Owolabi Bjälkander | Karolinska Institutet (original) (raw)
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Papers by Owolabi Bjälkander
International Journal of Women's Health, 2012
The Lancet Global Health, 2016
African Journal of Reproductive Health, 2012
The objectives of this study were to identify decision makers for FGM and determine whether medic... more The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals' associations need to consider how to prevent further medicalization of the practice.
Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the wor... more Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attend-ing antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 res...
Background: Female genital mutilation (FGM) prevalence in Sierra Leone is the seventh highest in ... more Background: Female genital mutilation (FGM) prevalence in Sierra Leone is the seventh highest in Africa, yet there is little research on its effects on girls and women. Objectives: This thesis provides knowledge on the effects and experiences of girls and women, and the views of adolescent boys, about FGM which is performed within the initiation ceremony of the Bondo Society in Sierra Leone. Methods: Four articles (I to IV) analyse data collected in the Northern and Eastern Provinces and in the Western Urban Area of Freetown. Women and girls (n=1018) were recruited for articles I – III, and adolescent boys (n=75) for article IV. Results: Most decisions (65.1%) for FGM were made by females; males decided in 30.7% cases. FGM is performed mainly by traditional excisors, and medicalization occurred in 13.2% cases. FGM-related health complications were reported by 84.5% of respondents (n=258), the most common being bleeding, delay in healing, and tenderness. Fever was reported by 46%, an...
Objective. To determine forms of female genital mutilation (FGM), assess consistency between self... more Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This crosssectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12-47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn cl...
In collaboration with the European Network for the Prevention of Female Genital Mutilation (EuroN... more In collaboration with the European Network for the Prevention of Female Genital Mutilation (EuroNet-FGM) With the support of the EC Daphne programme Leye Els (2005). Strategies of FGM prevention in Europe. In: Momoh Comfort, Female Genital Mutilation, Radcliffe Press, Oxford (in press). Mackie Gerry (2000). Female genital cutting: the beginning of the end. In: Bettina Shell-Duncan and Ylva Hernlund, eds., Female 'Circumcision' in Africa. Culture, Controversy, and Change. Lynne Riener Publishers, Inc., Colorado. Masterson J and Swanson JH (2000). Female Genital Cutting: Breaking the Silence, Enabling Change. ICRW and CEDPA. Melching M. (2004). Tostan, community empowerment program for the abandonment of FGM. Presentation on the consultative meeting on determinants of successful communitybased FGM interventions, November 30-December 4, 2004, Bamako, Mali. Parker, W. (2004). Rethinking conceptual approaches to behaviour change: the importance of context. In: Communicating AIDS needs project/CAN. Piotrow, Kincaid, Rimon II and Rinehart (1997). Health communication: Lessons learned from family planning and reproductive health. Praeger Publishers.
Objective. To determine forms of female genital mutilation (FGM), assess consistency between self... more Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This crosssectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12-47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn closed. Conclusion. Types I and II are the main forms of FGM, with labia majora alterations in almost 5% of cases. Self-reports on FGM status could serve as a proxy measurement for FGM prevalence but not for FGM type. The DHS FGM questions are inaccurate for determining cutting extent.
Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and ye... more Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attending antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 respondents (84.5%), the most common ones being excessive bleeding, delay in or incomplete healing, and tenderness. Fever was significantly more often reported by girls who had undergone FGM before 10 years of age compared with those who had undergone the procedure later. Out of those who reported complications, 187 (85.8%) sought treatment, with 89 of them visiting a traditional healer, 75 a Sowei (traditional circumciser), and 16 a health professional. Conclusion: The high prevalence rate of FGM and the proportion of medical complications show that FGM is a matter for public health concern in Sierra Leone. Girls who undergo FGM before 10 years of age seem to be more vulnerable to serious complications than those who are older at the time of FGM. It is important that health care personnel are aware of, and look for possible complications from FGM, and encourage girls and women to seek medical care for their problems.
Correspondence www.thelancet.com/lancetgh Vol 4 July 2016 e447
The objectives of this study were to identify decision makers for FGM and determine whether medic... more The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals' associations need to consider how to prevent further medicalization of the practice. (Afr J Reprod Health 2012; 16[4]: 35-46).
International Journal of Women's Health, 2012
The Lancet Global Health, 2016
African Journal of Reproductive Health, 2012
The objectives of this study were to identify decision makers for FGM and determine whether medic... more The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals' associations need to consider how to prevent further medicalization of the practice.
Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the wor... more Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attend-ing antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 res...
Background: Female genital mutilation (FGM) prevalence in Sierra Leone is the seventh highest in ... more Background: Female genital mutilation (FGM) prevalence in Sierra Leone is the seventh highest in Africa, yet there is little research on its effects on girls and women. Objectives: This thesis provides knowledge on the effects and experiences of girls and women, and the views of adolescent boys, about FGM which is performed within the initiation ceremony of the Bondo Society in Sierra Leone. Methods: Four articles (I to IV) analyse data collected in the Northern and Eastern Provinces and in the Western Urban Area of Freetown. Women and girls (n=1018) were recruited for articles I – III, and adolescent boys (n=75) for article IV. Results: Most decisions (65.1%) for FGM were made by females; males decided in 30.7% cases. FGM is performed mainly by traditional excisors, and medicalization occurred in 13.2% cases. FGM-related health complications were reported by 84.5% of respondents (n=258), the most common being bleeding, delay in healing, and tenderness. Fever was reported by 46%, an...
Objective. To determine forms of female genital mutilation (FGM), assess consistency between self... more Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This crosssectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12-47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn cl...
In collaboration with the European Network for the Prevention of Female Genital Mutilation (EuroN... more In collaboration with the European Network for the Prevention of Female Genital Mutilation (EuroNet-FGM) With the support of the EC Daphne programme Leye Els (2005). Strategies of FGM prevention in Europe. In: Momoh Comfort, Female Genital Mutilation, Radcliffe Press, Oxford (in press). Mackie Gerry (2000). Female genital cutting: the beginning of the end. In: Bettina Shell-Duncan and Ylva Hernlund, eds., Female 'Circumcision' in Africa. Culture, Controversy, and Change. Lynne Riener Publishers, Inc., Colorado. Masterson J and Swanson JH (2000). Female Genital Cutting: Breaking the Silence, Enabling Change. ICRW and CEDPA. Melching M. (2004). Tostan, community empowerment program for the abandonment of FGM. Presentation on the consultative meeting on determinants of successful communitybased FGM interventions, November 30-December 4, 2004, Bamako, Mali. Parker, W. (2004). Rethinking conceptual approaches to behaviour change: the importance of context. In: Communicating AIDS needs project/CAN. Piotrow, Kincaid, Rimon II and Rinehart (1997). Health communication: Lessons learned from family planning and reproductive health. Praeger Publishers.
Objective. To determine forms of female genital mutilation (FGM), assess consistency between self... more Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This crosssectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12-47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn closed. Conclusion. Types I and II are the main forms of FGM, with labia majora alterations in almost 5% of cases. Self-reports on FGM status could serve as a proxy measurement for FGM prevalence but not for FGM type. The DHS FGM questions are inaccurate for determining cutting extent.
Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and ye... more Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attending antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 respondents (84.5%), the most common ones being excessive bleeding, delay in or incomplete healing, and tenderness. Fever was significantly more often reported by girls who had undergone FGM before 10 years of age compared with those who had undergone the procedure later. Out of those who reported complications, 187 (85.8%) sought treatment, with 89 of them visiting a traditional healer, 75 a Sowei (traditional circumciser), and 16 a health professional. Conclusion: The high prevalence rate of FGM and the proportion of medical complications show that FGM is a matter for public health concern in Sierra Leone. Girls who undergo FGM before 10 years of age seem to be more vulnerable to serious complications than those who are older at the time of FGM. It is important that health care personnel are aware of, and look for possible complications from FGM, and encourage girls and women to seek medical care for their problems.
Correspondence www.thelancet.com/lancetgh Vol 4 July 2016 e447
The objectives of this study were to identify decision makers for FGM and determine whether medic... more The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals' associations need to consider how to prevent further medicalization of the practice. (Afr J Reprod Health 2012; 16[4]: 35-46).