ArticlesFemale genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries
Introduction
FGM consists of all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons.1 It is common in several countries, predominantly in Africa, and more than 100 million women and girls are estimated to have had FGM worldwide. Whether obstetric outcomes differ between women who have and those who have not had FGM is unclear, since previous studies have been small and methodologically limited, so have been unable to provide reliable evidence, especially in relation to important outcomes, such as perinatal death.2, 3, 4, 5, 6 The aim of this study was to investigate the effects of different types of FGM on a range of maternal and neonatal outcomes during and immediately after delivery.
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Patients and procedures
Women who presented for singleton delivery at 28 obstetric centres in Burkina Faso (five centres), Ghana (three centres), Kenya (three centres), Nigeria (six centres), Senegal (eight centres), and Sudan (three centres) between November, 2001, and March, 2003, and gave consent to participate, were interviewed to obtain information about their personal characteristics and obstetric and medical histories. Those booked for elective caesarean section were not included. Participating women had an
Results
After exclusions, data from 28 393 women were available for analysis (table 1). As expected, the distribution of the type of FGM varied substantially according to the country from which women joined the study (table 1), as well as by centre within country (data not shown). Although study participants were not representative of or derived directly from the general population, these prevalences are broadly in keeping with the few data for FGM from these countries.1, 9 The distribution varied
Discussion
These results show that deliveries to women who have undergone FGM are significantly more likely to be complicated by caesarean section, postpartum haemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant, and inpatient perinatal death, than deliveries to women who have not had FGM. There was no significant association between FGM and the risk of having a low-birthweight infant.
This large prospective study was done at obstetric centres in countries where FGM is
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Group members listed at end of report