Although most participants believe they can control the risk of cervical cancer through sexual behavior, the Somali mothers particularly believe that all diseases are determined by God and indicate low self-efficacy. However, there is also individual religious responsibility to improve one’s health and prevent disease. Pharos. Female genital mutilation in the Netherlands: prevalence, incidence and determinants. Utrecht; 2013 The inclusion criteria has been comprised of being female and of Somali origin, living in the Netherlands, aged between 18 and 65, and having a migration date from the first or second wave of migration (see Table 1). Daughters whose mothers have participated in the study were excluded and vice versa because sexuality issues and health issues are sensitive to discuss in the Somali community, and it would have limited building rapport between the interviewees and the interviewer. Furthermore, convenience sampling has been used at community gatherings of the Somali women.

There is nothing more sad than seeing a xalimo showing off an ajnabi as if she won the lottery. Sad because in a few months or years the ajnabi 9/10 would dump her and move on to someone else.Every mother tells a lie to herself [and thinks]: ‘My daughter is great.’ While the daughter was just two months old when she arrived in the Netherlands, she is now 22 or 24 years old. What is the outcome? The child takes over the [Dutch] culture. Your child will not take over your [Somali] culture. Who is stronger than you? The people your child associates with. These people give her freedom. So we are obligated to vaccinate or examine her. [A mother in group discussion]

Van Heelsum A. Somaliërs in Nederland, een profiel [Somalis in the Netherlands, a profile]. Amsterdam: 2011 Kadra Ahmed Omar is an Ethiopian mannequin of Somali descent. This Somali sexy girl was working with modeling agencies and designers from all over the world. Kadra represented Heffner Management and Elite Model Management, Toronto agencies. She appeared in the 2000 Sports Illustrated Swimsuits. Cici Ali This [HPV vaccination] is a study. They [the government] want to know who will be the victims in the future. [N2 (Somali mother)] Olden A. Somali refugees in London: Oral culture in a western information environment. Libri. 1999;49(4):212–24.Combining an intersectional approach with the Health Belief Model provides contextualized knowledge on how the women’s different positions in aspects such as age, migration status and language skills, religion, or culture are interdependent and influence individual perceptions of preventive measures and health. According to Hankivsky et al. [ 19], intersectionality directs attention to health issues that are less well understood for certain groups, in our case, Somali women and the prevention of cervical cancer. Gendered, cultural, and social structures produce and reproduce inequalities that intersect, overlap, and reinforce each other in shaping a person’s health status. To prevent disease, it is important to gain an understanding of how women’s perceptions are contextualized, and we must also target our interventions towards institutions, such as healthcare and health promotion programs, rather than target individuals. Strengths and limitations to the study

Every nation has its own customs and traditions. It is recommended to study Somalian traditions before you start dating abeautiful Somali girl.It is not easy to be a woman in Somalia: In this study, we have identified perceived barriers to the use of preventive measures across three major themes: (1) Somali women and preventive healthcare; (2) Language, knowledge, and negotiating decisions; and (3) Sexual standards, culture, and religion. Many issues have been identified across these themes, e.g., distrust of the Dutch health care system or being embarrassed to get Pap smears due to Female Genital Mutilation (FGM) and having a Dutch, male practitioner; or a perceived low susceptibility to HPV and cancer because of the religious norms that prohibit sex before marriage. Conclusions Woonink F. Objections against vaccination: the perspective of those who refuse [ http://www.rivm.nl/dsresource?objectid=rivmp:55451&type=org&disposition=inline&ns_nc=1]Van Nes F, Abma T, Jonsson H, Deeg D. Language differences in qualitative research: Is meaning lost in translation? Eur J Ageing. 2010;7(4):313–6. Another major barrier is related to language. The Somali mothers from the second migration wave are often not fluent in Dutch, while Somali girls have access to Dutch language and culture through school. Hence, some young Somali women have to translate information about the HPV vaccination to their mothers, which daughters then sometimes perceive as a barrier. As a consequence, they have not always informed their mothers. Two natural group discussions were held and attended by 12 and 14 mothers (aged 23–66 years). The natural group discussions were conducted in Somali, lasted approximately 20 to 40 min, and took place in community centers in two different cities. A group interview protocol was developed by JS, who moderated the focused discussions [ 28].