Elsevier

The Lancet

Volume 367, Issue 9525, 3–9 June 2006, Pages 1835-1841
The Lancet

Articles
Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries

https://doi.org/10.1016/S0140-6736(06)68805-3Get rights and content

Summary

Background

Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome.

Methods

28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital.

Findings

Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1·03 (95% CI 0·88–1·21), 1·29 (1·09–1·52), 1·31 (1·01–1·70); postpartum haemorrhage 1·03 (0·87–1·21), 1·21 (1·01–1·43), 1·69 (1·34–2·12); extended maternal hospital stay 1·15 (0·97–1·35), 1·51 (1·29–1·76), 1·98 (1·54–2·54); infant resuscitation 1·11 (0·95–1·28), 1·28 (1·10–1·49), 1·66 (1·31–2·10), stillbirth or early neonatal death 1·15 (0·94–1·41), 1·32 (1·08–1·62), 1·55 (1·12–2·16), and low birthweight 0·94 (0·82–1·07), 1·03 (0·89–1·18), 0·91 (0·74–1·11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.

Interpretation

Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

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.

Section snippets

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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