids…ideally,

they would send their kids back home and have them cut, but because they are

struggling, and they are surviving, they don’t.

Interviewer: Do you mean in their new country?

Malala: Yes, in their new country, in diaspora. Living abroad, there’s no way

they could afford to send them back…I have a sense and a feeling that it impacted

more Somali girls in the UK than it did in Canada and the US.

Interviewer: Why is that?

Malala: Because it is cheaper to fly from the UK to Africa than from North

America to Africa, you know? So, I would say that this is the group that has a

high percentage of cuttings happening to girls outside of Somalia. Only because

of the ticket. If it was cheap to fly from Canada to Somalia, yeah, they would

totally do it too. (Malala, individual interview, age range 31-40)

Leaving home appears to have impacted generational cycles of FGC transmission with families now having to consider economic, immigration, and cultural implications in making decisions regarding FGC. It added a layer of complexity where difficult

133 discussions had to be had with regards to cutting girls, but also in addressing FGC consequences in a new country and culture.

Straddling Cultures

Participants spoke about attempting to find a sense of cultural belonging post- migration. Younger participants appeared to identify more with the diasporic cultures they had grown up with than their parents’ cultures. This identity-formation seemed to influence their views on FGC. Here are a few interview excerpts that highlight this:

Diya:

I see myself as Canadian. I’ve lived here longer than I’ve lived in Kenya. So,

when the question comes up, of course I love Kenya, of course I am a Kenyan by

birth ... I was born there and kind of grew up there, but I've lived here for so much

of my life that this is all that I really know and remember. When I look back on

what Kenya is and the people back home and things like that, I just find that I

can't really relate to them as much as I can relate to people here. I can say that I

am somewhat Kenyan, but I am most definitely Canadian. (Diya, individual

interview, age 18)

And Zemi;

I come from a Somali background. So, I would say I'm Somali Canadian even

thought my parents would say I'm fully Canadian, but I think I take both sides of

the cultures then I mash them together, the good from both sides. (Zemi,

individual interview, age range 31-40)

Like many other participants, Zemi and Diya appeared to straddle multiple worlds and identities, pulling from each when called for. They both agreed that while their parents

134 might have supported and engaged in FGC elsewhere, it was an outdated practice that did not fit into the ideals of their diasporic hybrid cultures.

Older participants also appeared to engage in all manner of cultural negotiation mostly regarding decisions about aspects of their old cultures to get rid of as well as those within the new culture to adopt without losing their cultural identities. This was a reflection of culture as always in flux.

Teso spoke about her religion and culture as “non-negotiable” ideals worthy of holding onto and yet shared about taking parenting lessons when she first arrived in Canada, lessons which she stated, helped her raise her daughters in a different and more open manner than her own mother. She also bragged about her two strong, independent daughters. One of her daughters, Diya, spoke about how her mother had raised her to be her own person, to be independent and to always strive to do what is right. Diya stated that her mother believed in her and respected her opinions.

On her part, Diya’s mother noted that she was beginning to revisit her own views on FGC based on what she was learning from her daughters. This mother-daughter dynamic reflected an intergenerational cultural knowledge reciprocity which I also noticed with other mother-daughter groupings in this study. , one of the uncut mothers, appeared to have a similar relationship with her two daughters. Her daughter Didi, spoke about having grown closer to her mother after they moved to Canada because according to Didi “it is not as if mom knows more about Canada than us” and so she stated that they had learned to rely on, and support each other through their settlement challenges which included having to adapt to a new culture together as a family. Didi also spoke about the parenting adaptation that her mother had to make:

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Something that is maybe seen as a problem in a first world country is maybe not

seen as a problem in a third world (sic) country, but I think that this has made my

mom change her parenting skills because all she had known was how her parents

raised and disciplined her when she was younger. My mom has had to adapt her

parenting style to fit the pressures that we face in a new culture. (Didi, individual

interview, age range 21-30)

This adaptation, according to Didi, was necessary for their mutual relationship in a new country and culture and in keeping with the legalities in their adopted country including with regards to FGC.

Other participants spoke about immigration status as influencing one’s ability to adapt to a new culture. Malala talked about perceptions of being an immigrant versus being a refugee as influencing adaptation to a new country and culture. Here is part of my discussion with Malala on this issue:

Malala: A refugee is often in survival mode for years and might be more

connected to their home and culture, while immigrants are likely to have some

control over their circumstances and are often better equipped economically.

Interviewer: So, for FGC in Canada, if someone is in survival mode, how does it

affect their attitude towards it?

Malala: They would likely to be more inclined to cut their daughters and

probably possess less education, religious or otherwise. Likely to memorize the

religion rather than educate themselves about it. (Malala, individual interview,

age range 31-40)

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Malala went on to describe survival mode as the propensity for human beings to zero in on pressing issues in their lives and to default to known coping mechanisms for dealing with those issues. So, if one is merely surviving, they are unlikely to have time for assimilation into a new culture. In a sense then, immigrants experience a new culture in a different manner than refugees, given that they usually have the benefit of time, planning, some initial resources, and research about their new countries, something of which most refugees do not always have the luxury. Still, both immigrants and refugees exist in a culture different from their home culture and often have to find ways to adapt and cope.

Participants also spoke about FGC as a borrowed practice within their cultures which meant that it could be relinquished in exchange for something else. Zemi described her abhorrence for the practice and her efforts to try and put an end to it in her family now that they were all in diaspora and away from Somali cultural influences back home.

She said:

This culture is not even our practice, I can’t even say it's a Somali practice or an

Ethiopian or a Kenyan practice. It came from Egypt, it came from Egyptians

when you look at the root cause behind it historically, but it has nothing to do

with religion. You might just as well wear a chastity belt, right? Just do that and

you're better off … but for me I'm thinking a different way because of my

education, of my privilege of being exposed to a different culture and also first-

hand experiencing it and saying, no, I don't care what the culture says that it is a

part of my culture, I'm not going to go with. That’s not going to be part of who I

am. It's not going to be part of my identity moving forward. I have a niece and I

told my sister, I'm like, if you ever even think of doing this barbaric practice, I

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will not only call the authorities on you, but I will take your child away from you.

She knows, and she's like, I would never even do that, I’ve been through it. I don't

ever want my child to go through it. But there is still that part of me that’s

hesitant because it's been practiced in my family for so many generations. It’s

kind of like I have to make sure that we're on the same page as far as moving on

from this thing. (Zemi, individual interview, age range 31-40)

For Zemi, a borrowed cultural practice can be unborrowed or relinquished in exchange for something else because cultures are dynamic. I view Zemi’s actions and resolve to question the veracity of her culture’s understandings of FGC, and her efforts to try and halt the generational transmission of the practice in her own family, as a reflection of black womanhood as agency. Zemi conceded that she could only take this stand within the safety of a Somali culture in flux given its diasporic location, and yet her ability to recognize and seize this hybrid location (Bubba, 1994) as a moment for change also speaks to the dynamism of her agency; an embodied agency in practice. She stated that this was one of the few things her much older siblings and herself actually agreed on, that certain aspects of their culture could change, especially in a diasporic milieu. For study participants straddling cultures meant a questioning of old cultural norms, an examination of new cultural presentations, and a renegotiation of their cultural understandings based on a meshing of cultures.

“All eyes on you”: Racialization, Folding in, Silencing, Islamophobia

Participants spoke about some of the settlement issues they faced as African immigrant and refugee women who were cut. While most of the participants stated that they had not experienced any overt discrimination based on their race, some thought that

138 their minority status likely played into how they were viewed all around. Zemi described herself as headstrong and stated that she knew her rights and therefore always made sure that they were respected in healthcare and other interactions, but that she feared that perhaps others were not as lucky as she was. Zemi spoke about instances where her views were ignored or overlooked and where she was left to wonder if it was because of her race or other factors. I had this conversation with her:

Zemi: So, when you’re a minority in a different land-- it's different to be a

minority in a place where you match, and you look at everybody, like everybody

looks like you. It's a whole different game when you are in a country where you

look different and you are part of the minority on top of that.

Interviewer: Could you tell me more about that?

Zemi: I can’t really say it is racism - well, maybe it is, but I think there is this

belief that if you are a person of colour, that you don't know what the hell you're

talking about, and if you are a woman on top of that forget it. They just downplay

it. I have certainly had my moments. I can only imagine how tough it must be for

women who are not headstrong like me. Like my sisters … one bad experience

and they are out … poof. (Zemi, individual interview, age range 31-40)

Zemi was alluding to being a minority within a minority group and the complexity of the intersections therein in terms of identifying nuances of exclusionary behaviour. Zemi went on to describe the multiple ways in which she was different: black, woman, refugee, circumcised. In intersectionality, each of these differentiators can be understood as axes

(Crenshaw, 1991, Veenstra, 2011), and these axes intersect to form multiplicative matrices of oppression and exclusion (Collins, 1990).Each of these axes symbolised, for

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Zemi, levels of trauma which she was exposed to whether she wanted to or not. For

Zemi, the more one was exposed to acts of exclusion related to the above axes, the lower the likelihood that one would pursue health services in diaspora. Zemi linked her older sisters’ resistance to obtaining basic health services in Canada to these multiple axes of exclusion. Both of her sisters had been cut as young children prior to their migration to

Canada. In this sense, this matrix of exclusion, often with multiple axes, served to silence women.

Other participants saw a disconnect in the perception of different cultures in diaspora with most pointing to a general denigration of African culture. With regards to

FGC, Asha thought there was a double standard when compared to some comparable practices in Western cultures like vaginal rejuvenations. Here is how she saw it:

To me it is cutting. She is going through that pain too, and same for men. So,

people here in Canada or other Western world (sic) are saying nothing about it,

and they think it is beauty, they think it is cosmetic, and that it is one hundred

percent okay…. we all know she is doing it for men. But when the cutting of Africa

or Arab people comes on the table it is a crime…it is a big crime like against this,

against that and that…but human beings are going through the same pain. (Asha,

individual interview, age range 41-50)

Zemi echoed Asha’s sentiments in discussing how FGC is named and viewed in North

America:

It is barbaric, and if a North American news outlet did say it's barbaric, I would

agree with them, it’s barbaric, but at the same time I think barbaric acts of

making women get fake implants to be considered beautiful, is a barbaric practice

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too. Because who are you to tell a woman that in order to be beautiful, you have

to have blonde hair, blue eyes and double D breasts and barely a stomach and no

hips. Like that to me is not a body. A woman's body should be whatever shape that

is. It should be voluptuous, it should be straight up and down, it should be pear, it

should be whatever shape you want it to be … that is barbaric in my opinion but

when you look at the media it’s called beauty. (Zemi, individual interview, age

range 31-40)

Participants thought it problematic that Western cultures overlooked certain questionable aspects of their own cultures and instead focused on and highlighted problematic aspects of other cultures. Many participants viewed this punitive state of affairs negatively with some viewing it as counterproductive. Malala described a scenario which she saw as playing out in her local Somali community:

Malala: So, for instance when we moved to North America, a lot of women in my

age group did not cover their heads or wear the hijab, but around the ages of 20-

25, they started going back to that.

Interviewer: Why do you think that happened?

Malala: I think it is the feeling of people being against Muslims, so they were just

showing solidarity by covering up. Islamophobia made them more religious. For

us when we were growing up, there wasn’t much Islamophobia, or no one even

knew where Somalia was on the map or thought of us as bad people. No one knew

or cared. They just thought of us as exotic like oh you are different, like in a

positive way. So, we enjoyed a lot of freedom and we were able to go swimming,

wear shorts, anything, and we were okay. But these girls that are here and

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younger than me are a lot more restricted and there is this community that has

decided that we have to protect our girls. So, if they see you walking around in

shorts or short skirts, tank top or anything, they will ask you to reconsider your

clothes and cover up. (Malala, individual interview, age range 31-40)

Malala’s assertion is particularly poignant in light of contemporary issues around religion, particularly Islamaphobia and the equating of Islam with terrorism in Western countries including Canada in the post 9/11 era. Reimer-Kirkham and Sharma (2011) discussed the importance of adding religion to race, class, and gender for studying intersectionality in Canadian healthcare contexts but also outlined the complexities therein. They warned against painting religion in any one light instead of looking at it in its entirety. Malala spoke about a time when inclusivity and perhaps the oft-lauded

Canadian multiculturalism had worked well for her and contrasted it with the current context where her community was “folding in” in response to societal hostility. Religion and patriarchal control were now taking over in an attempt to offer spiritual, cultural, and psychological protections for marginalized women and girls. This is what Malala referred to as “spiritual cutting.”

Malala saw this scenario as good for FGC and bad for the community at large and for young women in particular. She said:

… there are more shifts that are happening, and the community is further

isolating itself. In a way it is positive for cutting because they are now more

connected to religion and religion forbids this, so no more cutting. At the same

time there is no freedom for these girls, you know, they were born here yet they

live way more restricted lives than, and this is my opinion, than women back

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home. Women back home are not as religious as the women here …It’s a dilemma

and from an outsider perspective would be intriguing why that is the case. It is

almost like now when you say Somalis, it is almost expected to be covered from

head to toe and it wasn’t like that before. So, in terms of cutting, it is a win in

terms of minimizing it and reducing it, but religion took over. It has actually been

said that ten to fifteen years ago, Somalia were heading more toward secularism,

and communism, so some feel that everything that happened like the war was a

curse or punishment. Now there seems to be a contrast for Somalis living in

secular Western cultures – the more they experience secularism, the more they

want to cover up. I think that left to their own devices, they would revert to

secularism, which is more the Somali way. Traditionally Somali dress was more

revealing. It is almost as if they are now robbing us of our bodies in a spiritual

way.

Interviewer: That is very interesting! Reversing the culture?

Malala: Yes, we are being cut in a spiritual way.

Interviewer: And who is doing the cutting, do you think?

Malala: Everyone. The men, women, young girls. No one is taking the time to talk

about sexuality, women’s health, reproductive health and everything. (Malala,

individual interview, age range 31-40)

Malala viewed FGC as a form of control over women’s bodies and described it as having morphed from physical to “spiritual cutting” where girls and women were now being religiously and culturally policed. She referred to this scenario as “a folding in,” and saw it as a defense mechanism and her community’s effort to try and cope with and adjust to

143 forces within their adopted diasporic cultures including racism and islamophobia. In effect, one problematic cultural practice (FGC) was being replaced with other questionable practices and women and girls continued to bear the brunt of the harm caused by this material and spiritual surveillance.

FGC, a Dying Tradition?

Participants seemed to view FGC as a dying tradition in the sense that they did not see it as an ongoing problem within their diasporic communities. Participants who had experienced FGC were more concerned with navigating the health consequences of the practice than perpetuation of FGC. Participants spoke about the education that has gone into ensuring that people know about the practice and avoid it. Most participants stated their opposition to the practice and their commitment to not continuing it for their own daughters, particularly in diasporic locations away from any added pressures from families and communities who were pro-FGC. Most participants credited education and migration as major factors in the perceived curtailment of FGC at least within their diasporic communities. Malala talked about how she thought FGC was a nonissue among younger members of her community, and that they had other more pressing worries. She said:

I think my age group are affected but younger Somalis who are born here have no

experience and don’t have any awareness of cutting and if anyone in those groups

has experienced it, they are not sharing it. It is almost like something foreign to

them just like it would be for a Westerner. (Malala, individual interview, age

range 31-40)

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Other participants viewed FGC as dissipating in their communities both at home and in diaspora. I interviewed Binti and her two daughters individually and each stated that FGC was not an issue in their community. Binti said that while her mother had been cut, both herself and her daughters were not, and that cutting was never an option for any of them due to a combination of factors including education and socioeconomic status, having grown up in a middle-class family. Binti’s daughters were in fact so far removed from cutting that they were eager to learn about it during the interview despite being members of one of the few Kenyan tribes who have traditionally engaged in cutting.

The view of FGC as dying tradition bodes well for eradication endeavors, particularly in diasporic communities. Most participants did not view FGC as an ongoing concern and for those who had experienced it, navigating FGC-related health consequences was more of an issue than the perpetuation of the practice within their diasporic communities.

In all, participants viewed migration as a never-ending story of displacement, cultural negotiation, and change. While participants viewed migration positively especially with regards to life opportunities and FGC eradication, they nevertheless pointed to new challenges which they now had to navigate in healthcare and other settings including access to culturally responsive care, access to trauma-informed care, and some bottlenecks around relational practices in accessing healthcare. I discuss these challenges in the next theme: Mitigating FGC.

Mitigating FGC

Participants’ migration experiences highlighted multiple intersecting levels of trauma which they faced, from displacement all the way to the challenges of adaptation and settlement in diaspora. For participants who had undergone FGC, these challenges

145 were amplified in their attempts to access healthcare services in Canada. Participants spoke about reliving their FGC trauma through these attempts and their efforts toward advocating for themselves and their families. They spoke of challenges resulting from a lack of information on FGC by healthcare providers as well as the shame and stigma associated with it. In this next section, I discuss participants’ efforts to mitigate the effects of FGC through their healthcare encounters. Through these encounters, participants showcased their agency in the face of complex intersections of trauma and pain.

Most participants described positive encounters with healthcare professionals but also noted that cultural differences coupled with the almost always-present trauma, played a role in matters such as access, treatment, and quality of services for women affected by FGC. Participants also seemed to suggest that generational differences existed in the health-seeking behaviours of FGC-affected women. While none of the participants in this study stated that they had ongoing physical health issues needing intervention, most referenced ongoing psychosocial issues which I discuss in relation to access to culturally responsive care, access to trauma-informed care, and relational practices impacting participants’ health and health seeking-behaviours. I also highlight the always present trauma as well as aspects of generational factors impacting the health of FGC- affected women.

Access to Culturally Responsive Care – Gender and Generational

Participants saw access as an issue, but not in terms of their ability to physically meet with health care professionals or link to specific services. Rather, participants described how cultural beliefs held by diasporic women could impede the ability to

146 access services. One participant, Zemi spoke about how difficult it was to try and get her mother to go to a hospital when she was clearly in distress, and then after getting there, struggling to convince her to allow a male health care provider to attend to her after apparently waiting for a female attendant for over eight hours. Yet, upon deeper analysis, this reticence can be understood as indicative of a lack of access to culturally responsive healthcare. Here is part of her description of the encounter:

… I was like, you are either going to go or I’m going to call the ambulance. So,

she reluctantly went with me because I forced her to go, but again it's that whole

concept of I don't want to go to the hospital because they will touch me … my

mom is beyond extreme, so for her the mention of a hospital is already anxiety-

inducing, you know? … and second, coming from that generation in the culture

where it's like men should not touch you other than your husband, you should not

be undressing in a place that's not either your room or your bathroom, like all of

these things for her that are ingrained, it was just difficult getting her out … so

when you talk about getting pap tested it’s just … my mom can drop tomorrow

from stage four ovarian cancer and she wouldn't know it until she was in the

hospital or into the morgue and they did an autopsy. But the thing is, culturally, if

you actually die and the doctors and the medical systems say that you need to do

an autopsy, you don't. A lot of people have died because religiously speaking,

you're not supposed to, you're supposed to bury the body right away. You’re not

supposed to have an autopsy; you’re not supposed to put her into the morgue. A

lot of people have passed away from medical conditions that could have been

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preventable but weren't due to their cultural or religious beliefs. (Zemi, individual

interview, age range 31-40)

This quote by Zemi reflects the need for cultural safety and for diasporic healthcare settings to adapt their services to reflect the diverse needs of the populations they serve.

The concept of cultural safety reflects the core principles of nursing practice as relational, respectful, and value-free and has been shown to enhance the health of marginalized communities (Brascoupé & Waters, 2009; Browne, Smye, & Varcoe, 2007; Ramsden,

1993; Kirkham et al., 2002). With regards to cultural safety, I align with Kirkham et al

(2002) who caution against the simplistic application of this concept which they warn, can serve to reify the notion of culture as a binary which serves to delineate marginalized groups from mainstream ones. Moving away from this “explanatory” model recasts cultural safety as an “outcome” of successful healthcare interactions between at-risk communities and healthcare providers while acknowledging the ever-present power differentials therein (Brascoupé & Waters, 2009).

Cultural safety should also reflect generational understandings of health-seeking behaviours. Zemi explained the generational struggles in accessing care by referencing her mother’s reticence and the intergenerational renegotiation of cultural values which her family had to engage in in the absence of culturally responsive care. She noted:

Sometimes I’m like, “Mom, we’ve been waiting for eight hours, if we get a male

technician, we're going to get a male technician, period. We're going to accept it

mom. And she’s like, “fine.” You’ve got to work with what you have. It is like

changing that mentality, but the older generation they struggle with that a lot. It’s

not only in Somali culture, I think any immigrant background that’s not from a

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westernized viewpoint, it's very hard to adapt to the fact of doing investigative

work and preventative, it’s more of the “god will take care of it, we’ll be fine,”

but at the same time scriptures say you've got to work. I will help you, but you

need to show your initiative, nothing's going to come to you easily. But, yes,

generationally, I think it's different and the younger generation are more than

anything adapted to this world than back home. (Zemi, individual interview, age

range 31-40)

In addition to generational differences in adapting to diasporic health care practices, trauma also seemed to impact health seeking behaviours. I discuss this further in the next section

Access to Trauma-Informed Care in the Context of FGC

Participants in this study talked about how trauma factored into their healthcare experiences. Zemi spoke about how her family dealt with what she referred to as FGC- related trauma by describing how her older siblings who she said had experienced the most severe form of FGC handled its aftermath after migrating to Canada:

… the way that they process things and the way that they cope with things is that

you put it in a box and you shove it down into the abyss, and you never open it,

and you never talk about it … they're still entrenched in the Somali culture … they

will talk about fluffy things and world politics and science, but they won’t talk

about actual things that are affecting them …their level of OCD (sic) is off the

charts. I think … it's like if you've avoided talking about your past traumatic

experiences and it's been so suppressed but time goes on and on and on and

you're finding triggers along the way, but you don't talk about it, you're going to

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find a different way to get control because you can't control that piece any more

in your life. Their control is through their OCD. That's where things are at (sic).

When I even try to talk to them about that simple behaviour, I get shut down. So,

imagine trying to talk about circumcision, trying to talk about the war trauma,

trying to talk about the emotional aspect and wellness, and just depression … they

don't talk about it. They don’t even want to touch it with a 10-foot pole. Lots of

trauma and no talking. Imagine that. Just really a bad combo there, you know?

(Zemi, individual interview, age range 31-40)

Zemi’s quote is loaded with nuance. In addition to the cultural propensity toward

“boxing” issues which she referred to as “trauma therapy brewed in an African pot”, she also spoke to the generational differences in the handling of trauma within her own family, which I also noticed with other older participants. In a way, Zemi’s experiences highlight the African notion of toughing it out in the face of hardships, an untenable situation within a diasporic healthcare milieu as evidenced by Zemi’s family situation.

Malala, on the other hand, spoke about trauma, just like FGC, as generational and difficult to contend with, especially if older family members could not recognize and deal with if first. She suggested early intervention by healthcare professionals in diaspora as a possible remedy in curtailing generational transmission of FGC trauma. Such intervention, according to Malala, would target both parents and their FGC-affected children as she saw them all as being “trapped in their childhood”. Here is how Malala saw it:

I would say to health care workers to please have empathy and compassion, this

is something that happened to them as a child, and to her mother and

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grandmother as children, so it’s going back generations. So, these are all

traumatized children, and they don’t have the capacity to see it as an issue unless

they themselves move forward and heal from that. But if you are initially

encountering them and the parents don’t see it as a problem yet, please have

some empathy; don’t judge them because it is a cycle of trauma. You are not

getting whole people. (Malala, individual interview, age range 41-50)

It would therefore appear that access to effective, culturally safe health services by FGC affected women is reliant on the availability of trauma-informed care delivered by health care practitioners with some knowledge of FGC. Embedded within cultural safety and trauma-informed care is relational practice as an anchor for these axes of care delivery. I discuss relational practice in the next section.

Relational Practice - Dos and Don’ts

Relational practice is essential in the provision of culturally safe, trauma-informed care. Relational practice is the provision of reflexive and ethical healthcare to patients while acknowledging the complexities of their lived realities (Zou, 2016). Practitioners engaging in relational practice with FGC-affected women would need to have an understanding of the complexity of the women’s experiences in order to build mutually respectful healing environments imbued with trust.

Participants had mixed views with regards to treatment options and the quality of healing environments available to them. Some of the issues that came up had to do with diagnosing FGC-related issues and then deciding on the best therapy for issues identified.

Again, cultural safety was a major determinant of perceived satisfaction with treatment options. One participant, Malala, spoke about her struggles with trauma and how she had

151 successfully accessed mental health services and other therapies, to help her cope. But while acknowledging her successes, Malala thought that there was room for improvement, that more could be done to better align services to target FGC-related issues. Malala spoke about the importance of therapies targeting younger FGC-affected women. She said:

… don’t just jump to like giving them medications, and I know that is the system

here, but they may not need that …respond appropriately because you could be

doing more damage down the road especially for a young person. Helping them

even get therapy, that is so important, oh my God, that alone would really be

astounding if that would be something that could be done because experiencing

that trauma like that, that is not even something I thought about until I was in my

late 20s because I was having panic attacks, mental traumas, and yeah, it came

from my experiences with cutting. (Malala, individual interview, age range 31-40)

According to Malala, such early interventions would serve to alleviate some of the mental health issues faced by women affected by FGC down the road. She also alluded to the propensity toward pharmacological interventions in Western settings which she thought was not always appropriate especially if practitioners did not have a good understanding about the struggles faced by immigrant and refugee women affected by FGC. Other participants attributed this lack of understanding to the nature of the healthcare system where practitioners did not always have the luxury of time when it came to seeing patients. Binti described her experience thus:

… many times, I have been to a doctor and they would be standing like five feet

away and not even examining me. It’s like they’re in a hurry to get you out of

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there within ten minutes or five minutes because they have all these people they

need to see. So, I think that’s the drawback of a publicly funded health system

because we just become a number and so, I haven’t had very good experiences. I

prefer the healthcare system back home. (Binti, individual interview, age range

41-50)

Binti was a well-educated woman who grew up in an upper-middle-class family in her native Kenya and would have had access to some of the best healthcare, unlike most poor people in her country. Although she had not experienced FGC, she ventured a guess about what she assumed an encounter with a doctor in Canada would look like for a cut woman:

My guess is you would be sitting there and talking about this experience you’ve

had, and your medical provider, you doctor or whoever, will stand there and not

understand what you’re saying because I don’t know if they have any experience

with this process, and maybe you'd get a prescription for some antidepressants or

anti-anxiety and be sent to a psychologist or referred to a gynaecologist, where

you’d have to wait three or four months to get in to see them. That would be my

guess, I’m sorry but I just don’t see it being a good experience. (Binti, individual

interview, age range 41-50)

Binti described what she imagined as a typical healthcare encounter in Canada and saw it as a bad experience because of her aforementioned lamentation about lack of time investment by doctors, a necessity for a more therapeutic interaction, according to her.

Her reticence was based on her own problematic non-FGC health experiences within the

Canadian healthcare system, and so she thought that if she could face such issues as an

153 educated uncut woman then the experience had to be far worse for those who had been cut.

Another participant, Zemi, described her own dissatisfaction with the situation stating that she had in effect fallen through the cracks having undergone the less physically obvious type 1 FGC (clitoridectomy) and never having had doctors say anything to her about it, perhaps, she thought, because they likely missed it on their assessment. The following long quote by Zemi shows the need for relational practice; why it is important for healthcare professionals to pay attention and to ask questions, even uncomfortable ones, when encountering patients from diverse cultures:

I've had male doctors and female doctors who have done biopsies and who have

done my Pap test and stuff like that and never did one say, have you been a victim

or survivor or a recipient of FGM?” They've never said that, but at the same time

when I look at myself, I'm like, well I can pass as a regular untouched vagina, but

I know that I'm missing a part of my hood. But seeing anatomy pictures of

different types, I can see why they might not have thought that, but at the same

time coming from a medical field … it's just having a good bedside manner to ask

the question and to offer answers and to offer the ability for someone to come to

you for answers because you are more knowledgeable than I am. (Zemi,

individual interview, age range 31-40)

Zemi went on to describe how it had been very difficult for her to open up to anyone at all, including her partner, about her FGC experience and the feelings of inadequacy about her body and sex which she had carried all the way into her 20s. She blamed FGC for those body image issues but thought that she might have opened up if a trained

154 professional would have broached the subject during one of her many gynaecological examinations. So, while it is important that services are made available for FGC-affected women, relational practice is equally important. The need for healthcare providers to break out of their cocoons, ask the uncomfortable questions, and provide a safe and therapeutic environment for affected women to discuss their physical as well as psychosocial health concerns is key to relational practice.

Good quality services according to participants, involved a combination of knowledgeable service providers and a respect for patients’ wishes. When I asked Diya what she thought constituted an ideal interaction with a health care professional, this is what she said:

I think one of the biggest things about it is if you talk to somebody who knows or

who has done research or who has an idea of what it (FGC) is, or it has happened

to them, or they know people that it has happened to, or they have dealt with it

before. … So, when you get into a situation where you are talking to someone who

understands the struggle or understands what exactly has happened or whatever,

then it almost becomes a safety zone because this is something that is so difficult.

… So, when you are able to develop a relationship, or you are able to talk to

someone who can make that safe zone happen, that makes a world of a difference.

It would for me anyways. (Diya, individual interview, age 18)

The need to be understood without feeling overly exposed and vulnerable was a common theme among participants. However, many described encounters which they saw as not meeting the threshold for good quality. Shala spoke about her less than ideal encounter with a gynaecologist:

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The first gynaecologist that I went to, the moment she looked at me, I kept telling

her I’m scared, and she was like, “Why are you scared, it’s normal. It’s okay if

you’ve never had it.” She never understood why I was scared and all that. I told

her I’ve had this thing, but she tried making me comfortable by telling me, “It’s

not even going to be painful, and then, “I’m putting this thing in you and I’m

going to use a small one because you look like you’re very tight...you have a very

small cervix so I’m not going to fit the big one, I’m going to use a small one like

the one we use to do exams for little girls who are more or less 18, so I’ll

probably use the small one.” I told her “No, I want to be sedated. She told me,

“No, I’m going to use the smaller one.” Anyway, she got the smaller one and I

told her, “Please, can you warm it; I don’t want it to be cold.” All this time when

I was saying this, she was like, “Are you ready? I’m getting ready to go down

there” I thought, what do I do? I started screaming. It triggered me; I was

triggered right there. I started screaming and she said, “Are you okay? up here

everything is fine, are you okay?” So, I kicked her. (Shala, individual interview,

age range 41-50)

Shala’s experience reflected poor relational practice where she tried to explain herself and was repeatedly ignored by the gynecologist. Shala believed that this was an intentional act by the doctor since, she said, “I obviously look different down there.”

Being a social worker by profession, she expressed her frustration with the process and the indifference therein. She went on to share that the doctor had asked her about her sexual relations, a question she viewed as inappropriate, and that it had taken her a good part of a year and a “slew of professionals” to finally get some “decent and respectful”

156 services. Unlike Shala, Zemi talked about her own positive encounter, which she attributed to being listened to and acknowledged by her doctor, in other words, good relational practice. Zemi was due to have a hysterectomy secondary to cervical cancer and shared an exchange she had with her surgeon:

I said, what type of surgery are you going to use? Are you going to use caesarean

or are you going to do the laparoscopic one? And she said, “I've practiced this

for 15 years and I go by laparoscopic right now, we don't do caesarean, because

she said, you’re also Type I Diabetic, so we don't want to take the risk of

infections because you are at higher risk for infections and complications because

this is layers and layers of cutting. It's a longer incision, it's just more intrusive,

you already are losing an organ, and so we don't want to add more time to your

recovery”. And I said, Okay, so if you do laparoscopic, how are you going to

remove the organ? And she said, “Well, we will use the vaginal canal”, and right

away I said, “No way, I will do the caesarean, I will take that risk” and she said,

“May I ask why you are against laparoscopic and through the vaginal canal?”

And I said, “Because I've already had female circumcision and I don't want

anybody else messing up with the rest of my genitals.” I said, “I do don’t want to

lose any more sensation; I’ve already suffered enough as a woman.” Then she

said, “Well, we would never … we would just use the canal. We are not cutting;

we’re not doing anything. It’s just that you might have a little bit of bleeding but

it’s not the same as doing a caesarean. (Zemi, individual interview, age range 31-

40)

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Shala and Zemi’s experiences helped to highlight some of the dos and don’ts of relational practice for FGC-affected women. Participants in this study also offered suggestions for making healthcare interactions more effective including directly asking women “who fit the demographic” if they have experienced cutting (Samia), creating an open, safe, and non-judgmental environment for women, and having a good bedside manner in addition to offering preventative therapies instead of, or in addition to pharmacological treatments.

Overall, participants viewed health care resources as plentiful but not always accessible to them in a culturally responsive manner in acknowledgment of the complexity of their lived realities including dealing with FGC-related trauma. Additionally they decried the dearth of good relational practice but acknowledged that some practitioners were trying.

In this way, the available healthcare was inadequate in meeting participants’ needs.

Chapter Summary

In the preceding chapter, I discussed the theme of Migrating FGC where I highlighted participants’ stories of leaving home, straddling cultures, renegotiating new cultural understandings under the Western gaze, and interrogating the continuity of FGC or lack thereof, within their new diasporic communities. Additionally, I discussed participants’ efforts to mitigate the effects of FGC focusing on their efforts to access culturally safe and trauma-informed care within good relational healthcare mileus. In re- telling these migration and mitigation stories, I highlighted ways in which participants embodied agency through overt acts of collective and self-advocacy, as well as through intergenerational knowledge reciprocity, renegotiations of embedded cultural positionalities, and resultant learning and growth. Worth noting is the ways in which participants were able to navigate this complexity while re-living and somehow

158 transcending the traumas of their FGC experiences. This to me is embodied agency; black womanhood as agency.

In the next chapter, I offer a decolonizing interpretation of participants’ stories, a re-examination of their FGC stories through time and space, migration and settlement, adversity and resistance. Analysis was guided by reflections on my own positionality, and by the works of selected contemporary black diasporic researchers and intersectional thinkers in order to reflect contemporary realities and complexities of FGC and of researching black women in Global Northern research settings. In my decolonizing analysis, I focused on findings from my interpretive description analysis, findings which I deemed to be important “in the larger scheme of things” (Thorne, 2008, p. 193) while expounding on why they matter in the context of this research study.

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Chapter 6 Decolonizing Interpretation

The Master's Tools Will Never Dismantle the Master's House ~Audre Lorde

This quote by Lorde (1984) reflects how I approached my decolonizing interpretation. The idea that Western-derived methodologies are insufficient to the task of deconstructing the complex stories of African immigrant and refugee women affected by

FGC is central to my research. The work of Smith (1999) has been instrumental in my understanding of decolonizing epistemologies particularly her seminal text, Decolonizing

Methodologies, in which, with respect to the indigenous Maori of New Zealand, she decried the colonial nature of research and found it insufficient to the needs of her Maori people. Smith stated:

Research “through imperial eyes” describes an approach, which assumes that

Western ideas about the most fundamental things are the only ideas possible to

hold, certainly the only rational ideas, and the only idea which can make sense of

the world, of reality, of social life and of human beings. It is an approach to

indigenous peoples which still conveys a sense of innate superiority and an

overabundance of desire to bring progress into the lives of indigenous peoples –

spiritually, intellectually, socially, and economically. It is research which from

indigenous perspectives “steals” knowledge from others and then uses it to benefit

the people who “stole” it. Some indigenous and many minority group researchers

would call this approach simply racist. It is research which is imbued with an

“attitude” and a “spirit” which assumes a certain ownership of the entire world,

and which has established systems and forms of governance which embed that

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attitude in institutional practices. These practices determine what counts as

legitimate research and who counts as legitimate researchers. (Smith, 1999, p. 56)

This “overabundance of desire to bring progress into the lives of indigenous peoples – spiritually, intellectually, socially, and economically” (p. 56) was central to the scramble for, the partition of, and the subsequent colonization of Africa by Europeans in the 19th Century. The foci of colonial endeavors in this period were Christianity, civilization, and colonization – the three Cs (Oyewumi, 1997, Thiong’o, 1986). This desire lives on in neocolonial practices, which continue to mark the lives of marginalized and colonized peoples both in the Global South, and in Global North diasporic locations

(Werunga et al., 2016).

In recent decades, there has been growing recognition of the vital link between transnationalism and migration, and the need to enact discourses that recognize the ineffectiveness of Global North imperialist methodologies in researching non-Global

North populations and marginalized Global North populations (Ahmed, 2017; Bhabha,

1994; Beetham, 2019; Evans-Winters, 2019; Bhattacharya 2007, 2009, 2016, 2020;

Mohanty, 2003; Werunga et al, 2016). Such discourses have included transnational feminisms, including postcolonial feminism, African feminism, and intersectionality

(Anzaldua, 1999; Crenshaw, 1991; Collins, 2000; hooks, 1984; Spivak, 1988).

With regards to decolonizing methodologies, to date, there has been little agreement on how to properly carry out research in this tradition from start to finish while staying true to established tenets that constitute academic research. To this end, I align with Bhattacharya (2009) who contends that engaging in this kind of research as an othered researcher in diaspora is complicated and often messy, messy because of the

161 liminality of both the researcher and the researched who exist in dynamic colonized spaces and are therefore marked by these spaces. The researcher is often suspended somewhere between being oppressed and being privileged, often employing imperialist means such as the English language, to try and understand and re-tell the stories of marginalized research participants, all the while trying not to cause them further harm.

This is an untenable state of affairs, which calls for the researcher to embrace all of their colonized parts (Bhattacharya, 2009) in an effort to forge a more just existence for oppressed peoples. I borrow from Jackson and Mazzei (2012) who described the centeredness of interviewing practices in qualitative research as “working both within and against a project that is failed from the start” (p. vii). Given that I cannot imagine a part of my existence which is not influenced by colonial thinking and mindset, I likewise view my work within colonized Global North spaces as working within and against a failed colonial project but with the recognition of the partiality and incompleteness of the data and an understanding of the data as “always in a process of re-telling and re- membering” (Jackson & Mazzei, 2012, p. ix). Furthermore, established research tenets are steeped in colonial thinking and serve to advance Global North imperialist agendas.

The endpoint for me was therefore the minimization of imperialist harm.

As a researcher born in the Global South and now researching Global South women within a Global North setting, I remain aware of these dynamic influences on my decolonizing analysis and interpretations. With this awareness also comes a commitment to disrupting some embedded assumptions about African women and their bodies, which

I equate to Lorde’s master’s house; and an attempt to forge and use new decolonizing tools to address the unique issues faced by African immigrant and refugee women.

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According to Lorde, the master’s tools “may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change” (p. 112). Adopting new tools for this kind of work is especially important given the social justice mandate of decolonizing knowledge projects (Beetham, 2019; Evans-Winters, 2019; Collins & Bilge,

2016; McKinzie & Richards, 2019, Kirkham & Anderson, 2002).

In my research, a decolonizing interpretation refers to my way of retelling participants’ stories in liminal contexts, that is, situating their stories within wider narrations and historical trajectories which reflect shifting geographies and timelines. I aim to lay bare that which is often left out or skewed in more exoticized narrations of the

FGC problematic on the global stage. I seek to honor African immigrant and refugee women’s stories by highlighting how they cope, persist, and resist (Evans-Winters, 2019) in the face of a globalized single-story FGC narrative that paints them as hapless recipients of Global North charity aimed at rescuing them from their own cultures

(Adichie, 2015).

In Chapters 4 and 5, I embarked on analysis of participants’ stories using interpretive description with a focus on the presentation of main themes and subthemes generated during the coding process, along with data excerpts, to help demonstrate thematic linkages based on participants’ stories. I discussed the four major themes of experiencing, explaining, migrating, and mitigating FGC and offered brief commentaries on my understanding of, and interpretation of the themes based on participants’ stories in line with interpretive description (Thorne, 2016). With this interpretive description analysis, I was able to address my research aims which were to (a) to critically examine how immigrant and refugee women who have undergone FGC make sense of, and

163 explain the practice, both for themselves and for younger generations; and, (b) to explore the continuing impact of FGC on the lives of affected women including their perceptions of, and interactions with various health services in their new location. With the themes identified, I was able to explore some of the difficulties and barriers encountered by participants in their everyday navigation of their FGC experiences in Canada and the

United States.

In Chapter 6, I deepen the analysis by moving from a micro to a macro interpretive level in an attempt to situate participants’ stories within decolonial literature and offer wider structural and social contexts for participants’ FGC experiences. While participants described specific barriers and how they affected them and their families, it is incumbent on me as a decolonizing researcher to situate these experiences within larger structures that make the manifestation of these barriers possible because as Ahmed

(2017) stated, individuals exist within social structures in which some experience an enhanced sense of belonging while others may feel distressed due to perceived unfairness and disempowerment. In other words, inequalities and conditions of exclusion are created within larger socioeconomic structures which have to be critically interrogated as a necessary step in understanding and eradicating inequities and engendering equity and justice for all. So to summarize, Chapter 4 and 5 consititute the first step of the thematic analysis of participant’s stories using interpretive description. In Chapter 6, analysis shifts to the macro level, using a decolonizing interpretation.

In order to do this, I begin by situating myself as a researcher from the Global

South conducting research with participants from the Global South in a Global North setting. I then offer a re-imagined definition of FGC as an alternative to the often

164 dominant colonizing and punitive problematic highlighted in global media. I discuss some macro issues stemming from the four themes identified in Chapters 4 and 5 which I analyze as particularly relevant in highlighting participants’ stories. I situate these macro issues within current literature and explore their influences on participants’ life stories.

The following questions which stemmed from my interpretive description analysis of the themes experiencing, explaining, migrating, and mitigating FGC guided my decolonizing interpretations:

• What are the fractured understandings of FGC?

• How does (neo)colonization affect gender constructions (e.g. global colonization

of bodies and minds)?

• What intersecting factors affect participants’ transnational and hybrid experiences

of FGC?

• How does migration impact intergenerational attitudes on FGC?

Situating Self

In situating my researcher self as a decolonizing researcher, I recognize that my story as an African immigrant woman is interwoven with the stories of participants and that we each (researcher and participants) contend with somewhat similar sociopolitical structural bottlenecks even if we do so in different ways. This means that any effort that I put into presenting participants’ stories in a decolonized way would need to reflect my ongoing efforts to decolonize my researcher mind (Evans-Winters, 2019; Thiong’o,

1986) especially given that I grew up in a former British colony and have been immersed in colonial education and cultural systems throughout my life including in my formal and informal education. Referencing the inevitabiltity of escaping the influences of racism

165 and White privilege as a White American living in the United States and other White majority countries (emphasis mine), Robin DiAngelo described it as “literally swimming in racist waters.34 I likewise view my immersion in colonial life as literally swimming in imperialist waters.

By writing myself into this research, I am validating the women’s experiences and showing them respect and compassion as a knowledge co-creator as well as bearing witness not only to participants’ vulnerabilities but also to their agency and in this way, showcasing their strengths instead of their pathologies (Evans-Winters, 2019). Evans-

Winters (2019) saw this as significant in research relationships involving black women researchers and black women participants as knowledge co-creators, a culturally affirming reciprocity which methodologically aligns with Africana Womanism as well as other critical race and gendered analytical lens for researchers interested in making black women’s concerns the concerns of research and the concerns of research those of black women (Evans-Winters, 2019). This “bending backwards together” (Burnharm, 2005) rejects the propensity toward reflecting on self in relation to others which she sees as further contributing to othering, and instead focuses on structural axes and power relations which intersect and contribute to the alienation and hardships experienced by those on the margins of power (Collins & Bilge, 2016; hooks, 1984). I have recently been reflecting on how doing this work at this important moment in history when countries are dealing with a global pandemic as well as racial and economic strife is in and of itself an act of resistance and subversion akin to the black womanhood and agency discussed in

34 https://www.youtube.com/watch?v=kzLT54QjclA

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Chapter 4. For me, this has included participating in solidarity marches with local antiracist groups, reflecting on the impact of the pandemic and racism on a personal and familial level, and yet somehow finding the energy to focus on this very important work.

In reflexively analyzing my positionality as a nurse and researcher within a

Global North academic environment, I am well aware of the multiple privileges which I possess including the fact that I have of necessity learned to function within a system that was not designed with someone like me in mind, meaning that I have become adept at negotiating my existence within this system, sometimes by pushing back and other times by giving in or letting go in an effort to coexist with others within the structures in my adoptive home countries. Evans-Winters (2019) noted that one’s positionality in any given community and the social world influences how the person produces, consumes, and disseminates knowledge. What this means for me then is that I am potentially wont to re-produce my own re-negotiated understandings in my attempts to make sense of participants’ stories, something that I have remained aware of throughout this research.

Additionally, I am aware that my immigration experiences and my path to becoming a

USA resident and Canadian citizen although not smooth may not be as fraught with the perils, misery, and hardships that some participants expressed in their stories. And yet even in my position of privilege, I found a shared kinship with participants as an African immigrant woman, and in having a mother who experienced FGC as a teenager. Evans-

Winters (2019) saw the complexities of black women’s experiences as a unifying mosaic with multiple pieces, parts of which mirror black women researchers’ agency, vulnerabilities, and resilience. This being the case, I continually agonized over how to best interpret and convey participants’ stories while remaining cognizant of how my

167 interpretations would reflect on “my” people, as I understood that I could not detach from the process having made an effort during the interviewing stage of my research to wilfully and thoughtfully engage with participants in order to make the best out of the near-kinship relationships that I had formed with them.

I experienced a lot of uncertainties in my decision-making during the data coding process all the way through the assigning of themes and making analytic decisions. In many ways, the analytic process was tougher than I had anticipated as I found myself agonizing over the choices I was making starting with the names and designations I assigned to the nodes that ended up constituting my main analytical themes. I had to constantly think about the effects of language in meaning making, especially since I was using a language that was foreign to both myself as a researcher and to the research participants, to try and tell their stories. Language is an especially effective tool in the colonizer’s armoury, and yet given the diverse cultural and linguistic histories of participants and research context, English was the main shared language at our disposal and this made for an especially daunting analytical process as I constantly found myself stopping to deconstruct some of my chosen language descriptors to understand the ways in which I was potentially reproducing and re-enacting punitive narrative performances

(Bhattacharya, 2007).

The group interview, which I conducted with eight women, was in Kiswahili, a common language between all of us. Kiswahili is the lingua franca in several countries in the Eastern and Great Lakes regions of Africa where the eight participants hailed from. It is also the national language in my home country of Kenya. With this interview, I noted the difference in participants’ demeanours, the camaraderie between them, and the ease

168 with which they conversed with one another and told jokes, research topic notwithstanding. I contrasted this with other interviews where there was the initial ice breaking and where in many instances participants would fumble around for English words to best express their understandings of a topic that most had never spoken out loud with anyone before. Yet I still had to transcribe the Kiswahili interview into English in consideration of the research context and audience, an exercise which no doubt resulted in some of the original nuance of meaning being lost in translation given that Kiswahili, like English, has regional variations. So then, my transcription was a translation within a translation, perhaps a reflection of the real-life barriers faced by FGC-affected women in diasporic healthcare and other settings.

With regards to the naming of thematic categories, I remained aware that while it was part of the meaning making process, from a critical decolonial framing, naming was problematic. I therefore acknowledge that the names assigned to nodes, which formed themes, are mere placeholders for the varied ways in which participants experienced FGC across times and space. Evans-Winters decried the harmful nature of assigning names and categories declaring that this practice which she saw as being rife in science “has never worked for my people,” referencing African Americans in the United States and how they are bogged down by the either/or dualistic linguistic signifiers (Werunga et al., 2016) which mostly paint them in an extremely negative light and ensure their continued oppression, vilification, and othering (Evans-Winters, 2019).

In addition to my struggles with categorization, I also struggled with proper representation of stories in a manner that would honour the histories attached to them.

Evans-Winters (2019) saw this representation as a legitimation of ancestral knowledge,

169 and for me, this was especially poignant given my proximity to the topic. My mother experienced FGC as a teenager, and in narrating her story to me, she shared that she had run away with a few other teenage girls in her village, against their parents’ wishes, to go and have the cut, apparently because of the pomp and circumstance associated with the practice along with what she had at the time understood to be important ritual secrets imparted on girls who partook in the practice. To this day, my mother views her involvement in FGC as “a silly teenage mistake” but nevertheless has fondly talked about the ritualistic ceremonies which accompanied cutting for both boys and girls, and this is the part of the practice which she chose to share with my sister and myself, having been reluctant to offer any details about the actual cutting process. For me therefore, a re- presentation of participants’ stories was akin to a re-telling of my mother’s story, and I felt the weight of it on my shoulders in making decisions about how to best tell these stories in a way that would, according to Evans-Winters (2019), armour and humanize the participants and by extension my mother, as wholesome African women who were part of a mosaic (Evans-Winters, 2019; Speed, 2014) and were trying to make sense of life in a liminal diasporic space (Bhattacharya, 2020). Such a retelling would eschew the universalizing tendencies of Global North writings of African stories. I had to walk a fine line between shedding light on the entirety of a culture and nitpicking, weaponizing, and repackaging FGC for a world that already essentializes a whole continent and its cultures.

One way that I was inadvertently colonizing my own research was through the assigning of pseudonyms to study participants where one of my thesis supervisory committee members noted that some participants had Anglo-sounding pseudonyms and asked if this was intentional. I had to take a step back and interrogate my own mindset

170 and colonial first name. While I will not get into the issue of naming pre and post- colonization in Africa, I will concede that the unconscious assignation of Anglo pseudonyms to research participants was a reflection of my own colonized mind and further signifies the unending work of self-decolonization for all of us swimming in colonial waters.

It is against this backdrop that I now discuss the following three main themes which I analyzed as deserving of more attention in light of the decolonizing literature that has informed my research: (a) It is tricky: fractured understandings of FGC; (b) Exits, re- routings, and border crossings: intersectionalities of influence; and (c) Mothering and daughtering, then and now: intergenerational perspectives on FGC. I conclude this chapter by revisiting agency, an overarching theme in my analyses, where I discuss Black women’s resilience and coping.

It is Tricky: Fractured Understandings of FGC

I revisited participants’ stories of Experiencing FGC and Explaining FGC and thought about some of the themes that arose for me in reconciling these stories with some of the “truths” which abound in literature on FGC both in participating countries and in

Global North locales. All the participants spoke about the roles their parents, relatives and members of their wider communities played in their cutting which led me to, Who

Hurt You? FGC and the Blame Game, as a way to examine the role of gender and patriarchy in women’s stories vis a vis understandings in the literature on FGC. I also thought about the prominent positioning of FGC on the global health stage and considered the issues of voice and representation in the subthemes, Lost in Translation:

Who is Speaking for Whom? and Who Gets Viewed as Doer? African Women at Work,

171 to capture some of the disconnect between participants’ understandings and what was being put out in the local and global media and the popular and health sciences literature.

Participants also mentioned how traumatic their cutting experiences had been which led me to, Where Does it Hurt? Intersections of Trauma, to attempt to capture the many manifestations of trauma through their transnational, hybrid identities. I detail these four interweaving subthemes in the next section.

Figure 3: It is Tricky: Fractured Understandings of FGC

Who Hurt You? FGC and the Blame Game

Who Gets Viewed as It is Tricky: Doer?: African Women at Fractured Work Understandings of FGC Who is Speaking for Whom? Lost in Translation

Where Does it Hurt? Intersections of Trauma

Who Hurt You? FGC and the Blame Game

Depending on who you ask or what information you refer to, there are any number of explanations for the FGC problematic including culture, patriarchy, and the oppression of, and violence against women and girls. While I did not ask the question directly, participants spoke about FGC in their cultures generally and spoke about the specific roles played by men and women in their cutting. They also offered varying

172 explanations for the practice including religion, marriageability, cleanliness, and chastity.

Gruenbaum (2001) cautioned against the danger of singling out patriarchy as the main reason for FGC noting that even in communities where men hold sway in numerous matters, there are delineations in the powers wielded therein with certain women holding more power than certain men. Many women spoke about the roles their mothers played in their cutting with Zemi stating that her mother “wore the pants” in the house and was in control even if she sometimes “chose to” relinquish that control to her father. Samia also spoke of the resentment she had felt toward her mother for several years for having gone against her father’s wishes to have her and her sisters cut. While these stories do not summarily refute the presence of patriarchy in Africa, they are nevertheless, in relation to

FGC, consistent with studies which problematize the presentation of a simplified narrative on women’s subjugation while ignoring the complexity of FGC (Njambi, 2011).

From a decolonizing viewpoint, I see this oversimplification of the FGC narrative as consistent with Global North theorizations of gender, also a Global North construct

(Oyewumi, 1997). The assignation of a priori victimhood to African women diminishes the innumerable efforts by generations of African women all over the continent who have stood up for their communities for millennia including taking up arms as did the Agikuyu women of Kenya who fought alongside their men in the Mau Mau uprising during the country’s fight for independence from British rule (Thiong’o 1986). The Kenyan Kikuyu tribe is believed to have been matrilineal with the mother’s side directing inheritance and identity – in fact, the tribe is referred to as the house of Mumbi, Mumbi being the wife of

Gikuyu, the tribal patriarch (Kenyatta, 1938). Colonial writings on Kenya’s history do not reflect these histories and instead focus on a hierarchical presentation of African history

173 with heroic depictions the colonizers and narrations of African men and their perceived tribal exploits. African women were at the very bottom of the hierarchy and were largely ignored in colonial writings. Oyewumi views this erasure of African women and their role in history as akin to a relay of men where the baton is passed from man to man, colonizer and colonized alike.

This men’s relay lives on in societies both in the global North and South and is, I argue, a contributor to theorizations on the FGC problematic. It lives on in postcolonial

Africa where colonial patriarchal practices were entrenched in the psyche of previously colonized nations – a colonization of minds (Fanon, 1967, Thiong’o, 1986). Ultimately, this men’s relay resulted in generational transmission of patriarchy and the extinction of unsourced sacred oral stories that had traditionally been transmitted through women

(Oyewumi, 1997). Most participants in my research study viewed their FGC experiences as a complex cultural amalgam with men and women acting interchangeably in tandem, within complicit cultural milieus, to aid its propagation. None of the women pointed to their mothers or grandmothers as victims of men per se. For the most part, women in this study saw men, particularly their fathers, as passive and even unwitting participants in the cutting process. And yet Global North narrations implicate patriarchy and a narrative of violence against women and girls above all else.

Who Gets Viewed as Doer? African Women at Work

I recently saw an online posting for the sale of an art piece which was a play on the widely used “Caution, Men at Work” traffic sign but with a byline stating “women

174 work all the time, men have to put up signs when they work”35 . This revised signage was no doubt meant for humour and satire, but it got me thinking about the embedded assumptions about “who” gets viewed as the doer within cultures in the Global North, but especially in the Global South. In addition to implicating mothers, grandmothers and other women within their communities, participants spoke about the roles played by women beyond FGC, especially in the context of shifts caused by wars, displacement as well as changes brought on by migration and settlement in new locales. Participants spoke about their mothers and grandmothers as having authority over family affairs including on decisions regarding choice of spouses for their children. Maria spoke about women taking on bigger roles in the absence of men who may have been away for work or due to wars and stated that sometimes mothers clashed with their sons over the insistence on marrying women who were cut even if the son’s preference was for an uncut woman. Participants used descriptors such as “headstrong,” “always gets her way,” and “stubborn” in describing their mothers. Didi stated that her mother held “very strong views” on things and was unlikely to have been talked into getting her two daughters cut.

Other participants spoke about their own FGC advocacy work (Asha and Shala) within their communities.

These examples highlight the dynamic roles played by women in their communities and are in line with some of the literature on African women’s agency.

Ugandan gender activist and feminist scholar Sylvia Tamale emphasized the importance of merging culture and African women’s rights in feminist theorizing on women’s issues,

35 (https://www.amazon.com/SmartSign-Caution-Work-Funny-Plastic/dp/B00U3FRY4M).

175 including sexualities on the African continent (Salo, 2013, Tamale, 2008, 2011). She particularly highlighted the issue of FGC that is often pitted against the biomedical model with most anti-FGC activists and scholars depicting African culture as inherently hostile to women in matters of sexualities, gender rights, and bodily integrity. She presented the exemplar of the practice of elongating the labia within the cultural milieu of the Baganda tribe; a practice which is said to enhance the erotic experience and sexual pleasure of both women and men and has for centuries been used as an identifying feature for the

Baganda women who proudly own it. Tamale decries the WHO classification of this practice as harmful along with other “mutilations” in complete disregard of the agency and lived experiences of Baganda women (Oloka-Onyango & Tamale, 1995; Tamale,

2008).

The Baganda exemplar affirms Adichie’s (2015) notion of the inseparability of context from experience which she refers to as “story.” In the diasporic space, African women’s stories ought to include stories about Africa told by Africans (Oyewumi, 1997).

Such stories would of necessity be embedded in the cultural, social, and political domains of experience. For African immigrant and refugee women affected by FGC, these stories would have to reflect the fact that African women are, and have always been at work, and that some of this work has indeed been harmful or at the very least, complicit. This complexity of who is viewed as doer was evident in the stories shared by women, some of which I have detailed above.

In revisiting the question of FGC harm and where to apportion blame and who gets viewed as doer, most participants were reluctant to, and were actually unsettled by the idea of blaming parents for their cutting. They instead pointed to their cultures for

176 lagging behind in terms of letting the practice fade into oblivion. Asha wondered how she could possibly blame her mother when she (the mother) had just carried out a tradition that had been handed down for centuries. Her views best captured most participants’ sentiments on this:

I don’t blame my mother, I don’t blame my grandmother because that’s what they

knew, that’s what they thought was better for us. If I have to advocate, I will

advocate different ways because my mom would never harm me, I know that for

sure… she just did it because she thought it was better for me, so I would

advocate it as a health risk. (Asha, Individual interview, age range 41-50).

The apportioning of blame is a zero-sum game particularly in situations where several factors are in play including considerations of class, economics, level of education and the need for one to fit into, and function within the fabric of their own culture.

The subjugation of women is not exclusive to Africa, it happens in Global North countries too for example with the current curtailing of women’s reproductive rights in the United States. It is however erroneous to assume that women are passive recipients of any such subjugation. Many women in the United States have marched for the right to make decisions about their own bodies while some American women are vehemently opposed to reproductive freedoms due to their faith and other factors. Similarly, African women have advocated for themselves for millennia, but some African women have participated in and propped up oppressive systems. Cultural change anywhere is complicated and takes time.

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Who is Speaking for Whom? Lost in Translation

Beyond the problematic depictions of Africans in global media, a great deal of previous research on Africa has been conducted with little input from Africans, a phenomenon which Bhattacharya (2007) refers to as researching “on” instead of “with” marginalized communities. This manner of researching runs counter to decolonizing work in its exclusionary practices and serves to perpetuate and cement erroneous, harmful, and essentialist views of Africa and its peoples. In the absence of input from marginalized groups, research products end up reflecting researchers’ inherent biases.

Participants in this study spoke about how FGC and Africans as a whole were perceived in Global North media. They discussed the use of terminology such as

“barbaric” in descriptions of FGC with some linking this to the overall denigration of

Africans in global media. Malala and Zemi singled out the double standards in perceptions around FGC and cosmetic surgical procedures carried out in Global North locales. It is important to note that all but one of the participants (the oldest one) agreed that FGC is harmful, but they decried the means employed in an attempt to get this messaging out. As I stated earlier in this chapter, language is a particularly portent tool in the colonizer’s armory and can inflict untold harm on those to whom it is leveled, a problem with which participants could identify.

The following quote from the preface of the 2015 book by British Journalist and

Sociologist Hilary Burrage titled, Female Genital Mutilation: The truth behind the horrifying global practice of female genital mutilation, perhaps best captures some of the concerns raised by women in this study regarding the overgeneralization of harm:

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For the purpose of clarification and exhaustiveness, FGM has been classified in

different types depending on severity and depth of the mutilation. This

classification, although academically interesting, cannot hide the fact that there is

actually one single type, the one that damages girls and women in their flesh, no

matter the depth of the cut, which sometimes ends in the almost total closure of

the vagina (pg. 6).

I concur that classification of FGC is problematic as in its current form, it not only negates the inherent cultural differences between practising communities but also neutralizes the experiences within multiple cultures where the practice is viewed as other than harmful (Njambi, 2011., Tamale, 2011). Additionally, acknowlegement is not given to the genital alteration practices in contemporary Global North locales which are generally not viewed as harmful.

However, Burrage perpetuates the notion of universalization of harm with FGC irrespective of the type of cut. This is a notion which is also perpetuated in key global policy documents on Human Rights and the elimination of violence against women and girls. For instance, according to the United Nations (UN) general assembly, FGM/C is in contravention of the Universal Declaration of Human Rights of 1948 as well as the 1989

Convention of the Rights of the Child. Additionally, FGM/C is considered in violation of

The Declaration on the Elimination of Violence against Women and the 1979 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) the latter of which:

not only bars discrimination against women but also requires countries to modify

their “social and cultural patterns of conduct with a view to achieving the

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elimination of prejudices and customary and all other practices which are based

on the idea of the inferiority or the superiority of either of the sexes or on

stereotyped roles for men and women. (pp. 11-12)

The elimination of discrimination and violence against women and girls is a universal global imperative supported by many including the UN, nevertheless, both followers and critics of universalization of rights agree that it might be worthwhile to vernacularize and contextualize requisite policies to better address the nuances of diverse global cultures

(Ibhawoh, 2008). Ibhawoh (2008) contends that vernacularizing human rights policies and statues could serve to avoid the pitfalls of re-inscribing Global North colonial understandings on what constitutes rights; pitfalls which could sustain existing colonial- derived power structures rather than emancipate those who are constrained by those same power structures. Vernacularizing human rights policies and statutes becomes especially important as understandings of what it means to be wholly human are often contextual and culturally-specific and are subject to differing interpretations (Ibhawoh, 2008). The sheer scope and context when it comes to understanding customary versus universalized human rights calls for nuanced capture of culturally specific contexts (Ibhawoh, 2008).

Without this, policies and discourses meant to liberate could result in harming diverse peoples. Perhaps with nuanced vernacularizing of human rights policies and statutes, the global fight for the elimination of harmful cultural practices including FGC would be met with more acquiescence than pushback as with the decades-long FGC elimination endeavors (Hopgood, 2017; Werunga et al., 2016).

In further addressing the issue of writers from the Global North writing about

FGC and other African cultural practices, Gruenbaum (2001) stated that:

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“To explore these issues in our writing is not the same us trying to “speak for”

others or becoming their unauthorized “allies.” Nor is it intended to tell “them”

what to do or pretend that some imaginary superior “we” has the answer to the

questions of when and how to pursue change. Instead, grappling with difficult

questions is a human and moral imperative, or try to understand our world and

promote discussion and understanding across the boundaries that divide people”

(p. 24).

While it seems legitimate that it is a human and moral imperative to grapple with difficult questions, I suggest that it is tough to argue this point in situations of unequal power relations as is the case with FGC discussions. So for instance, one would be hard pressed to find scenarios where Africans evaluate happenings in any Global North country and issue guidelines based on their culturally-informed moral imperatives. While Africans find a lot of Global North cultural practices objectionable (Hopgood, 2017; Lionnet,

2003), their objections are at best, dismissed and seen as inconsequential, a demonstration of paternalism and structural power in action (Hopgood, 2017). So, who is speaking for whom? In discussing the airing of African taboo subjects by Global North activists, one participant Malala wondered, “who appointed them?” and noted that these unsolicited, unflattering discussions about African women’s bodies just made it harder for women to share their FGC stories and according to her, needed to be had in private settings instead of out loud on global bully pulpits.

Oyewumi (1997) highlighted “the paradox of the imposition of Global North hegemony’ on African women by sharing the story of an “eminent” colonial anthropologist R.S Rattray who in the 1920s had apparently spent many years studying

181 the Ashanti people of Ghana and was surprised to “discover” after expertly studying this tribe for so long, that women held important positions in the state and family. Naturally, he wanted to know why no one had told him this and was subsequently told by elderly

Ashanti men and women that in addition to not having asked them the question, he had insisted on dealing with only men and that based on this, the tribe surmised that women did not matter to Europeans, that they were not recognized the same way they were among the Ashanti. This is a classic example of information lost in translation when researching on instead of with communities. In the case cited by Oyewumi, the foreign researcher was embedded within the community for years but was studying them from a male, Global North, colonial viewpoint thus completely invisibilizing and devaluing the nuances of the Ashanti culture.

The above example by Oyewumi also denotes the subaltern which in postcolonial discourse is understood as a member of a historically marginalized group who has tended to be spoken at, and for, and whose voice has been coopted by others, usually those in dominant groupings or in power, who claim to speak for this oppressed person. In global writings on FGC, African women are often depicted as subaltern in the way they are portrayed as helpless. Gayatri Spivak is credited with originating the term, subaltern, in her seminal essay, Can the Subaltern Speak a reference to her work with South Asian women. Subalternity therefore is as much about representation and voice (Spivak, 1988) and marginality (hooks, 1984) as it is about who gets a seat at the table (Werunga et al.,

2016) and who gets left out (Davis, 1983).

While I acknowledge that the work of ending FGC cannot be left to Africans alone, participants’ concerns point to the need for tactful engagement with this sensitive

182 topic. A lack of tactful engagement can lead to further denigration of cultures which would serve to engender shame in women who already have to endure so much in living with the effects of FGC in diasporic and other locations. This shame was evident when

Doria, the oldest participant in my study explained to me that she viewed cutting as a positive and blameless cultural practice but was against “primitive and dirty ways of doing it” which for her meant the performance of FGC the traditional way and outside of modern, Global North style, sterile environments. I found this to be quite ironic because at 68 years of age, Doria was unlikely to have been cut in a hospital, but she had clearly internalized the messages put out through the Global North media and other sources.

Other women spoke about being reluctant to bring up FGC in their interactions with healthcare providers (Samia) or avoiding those interactions altogether as was the case with Zemi’s older sisters.

The FGC problematic will likely remain a fixture on the global health stage for the foreseeable future especially given recent upward projections for numbers of girls and women who have been cut in countries like Indonesia (UNICEF, 2016). Research also increasingly shows that in countries where the practice is dwindling, this has been due to sustained grassroots, culturally sensitive efforts led by community members, not the enactment of universal edicts (Koukoui & Guzder, 2017). Perhaps then, as Mohanty

(2003) noted, it is time to stop speaking for African women and portraying them as overly controlled, uneducated victims of their own cultures and instead start viewing them the same way Global North women are; as possessing certain freedoms and control over their own bodies and lives. Including African women in FGC knowledge projects on the global stage will ensure that cultural nuances are not lost in translation.

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Where Does it Hurt? Intersections of Trauma

Some women in this study spoke about the trauma of having undergone FGC with many of them pointing to the actual cutting as the source. Additionally, women also spoke about other traumas in their lives. Zemi shared her family’s migration story which included living in a warzone in Somalia and enduring a daily barrage of artillery and loosing neighbors and family members to war. When Zemi’s family decided to leave the fairly affluent life they had built for themselves in Somalia, they encountered rejections along the way with many countries refusing to take them in before they finally landed in

Canada. The cultural shock and other settlement issues added to the traumas experiences for this family and so according to Zemi, it was layer after layer of trauma with individual family members adapting to the best of their ability.

Similarly, Tamu spoke about her own traumas starting with getting cut which she said paled in comparison to the trauma of watching her mother experience daily seizures due to some health issues. After migrating to Canada with her family and daughters,

Tamu had to deal with multiple settlement issues which were exacerbated when her husband was taken ill forcing her to take on the role of provider and caretaker.

These two examples help highlight the multiplicity of traumas faced by participants in a transnational setting. In revisiting these stories, I began to see how for participants in this study, the stories they shared about FGC trauma were also stories of multiple continuous layers of trauma which they had to navigate in their daily lives. I also began to recognize the potential futility of addressing only FGC-related trauma given the cumulative and relative effects of traumas related to, for example race, ethnicity, religion, migration status, and wars. This begged the question: How does one heal from FGC-

184 related trauma while simultaneously swimming in a sea of trauma? Here is how Zemi saw her family’s handling of these multiple and diverse traumas:

To be honest with you I think it’s a mortal survival; it’s like an African mentality,

it’s like you just move on. It's like when we were in the war and we lived through

a civil war before we were able to flee for seven months and it was like every

morning you woke up and the building next to you or behind you was half gone.

Your mind goes to, well, it wasn't me, it wasn’t my house (Zemi, individual

interview, age range 31-40).

While I cannot speak to the successes and failures of this “African mentality,” I revisit trauma, not in an exhaustive way, which would be beyond the scope of this dissertation, but to reflect on some of the ways that trauma might be theorized differently for black women based on the multiplicative axes of marginalization they face (Collins, 2000) as well as their own cultural and spiritual understandings of trauma and coping practices.

Black women face trauma every day in many ways and often with unsolicited triggers relating to race, gender, police brutality, and countless, sometimes daily microaggressions. Some researchers in the field of traumatology have theorized that trauma exists within a contextual spectrum of oppression and body politics and within complicit societal structures (Burstow, 2003; Scaer, 2005). In consideration of these truths, and even though there have been advancements in the provision of appropriate trauma care to different populations, other theorists problematize Global North approaches to trauma therapy which tend to be reliant on medical models while paying little attention to other factors including trauma stemming from racism and socio- structural inequalities attributable to race (Gómez & Gobin, 2020; Pétigny, 2014).

185

Most participants in this research study referenced trauma and shared some ways that they have managed to cope in a transnational setting. Shala spoke about some practices which helped her to manage her triggers which included engaging in anti-FGC work, facilitating workshops with FGC-affected women, and supporting organizations to end FGC in her tribe back in her home country of Kenya. Shala also shared some triggers for her trauma including the refusal of her White gynecologist to listen to her concerns during a health examination perhaps a reflection of anti-black racism in healthcare, a sentiment shared by Zemi who also spoke to being ignored by health care professionals on multiple occasions. Tamu on the other hand spoke about “just dealing with it” and taking things one day at a time. She conceded that the first-paced nature of diasporic life left her no time to in effect “mourn about the past” stating that she considered herself a strong woman and just preferred to tackle problems as they occurred. She stated that her faith community had helped her a lot especially following her husband’s illness. Malala on the other hand stated that she had benefited from seeing a therapist in order to deal with her FGC trauma and other issues. She was also involved in Somali women’s organizations and stated that although they did not discuss FGC specifically, they all understood that they had undergone the practice and supported each other in more practical ways to ease their settlement experiences.

With regards to FGC then, the notion of healing FGC-traumatized bodies requires a multi-pronged, culturally safe approach which can utilize the innate survival skills that black women have cultivated for centuries including a reliance on the collective as in

Malala’s and Tamu’s case, instead of reliance on individual re-sourcing. Recognition of the role of society as a re-traumatizer is also required (Lykes,1983). So then, in order to

186 heal “trauma brewed in an African pot,” which is how Zemi had described what she perceived to be the African ways of bottling up issues, therapy cannot only focus on survival especially in the face of unrelenting triggers, rather, therapy should include “less direct” coping strategies and incorporate cultural somatics aimed at confronting discrimination and engendering social justice. For example, one way in which Black

American women have engaged with the many traumas in their lives stemming from systemic generational violence has been by creating spaces where they get to “share and speak back to the traumas of violent enslavement, sexual violence, destruction of communal bonds, and infringement on their rights to survival” (Pétigny, 2014, p. 69).

Black women also create online groups to allow them to engage with each other in private. One such group is the Nap Ministry36 which focuses on rest as a form of resistance and liberation in a world rife with unending cycles of trauma. Additionally, marginalized women engage in radical writing for healing (Anzaldua, 1999) and in activism, and organizing in solidarity to confront individual and collective trauma

(Pétigny, 2014). As mentioned above, participants in this study engaged in some of these healing practices. It is therefore important to consider these, and other ways of coping and resistance by Black women (Evans-Winters, 2019) because when it comes to healing and trauma and FGC, one size does not fit all. The enactment of healing practices has to take into account the ever-present traumatizing events and triggers in the wider society including racism in and out of healthcare settings, sexism, and islamophobia, to name a few.

36 https://www.instagram.com/thenapministry/?hl=en

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Exits, Re-routings, and Border Crossings: Intersectionalities of Influence

Disciplinary power … is exercised through its invisibility; at the same time it imposes on

those whom it subjects a principle of compulsory visibility … It is this fact of being constantly seen, of being able always to be seen, that maintains the disciplined individual

in his subjection ~ Michael Foucault

I thought about this quote by Foucault (1977) in formulating this theme.

Participants in this study related their FGC stories but also stories of leaving their home countries, crossing multiple borders, being denied entry in certain countries as well as stories about settlement in their new country. Within these interweaving stories, I heard, as a decolonizing researcher, deeper stories of the legalities of transnational migration, renegotiation of cultural understandings, as well as identity issues around the practice of

FGC in the context of the intersections of race, ethnicity, religion, and gender.

Participants spoke about the always present visibility on account of being racialized minorities in majority White countries and how it impacted their lives and health. In order to address these varied components of migration and settlement stories vis a vis

FGC, I identified three subthemes: Who am I?, Representation Matters, and Folding In. I discuss them in the next section.

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Figure 4: Exits, Reroutings and Border Crossings: Intersectionalities of Influence

Who am I? Cultural Fragmentations and New Understandings Exits, Reroutings, and Border Crossings: Representation Matters Intersectionalities of Influence Folding in: Religion as a safe space

Who am I? Cultural Fragmentations and New Understandings

Leaving one’s country to embark on a new life elsewhere is not easy even under the best of circumstances. It is especially difficult when one is forced to leave because of insecurity and strife in one’s home country and this was the case for many of the women in this study. A few of the participants moved to Canada as immigrants but the majority emigrated as refugees. The Merriam-Webster Dictionary defines an immigrant as a person who comes to a country to take up permanent residence and a refugee as a person who flees to a foreign country or power to escape danger or persecution. The notions of permanence and fleeing are at the heart of some of the unique problems these two populations face. Malala described refugees as always in “survival mode” whereas she thought immigrants had more leeway in that they would likely have had time to plan, mobilize some funds, and perhaps even learn the language.

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Yet, even with the benefit of preplanning, immigrants are still prone to the same compulsory visibility to which the Foucault quote referred. I offer my own story here as an exemplar. A few years ago, while taking some time off from a busy day of writing on my college campus, I decided to take a mental break by visiting the university gallery. While browsing the art display, I met and started chatting with a fellow gallery visitor, first about the art, and then about events in our lives including our studies. We quickly discovered that we had some commonalities in our experiences, her family having emigrated to Canada from the U.K, and mine to the U.S from Kenya. And that is where the parallels ended, apparently, because we then proceeded to have the following conversation:

Her: So what happened to your family?

Me: What do you mean?

Her: What made you move? Like were you persecuted? what were you running

from?

Me: Nothing happened. We just decided to seek out new opportunities, like your

family.

Her: What do you mean?

Me: You are an immigrant, right?

Her: Well yes, I suppose you could say that. We sort of just moved here though,

you know?

No, I did not know. As we continued swapping family stories, and as I pressed my new friend on her understanding of her own immigration status, I quickly learned that she associated “immigrant” with racialized others, not a white person like herself, or perhaps not a white person of British descent. While I doubt that this lady’s intention was to

190 discomfit me or to delineate our differences beyond our obvious racial ones, the impact of her words did just that. Whiteness equals invisibilized and visible power in most Global

North societies, and my new friend inadvertently wielded this power over me despite the many other ways our lives intersected as immigrant women, graduate students taking the time off to enjoy some art.

Participants shared similar stories of being racialized and othered. It is worth noting that this racialized painting, so to speak, of immigrants and refugees with one brush also fails to account for the diversity of their pre-migration lives. Several participants stated that they had come from families of means and had lived prosperous lives prior to emigrating.

Didi and her sister Chali spoke about feeling different at school and struggling to adjust and make friends. At age 18, Chali (who had been seven years old when her family moved to Canada) stated that although she claimed both identities, Kenyan and Canadian, she did not feel like she fully belonged in Canada sharing that she sometimes felt torn about her identity given all the negative connotations about Africa in the media but also given the jokes she heard about Africa from the kids at her school. While Didi and Chali did not share how these actions had impacted their health and wellbeing, studies show that straddling cultures can be detrimental to the physical and mental health of young people attempting to acculturate (Perez, 2016).

Zemi offered that she saw as a direct link between the stressors of acculturation and some of the issues faced by her older sisters. She stated that they had faced so much discrimination “out there” due to their manner of dress and their race that they had chosen to cut out the outside world and just focus on their own family, the result of which was the development of multiple phobias along with what Zemi deemed to be obsessive

191 compulsive disorders “to make up for what they could not control outside.” These experiences of participants are supported by research which shows that multiple interdependent factors including stress can interact to impact the physical and mental health and wellbeing of individuals (Guruge & Khanlou; 2004; Hankivsky & Christoffersen,

2008).

Participants also shared stories of role reversals within their families with mothers taking on non-traditional roles, and children sometimes helping to educate their parents on issues including the (il)legalities of FGC which I will cover further in the “intergeneration” theme three. This reversal of roles led to a strengthening of family structures with members relying more on each other in the absence of traditional support systems including extended family. In terms of FGC, this reversal of traditional family roles and cultural transformation brought on by a mixing of African and diasporic cultures serves to enhance the agency of family members by encouraging intergenerational dialogue., and yet is also an indictment of an immigration system that could perhaps do more in removing some of the structural bottlenecks that stand in the way of better transitions for black immigrants and refugees.

Participants’ settlement stories highlight the need for programs to help with acculturation and integration into diasporic systems including healthcare.

In a sense then, the answer to the question Who am I? was for most immigrants and refugee women in this study, a discovery of who they were not in the context of the intersections of race, displacement, and migration. In other words, it exposed the many ways in which they were seen or even labeled as different from the normative White race and culture. And yet participants’ stories showed that they had found ways to overcome many of these obstacles and forge new lives for themselves and their families. Teso’s two

192 daughters Tamu and Diya were well rounded young ladies with Tamu working a good job and engaged to be married and Diya doing well in college. Other participants similarly shared that they were living their lives the best way they could. Participants’ abilities to somehow build a home away from home and create spaces to try and heal and continue to advocate for themselves despite the social and structural challenges is consistent with literature on the inherent agency of immigrants and refugees (Dyck & Dossa, 2007).

Representation Matters

Study participants, both immigrants and refugees spoke about failing to locate support systems outside of their own families after moving to Canada. Younger participants reported that while they found it easier to integrate with kids from other cultures, mainly at school, there was a limit to what they could realistically discuss with their non-African friends especially with regards to FGC. Two sisters Chali and Didi who were uncut stated that it would be difficult to discuss FGC at school with a teacher or someone who is “not from the culture” because they thought that this would further shame the culture especially since they said, they had seen “how poorly we are portrayed” in media. This is consistent with literature on the subject of negative representations of refugees, asylum seekers and immigrants in media (KhosraviNik,

2010) and a general negative depiction of black people across all media platforms in the

U.S and other Global North countries (Dixon & Linz, 2000).

Current calls for the interrogation of anti-black systemic racism have highlighted the dearth of representation of minorities especially black women, in positions of power in the U.S but also in Canada. A lack of representation can lead to the production, upholding, and sustenance of problematic narratives about marginalized populations even

193 when intentions are noble. Lack of representation in multiple societal settings such as in healthcare, law enforcement, media, and education can lead to the sensationalizing and othering of those who are already marginalized (KhosraviNik, 2010), and this is also true for FGC. Following the 9-11 attacks in New York, the narrative on terrorism and who are perceived as terrorists has been fodder for mainstream media. Without sufficient alternative representational voices such as those of Blacks and other minority groups in leadership positions including in politics and mainstream media spaces, the narrative has been crafted to single out Muslim communities and label them terrorists, with almost any crime performed by a Muslim person speculated about as terrorism often before any real investigations have been performed. I will discuss this labelling of terrorist further in the subtheme “folding in.”

Several young participants in this study noted that they would feel more comfortable opening up about FGC at school (Diya) or in a hospital setting (Malala and

Zemi) if they were speaking with someone who understood them, preferably someone from a similar background. Representation is therefore essential in meeting the healthcare needs of FGC-affected women and in decolonizing the problematic narrative which props up barriers standing in the way of progress in the health and wellbeing of affected women and girls.

Folding in: Religion as a safe space

I shared the quote by Foucault (1977) on forced visibility at the beginning of this thematic category, but it is perhaps most relevant in this section. I recently watched a

194 documentary titled The Feeling of Being Watched37 in which journalist Assia Boundaoui sets out to look into rumors of a years-long surveillance of her Muslim-American neighborhood in a suburb of the U.S city of Chicago. She ends up discovering that the

Federal Bureau of Investigation (FBI) has indeed been not-so-discreetly watching the community for decades both pre- and post-9/11 with lasting social and psychological impacts to the community. While this was an actual physical surveillance complete with cameras installed on streets, around Mosques, and in several other places in the neighborhood, this story is not dissimilar to the stories shared by participants in this study. In the absence of adequate representation, even in a country like Canada which lauds its inclusivity, immigrant and refugee communities and other marginal communities tend to look within their own groupings for solace and psychological protections.

Malala described a situation where young Somali women along with the community in general were becoming more religious and isolated in response to islamophobia and described this and other shifts as counter to how the previously secular

Somali community had operated. With these religious shifts, elders were slowly beginning to mandate prayers, manner of dress, and behavior for girls, a situation which

Malala described as “being cut in a spiritual way” meaning that while girls were not experiencing FGC, their bodies were still being policed in the name of religion and protection, a no-win situation. While community spaces for marginalized individuals in

Global North locales can positively influence how individuals carry out their

37 http://www.feelingofbeingwatched.com

195 intersectional identities (Huot & Veronis, 2018), they can also be a double-edged sword especially in the context of forced visibility and the resultant surveillance and profiling which is rife in Global North countries. So while folding in can offer a sense of community and well-being, for Muslim immigrants, it can also lead to renewed suspicions over concerns for the rise of fundamentalism, a harmful vicious cycle.

Islamophobia is an added layer (intersection) of othering in addition to the denigration that already exists for immigrants and refugees in the U.S but also in Canada

(Dauvergne, 2020), sometimes from the highest levels of leadership. For instance, the current U.S president does not even pretend to mask his hatred of immigrants and refugees from certain countries. This othering serves to further alienate large groups of already marginalized groups (Nagra, 2018), and with regards to FGC-affected women, it serves to erase gains made toward their religious and cultural emancipation (Bastug &

Akca, 2019; Poynting & Briskman, 2018). It is worth noting that despite the many decades of surveillance of the Muslim-American community in Chicago, no evidence of terrorist activity was ever unearthed. The only people who were terrorized in this case were community members and their families, and per this documentary, they are still living with the psychosocial consequences of the act along with fears of continued surveillance given the political climate. Next, I discuss post-migration intergenerational perspectives on FGC, the main theme and subthemes.

Mothering and Daughtering, Then and Now: Intergenerational perspectives on

FGC

The African continent continues to carry a disproportionate FGC burden in comparison to all of the other countries where FGC is practiced (WHO, 2013). The long

196 history of FGC in Africa reflects the multigenerational transmission of the practice, and studies have been carried out to try and understand the forces behind this phenomenon. In her study about the multigenerational transmission of trauma through FGC, Raya (2010) examined the complex process of mental concept map formation that becomes etched into a child’s psyche and unconsciously serves to ensure that the child grows up to become the next transmitter of the practice. She found that parents as well as the overall cultural milieu in which FGC occurs played a role in cross-generational transmission of

FGC and related effects including trauma.

When I first started formulating this study, I made the decision to include women from different generations to try and capture different generational viewpoints. While I had not been sure about the possibility of getting mother-daughter participants, I ended up getting several which led to robust conversations on what each other thought. In contemplating this, I looked back to the group interview where random African women, some of whom had never met before referred to each other as “mama”, “grandma,” and

“aunty,” a reflection of African ways of addressing one’s elders. For me therefore, this dynamic reflected mothering and daughtering which I will detail next as: Conversation and Let’s Talk about FGC: Hybrid Spaces and Intergenerational Views.

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Figure 5: Mothering and Daughtering, Then and Now: Intergenerational Perspectives on FGC

Mothering and Conversation Daughtering, Then and Now: Intergenerational Let’s Talk about FGC: Perspectives on FGC Hybrid Spaces and Intergenerational Views

Conversation

Participants in this study spoke about the silence around discussions on FGC especially prior to migrating to Canada and attributed this to the young age at which the cutting had occurred which they said made it impossible for any meaningful discussion on FGC to happen. Diya noted that for her, several factors played into the silence including the private nature of FGC along with “other awkward stuff” like the fact that her consent was not obtained and for her, a discussion would need to start with the consent question. However, most of the participants stated that on top of making decisions about not cutting their own daughters, they spoke to their daughters openly about FGC, unlike their own mothers’ failure to do so with them (Asha, Tamu, Shala). In

198 this way, participant appeared to recognize the value of conversation and the need to have open avenues for intergenerational knowledge exchange.

Finke (2006) analyzed a project by the nongovernmental organization (NGO)

German Technical Cooperation (GTZ) which sought to encourage intergeneration dialogue on FGC in the African country of Guinea. For this project, various NGOs partnered with members of a few target communities to institute “discussion days” which would be value-free, supportive, and respectful and were meant to foster opportunities for meaningful dialog across different age groups and genders (Baumgarten, Finke, Manguet,

& Von Roenne, 2015). Participants reported increased sense of community and ease of dialogue about FGC in family units. Additionally, some of the participants went on to become role models for intergenerational dialogue (Baumgarten et al., 2015).

Although this type of community conversation was not possible for participants in this study owing to the geographical separation from their extended families and communities, participants in the group interview offered an exemplar of it. Participants in this interview ranged in age from 18-66 years old, there were mothers, daughters, and granddaughters, some participants were cut or had family members who were cut, and others were not. The discussion led to exchanges of and sharing of cross-cultural ideas on cutting and other African practices around sexuality. Even within this very diverse group of intergenerational African women, there was a robust and respectful exchange of information and questioning of cultural norms and an openness to listen and learn from each other. It was during this group interview that Teso shared that she was very proud of both her daughters (who were not present for this interview) and trusted them to make the right decisions for themselves based on life lessons she had imparted on them. She also

199 shared that she would be following up with her daughters to better understand their FGC experiences. Her youngest daughter subsequently shared that she had been raised to be

“strong and independent” which for her included challenging her mother on her understandings of FGC within their culture. Conversation therefore appeared to contribute positively to intergenerational understandings of FGC and is supported by the research literature (Koukoui, Hassan, & Guzder 2017).

Let’s Talk about FGC: Hybrid Spaces and Intergenerational Views

While the scope of the research as well as logistical issues would not allow for joint mother-daughter interviews, participants were able to share stories about communication styles and challenges to dialoging about FGC within families. I detailed some of these stories in the interpretive description chapters, but most participants seemed to point to poor intergenerational communication in explaining information gaps in their understandings of FGC as well as the silence and even intergenerational transmission of FGC-related trauma.

Didi: Hmmm. I think when I see my relationship with my mom right now, I think

she is very open-minded, and she wants us to ask her questions and find out things

from her rather than find out by ourselves kind of thing…. But I think when I see

my mom’s relationship with my grandma, I see there’s that respect and openness

to a certain degree, but I think that the dynamic of their relationship has also

changed…like if she was my age and my grandma was her age right now… of

course since they’ve both had children so maybe they have more opportunity to be

open but maybe some things are still …there’s some sort of distance in that

200

relationship so that my grandma can still be viewed as the mother, as a higher

authority, and my mom as the child… if that makes sense.

And yet in speaking with participants, most expressed that they would be willing to have discussions with their mothers or daughters or siblings to try and understand their views. Younger participants tended to be more outspoken about FGC and more willing to broach the subject with their mothers and other older family members. One participant,

Teso revealed that her views on FGC had changed and that she was beginning to question some of her prior understandings after her youngest daughter initiated a conversation on

FGC vis a vis religion and laws. Teso attributed the change in her views to talks with her daughters but also to the exposure that she had with her work which involved helping immigrant families with parenting in diaspora. This is in line with studies which show that education along with socioeconomic opportunities contribute to changes in how women perceive customary beliefs Assaad (1980). This is more so in the context of migration as in this study.

To borrow Boveda’s (2019) analogy, intergenerational understandings of FGC appeared to be shaped by “audacious departures” relating to shifting perceptions of and understanding of FGC across generations. This contextual evolution of knowledge on

FGC is indicative of the location of FGC within hybrid diasporic cultures in flux

(Bhabha, 1994). It is also indicative of traditional role reversals where knowledge flow is no longer one-way as was often the case in traditional African cultures where matriarchs transmitted knowledge to younger generations via sacred oral storytelling (Oyewumi,

1997). There is now more intergenerational co-learning in migratory settings due to the

201 complexities of settlement in a new country and culture. One young participant summed this up nicely as follows:

Yeah, I think it does change dynamics because moving to a new country … we all

had to adapt at the same time to a new culture, so it is not as if maybe my mom

knew more about Canada than we did, but we all just had to adapt to a changing

environment, So I think that made it easier to be more open about how we felt

about moving, seeing a new culture and how it is different. All of us having to

adapt at the same time was different than the children adapting to a culture that is

already there. (Didi, individual interview, age range 21-30).

With this adaption came the need for engaging in discussions on sexuality, marriageability and the legal aspects of FGC. Teso shared about her evolving views on

FGC and noted that although she had decided against cutting her own daughters, she still saw the practice as an important component of her culture for those who chose to continue with it. This was until she was challenged by her youngest daughter who had seen a story on television about a doctor from their community who was facing prosecution for privately conducting FGC in her clinic and in so doing breaking the law in her U.S state. According to Teso, this opened up a conversation with her daughters where they discussed some of their own experiences with cutting which led to the revision of her own views and perceptions on FGC including noting that she was okay with whatever decisions her daughters made about their own children with regards to

FGC. Both daughters shared that if they had daughters in the future, they would not cut them.

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A 2009 study by Tadros summed up some of the key points that I raise regarding intergenerational transmission of FGC knowledge which if adequately utilized in diasporic locations could help inform policies on relational practice and the provision of culturally safe healthcare services in addition to productively engaging affected communities on inclusive non-punitive dialogue on FGC eradication. These key points are that (a) there exists an ambivalence as well as fluidity in FGC knowledge transmission; (b) multiple factors including hierarchical gendered roles play a role in knowledge transmission; (c) location and context affect knowledge transmission; and (d) children can be agents for change when intergenerational knowledge reciprocity is encouraged (Tadros, 2009).

Overall, participants’ intergenerational views on cutting in diasporic hybrid spaces reflected positive parenting and daughtering experiences with regards to openness with discussing FGC and hearing each other out as well as a commitment to at the very least, rethink some long-held beliefs around the practice including the silence and stigma.

Hybrid spaces therefore not only reflect cultures in flux but also cultural practices in flux as was demonstrated by participants’ FGC stories. Hybrid spaces also opened up opportunities for intergenerational knowledge reciprocity.

Agency Revisited

You may shoot me with your words, you may cut me with your eyes, you may kill

me with your hatefulness, but still, like air, I’ll rise ~ Maya Angelou

The agential nature of black womanhood is not a new phenomenon. At the beginning of Chapter 4, I laid out my understanding of black women’s agency and its use as an everyday means of coping and resisting in a world which overall does a poor job of

203 recognizing and honoring women and girls. The ability of black women to survive in the face of sheer pessimism and unimaginable levels of denunciation and trauma while navigating multiple axes of marginality (Collins, 2000b; Collins & Bilge, 2016) has been lauded by many researchers (Angelou & Broun, 1994; Evans-Winters, 2019; Lykes,

1983; Pétigny, 2014). Black women manage to still rise even while carrying generational burdens of oft-times unhealed traumas and while also dealing with ongoing traumas, all while continuing to exhibit “resourcefulness, flexibility, and creativity” in navigating their everyday lives (Lykes, 1983). Black womanhood as agency was a basic assumption of my interpretive description analysis as well as my decolonizing interpretation of the stories of African immigrant and refugee women affected by FGC. Joyce Ladner (1972) described black women thus:

One of the chief characteristics defining the Black woman is her [realistic

approach] to her [own] resources. Instead of becoming resigned to her fate, she

has always sought creative solutions to her problems. The ability to utilize her

existing resources and yet maintain a forthright determination to struggle against

the racist society in whatever overt and subtle ways necessary is one of her major

attributes (pp. 276-277).

This is how I as a decolonizing researcher describe the African women in this study.

Through their stories of experiencing, explaining, migrating, and mitigating the effects of

FGC, they demonstrated their resilience in the face of systemic challenges in all phases of their migration and settlement experiences, and showed their persistence through the highs and lows of these experiences; Black womanhood as embodying agency.

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While it is true that black women embody agency individually and collectively based on shared experiences, a point that needs emphasizing given the reification of the

Strong Black Woman (SBW) stereotype is that agency does not take away from the very real harm and structural vulnerabilities faced by Black women. To put it another way, just because Black womanhood embodies agency does not mean that the systems that infringe, oppress, colonize, and traumatize them should be overlooked. Indeed, studies suggest that the notion of SBW and its internalization by Black women (Beauboeuf-

Lafontant, 2009) leads to negative mental and physical health outcomes (West, Donovan,

& Daniel, 2016). My discussion of agency and Black Womanhood is not meant to

“pathologize their strength” (Abrams, Hill, & Maxwell, 2019) or to suggest that they can do it all; rather, it is meant to encourage the harnessing of Black Women’s agencies for the betterment of their health and well-being while also holding oppressive structures to account.

I would also like to caution against the potential problematic of essentialism of

Black women. bell hooks (1989, 1991) critiqued the notion of a monolithic Black identity and cautioned against viewing the subjectivity and identity of marginalized groups as all- encompassing. This essentialism runs counter to Black feminist thought (Collins, 1990,

2000, 2016) and decolonizing discourse (Schiwy, 2007) both of which view knowledge as situated. Ultimately, my goal here is to armor and humanize (Evans-Winters, 2019)

Black women’s agency without essentializing the unique ways in which they cope and resist.

Context can enhance agency as was the case in this research. Women’s agency, particularly the younger ones was likely enhanced in their new cultural location. Tammy

205 and Diya noted that their FGC views were informed by reason, evidence, and what Tami referred to as “common sense,” counter to cross-generational received notions of FGC.

So education and migration can be said to enhance agency. Participants also shared that their evolved views on FGC were likely due to the physical separation from their extended families and the associated communal pressures to cut girls. The literature supports this notion of changes in points of view in the context of migration (Koukoui &

Guzder, 2017).

Chapter Summary

In this chapter, I focused on my decolonizing interpretation of study findings in relation to larger structures which impact the health and wellbeing of immigrant and refugee women affected by FGC. After situating myself as a Global South researcher in the Global North conducting research on the subaltern, I discussed three main themes:

Fractured Understandings of FGC; Exits, Re-routings, and Border Crossings:

Intersectionalities of Influence; and, Mothering and Daughtering, Then and Now:

Intergenerational perspectives on FGC. I concluded this chapter by revisiting agency from a decolonizing position, briefly discussing Black women’s resilience and coping despite experiencing multiple oppressions. In the next chapter, I offer a summary discussion of the research findings along with recommendations for future research, policy, and health/nursing practice.

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Chapter 7 Conclusion

In interpretive description research, the discussion of research findings is referred to as the “so what” of the study (Thorne, 2008, 2016). In my decolonizing interpretation in Chapter 6, I situated the interpretive description findings in decolonizing literature to show how the experiences of immigrant and refugee women affected by FGC are shaped by their abilities to navigate intersecting sociopolitical, often oppressive power structures in their efforts to seek healthy healing environments for themselves and their families. In considering the “so what” question in this chapter, I reflect on my research questions and the various critical decolonizing perspectives which informed my research and influenced my interpretations.

This interpretive description study informed by decolonizing perspectives grew out of my desire to address what I viewed at the time as a very specific need, which was the ability for African immigrant and refugee women affected by FGC to access nursing and health care that was responsive to their needs given the private nature of the topic.

Even without considering how immensely divisive and triggering the topic of FGC tends to be both for affected women as well as for interested parties around the world

(Abdulcadir, Rodriguez, & Say, 2015; Berg et al, 2018; Vissandjee et al, 2014; Werunga et al, 2016), the whole idea of leaving one’s birth country for any kind of reason, crossing borders, and settling in in new locations is fraught with complexity. This is more so when transnational border crossers do so from the Global South to the Global North given the implicit meanings associated with these locations (as developed and undeveloped) as well as the imperialist, unequal power structures embedded therein (Bhattacharya, 2009;

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Njambi, 2004). So then, the South-to-North transnational migration of African immigrant and refugee women affected by FGC happens within systems which function to further perpetuate inequality, marginalization, and othering (Bhattacharya, 2009; Mohanty, 2003;

Spivak,1993). This understanding of how imperialist and neocolonial structures operate to disadvantage and oppress already marginalized groups factored into my decision to conduct interpretive description research informed by decolonizing perspectives. My hope was that I could fully explore, describe, and interpret research findings to reflect how immigrant and refugee women affected by FGC navigate such complex structures both in their understandings of FGC practices as well as in their healing practices and health seeking behaviours.

Since the purpose of my research was to critically examine how immigrant and refugee women who have undergone Female Genital Cutting (FGC) make sense of, and explain FGC practice, both for themselves and for younger generations; and to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women including their perceptions of, and interactions with various health services in Canada and the U.S, I sought to explore affected women’s understandings of their FGC experiences across time and space, and to situate these understandings within intersecting structural systems of gender, race, class, ethnicity, nationality, and migration (Collins, 2000). In doing so, I also sought to offer a critical understanding of how multiple intersecting systems of power shape the experiences of immigrant and refugee women affected by FGC, and how these systems influence women’s ability to gain access to healthcare delivery programs that offer culturally safe,

208 socially just, timely and equitable nursing and other health care services in Canada and the U.S. My intent throughout the research process was to address the stated research purpose with rigor, substantively and methodologically.

It is worth mentioning that I did not set out to conduct decolonizing research, rather, I sought to conduct research that would reflect the experiences of African women while honoring the African cultural space. Ultimately, the research process led me to the decolonizing methodology through an initial foray into understanding critical and decolonizing discourses via a directed studies course on critical perspectives in nursing and healthcare which helped open up the possibility of utilizing some of these perspectives in my research. I later immersed in more contemporary decolonizing transnational discourses in trying to make sense of my research data and situate my participant stories within relevant contexts through what Bhattacharya (2016) views as deviation from established norms of research and culture.

In this final Chapter 7, I provide a re-examination of the initial research questions and briefly discuss study findings in view of these questions. I then discuss the strengths and limitations of the study as well as implications for nursing practice, research, and policy.

Main Findings and Issues Arising

For my study, I focused on the FGC experiences of African immigrant and refugee women, which I contended cannot be fully comprehended outside their individual and communal cultural histories and migratory structural trajectories. Additionally, as I

209 stated in Chapter 1, African immigrant and refugee women’s experiences cannot be understood in preclusion of an African feminist perspective, a traditionally marginalized critical perspective which is discursively constituted within colonial history (Werunga et al., 2016).

Specific research questions that guided this study were as follows:

1) What are the effects of FGC on the lives of affected African immigrant and

refugee women (younger and older)?

2) How has migration to Canada shaped how African women (younger and older)

view FGC, including how views evolve across generations and geographies?

3) What happens when affected African women (younger and older) interact with

various health services?

4) What implications for healthcare services do the understandings of FGC have for

affected women (younger and older)?

In the following section, I discuss study findings in relation to the four research questions. Implications for nursing education, leadership, and clinical practice are integrated into the fourth research question followed by separate sections on research implications and on policy implications.

What are the effects of FGC on the lives of affected African immigrant and refugee women (younger and older)?

Study findings suggest that participants’ understandings of FGC are inextricably interwoven with their health, trauma, and grieving experiences. Participants spoke of having to live with not just the physical but also the psychosocial effects of FGC and having to adapt to the associated challenges through various life stages including

210 relationships, marriage, and childbirth. The challenges were exacerbated in the context of migration with participants going through a grieving process with regards to making sense of and learning to live with the health consequences of FGC in new cultural locations while also dealing with multiple stressors related to intersecting oppressions and exclusions relating to their gender, race, and immigrant/refugee statuses.

Additionally, results suggest that FGC-related trauma is an ongoing health issue for affected immigrant and refugee women. All but one of the cut women specifically referenced trauma especially when remembering and relating the actual cutting experience, the sole exception being the oldest participant who also stated that she saw nothing wrong with the practice of FGC. Women seemed to engage in complex processes of renegotiating their grief and trauma experiences in healthcare systems which were not always responsive to their specific needs. These findings have implications for nursing and mental health providers with regards to access to culturally responsive and trauma- informed healthcare.

Findings further suggest varied understandings of FGC from participants’ standpoints with invocations of religion, culture, Hive Mind phenomenon as well as gender, patriarchy, class and rurality offered as explanations for the continuation of FGC.

Participants appeared to walk a fine line between a respect for their cultures and criticizing a practice which many saw as outdated and harmful, all the while honoring the very same elders and cultures which had subjected them to FGC. This particular finding has policy implications, particularly with regards to legalities around punishing parents who cut their daughters. While it is important to enforce FGC laws, there needs to be a way to do it so that it does not leave affected women and girls feeling like they have

211 participated in locking their parents up, for example. Less extreme measures could be undertaken including mandatory education, including religious education which participants lauded as having an impact on understanding the effects of FGC and curtailing its continuation. In examining participants’ navigation of their health and FGC- related trauma along with their views on culture, religion, and the social dynamics of

FGC, study findings suggested a level of resilience with participants finding ways to cope, resist, and in certain cases, triumph in the face of social and structural obstacles.

How has migration to Canada shaped how African women (younger and older) view

FGC, including how views evolve across generations and geographies?

Participants’ navigation of their transnational journeys factored into their understandings of FGC in diasporic milieus as they sought to understand their post- migration FGC experiences while also attempting to mitigate the effects of FGC. Stories of displacement, straddling cultures, and making sense of their new hybrid cultures featured in their efforts toward mitigating the effects of FGC in diasporic locations. Pre- migration preparedness in terms of refugee or immigrant status appeared to play a role in the way participants enacted not just coping mechanisms, but also in making decisions regarding accessing care in diaspora with participants stating that immigrants were better prepared than refugees to handle the multiple transnational challenges.

Additionally, leaving home appeared to impact generational cycles of FGC transmission with new considerations for economic, immigration, and cultural FGC implications adding other layers of complexity to an already complex topic. There were also differing generational understandings with regards to health-seeking behaviours with participants engaging in intergenerational cultural renegotiations in an effort to adapt to

212 transnational healthcare practices. For study participants straddling cultures meant a questioning of old cultural norms, examining new cultural presentations, and renegotiating cultural understandings based on a meshing of cultures and the formation of a hybridized culture in flux (Bhabha, 1994). This has implications for nursing and health policies targeting change through community education, as change is possible within a hybrid culture which by definition is transmuting and changing in real time. One of the study participants (Teso) spoke about taking parenting classes when she first arrived in

Canada with her family. She stated that the classes not only helped her with her own children but she also started working in an NGO and teaching others about parenting.

FGC information could be incorporated into such parenting classes using respectful, culturally appropriate language and with input from community members. This way,

FGC-affected women like Teso can take the lead in advocating for themselves and for others.

What happens when affected African women (younger and older) interact with various health services?

Findings in this study reveal participants’ frustrations with the health care services available to them although they generally viewed their migration experiences positively.

These frustrations had to do with a lack of access to culturally responsive care, trauma- informed care, and in some instances a lack of good relational practice. Participants had mixed views with regards to treatment options and the quality of healing environments available to them. Some issues that came up included diagnosing FGC-related health problems and accessing appropriate treatments and therapies. Most women noted that they just needed help with coping and managing FGC-related issues across the lifespan

213 including matters of intimacy and sexual relations, body image issues as well as managing trauma, and yet the traditional frame for understanding health and coping at their disposal seemed insufficient to their needs given its focus on treatment of physical symptoms. Cultural safety was a major determinant of perceived satisfaction with treatment options. This finding has implications for nursing practice in terms of the provision of culturally responsive trauma-informed care.

Study results also suggested that relational practice is often lacking with regards to immigrant and refugee women affected by FGC. Migration and settlement are difficult enough without the added pressure of poor relational healthcare practice. In terms of good relational practice, participants who experienced it saw it as involving a combination of knowledgeable culturally competent providers and a respect for patients’ wishes including being listened to. Such practices would be guided by culturally responsive care as well as trauma-informed care. Results suggest that this kind of care is present but not consistent, suggestive of a need for more education for healthcare workers in the provision of these services.

While not expressly stated by participants, racialization appeared to play a role in how participants perceived their healthcare interactions and their ability to access care.

Participants stated that they would accept care from providers who were well informed with regards to FGC and could meet their needs but also noted the lack of representation in the form of providers of colour. This is especially important when it comes to mental health care with research showing that barriers exist for racialized individuals including in the areas of access (Sentell, Shumway, & Snowden, 2007) which often leads to an increased burden of disease, a situation which is compounded by structural and racial

214 disparities in marginalized communities (Rivera, 2014) along with stigma about mental health and cultural mistrust by immigrant communities trying to acculturate in hostile environments (Amri & Bemak, 2013). All these factors influence the help-seeking behaviours of immigrants and refugees. One way to enhance communities’ help-seeking behaviours would be to sufficiently train providers on culturally responsive care so that they can be better equipped to meet the unique needs of racialized others, including Black immigrants and refugees. One participant in this study noted that it had taken her the better part of a year before she finally found a therapist who could meet her needs. The realities of racialization can lead to silent suffering by those most in need of mental health and other services (West, 2015); a suffering which is exacerbated for African immigrant and refugee women affected by FGC given the multiple interlocking challenges of being, Black immigrant women (Collins, 2000) in addition to the challenges of assimilation to new cultures as cut women.

The findings of this study provide an understanding of factors hindering health access and utilization for immigrant and refugee women affected by FGC. With these findings, health service providers can work on ways to mitigate these issues including perhaps expressly offering health services, including mental health services to affected women through collaborative culturally responsive community initiatives. Additionally, participants stated that it would be prudent for health service providers to ask patients questions about FGC instead of making assumptions, or worse, staying quiet even when they notice anatomical genital differences during physical assessments. Initiating this line of questioning would offer opportunities for mutually beneficial relational practice.

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What implications for healthcare services do the understandings of FGC have for affected women (younger and older)?

Findings from this research study have applicability for healthcare providers across multiple disciplines and settings including nursing, community health, mental health, obstetrics and gynaecology, and family practice. The finding of a lack of cultural responsiveness by health professionals should be of interest to nursing and other practitioners including mental health therapists as this knowledge underscores the importance of crafting care practices which are more responsive to and reflect the needs of immigrant and refugee women affected by FGC. A culturally responsive, trauma- informed curricular framework could be incorporated into health care education to better prepare future nurses and other health practitioners to provide culturally safe and competent care in the face of increasingly diverse communities including immigrant and refugee communities in Canada.

Specific to the findings from this research, the curricular framework could incorporate the main themes of experiencing, explaining, migrating, and mitigating FGC as well as the three decolonizing themes. Curricular content could include women’s understandings of trauma and grieving experiences, black women’s agency, resilience and coping, health equity, structural and racial disparities, mental health stigma and discrimination by health professionals, and access to and delivery of safe and responsive health care. This type of education would ideally be delivered from a culturally responsive trauma-informed standpoint with multiple opportunities for experiential learning and critically reflexive, inclusive relational practices. Previous research has showed the effectiveness of incorporating gender responsive and trauma-informed care

216 for women facing unique mental health challenges (see for example Covington & Bloom,

2006; Guthrie, 2011; Harner & Burgess, 2011). Additionally, with regards to culturally responsive and trauma-informed care, practitioners could institute ways to work in conjunction with affected women by tapping into and incorporating communities of support and healing practices which reflect their cultural understandings of health and healing. Involving FGC-affected women in their healthcare would also be good for enacting effective relational practices which when applied reflexively (Burnham, 2005) in conjunction with culturally responsive care, could help narrow the health equity gap

(Bonnefoy, 2009; Browne et al., 2012). Nursing and other healthcare practitioners are tasked with providing holistic care to a diverse clientele, a care which reflects the uniqueness and complexities of different clients and communities (O’Mahony &

Donnelly, 2010). For African immigrant and refugee women affected by FGC, this complexity would include an understanding of the social, political, and structural factors which influence healing practices and health-seeking behaviours in a transnational setting.

Inherent within critical theories including this interpretive description study informed by decolonizing perspectives is a social justice and health equity mandate

(Kirkham & Anderson, 2002; Racine, 2003). Research shows that countries including

Canada and the U.S are grappling with health disparities which exist along multiple axes of exclusion including race, class, and gender (Hankivsky, 2011; Nash, 2017). Critical inquiry offers an understanding of how structures and systems as well as social locations interact to catalyze these inequities (Hankivsky, 2011). An understanding of why the equity gaps exists is a necessary first step in tackling inequality, therefore nurses need to

217 be aware of how these factors interact and how they are reflected in individual patient experiences. With this knowledge, nurses can help to influence policy to make it more reflective of the unique needs of immigrant communities. Nursing and multidisciplinary healthcare policies and practices require a multilayered approach which recognises, spotlights, and helps tackle issues around race, gender, religion, culture, marginality, and nationality all of which work in tandem to influence the social determinants of health and wellbeing of immigrant and refugee women affected by FGC. In a recent Journal of

Nursing Education editorial, Murray and Lloyd (2020) highlighted the presence of structural racism in American academic nursing institutions arguing for actionable dismantling through opportunities such as examination of policies and processes of exclusion including admission policies and processes, engagement with communities of color, funding of support services for students of color, and hiring of people of color as faculty. Nurses can play a pivotal role in the enactment of inclusive practices which take into account the intersectionality of multiple factors including the recognition of anti-

Black racism as a contributor to inequities in social determinants of health (Abdillahi &

Shaw, 2020) for as Ewashen & Bender (2000) noted, “not to confront systemic social issues being expressed is to maintain a status quo that locates issues or problems primarily in the individual, often to the exclusion of the social environment in which we all participate” (p. 306). Nursing curricula, policy, and practice designed as inclusive while respectfully responsive to the uniqueness of each person and community, and incorporating critical reflexivity in examining the intersectionality of multiple factors in sustaining health inequities would better prepare knowledgeable practitioners for the social justice and health equity mandate of nursing and health care.

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Policy Implications

The topic of FGC spans transnational borders and discursive spaces and can therefore be said to have far-reaching policy implications. Findings in this study have implications for healthcare policy, especially the enactment of programs to address issues of access to culturally responsive care. Participants spoke about barriers to such programs and services, for instance, Zemi spoke about how her mother and older sisters had resisted accessing care because they could not find providers who could relate to their specific needs as cut women and to their religious and cultural need for modesty in terms of for example, undressing in the presence of male strangers. These and other barriers faced by immigrant and refugee women in this study underscore the need for the enactment of policies that target health and social services in the context of immigration.

These policies would require multisectoral collaboration, including in the areas of education, immigration and settlement, healthcare, and community programs to effectively link services and ensure continuity across agencies which service immigrant and refugee women.

Findings also suggest some troubling exclusions, especially the exclusion of

FGC-affected women from decision-making regarding global policies which affect them, for example the issue of FGC legalities. This finding implies the need to identify local and global practices which serve to further marginalize African women affected by FGC especially in the transnational context. Marginalizing practices manifest in different ways including in the stereotypical treatment of immigrant and refugee women which increases already present cultural gaps. Vernacularization of policies could help to capture culturally specific contexts which might otherwise be lost when the spotlight is placed on

219 universalization (Ibhawoh, 2008). Vernacularization is in line with cultural responsiveness and can serve to open spaces where local, national, and global policies affecting immigrant and refugee women affected by FGC can be questioned without fear of retribution or further marginalization. Additionally, incorporating the views of FGC- affected women would have policy implications for affected communities especially if those policies acknowledge the resilience of women. Resilience according to the National

Scientific Council on the Developing Child (2015) can be “an outcome, a process, or a capacity, the essence of which would be a positive, adaptive response in the face of significant adversity” (p. 1). The women in this study demonstrated resilience in the face of significant adversity including their often traumatic FGC experiences and the multiple challenges of migration and settlement. Incorporating women’s experiences and acknowledging resilience and agency would not only be empowering for women but would also result in the enactment of transformative and actionable policies for affected women and their families. Several existing programs have utilized innovative ways of engaging with FGC-affected communities, ways that are ethical, respectful of cultures, inclusive, and that seek to mitigate harm for already stigmatized communities

(Vissandjee et al., 2014). The international foundation, Wassu-UAB38, comprised of an interdisciplinary team of researchers and other professionals, works to advance the health and welfare of FGC-affected girls and women through a collaborative effort to manage and prevent FGC in Spain and The Gambia. The foundation is based at the Autonomous

38 https://translate.google.com/translate?hl=en&sl=es&u=https://www.uab.cat/web/fundacio-wassu-uab- 1345799785541.html&prev=search&pto=aue

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University of Barcelona and is affiliated with the Wassu Gambia Kafo, a non-profit organization based in Wassu in The Gambia39. These two organizations utilize research knowledge on immigration and culture to improve maternal and child health while empowering women to be at the forefront of FGC eradication through effective knowledge transfer strategies40. While the scope of this foundation is decidedly wide, similar strategies could be utilized in North America in partnership with immigrant communities and stakeholders including health professionals, local governments, migrant associations, training institutions, and community and religious institutions in efforts to co-create, translate, and disseminate knowledge within immigrant communities including

FGC affected communities. Some of these strategies have been employed in the Sexual

Education Resource Centre Manitoba (Vissandjee et al., 2014) which uses education to promote sexual health while focusing on “...the intersections of sexuality and culture, values, gender, identity and migration.” Collaborations between the healthcare and private sectors could lead to more culturally congruent and actionable curative practice guidelines. Additionally, knowledge translation projects could be required to include interventions which take into account the multiple axes of marginalization and exclusion for immigrant communities, and funding sources should reflect this requirements especially with research highlighting the need for inclusivity and diversity in knowledge translation and dissemination endeavours (Gogovor, Mollayeva, Etherington, Colantonio,

& Légaré, 2020).

39 www.mgf.uab.es/eng/wassu_foundation.html 40 Ibid

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Research Implications

This study extends the existing literature on FGC by examining the roles of transnational social, political, and cultural structures on conceptualizations of health- seeking and healing practices by affected women, and by examining the renegotiations of cultural identities with regards to FGC, across time and space. This is important in this era of globalization and the resultant power structures which reflect imperial hegemony, and which have real life implications for marginalized individuals across the globe including those who engage in South to North border crossings as did women in this study.

This study also contributes to existing nursing research projects which have utilized critical research perspectives including postcolonial feminist perspectives to challenge embedded assumptions and reimagine new ways of conceptualizing difference while highlighting the complexity of the human condition and the multiplicity of factors including social, economic, political, and historical which shape immigrant women’s health care experiences (Anderson, 2004; Anderson et al., 2003; O’Mahony & Donnelly;

Racine, 2003). This study specifically adds to these knowledge projects by showing that gender can be examined from multiple spatial locations to reflect the experiences of those who are forced by circumstances to inhabit those locations in the course of their lives, and that only through moving through these spaces in which experiences are constructed, with women who live the experiences, can researchers provide more authentic representations which can positively impact the health of affected women.

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I however recognize that this study is insufficient to the needs of African immigrant and refugee women affected by FGC given the breadth and scope of the FGC problematic internationally. In looking back, I see multiple areas that warrant further investigation in future studies. A recent document from the Social Determinants of

Health Division of the Public Health Agency of Canada (Abdillahi & Shaw, 2020) offered a snapshot of inequities in health and social determinants of health for black

Canadians. Several data gaps were identified. These gaps included a shortage of identity- specific data on race and immigration status, which then leads to challenges in identifying and quantifying different subpopulations who might possess similar phenotypical features. Abdillahi & Shaw (2020) also identified the mismatch between national-level health outcome measures and how individual communities may understand their health needs. These issues hold relevance for FGC research which should be collaborative and inclusive of members of affected communities, ideally both men and women, with the knowledge generated transferable for purposes of improving nursing and health services for African Canadian immigrants and refugees and their communities.

Future FGC research could also involve fathers and sons especially given what women in the study said regarding the roles of fathers in decision-making on FGC; that fathers were for the most part resistant to the idea of cutting their daughters. In addition to further examining the role of gender in the perpetuation of FGC, studies in this area would perhaps examine ways in which men and fathers could be included in eradication endeavors especially in transnational contexts. Studies examining the involvement of sons and young men would help shed some light on multigenerational gender dynamics including the role of FGC in marriageability and economic stability for practising

223 families and cultures. Additionally, future studies could utilize multiple interviews with participants, incorporate member checking if warranted, and, in obtaining additional data, better reflect participants’ experiences. Researchers in future studies could also hold joint focus group discussions with nurses and FGC affected women to explore the women’s experiences of being cared for by health professionals, and the nurses’ experiences of caring for African immigrant and refugee women affected by FGC in order to glean more understanding of health care situations and relational practices, as well as generate ways of bridging knowledge gaps. Other critical research methodologies like action research could also be utilized in future research to more fully involve participants as knowledge co-creators and as agentic beings.

Future studies could also expand on the decolonizing maneuvers that are suggested in this research project including resisting universalization of women’s experiences, considering the role of intersectionality, and recognizing that marginalized women are the experts when it comes to their own life experiences (Werunga et al.,

2016). Additionally, future studies could examine how social determinants of health work in tandem with the multiple intersecting influences in immigrant women’s lives to fully capture the spectrum of sociopolitical as well as economic and environmental factors that influence their health and wellbeing. In doing so, future research projects would be positioned to better explore the notion of research as resistance in line with the social justice mandate of decolonizing work.

Study Strengths

The interpretive description design logic incorporating qualitative interviewing, critical reflexivity and decolonizing perspectives allowed for rigor and credibility and

224 was a strength of this research. Semi-structured qualitative interviewing both individual and group, generated sufficient rich descriptions for robust interpretive description theme-based analysis as well as a decolonizing interpretation linking back to theory in line with the study design (Thorne, 2020). Critical reflexivity at all levels of research was another strength of this study which I discuss in the next section.

Critical Reflexivity and Relationality in Decolonizing Research

This interpretive description study informed by decolonizing perspectives is the kind of study in which a researcher could fall prey to what Thorne et al (2004) referred to as “lachrymal validity” which is the evaluation of research based on the ability of the project to elicit tears from readers. And yet this study was difficult, even emotionally draining, and it did involve tears from participants. I however tried to present the authentic experiences of the women in the study including the rawness that was almost always there. For my part, I engaged in frequent critical reflexivity throughout the research process in order to maintain an honest account of women’s expressed experiences even while acknowledging the inseparability of the researcher from the

“object of inquiry” (Thorne, 2008, p.82).

Critical reflexivity helps to ensure that a researcher’s biases and preconceptions do not stand in the way of participants stories especially given that decolonizing work is not a disengaged process but instead is relational and reliant on trust and accountability.

By occasionally stepping away from the research and reflecting on the data and on my role as a learner and knowledge co-creator, I was able to embrace and hone my attitude of

“empathic imagination” (Moosa-Mitha, 2005) which allowed me to continually honour the women’s agency as experts on FGC. Empathic imagination embodies relationality

225 which in turn aligns with decolonizing research (Gerlach, 2018) and with the interpretive description research design. Reflexivity and relationality can be said to enhance the design logic of interpretive description and decolonizing studies, which in turn bolsters the credibility of research projects. Such was the case in this study.

Interpretive Description Design Logic

Thorne (2020) posits that the ability to effectively find ways of answering complex questions that have to do with the human condition should be viewed as being more important than mere abstract theorizing in applied research designs. In other words, integrity is enhanced by adhering to what Thorne et al. (2004) refer to as a “design logic” which adheres to scaffolding informed by “nursing's disciplinary epistemology” (Thorne,

Stephens, & Truant, 2016) and which can withstand scrutiny in terms of decisions made throughout the research process. While new theorizing was not the original intent of this study, the interpretive description decolonizing methodology employed contributes to theorizing marginality differently. Most importantly however, this study attempts to go beyond thematic presentation of information and “takes us somewhere beyond what we already know” (Thorne, 2020, p.2). This study’s credibility was enhanced by its adherence to the interpretive description design logic.

Study Limitations

While this study had various strengths, I would be remiss if I failed to mention some limitations which became apparent through the course of the study. First, since I was seeking intergenerational understandings, it would have been beneficial to have interviewed mothers and daughters together where possible to more fully capture the

226 intergenerational dynamic. In my study, participants gave their separate intergenerational understandings on this subject.

Second, as I mentioned in Chapter 3, a possible weakness would be the snowball sampling approach which potentially shuts out more hidden subpopulations within an already hidden population due to the potential homogenizing effect of the word of mouth snowballing recruitment strategy. The scope and timing of this thesis-based research limited exploration of what would perhaps have been a more representative sample of

African immigrant and refugee women affected by FGC.

Third, in line with interpretive description, this research is not meant to be generalized beyond the understandings and experiences of the women in the study, rather, it is hoped that findings from this study can help to inform nursing practice, research, and policy (Thorne, 2016).

Disseminating Study Findings/Knowledge Translation

Knowledge translation and dissemination of research findings is a natural culmination of any research project and this is no different for this research study.

Findings from this study will add to the body of theorizing in the decolonizing and interpretive description research traditions. Apart from publishing the substantive and methodological findings from this study in professional journals, I will also look for opportunities to present at academic and non-academic conferences. Additionally, given the assistance that I was afforded by community groups during my data collection, I will explore ways of disseminating my research findings in these communities in accessible and respectful ways, hopefully with input from members. One avenue would be through

227 speaking at community events – this would be a valuable opportunity to engage with and get feedback from members of FGC-affected communities. Additional target audiences for knowledge dissemination for this study include healthcare providers and policymakers.

Chapter Summary

Given that (neo)colonialism and imperialism pervade every facet of the current global sociocultural order, it also follows that there is a strong relationship between power and knowledge, with Black women, particularly those from the Global South taking the brunt of the associated epistemic violence (Spivak, 1988) as well as the regulation of their bodies through intersecting axes of exploitation and subjugation

(Bilge, 2012; Collins & Bilge, 2016; Crenshaw, 1991). This epistemic violence and the need to interrogate and decolonize the imperialist discourses which serve to prop it up was the basic premise of my thesis.

As I have noted multiple times in this thesis, the complexity of FGC in terms of the diversity of cultures which engage in it (including their justifications for it), the variation in types of FGC, and the contentious debates around the practice in terms of eradication endeavors defies any simplistic means of addressing any FGC-related research. This is the reason why I chose the interpretive description research design informed by decolonizing perspectives to allow me to deconstruct the FGC problematic from many different viewpoints. A lot has been said and will likely still be said about

FGC and why cultures including those of the participants in this study continue to engage

228 in it. Consequently, this study can be looked at as part of this ongoing conversation, one that suggests a slightly different way of viewing the topic, and one that certainly centres the views of the women affected by FGC. The interpretive description research design informed by decolonizing perspectives presented in this thesis is a heuristic which will hopefully allow for a broadening of the discussion on FGC through questioning essentialized understandings of the topic and through continually interrogating the role of intersecting social structures including race, ethnicity, culture, and nationality in the constructions of the transnational understandings of FGC as well as the resistance, oppression, and liberation narratives of affected immigrant and refugee women.

I am well aware that FGC is a contentious topic, and that the UN Human Rights

Commission and numerous civil society organizations have taken up what could be considered uncompromising stances in terms of internationally-endorsed legal and policy measures meant to protect women and children41 and I would be remiss if I did not recognize these very important contributions which I view as having merit. I nevertheless argue that this research aligns with the moral imperative of protecting the health and wellbeing of women and girls which ultimately, is what is at stake here. And yet, even that which is morally right does not defy interrogation, and that is where this research contributes because as Thorne (2008) notes, researchers:

…wrestle with complex human phenomena, uncover the intricacies of their

contextual and relational components, and forecast the effects of various solutions

41 For example Eliminating Female Genital Mutilation: an Interagency Statement https://www.un.org/womenwatch/daw/csw/csw52/statements_missions/Interagency_Statement_on_Elimina ting_FGM.pdf

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upon the kinds of problems we collectively face. We confront this challenge

armed with an increasingly sophisticated set of inquiry tools designed to guide

applied researchers in the generation of meaningful and essentially useful new

knowledge in the service of these disciplinary projects (pp 245-26).

This study opens avenues for considering alternative ways of conceptualizing FGC and in doing so lives up to the interpretive description mandate. Transformational change can only occur within inclusive and decolonized discursive spaces where knowledge production involves all the consumers of knowledge, particularly racialized, gendered, classed, and marginalized groupings around the world (Werunga et al, 2016). This is only possible through critical examination of embedded colonizing assumptions which aim to silence subaltern voices (Smith, 1999; Spivak, 1993) and a desire to create spaces which are more representational and from where epistemologies of resistance can not only be created but where they can also thrive. As Lorde (1984) argued, discussions within the feminist tradition that are not representative of all women are essentially flawed. If flawed research produces flawed results, then it follows that the utility of such knowledge becomes questionable when it is applied in practice. That is why I argue decolonizing methodologies are both highly relevant and necessary in nursing and other transnational knowledge projects, in the here and now.

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References

Abdillahi, I., & Shaw, A. (2020). Social determinants and inequities in health for Black

Canadians: A snapshot. Social Determinants of Health Division, Public Health

Agency of Canada. Retrieved from https://www.canada.ca/en/public-

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APPENDIX A: ETHICS CERTIFICATE

Conjoint Health Research Ethics Board Research Services Office 2500 University Drive, NW Calgary AB T2N 1N4 Telephone: (403) 220-2297 [email protected]

CERTIFICATION OF INSTITUTIONAL ETHICS APPROVAL

The Conjoint Health Research Ethics Board (CHREB), University of Calgary has reviewed and approved the requested modification to the following research protocol:

Ethics ID: REB17-0115_MOD1 Principal Investigator: Carol Janis Ewashen Co-Investigator(s): There are no items to display Student Co-Investigator(s): Jane Werunga Study Title: Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology Sponsor: University of Calgary

Effective: Tuesday, May 8, 2018 Expires: Wednesday, May 8, 2019

The following documents have been approved:

FGC Recruitment Poster Version 4, 4, June 6, 2018 Revised Consent Form Version 4 , 4, May 10, 2018 Revised Consent Form Version 5, 5, June 6, 2018

The CHREB is constituted and operates in accordance with the current version of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS); International Conference on Harmonization E6: Good Clinical Practice Guidelines (ICH-GCP); Part C, Division 5 of the Food and Drug regulations, Part 4 of the Natural Health Product Regulations and the Medical Device Regulations of Health Canada; Alberta's Health Information Act, RSA 2000 cH-5; and US Federal Regulations 45 CFR part 46, 21 CFR part 50 and 56. Restrictions: This Certification is subject to the following conditions:

1. Approval is granted only for the research and purposes described in the application. 2. Any modification to the approved research must be submitted to the CHREB for approval. 3. An annual application for renewal of ethics certification must be submitted and approved by the above expiry date. 4. A closure request must be sent to the CHREB when the research is complete or terminated.

Approved By: Date: Kathleen Oberle, PhD, Vice-Chair , CHREB Thursday, June 7, 2018

Note: This correspondence includes an electronic signature (validation and approval via an online system).

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APPENDIX B: CONSENT FORM

KEY PARTICIPANT INFORMATION AND CONSENT FORM TITLE: Female Genital Cutting and African Women’s Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology

SPONSOR: University of Calgary Faculty of Nursing

INVESTIGATORS:

Principal Investigator: Dr. Carol Ewashen

Doctoral Student Investigator: Jane Werunga

This consent form is only part of the process of informed consent. It should give you the basic idea of what the research is about and what your participation will involve. If you would like more detail about something mentioned here, or information not included here, please ask. Take the time to read this carefully and to understand any accompanying information. You will receive a copy of this form.

You are being asked to participate in this study because you are an African immigrant or refugee woman who has experienced cutting either directly or indirectly. We would like to learn about your experiences with cutting, particularly how it may be affecting your health, access to healthcare, and everyday life.

BACKGROUND

The topic of female genital cutting has been debated and studied a lot around the world. Many of these debates and studies focus on the health complications of cutting as well as efforts to stop it. Most studies do not look at the opinions, traditions, and cultures of the communities who view cutting as very important to them nor do they consider the experiences of women who are directly affected by cutting. As a nurse and immigrant from a country where cutting is widely practiced, I, (Jane) became aware of how complicated the topic of cutting can become when moving to a country where the culture

266 and understanding of cutting is very different. Because cutting has been shown to affect the health of women, we as health care providers need better understanding to provide safe healthcare for women who are affected while respecting their cultures and traditions.

WHAT IS THE PURPOSE OF THE STUDY?

The purpose of this study is to have a better understanding of how African immigrant and refugee women who are affected by cutting, and have migrated to Canada, explain it and understand it for themselves and for younger generations. Another purpose is to determine how women’s interactions with health services are affected.

WHAT WOULD I HAVE TO DO?

If you consent to take part in this research, then the researcher will arrange a 1-2-hour interview with you to talk about your experiences with cutting and with accessing health care. Providing verbal consent indicates that you agree to be interviewed by the researcher. The researcher will request your permission to record the interview on a digital recorder to be analyzed by the researchers. The researcher may also take brief notes while talking with you. You are free to stop the interview at any time if you feel uncomfortable without any penalty to you.

Interview questions will be about your experiences with cutting and may include questions like these:

• Would you tell me about your experience with cutting? • How has cutting affected your life? • How has cutting affected your health? • How has cutting affected your generation? These questions are only suggestions, and you will be free to only answer the questions that you are comfortable with.

WHAT ARE THE RISKS?

There are no known risks to you by agreeing to take part in this study. However, it is possible that some of the questions may bring up some uncomfortable memories. If this happens, you will be provided additional support and resources for your safety and well- being. These resources will include Eastside Family Centre at 403-299-9696 where free 24-hour phone-in counseling services are available.

Please note that we will not be asking you questions about any plans you might have to cut your own daughter(s) in the future.

WILL I BENEFIT IF I TAKE PART?

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While this study may not directly benefit you, you will have the opportunity to share your thoughts and experiences as an African immigrant or refugee woman who is affected by cutting. Results from this research may have a positive impact on how health care services are delivered to African immigrant and refugee women who are affected by cutting, help with education of nurses and other health care providers who serve women who are affected by cutting, and decrease stigma and improve access to health services.

DO I HAVE TO PARTICIPATE?

Your participation in this study is voluntary, and you may stop participating at any time. Please let the researchers know if you want to withdraw from the study by phoning or emailing us that you wish to withdraw. If you withdraw from the study before analysis of anonymized interview data begins all identifiable information including consent and interview conversations will be destroyed and not used in the study. Only interview data that is anonymized and aggregated will be used for the research. WHAT ELSE DOES MY PARTICIPATION INVOLVE?

We are recruiting women to voluntarily join our study by word of mouth, so if you know any African immigrant or refugee woman who is cut or affected by cutting, and is willing to take part in our study, you are encouraged to share our information with her so that she can contact the researchers directly. Although we are primarily recruiting women here in Canada, we are open to recruiting African immigrant and refugee women who live in the United States because your experiences could help us understand the migration experiences of women and experiences with cutting, particularly how it may be affecting your health, access to healthcare, and everyday life.

WILL I BE PAID FOR PARTICIPATING, OR DO I HAVE TO PAY FOR ANYTHING?

You will not be paid to participate in this study and there will be no cost to you.

WILL MY RECORDS BE KEPT PRIVATE?

Your privacy and confidentiality of information will be maintained during interviews, analysis of interviews, and presenting of research findings. Any identifying information such as your name and age will be changed to protect your privacy. Other identifying characteristics such as the name of the city or agency will also be made anonymous.

Since you may be participating in research interviews with friends or family members, you will be discussing aspects of your experiences with others. While the researchers will take all possible precautions to safeguard your anonymity and confidentiality, we cannot

268 absolutely guarantee that other participants will abide by the anonymity and confidentiality agreement required for the conduct of a group interviews. We will however ask all participants not to disclose other participant identities or the contents of the interview.

All interview and consent information collected from you will be locked in a secure filing cabinet in a locked research office. Electronic files, edited for anonymity (names and identification removed), will be stored on a password-protected computer, updated with current software and virus protection, and available only to the researchers. As well, all electronic files will be password protected. Interview recordings will be deleted once anonymized interview transcripts are completed. Backup data files will be kept on an external hard drive, password protected, and locked in a secure filing cabinet in a locked research office.

The University of Calgary Conjoint Health Research Ethics Board will have access to all locked records. Five years after this study is completed, all records including paper files and electronic data files on the password protected computer and external hard drive will be erased permanently.

VERBAL CONSENT

Your verbal consent in lieu of a signature on this form indicates that you have understood to your satisfaction the information regarding your participation in the research project and agree to participate as a participant. In no way does this waive your legal rights nor release the investigators or involved institutions from their legal and professional responsibilities. You are free to withdraw from the study at any time without jeopardizing your health care. If you have further questions concerning matters related to this research, please contact:

Jane Werunga Dr. Carol Ewashen

If you have any questions concerning your rights as a possible participant in this research, please contact the Chair, Conjoint Health Research Ethics Board, University of Calgary at 403-220-7990.

Do you have any further questions at this time? Yes No

Do you consent to voluntarily participate in this research study and allow me to tape record our conversation?

Participant’s response Yes No

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Participant’s Name Verbal Consent and Date

Investigator/Delegate’s Name Signature and Date

The University of Calgary Conjoint Health Research Ethics Board has approved this research study.

A signed copy of this consent form has been given to you via email to keep for your records and reference.

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APPENDIX C: VERBAL CONSENT SCRIPT

VERBAL CONSENT SCRIPT

As you know, I am a nurse researcher from the University of Calgary, in Canada. I am conducting a study on female genital cutting, and I would like to ask you some questions about that. We are recruiting women most of whom are in Canada but also African immigrant and refugee women who live in the United States. We would like to learn about your experiences with cutting, particularly how it may be affecting your health, access to healthcare, and everyday life. There are no known risks to you by agreeing to take part in this study. However, it is possible that some of the questions may bring up some uncomfortable memories. If this happens, you will be provided additional support and resources for your safety and well-being. The Eastside Family Centre in Calgary provides free phone-in counseling services and can be reached at 1-403-299-9696.

I would like to tape record our conversation so that I can get your words accurately. If at any time during our talk you feel uncomfortable answering a question please let me know, and you don’t have to answer it. Or, if you want to answer a question but do not want it tape recorded, please let me know and I will turn off the machine. If at any time you want to withdraw from this study please tell me and I will erase the tape of our conversation. I will not reveal the content of our conversation beyond myself and my supervisor, Dr. Carol Ewashen, to maintain your privacy and the confidentiality of the information you share with us.

Do you have any questions? Yes No

Now I would like to ask you if you agree to participate in this study and to talk to me about your experiences with cutting.

Do you agree to participate, and to allow me to tape record our conversation?

Participant’s response: Yes No

______Name of Person Obtaining Consent Signature and Date

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APPENDIX D: RECRUITMENT POSTER

Are you an African immigrant or refugee woman who has experienced genital cutting?

I am a nurse researcher, and I invite you to participate in this research study which could help improve health care for affected women.

We are recruiting African immigrant or refugee women who § have experienced cutting § may not have been cut but have parents, grandparents, friends, or other family members who are cut § 18 years or older § Come from an African community where women experience For more information, cutting please contact: § live in Canada or the United States of America § Jane Werunga, MSN, English-speaking RN, MEd, Doctoral You will have the opportunity to be interviewed about your thoughts Candidate and experiences as someone who is directly or indirectly affected. 403-880-0623 An understanding of your experiences will be very helpful for those [email protected] who provide health services to you and your families.

Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology This study has been approved by the University of Calgary Conjoint Health Research Ethics Board. PI: Dr. Carol Ewashen [email protected] 403-220-6259 Ethics ID: REB17-0115

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APPENDIX E: INTERVIEW GUIDE

Female Genital Cutting and African Women's Migration to Canada: Toward a

Postcolonial Feminist Decolonizing Methodology

Sample Interview Questions:

1. Would you tell me about your experience with cutting?

2. How has cutting affected your life?

3. How has cutting affected your health? (Physical, mental, sexual)

4. How has cutting affected your generation?

5. Have your views about cutting changed since moving to Canada? How?

6. What kinds of experiences have you had with health services here in Canada?

7. If you could, what would you change? (Perceptions within and outside

community)

8. Are you receiving adequate health care with regards to your experiences with

cutting?

9. Is there anything else you would like to share about your experiences with

cutting?

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APPENDIX F: RECRUITMENT EMAIL

Recruitment Email/Cover Letter Ethics ID: REB17-0115 Study Title: Female Genital Cutting and African Women’s Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology

The University of Calgary Conjoint Health Research Ethics Board has approved this research study.

Email Title: Opportunity to Participate in Research on Genital Cutting To Whom It May Concern: We are contacting you about an important research study that could help improve health care for women who are affected by genital cutting. We are inviting you to consider participating in this study. The purpose of the study is to understand how African women who are immigrants or refugees in Canada are affected by cutting, explain cutting and how it affects their health care services. All information will be kept private and confidential. The study will be conducted by Jane Werunga who is a nurse and PhD Candidate in the Faculty of Nursing at the University of Calgary, along with her supervisory committee including Dr. Carol Ewashen, the study lead. If you are interested in the study, please read the attached research poster for more information. Please contact the researcher, Jane Werunga at [email protected] or by calling 403-880-0623 to let her know that you are interested or would just like more information. She will answer any of your questions and provide more information on the study. If you do decide to participate, she will organize a time and place to meet with you individually. Your participation in this research could have a positive impact on how health care services are delivered to African immigrant and refugee women who are affected by cutting. If you choose to participate, or have any questions about the study, please contact Jane Werunga at [email protected] or by calling 403-880-0623. We hope you will consider sharing your knowledge with the researchers.

With regards, Research Team.