Effects of female genital mutilation on childbirth

Abstract

Female genital mutilation (FGM) is defined by the World Health Organisation as the deliberate total or partial removal of the external female genitalia, or other deliberate injury to the female genitalia, which is carried out for non-therapeutic purposes. The practice is widely condemned. Even though the adverse effects of the practice have been well documented in many small studies and case reports, FGM is still common in many countries. The effects of this practice are also being felt in many developed countries due to substantial migration in recent years. One of the limiting factors in encouraging eradication is the availability of high quality evidence of the effects of the practice on the process of childbirth. By highlighting the effects of FGM on the process of childbirth, the objective was to encourage policy makers, in co-operation with many relevant organisations, to work together to eradicate the procedure. This original study investigates the effects of FGM on the process of childbirth using a large international epidemiological case control study involving three centres in three different countries. The inclusion criteria were strict and comprised of agreement by the woman and or her husband to participate in the study, for a normal singleton pregnancy at term with a cephalic presentation which resulted in a normal baby, for the women with and without FGM during the period of study. Women who did not fulfil these criteria were excluded. Maternal outcome measures included length of labour, obstruction to the progress of labour, operative delivery, urine retention, perineal complications, intrapartum and postpartum haemorrhage and blood loss during the process of labour. Newborn outcome measures included birth status at delivery, Apgar scores at 5 and 10 minutes, requirement for resuscitation, admission to special care unit and time taken from delivery to the first breast feed. Psychological sequelae were not assessed. The total number of participants in these three centres was 1,970 women; 526 with no FGM (control) and 1444 with different types of FGM. Every effort was taken to keep confidentiality and not to interfere with management of labour during data collection. The results indicate a highly significant difference between the two groups when comparing length of the process of labour, mode of delivery and the need for instrumental deliveries, episiotomies and tears, blood loss during and after delivery, the need for catheterisation following deliveries and duration of hospital stay following birth. Adverse effects were not confined to women and were found to have extended to the new-borns in the two groups again with highly significant difference with regard to birth trauma, requirement for resuscitation and medical attention. The time taken for the first breast contact was different in the two groups with possible effects which may be difficult to establish and require further research. The data provide clear evidence that the practice of FGM is associated with clinical adverse effects, which are not only confined to women but involve the newborn as well. It is hoped that this systematic and comprehensive collection of evidence will make a substantial contribution to the world wide effort to eradicate this harmful practice.