Female circumcision as a public health issue
In many civilizations, certain surgical procedures have profound cultural and social meanings. Male circumcision, for example, has deeb importance as a symbol of religious and ethnic identity and has played a major part in the political and social history of many peoples. Female circumcision has particularly strong cultural meaning because it is closely linked to women’s sexuality and their reproductive role in society…
Midwifery. 2004, 20(4); 299–311.
Female genital mutilation: The abuse has to stop
Female genital mutilation (FGM) involves the partial or total removal of the female external genitalia or injury of the genitalia with no medical indication or resulting health benefit (World Health Organisation, 2008). It is a custom prevalent in sub-Saharan countries of Africa, with some countries including Egypt, the Sudan and Somalia estimated to have a FGM prevalence of around 90% (United Nations Children׳s Fund, 2013). More midwives and other health professionals in the UK and elsewhere are providing care and support for women who have sustained FGM as a consequence of increased migration from countries where FGM is practiced.
J Obstet Gynaecol Can. 2014 Aug;36(8):671-2.
Female genital cutting
Kotaska A, Avery L
Comment in J Obstet Gynaecol Can. 2014 Aug;36(8):672.
Female genital cutting (FGC) is unethical. It causes physical, psychological, and emotional harm, and is rarely performed with consent. SOGC Clinical Practice Guideline no. 299 on FGC outlines this argument well.1 However, re-infibulation is inappropriately bundled together with FGC. Re-infibulation is fundamentally different, surgically and ethically, from FGC. The two need to be examined independently, particularly since the guideline prohibits re-infibulation…
BMJ Open. 2014 Nov 21;4(11):e006316. doi: 10.1136/bmjopen-2014-006316.
Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis
Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE
OBJECTIVE: Worldwide, an estimated 125 million girls and women live with female genital mutilation/cutting (FGM/C). We aimed to systematically review the evidence for physical health risks associated with FGM/C.
DESIGN: We searched 15 databases to identify studies (up to January 2012). Selection criteria were empirical studies reporting physical health outcomes from FGM/C, affecting females with any type of FGM/C, irrespective of ethnicity, nationality and age. Two review authors independently screened titles and abstracts, applied eligibility criteria, assessed methodological study quality and extracted full-text data. To derive overall risk estimates, we combined data from included studies using the Mantel-Haenszel method for unadjusted dichotomous data and the generic inverse-variance method for adjusted data. Outcomes that were sufficiently similar across studies and reasonably resistant to biases were aggregated in meta-analyses. We applied the instrument Grading of Recommendations Assessment, Development and Evaluation to assess the extent to which we have confidence in the effect estimates.
RESULTS: Our search returned 5109 results, of which 185 studies (3.17 million women) satisfied the inclusion criteria. The risks of systematic and random errors were variable and we focused on key outcomes from the 57 studies with the best available evidence. The most common immediate complications were excessive bleeding, urine retention and genital tissue swelling. The most valid and statistically significant associations for the physical health sequelae of FGM/C were seen on urinary tract infections (unadjusted RR=3.01), bacterial vaginosis (adjusted OR (AOR)=1.68), dyspareunia (RR=1.53), prolonged labour (AOR=1.49), caesarean section (AOR=1.60), and difficult delivery (AOR=1.88).
CONCLUSIONS: While the precise estimation of the frequency and risk of immediate, gynaecological, sexual and obstetric complications is not possible, the results weigh against the continuation of FGM/C and support the diagnosis and management of girls and women suffering the physical risks of FGM/C.
TRIAL REGISTRATION NUMBER: This study is registered with PROSPERO, number CRD42012003321.
J Matern Fetal Neonatal Med. 2014 Sep 19:1-23. [Epub ahead of print]
Maternal infibulation and obstetrical outcome in Djibouti.
Minsart AF, N’guyen TS, Hadji RA, Caillet M.
The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status. Methods This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model. Results Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10-2.27), p-value=0.014. Conclusions Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.
Midwifery. 2014 Sep 6. pii: S0266-6138(14)00222-8. doi: 10.1016/j.midw.2014.08.012. [Epub ahead of print]
Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience.
Dawson A, Turkmani S, Fray S, Nanayakkara S, Varol N, Homer C.
OBJECTIVE: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care.
DESIGN: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014.
FINDINGS: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial.
KEY CONCLUSIONS: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice.
IMPLICATIONS FOR PRACTICE: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.