Archives Blog Original research

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).

METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage.

RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy.

CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed.

This article can be accessed in this LINK

Archives Blog Original research

Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010

Int J Equity Health. 2015 May 8;14(1):42. doi: 10.1186/s12939-015-0171-1. FREE

Trends and protective factors of female genital mutilation in Burkina Faso: 1999 to 2010.

Chikhungu LC, Madise NJ


BACKGROUND: The practice of Female Genital Mutilation (FGM) is common in several African countries and some parts of Asia. This practice is not only a violation of human rights, but also puts women at risk of adverse health outcomes. This paper analysed the trends in the prevalence of FGM in Burkina Faso and investigated factors that are associated with this practice following the enactment of an FGM law in 1996.

METHODS: The study used the Burkina Faso Demographic and Health Survey (DHS) data sets from women aged 15 to 49 years undertaken in 1999, 2003 and 2010. Chi square tests were carried out to investigate whether there has been a change in the levels of FGM in Burkina Faso between 1999 and 2010 and multilevel logistic regression analysis were employed to identify factors that were significantly associated with undergoing FGM.

RESULTS: The levels of FGM in Burkina Faso declined significantly from 83.6% in 1999 to 76.1% in 2010. The percentage of women circumcised between the ages of 0 to 5 years increased from 34.2% in 1999 to 69% in 2010. Significantly more women in 2010 than in 1999 were of the opinion that FGM should stop (90.6% versus 75.1%, respectively). In 2010, the odds of getting circumcised were lowest amongst women that were born in the period 1990 to 1995 (immediately before the FGM law was enacted) compared to women born in the period 1960-1965 [OR 0.16 (0.13,0.20)]. There was significant variation of FGM across communities. Other factors that were significantly associated with being circumcised were education level, religion, ethnicity, urban residence and age at marriage.

CONCLUSIONS: Although the prevalence of FGM has declined in Burkina Faso, the levels are still high. In order to tackle the practice of FGM in Burkina Faso, the government of Burkina Faso and its development partners need to encourage girls’ participation in education and target its sensitization campaigns against FGM towards Muslim women, women residing in rural areas and women of Mossi ethnic background.

This article can be accessed in this LINK

Archives Original research

Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes

Stud Fam Plann. Sept 1999 30(3): 219–230

Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes

Jones H, Diop N, Askew I, Kaboré I


Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety-three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.

This article can be purchased in this LINK

Archives Blog Original research

[Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. About 94 cases]

Annales de Chirurgie Plastique EsthetiqueDisponible en ligne depuis le vendredi 11 mai 2012. Doi : 10.1016/j.anplas.2012.04.004

[Pratique de la chirurgie plastique reconstructrice du clitoris après mutilations génitales au Burkina Faso. À propos de 94 cas]

[Article in French]

C.M.R. Ouédraogo, S. Madzou, B. Touré, A. Ouédraogo, S. Ouédraogo, J. Lankoandé


But de l’étude Décrire et évaluer les résultats de la chirurgie plastique reconstructrice du clitoris dans le but de promouvoir la santé de la reproduction.

Patientes et méthode Nous avons réalisé une étude rétrospective de 2007 à 2010. Ce sont 94 femmes qui ont été incluses dans notre étude.

Résultats L’âge moyen était de 32,3ans. L’évaluation du vécu de la sexualité avant la reconstruction montrait que 41,5 % des patientes n’avaient jamais eu un désir sexuel avant l’intervention ; plus de la moitié n’avaient pas d’orgasme clitoridien et la dyspareunie était vécue par environ un tiers d’entre elles. Le principal motif de consultation dans notre série était le dysfonctionnement sexuel qui concernait plus de la moitié de notre population d’étude. Toutes nos patientes ont été opérées, selon la technique du Dr Pierre Foldès. L’évaluation avec un recul d’au moins six mois après l’intervention nous a montré une restauration du massif clitoridien chez 89,7 %. Il existait une différence significative entre le désir sexuel avant et après l’intervention. Une nette amélioration de la sexualité a été observée chez 83,6 % des patientes. Il n’existait, cependant, pas une différence significative entre l’orgasme avant et après l’intervention. Cela nous révélait que l’obtention d’un orgasme est multifactorielle et il ne suffit pas d’avoir un clitoris pour avoir un orgasme, Il faut savoir l’utiliser.

Conclusion Quel que soit le résultat anatomique et fonctionnel, toutes les femmes étaient satisfaites quant à l’intégrité physique retrouvée.

This article can be purchased in this LINK


Archives Blog Original research

[Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso)].

Sante Publique. 2010 Sep-Oct;22(5):563-70.

[Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso)].

[Article in French]

Ndiaye P, Diongue M, Faye A, Ouedraogo D, Tal Dia A.

Mèdecine Preventive et Santé Publique, Université Cheikh Anta Diop, BP 16 390 Dakar, Sénégal.


In order strengthen activities against female genital mutilation (FGM), this study aimed to assess the prevalence of childbirth complications due to FGM in the province of Gourma, Burkina Faso. The cross-sectional study was both descriptive and analytical; it was conducted between June 15 and August 15, 2007. The sampling was comprehensive, incorporating all of the women who gave birth in  the four maternity wards in Fada Ngourma, the provincial capital. The survey included an interview, clinical examination and document analysis of archives and records. The 354 respondents were younger than 25 years-old in 58% of the cases, and 78% of all women participating were illiterate. FGM was Type I, II or III for 28%, 28% and 3% for them respectively. Obstructed labor occurred in 29% of the cases, and a caesarean section was preformed in 7% of the cases. Of all the
normal vaginal deliveries, 24% required episiotomies, 18% experienced obstetric Hemorrhaging, 20% had uterine retroversion and 3% needed blood transfusions. Among the newborns, 5% were resuscitated and 4% were stillbirths. The existence of FGM has statistically increased the proportion of dystocia (OR = 11.5), cesarean section (OR = 17.6), episiotomy (OR = 64), perineal tears (OR = 10, 2), postpartum hemorrhage (OR = 13.0), retroverted uterus (OR = 14.7), blood transfusions (OR = 8.0) and stillbirths (OR = 10.2). Women with FGM Type 2 and 3 were more prone to dystocia and obstructed labor (OR = 5.7) and cesarean delivery (OR = 5.2) than those with FGM Type 1. FGM constitutes an important risk factor for complications during childbirth. It should be eradicated for good health of the mother, newborn and child in Burkina Faso.

There is no LINK to view this article online.

Actors Blog Ngo

NGO Clitoraid


The Las Vegas, US-based NGO Clitoraid has been criticized for their use of the motto “Adopt a Clitoris” as a reclaim for fundraising. In some of its activities, such as the last one held in Italy last July 2012, the coordinators gifted the attendants to the event with “Clito-boxes” (see LINK). Researcher Sylvia Tamale, in her introduction to her work “African Sexualities: a Reader”, condemns the frivolity and racism of these terms Clitoraid uses to collect money.

Closely linked to the Raelian sect, in its WEBPAGE, this is how they introduce themselves:

“Given the barbaric nature of clitoral excision or female genital mutilation (FGM), Rael, spiritual leader of the Raelian Movement, founded Clitoraid, a private non-profit organization whose goal is to sponsor any African woman who wants to have her clitoris rebuilt.

Since 2006, Clitoraid has been able to train several doctors and assist in providing clitoral repair surgery for many women in France and the United States. All of our patients have reported improvements after the surgery, and about 60 percent of them have experienced orgasm – something they thought would never happen for them.

We’re now halfway through the construction of our ‘Pleasure Hospital’ in Bobo Dioulasso, Burkina Faso, where we will enable local women and women of West Africa to have the procedure for free. This is our main goal, since too many women cannot afford this surgery. Without our help, it would cost several years of their wages for them to have it, so they are hoping and waiting for us!”


Views of women and men in Bobo-Dioulasso, Burkina Faso, on three forms of female genital modification

Reprod Health Matters. May 2010, 18(35):84-93

Views of women and men in Bobo-Dioulasso, Burkina Faso, on three forms of female genital modification

Jirovsky E


This paper is about how female circumcision/female genital mutilation (FC/FGM) was viewed by women and men aged 18–89 in Bobo-Dioulasso, Burkina Faso, now that it has been against the law for almost 15 years. The findings come from 11 months of field research, participant observation and interviews in 2008. The practice of FC/FGM was an important issue in Bobo-Dioulasso, even though prevalence seems to be falling. The most important argument for continuing it was not a traditional role, but the need to control female sexuality – regarded as very active – not to negate it, but to ensure morally acceptable behaviour. When I talked about female genital cosmetic surgery it emerged that Bobolaise women used various substances to enhance sexual pleasure for men, both to keep the relationship and to protect the gifts and money many women needed to survive and for their children. FC/FGM was seen as a socio-cultural obligation, necessary to achieve a respectable status. Other forms of genital modification were seen as a means of satisfying male sexual needs, though vaginal tightening to hide sexual experience was also a way of demonstrating respectability. What emerged overall is that Bobolaises had their own perspectives about all the forms of female genital modification that were discussed.

This article can be purchased in this LINK

Archives Blog Original research

Religious Differences in Female Genital Cutting: A Case Study from Burkina Faso

Religious Differences in Female Genital Cutting: A Case Study from Burkina Faso

Hayford SR, Trinitapoli J


The relationship between religious obligations and female genital cutting is explored using data from Burkina Faso, a religiously and ethnically diverse country where approximately three-quarters of adult women are circumcised. Data from the 2003 Burkina Faso Demographic and Health Survey are used to estimate multilevel models of religious variation in the intergenerational transmission of female genital cutting. Differences between Christians, Muslims, and adherents of traditional religions are reported, along with an assessment of the extent to which individual and community characteristics account for religious differences. Religious variation in the intergenerational transmission of female genital cutting is largely explained by specific religious beliefs and by contextual rather than individual characteristics. Although Muslim women are more likely to have their daughters circumcised, the findings suggest the importance of a collective rather than individual Muslim identity for the continuation of the practice.

This article can be purchased in this LINK

Archives Blog Original research

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

Lancet. 2006 Jun 3;367(9525):1835-41.

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

WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M.

National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia.

Comment in Lancet. 2006 Jun 3;367(9525):1799-800.

Lancet. 2006 Aug 12;368(9535):579.

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.

This article can be purchased in this LINK

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Women’s sexual health and contraceptive needs after a severe obstetric complication (“near-miss”): a cohort study in Burkina Faso

Reproductive Health 2010, 7:22

Women’s sexual health and contraceptive needs after a severe obstetric complication (“near-miss”): a cohort study in Burkina Faso

Ganaba R, Marshall T, Sombié I, Baggaley RF, Ouédraogo TW, Filippi V.

Corresponding author: Rasmané Ganaba



Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum.


Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women’s reproductive intentions.

Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso.


Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group.


Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication.

The open access article can be found in this LINK