A small fish swims up to an older fish and says: “I’m trying to find this thing they call “the ocean”.”

The older fish says, “The ocean? That’s what you’re in right now.”

“This?” says the young fish. “This is water. What I want is the ocean!” 

When looking for a catchy introduction, I remembered the previous dialogue from a Disney animation called Soul which describes how I felt four months ago when I sought medical help for severe cramps and chronic pelvic pain – health consequences of circumcision. I walked into a nearby health center in Malmö with no doubts at all, as “the Swedish Health System is renowned for its accessibility, quality, and patient-centered care”. I walked out having mixed feelings of frustration and unmet needs, though. The nurse didn’t know much about circumcision, she just prescribed painkillers that were not useful, at least in my case. However, what really intrigued me to dig a bit deeper was a friend who gave birth to a beautiful girl last year here in Sweden. Of course, she is circumcised  like 87 % of the other girls and women in Sudan, sadly.  She told me about how she faced insensitive and judgmental behavior from the midwife. And so I looked a bit more into this issue of (lack of) quality care for this particular group of patients in Sweden.

I was shocked when I found dozens of articles about circumcised migrant females complaining about poor quality health services and discriminatory behaviors from health professionals, not only in Sweden but also in other high-income countries. Their stories reflect how the needs of over half a million girls and women with Female Genital Mutilation/Circumcision (FGM/C) are often overlooked and neglected in European countries renowned for providing high-quality and equitable healthcare services. 

Female genital mutilation/circumcision

The WHO and the United Nations refer to “all procedures to remove the external female genitalia, partially or totally, for non-medical reasons” as female genital mutilation/circumcision (FGM/C). The practice is considered a violation of human rights and integrity, for very good reasons, as well as a form of gender-based violence against girls and women. It is classified into 4 types that differ in the cutting pattern and seriousness of physical and mental consequences. 

The physical consequences include short-term complications such as severe pain, bleeding, and infection. Long-term complications include chronic pain, sexual dysfunction, delivery complications, and a high risk of maternal and infant mortality. In some cases, FGM/C can even cause death. As for mental health, the trauma associated with FGM/C can last forever, thus deteriorating overall mental health status and well-being. Also, depression, anxiety, and other psychological disorders have been reported. 

Now let’s get back to our metaphor from the start.

The ocean (expectations)  

Many reports ( see for example this  international comparison ) have claimed that the Swedish health system is a model to follow in terms of its commitment to equity. Indeed, many laws, policies, and acts were adopted to “ensure that everyone has the right to timely and equal access to health services, regardless of age, gender, or social status”. With that in mind, I would argue that circumcised females in Sweden also have this right. Unfortunately, that doesn’t seem to be the case. 

The water (reality)  

Based on a (2015) survey by the (Swedish) National Board of Health and Welfare, almost 38,000 girls and women in Sweden live with the consequences of FGM/C (with 20% being under 18 years of age). The real number is probably much higher due to many reasons such as the sensitivity of the topic, language barriers, not feeling safe/secure enough to speak up, the hesitancy to seek help, and undocumented experiences.  Although anti-FGM/C legislation in Sweden has been in place for almost four decades, and a full-blown governmental action plan was already announced by the Ministry of Health and Social Affairs in 2003, in reality, a significant number of migrant girls and women are still encountering health inequities and stigmatization for being circumcised. Politicians and policymakers remain rather numb about this. I keep wondering how a country like Sweden that embraces equity and fights social injustice could achieve such slow progress in addressing health disparities associated with FGM/C!   

Many articles portray the failure in prioritizing and addressing the health inequity related to FGM/C as a “resource shortage”. But isn’t it a normal situation to have limited resources? I mean, we live in a finite world and we will always face limitations when it comes to resources. So, what is really going on here? From what I have learned from the health policy course, I would say it is more about lack of a strong political stance and prioritization.

The question then becomes: Why do we lack political willingness? Why can’t we provide specialized support to FGM/C victims?  Is it because FGM/C related stigma and inequity do not affect Swedish women?  I certainly hope not.

I do believe that policymakers should take bold steps and actions to offer every girl and woman, regardless of their background or culture, a life free from physical and emotional trauma. A life where their needs are fulfilled and not “left behind”.