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SOGC Female Genital Mutilation/Cutting

Society of Obstetricians and Gynaecologists of Canada. JOCG 2012 Feb; 272.

SOGC Policy Statement: Female Genital Mutilation/Cutting

Perron L, Senikas V

Clinical guideline on FGM/C. This policy statement has been reviewed by the Social Sexual Issues Committee, the Ethics Committee, and the Clinical Practice Gynaecology Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.

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Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?

Trop Med Int Health. 2002 FEB; 7 (2): 159-165

Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?

Msuya SE, Mbizvo E, Hussain A, Sundby J, Sam NE, Stray-Pedersen B

ABSTRACT

OBJECTIVES  To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV.

METHODS  In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken.

RESULTS  Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged ≥35 were twice as likely to be cut as those < 25 years. Seventy-six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC.

CONCLUSION  FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken.

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The Health Consequences of Female Circumcision: Science, Advocacy, and Standards of Evidence

Med Anthropol Q. 2003 Sept; 17 (3): 394-412

The Health Consequences of Female Circumcision: Science, Advocacy, and Standards of Evidence

Makhlouf Obermeyer C

ABSTRACT

This two-part article addresses questions that have arisen in current debates on the health consequences of female circumcision. The first part responds to a critique of a 1999 article and focuses on three major points: the role of research and advocacy in discussions of harmful effects, the sort of evidence that is appropriate for measuring health effects, and the way in which different disciplines—demography, epidemiology, and anthropology—are brought together to analyze data on health consequences. The second part of the article reviews published sources and provides an update on their results. It shows that few studies are appropriately designed to measure health effects, that circumcision is associated with significantly higher risks of a few well-defined complications, but that for other possible complications the evidence does not show significant differences, [female genital mutilation, female genital cutting, circumcision, health consequences, advocacy, evidence, multidisciplinary]

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The use of intrapartum defibulation in women with female genital mutilation.

BJOG. 2001 Sep;108(9):949-51.

The use of intrapartum defibulation in women with female genital mutilation.

Rouzi AA, Aljhadali EA, Amarin ZO, Abduljabbar HS.

Department of Obstetrics and Gynaecology, King Abdulaziz University Hospital, Saudi Arabia.

OBJECTIVE: To assess the use of intrapartum defibulation for women who have had female genital mutilation.

DESIGN: A retrospective case analysis.

SETTING: King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia.

SAMPLE: Two hundred and thirty-three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999.

METHODS: The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation.

RESULTS: One hundred and fifty-eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred.

CONCLUSIONS: Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.

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Effects of female genital mutilation on birth outcomes in Switzerland.

BJOG. 2009 Aug;116(9):1204-9. Epub 2009 May 14.

Effects of female genital mutilation on birth outcomes in Switzerland.

Wuest S, Raio L, Wyssmueller D, Mueller MD, Stadlmayr W, Surbek DV, Kuhn A.

Department of Obstetrics and Gynaecology, University of Berne and Inselspital Berne, Berne, Switzerland.

OBJECTIVE: The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland. Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.

DESIGN: A retrospective case-control study.

SETTING: A teaching hospital.

POPULATION: One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.

METHODS: Data for patients’ wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.

MAIN OUTCOME MEASURES: Patients’ satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.

RESULTS: Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.

CONCLUSION: An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.

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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. FGMStudyGroup@who.int

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.

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Is there an association between female circumcision and perinatal death?

Bull World Health Organ vol.80 no.8 Genebra Aug. 2002

Is there an association between female circumcision and perinatal death?

Birgitta Essén, Birgit Bödker, N-O. Sjöberg, Saemundur Gudmundsson, P-O. Östergren, & Jens Langhoff-Roos

ABSTRACT

OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. 
METHODS: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990–96 to circumcised women. 
FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. 
CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.

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Estimating the obstetric costs of female genital mutilation in six African countries

Bull World Health Organ vol.88 no.4 Genebra Apr. 2010

Estimating the obstetric costs of female genital mutilation in six African countries

Taghreed AdamI; Heli BathijaI; David BishaiII,*; Yung-Ting BonnenfantII; Manal DarwishIII; Dale HuntingtonI; Elise JohansenI for the FGM Cost Study Group of the World Health Organization

IWorld Health Organization, Geneva, Switzerland 
IIJohns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America 
IIIAssiut University, Assiut, Egypt

ABSTRACT

OBJECTIVE: To estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. 
METHODS: A multistate model depicted six cohorts of 100 000 15-year-old girls who survived until the age of 45 years. Cohort members were modelled to have various degrees of FGM, to undergo childbirth according to each country’s mortality and fertility statistics, and to have medically attended deliveries at the frequency observed in the relevant country. The risk of obstetric complications was estimated based on a 2006 study of 28 393 women. The costs of each complication were estimated in purchasing power parity dollars (I$) for 2008 and discounted at 3%. The model also tracked life years lost owing to fatal obstetric haemorrhage. Multivariate sensitivity analysis was used to estimate the uncertainty around the findings. 
FINDINGS: The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15–45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130 000 life years is expected owing to FGM’s association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. 
CONCLUSION: Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.

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The consequences of female circumcision for health and sexuality: an update on the evidence.

Cult Health Sex. 2005 Sep-Oct;7(5):443-61.

The consequences of female circumcision for health and sexuality: an update on the evidence.

Makhlouf Obermeyer C.

Department of Population and International Health, Harvard University, Boston, MA 02115, USA. coberm@hsph.harvard.edu

Abstract

This systematic review of published sources between 1997 and 2005 shows that female circumcision is associated with some health consequences but that no statistically significant associations are documented for a number of health conditions. This is in part a result of the difficulty of designing studies on the more extensive operations (infibulation). The findings of the analysis can be summarized as follows: statistically higher risks are documented for some but not all types of infections; the evidence regarding urinary symptoms is inconclusive; the evidence on obstetric and gynecological complications is mixed: increased risks have been reported for some complications of labour and delivery but not others, and for some symptoms such as abdominal pain and discharge, but not others such as infertility or increased mortality of mother or infant. Concerning sexuality, most of the existing studies suffer from conceptual and methodological shortcomings, and the available evidence does not support the hypotheses that circumcision destroys sexual function or precludes enjoyment of sexual relations. This review highlights the difficulties of research on the health and sexuality consequences of FGC, underscores the importance of distinguishing between more and less extensive operations, and emphasizes the need to go beyond simple inventories of physical harm or frequencies of sexual acts.

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Female genital mutilation: cultural awareness and clinical considerations

J Midwifery Womens Health. 2007 Mar-Apr;52(2):158-63.

Female genital mutilation: cultural awareness and clinical considerations.

Braddy CMFiles JA.

Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA.

ABSTRACT

Clinicians in the United States are increasingly encountering girls and women who have undergone female genital mutilation. To foster a more trusting relationship with such patients, health care providers must have an accurate understanding of the cultural background surrounding this practice, a working knowledge of the different types of female genital mutilation procedures that may be encountered, and an awareness of both the acute and long-term complications. Some of these complications are potentially fatal, and the correct clinical diagnosis can be lifesaving

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