Tag Archives: Comparative study

Comparison of outcomes, results, responses, etc for different techniques, therapeutic approaches or other inputs.

Thirty-year trends in the prevalence and severity of female genital mutilation: a comparison of 22 countries

FREEBMJ Glob Health. 2017 Nov 25;2(4):e000467. doi: 10.1136/bmjgh-2017-000467. eCollection 2017.

Thirty-year trends in the prevalence and severity of female genital mutilation: a comparison of 22 countries.

Koski A, Heymann J


Introduction: Female genital mutilation (FGM) harms women’s health and well-being and is widely considered a violation of human rights. The United Nations has called for elimination of the practice by 2030. Methods: We used household survey data to measure trends in the prevalence of FGM in 22 countries. We also examined trends in the severity of the practice by measuring changes in the prevalence of flesh removal, infibulation and symbolic ‘nicking’ of the genitals. We evaluated the extent to which measurement error may have influenced our estimates by observing the consistency of reports for the same birth cohorts over successive survey waves. Results: The prevalence of all types of FGM fell in 17 of 22 countries we examined. The vast majority of women who undergo FGM have flesh removed from their genitals, likely corresponding to the partial or total removal of the clitoris and labia. Infibulation is still practised throughout much of sub-Saharan Africa. Its prevalence has declined in most countries, but in Chad, Mali and Sierra Leone the prevalence has increased by 2-8 percentage points over 30 years. Symbolic nicking of the genitals is relatively rare but becoming more common in Burkina Faso, Chad, Guinea and Mali. Conclusion: FGM is becoming less common over time, but it remains a pervasive practice in some countries: more than half of women in 7 of the 22 countries we examined still experience FGM. The severity of the procedures has not changed substantially over time. Rigorous evaluation of interventions aimed at eliminating or reducing the harms associated with the practice is needed.

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Impact of the complete ban on female genital cutting on the attitude of educated women from Upper Egypt toward the practice

Int J Gynaecol Obstet. 2013 Mar;120(3):275-8. doi: 10.1016/j.ijgo.2012.10.010. Epub 2012 Dec 11.

Impact of the complete ban on female genital cutting on the attitude of educated women from Upper Egypt toward the practice.

Hassanin IM, Shaaban OM.

Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Sohag, Egypt.

OBJECTIVE: To compare the prevalence of female genital cutting (FGC) before and 5 years after the law completely banned the practice in Egypt, and evaluate the attitude of educated mothers of girls toward FGC in Upper Egypt.

METHODS: All women attending 2 outpatient clinics in Upper Egypt were approached from January 1 through November 30, 2011. A trained nurse interviewed those who had daughters, and factors influencing their attitude toward FGC were evaluated. The participants in a previous study done in the same locality acted a historical comparison group.

RESULTS: The percentage of women who had FGC performed on at least 1 daughter was significantly lower in 2011 than in 2006 (71.6% vs 77.8%, P=0.04). The main reason for performing FGC, given by 42.6% of the participants, was family pressure. The percentage of FGC procedures practiced by physicians was significantly lower in 2011 than it was in 2006 (34.6% vs 39.3%, P=0.04).

CONCLUSION: The decrease in prevalence of FGC after its complete ban was small after 5 years, with little change in attitude among educated families in Upper Egypt. In addition to the current law, a change in attitude will be needed to wipe out this custom.

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Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births

Acta Obstet Gynecol Scand. 2013 Jan;92(1):101-8. doi: 10.1111/aogs.12010. Epub 2012 Nov 1.

Infibulated women have an increased risk of anal sphincter tears at delivery: a population-based Swedish register study of 250 000 births.

Berggren V, Gottvall K, Isman E, Bergström S, Ekéus C.

Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.


OBJECTIVE: To investigate the risk for anal sphincter tears (AST) in infibulated women. DESIGN: Population-based cohort study. SETTING: Nationwide study in Sweden. POPULATION: The study population included 250 491 primiparous women with a vaginal singleton birth at 37-41 completed gestational weeks during 1999-2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalia group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan group, n = 955, where the majority are infibulated, compared with other African countries, n = 1035, where few individuals are infibulated but had otherwise similar anthropometric characteristics. These women were compared with 247 572 Swedish-born women. METHODS: Register study with data from the National Medical Birth Registry. MAIN OUTCOME MEASURES: AST in non-instrumental and instrumental vaginal delivery. RESULTS: Compared with Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95%CI 2.08-3.54), followed by women from Eritrea-Ethiopia-Sudan 1.80 (1.41-2.32) and other African countries 1.23 (0.89-1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. CONCLUSION: Delivering African women from countries where infibulation is common carries an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.

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Comparative Study of Meanings, Beliefs, and Practices of Female Circumcision Among Three Nigerian Tribes in the United States and Nigeria

J Transcult Nurs. April 2004 15: 103-113

Comparative Study of Meanings, Beliefs, and Practices of Female Circumcision Among Three Nigerian Tribes in the United States and Nigeria

Prisca O. Anuforo, Lola Oyedele, Dula F. Pacquiao, Kean University


The study was conducted to gain insight into the meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. Participant-observations occurred in three sites in Nigeria (Ibadan, Lagos, and Owerri) and in Essex County, New Jersey (Newark, Irvington, and East Orange). A total of 50 informants included adult males and females from the three main Nigerian ethnic tribes: Igbo, Yoruba, and Hausa. Leininger’s culture care theory of diversity and universality was the study framework. Findings revealed existence of similarities and differences in the cultural meanings, beliefs, and practices among the tribes. Religion, education, and occupation were significant factors influencing informants’ attitudes toward continuation of the practice. Government-sponsored public education and influence by the media were found to increase informants’ awareness of complications of female circumcision. Changes in attitudes toward the practice and use of alternative practices were evident.

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The impact of health education on attitudes towards female genital mutilation (FGM) in a rural Nigerian community.

Eur J Contracept Reprod Health Care. 2008 Sep;13(3):289-97.

The impact of health education on attitudes towards female genital mutilation (FGM) in a rural Nigerian community.

Asekun-Olarinmoye EO, Amusan OA.

Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria. estoaskol@yahoo.com

OBJECTIVES: To determine the level of practice of female genital mutilation (FGM) and the impact of a health education intervention in Shao community. MATERIALS AND METHODS: Intervention study using a multistage sampling technique. The instrument was a pre-tested, structured questionnaire. The survey was supplemented by an in-depth interview of the traditional excisors. RESULTS: Most respondents (88.0%) cited traditional excisors as operators of the procedure, while 7.8% mentioned health workers. Factors found to be statistically significantly associated with the practice of FGM are age, gender and educational status of respondents (p<0.05). The age at which FGM is usually performed was put at under one year old by 60.3% of respondents. All respondents cited type II FGM as the type practised in the community. Most (88.0%) of the female respondents were excised. A greater proportion of men than women did not want the practice of FGM stopped in the pre-intervention stage; however, there was a statistically significant decrease in the proportion of males who did not want the practice of FGM stopped in the post-intervention stage. Also, there was a statistically significant increase in the proportion of respondents who had no intention to excise future female children in the post-intervention stage (p<0.05). Legislation, female literacy and empowerment, educating men and provision of alternative vocation for excisors were means suggested by respondents for stopping the practice. CONCLUSION AND RECOMMENDATIONS: The health education intervention had a positive impact on the attitude of respondents towards FGM. However, for sustainable behavioural changes that will lead to elimination of FGM practice, we recommend placing FGM elimination efforts within a comprehensive development strategy and the larger context of reproductive health and gender education in Nigeria.

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The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

BJOG. 2002 October; 109(10): 1089–1096

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

Okonofua FE, Larsen U, Oronsaye F, Snow RC, Slanger TE


Objective To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.

Design Cross sectional study.

Setting Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.

Population 1836 healthy premenopausal women.

Methods The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women’s socio-demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.

Main outcome measures Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.

Results Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).

Conclusion Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

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Male and female genital cutting among Southern Thailand’s Muslims: rituals, biomedical practice and local discourses

Cult Health Sex. 2010;12(7):725-738

Male and female genital cutting among Southern Thailand’s Muslims: rituals, biomedical practice and local discourses

Merli C

Department of Anthropology, Durham University, Durham, UK

This paper explores how local people in a province in southern Thailand perceive the practice of male andfemale genital cutting. In order to understand the importance placed on these practices, a comparison is drawn between the two and also between the male circumcision and the Buddhist ordination of monks as rites of passage. Discourses on the exposure or concealment of male and female bodies, respectively, witness to the relevance of both the local political-historical context and biomedical hegemony to gendered bodies. The comparisons evince the need to reflect upon the theoretical and ethical implications of studyinggenital cutting and focusing exclusively on one of the two practices rather than, as this paper claims to be necessary, considering them as inextricably connected.

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Female genital cutting: current practices and beliefs in western Africa

Bull World Health Organ vol.90 no.2 Genebra Feb. 2012

Female genital cutting: current practices and beliefs in western Africa

Heather L SipsmaI, Peggy G ChenI, Angela Ofori-AttaII, Ukwuoma O IlozumbaIII, Kapouné KarfoIV, Elizabeth H BradleyI

IDepartment of Health Policy and Administration, School of Public Health, Yale University, 2 Church Street South, New Haven, CT 06519, United States of America (USA) 
IIDepartment of Psychiatry, University of Ghana Medical School, Accra, Ghana 
IIIHelen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA 
IVDepartment of Psychiatry, Ouagadougou University School of Medicine, Ouagadougou, Burkina Faso



To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa.

METHODS: Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised, having had a daughter circumcised, and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome.


The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone, Gambia, Burkina Faso and Mauritania, the prevalence of FGC was 94%, 79%, 74% and 72%, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6%. Older age and being Muslim were generally associated with increased odds of FGC, and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74%) to their daughters (25%); only 14.2% of the women surveyed in that country said that they believe the practice should continue.


The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences, successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices.

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Female circumcision in Somalia: some psychosocial aspects

Genus. 1985 Jan-Jun; 41(1-2):133-47

Female circumcision in Somalia: some psychosocial aspects

Gallo PG


This article on female circumcision begins with a brief review of literature, and goes on to discuss the results of an extensive field investigation on female circumcision conducted in Somalia, resulting in an analysis of the psychosocial aspects connected with the practice. The attitudes of women towards the practice, their opinions regarding the maintenance of the practice in the country, and their expectations as to their daughter’s circumcision were examined. The study population contained 2947 subjects, including 1410 married women, mostly mothers, 19.4% of which were illiterate, 20.3% with primary education. The average age was 25.8 years +or- 16.30. The results reveal: 1) The positive attitudes of the study population towards the custom. This approval shows no special relationship with ethnic group, rural or urban residence, or custom regarding mode of circumcision (infibulation, sunna, or clitoridectomia). It finds support in the ignorance of the negative aspects of the practice and the relative value granted to the positive ones. Most of the consequences become evident only several years after the operation; as a result the connection between cause and effects is not made by all of the women. 2) An average of 4 out of 5 women believe that circumcision should be continued and only 1 in 5 declared that it should be abandoned; whatever the age group ethnic group, or education group to which the women belong. 3) The interviewed subjects were generally in favor of the attenuated type of circumcision for their daughters. Few mothers (5%) in modern Somalia accept the idea of not submitting their daughters to traditional customs. In fact, many factors related to the whole family and social environment, not only the mother’s wishes, condition the decision regarding the girl’s circumcision.

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