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Lindqvist PG, Gissler M, Essén B. Is there a relation between stillbirth and low levels of vitamin D in the population? A bi-national follow-up study of vitamin D fortification. BMC Pregnancy Childbirth 2023; 23:359. [PMID: 37198534 DOI: 10.1186/s12884-023-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Stillbirth has been associated with low plasma vitamin D. Both Sweden and Finland have a high proportion of low plasma vitamin D levels (< 50 nmol/L). We aimed to assess the odds of stillbirth in relation to changes in national vitamin D fortification. METHODS We surveyed all pregnancies in Finland between 1994 and 2021 (n = 1,569,739) and Sweden (n = 2,800,730) with live or stillbirth registered in the Medical Birth Registries. The mean incidences before and after changes in the vitamin D food fortification programs in Finland (2003 and 2009) and Sweden (2018) were compared with cross-tabulation with 95% confidence intervals (CI). RESULTS In Finland, the stillbirth rate declined from ~ 4.1/1000 prior to 2003, to 3.4/1000 between 2004 and 2009 (odds ratio [OR] 0.87, 95% CI 0.81-0.93), and to 2.8/1000 after 2010 (OR 0.84, 95% CI 0.78-0.91). In Sweden, the stillbirth rate decreased from 3.9/1000 between 2008 and 2017 to 3.2/1000 after 2018 (OR 0.83, 95% CI 0.78-0.89). When the level of the dose-dependent difference in Finland in a large sample with correct temporal associations decreased, it remained steady in Sweden, and vice versa, indicating that the effect may be due to vitamin D. These are observational findings that may not be causal. CONCLUSION Each increment of vitamin D fortification was associated with a 15% drop in stillbirths on a national level. If true, and if fortification reaches the entire population, it may represent a milestone in preventing stillbirths and reducing health inequalities.
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Affiliation(s)
- Pelle G Lindqvist
- Clinical Sciences and Education, Obstetrics and Gynecology, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm, 11883, Sweden.
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/IMHm, Uppsala University, Uppsala, Sweden
- WHO Collaborating Centre On Migration and Health, Uppsala University, Uppsala, Sweden
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2
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Bertuit J, Luzolo Nzinga AM, Jaouan ML, Feipel V. Systematic Review of Obstetric and Neonatal Complications Associated With Female Genital Mutilation. Nurs Womens Health 2023; 27:152-161. [PMID: 36893790 DOI: 10.1016/j.nwh.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To assess the prevalence of obstetric and neonatal complications in women with female genital mutilation (FGM) compared to women without FGM. DATA SOURCES Literature searches carried out on three scientific databases (CINAHL, ScienceDirect, and PubMed). STUDY SELECTION Selected observational studies published from 2010 to 2021 that assessed prolonged second phase of labor, vaginal outlet obstruction, emergency cesarean birth, perineal tear, instrumental births, episiotomy, and postpartum hemorrhage in women with and without FGM, as well as Apgar score and resuscitation of their newborns. RESULTS Nine studies were selected, including case-control, cohort, and cross-sectional studies. There were associations between FGM and vaginal outlet obstruction, emergency cesarean birth, and perineal tears. CONCLUSION For obstetric and neonatal complications other than those listed in the "Results" section, researchers' conclusions remain divided. Still, there is some evidence to support the impact of FGM on obstetric and neonatal harm, particularly in cases of FGM Types II and III.
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3
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Tordrup D, Bishop C, Green N, Petzold M, Vallejo FR, Vogel JP, Pallitto C. Economic burden of female genital mutilation in 27 high-prevalence countries. BMJ Glob Health 2022; 7:bmjgh-2020-004512. [PMID: 35105556 PMCID: PMC8744099 DOI: 10.1136/bmjgh-2020-004512] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation. Methods Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full/partial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices. Results Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047. Conclusion FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.
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Affiliation(s)
- David Tordrup
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht, The Netherlands.,Triangulate Health Ltd, Doncaster, UK
| | | | | | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christina Pallitto
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and ResearchTraining in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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4
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Chavez Karlström A, Danielsson L, Dahlberg H. Medical Defibulation as a Possibility-the Experiences of Young Swedish- Somali Women. Int J Qual Stud Health Well-being 2021; 15:1848026. [PMID: 33287677 PMCID: PMC7734019 DOI: 10.1080/17482631.2020.1848026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Infibulation is the most pervasive form of female genital cutting. Infibulated women face difficulties such as obstruction of urine and menstrual blood flow, sexual problems, and birth complications, and may therefore need medical defibulation. This study explores the lived experiences of young migrant women from Somalia and their views on undergoing medical defibulation in Sweden. Methods: A qualitative study was conducted using phenomenological lifeworld research. Data were collected through in-depth interviews with nine young women originating from Somalia, now resident in Sweden. The interviews were analysed to reveal the meaning of the phenomenon of infibulation. Results: The essential meaning of the phenomenon is characterized by a limbo regarding both infibulation and defibulation. There is a strong desire both to handle the Swedish perspective on infibulation and to stay with the Somalian cultural values. These women are being exposed to a tacit tradition that makes it hard to relate to the possibility of medical defibulation. As a result, the women perceive the possibility to undergo medical defibulation as limited or non-existent. Conclusions: Healthcare professionals can be a support to encourage women in need of medical defibulation to reflect on traditional ideals concerning infibulation and defibulation.
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Affiliation(s)
- Anna Chavez Karlström
- Gothenburg and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Louise Danielsson
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Helena Dahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
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5
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Johnsdotter S, Essén B. Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1943-1948. [PMID: 32170548 PMCID: PMC8275533 DOI: 10.1007/s10508-020-01676-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 05/13/2023]
Affiliation(s)
- Sara Johnsdotter
- Centre for Sexology and Sexuality Studies, Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden.
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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6
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Taraldsen S, Vangen S, Øian P, Sørbye IK. Female genital mutilation/cutting, timing of deinfibulation, and risk of cesarean section. Acta Obstet Gynecol Scand 2021; 100:587-595. [PMID: 33719034 DOI: 10.1111/aogs.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The impact of female genital mutilation/cutting on obstetric outcomes in high-income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk. MATERIAL AND METHODS This was a historical cohort study of nulliparous Somali-born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes. RESULTS Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33-0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46-0.88 P = .01). CONCLUSIONS High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.
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Affiliation(s)
- Sølvi Taraldsen
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Ingvil K Sørbye
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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7
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Essén B, Mosselmans L. How to ensure policies and interventions rely on strong supporting facts to improve women's health: The case of female genital cutting, using Rosling's Factfulness approach. Acta Obstet Gynecol Scand 2021; 100:579-586. [PMID: 33305361 PMCID: PMC8248391 DOI: 10.1111/aogs.14059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
Rosling et al’s book Factfulness aims to inspire people to use strong supporting facts in their decision‐making, with 10 rules of thumb to fight dramatic instincts. In this paper, the Factfulness framework is applied to female genital cutting (FGC), in order to identify possible biases and promote evidence‐based thinking in studies on FGC, clinical guidelines on management of FGC, and interventions aimed at abolishing FGC. The Factfulness framework helps to acknowledge that FGC is not a uniform practice and helps address that variability. This framework also highlights the importance of multidisciplinarity to understand causalities of the FGC issue, which the authors argue is essential. This paper highlights the fact that FGC is a dynamic practice, with changes in the practice that are ongoing, and that those changes are different in different contexts. The “zero tolerance” discourses on FGC fail to acknowledge this. Factfulness encourages us to be more critical of methodologies used in the area of FGC, for example when estimating girls at risk of FGC in migration contexts. Factfulness provides the tools to calculate risks rather than judgments based on fear. This may help limit stigmatization of women with FGC and to allocate resources to health problems of migrant women based on real risks. The framework also calls for more research and production of less biased facts in the field of FGC, in order to improve interventions aimed at abolishing FGC, and clinical guidelines for the treatment of FGC. Factfulness is a useful and structured foundation for reflection over constructs, biases and disputes surrounding FGC, and can help improve the quality of future evidence‐based interventions and education that address the actual needs of women with FGC and girls at risk of FGC.
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Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
| | - Luce Mosselmans
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
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8
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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Barriers to access to the Norwegian healthcare system among sub-Saharan African immigrant women exposed to female genital cutting. PLoS One 2020; 15:e0229770. [PMID: 32187198 PMCID: PMC7080260 DOI: 10.1371/journal.pone.0229770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/14/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Millions of women and girls have been exposed to female genital cutting (FGC). The practice of FGC extends beyond countries in Africa and Asia in which it is traditionally practiced. Women living with FGC in Norway have been reported to be in need of healthcare, but there is evidence of suboptimal use of healthcare services among this group, and we lack the women's perspective about this problem. This study aims to explore the experiences and perceptions hindering access and use of the Norwegian healthcare system among sub- Saharan African (SSA) immigrant women exposed to FGC. METHOD This qualitative research was conducted using purposive and snowball sampling to recruit thirteen SSA immigrant women in Norway previously exposed to FGC. Interviews were conducted from October 2017 to July 2018. The Interpretative Phenomenological Analysis method was used. RESULTS The findings indicate that women experience barriers both in reaching out to the healthcare system and within the healthcare system. Barriers prior to contact with the healthcare system include lack of information, husband and family influence on healthcare, and avoiding disclosing health problems. Barriers within the healthcare system include care providers with insufficient knowledge and poor attitudes of care providers. CONCLUSION This study reveals multiple barriers to healthcare access that co-exist and overlap. This indicates that SSA immigrant women are 'left behind' in being able to access and use the Norwegian healthcare system. Therefore, appropriate interventions to improve access to healthcare should be considered in order to reach Universal Health Coverage, thus having a positive impact on the health of these women. Equitable healthcare should be reflected in policy and practice.
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Affiliation(s)
- Vivian N. Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A. Gele
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N. Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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9
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Matanda DJ, Sripad P, Ndwiga C. Is there a relationship between female genital mutilation/cutting and fistula? A statistical analysis using cross-sectional data from Demographic and Health Surveys in 10 sub-Saharan Africa countries. BMJ Open 2019; 9:e025355. [PMID: 31362960 PMCID: PMC6678015 DOI: 10.1136/bmjopen-2018-025355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Literature on associations between female genital mutilation/cutting (FGM/C) and fistula points to a common belief that FGM/C predisposes women to developing fistula. This study explores this association using nationally representative survey data. DESIGN A secondary statistical analysis of cross-sectional data from Demographic and Health Surveys was conducted to explore the association between FGM/C and fistula. SETTING Sub-Saharan Africa. PARTICIPANTS Women aged 15-49 years in Burkina Faso (n=17 087), Chad (n=17 719), Côte d'Ivoire (n=10 060), Ethiopia (n=14 070), Guinea (n=9142), Kenya (n=31 079), Mali (n=10 424), Nigeria (n=33 385), Senegal (n=15 688) and Sierra Leone (n=16 658). MAIN OUTCOME MEASURES Fistula symptoms. RESULTS Multivariate logit modelling using pooled data from 10 countries showed that the odds of reporting fistula symptoms were 1.5 times (CI 1.06 to 2.21) higher for women whose genitals were cut and sewn closed than those who had undergone other types of FGM/C. Women who attended antenatal care (ANC) (adjusted odds ratio (AOR) 0.51, CI 0.36 to 0.71) and those who lived in urban areas (AOR 0.62, CI 0.44 to 0.89) were less likely to report fistula symptoms than those who did not attend ANC or lived in rural areas. CONCLUSIONS Severe forms of FGM/C (infibulation) may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. Multisectoral interventions that concurrently address harmful traditional practices such as FGM/C and other contextual factors that drive the occurrence of fistula are warranted. Promotion of ANC utilisation could be a starting point in the prevention of fistulas.
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Affiliation(s)
| | - Pooja Sripad
- Department of Reproductive Health, Population Council, New York, New York, USA
| | - Charity Ndwiga
- Department of Reproductive Health, Population Council Kenya, Nairobi, Kenya
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10
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Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review. Health Equity 2019; 3:36-46. [PMID: 30805570 PMCID: PMC6386073 DOI: 10.1089/heq.2018.0036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We aim to provide a comprehensive overview of the health consequences of female genital mutilation/cutting (FGM/C), with a particular focus on the psychosexual implications of this practice and the overall impact of reconstructive plastic surgery. Methods: A MEDLINE search through PubMed was performed to identify the best quality evidence published studies in English language on long-term health consequences of FGM/C. Results: Women with FGM/C are more likely to develop psychological disorders, such as post-traumatic stress disorder, anxiety, somatization, phobia, and low self-esteem, than those without FGM/C. Most studies showed impaired sexual function in women with FGM/C. In particular, women with FGM/C may be physiologically less capable of becoming sexually stimulated than uncut women. Reconstructive surgery could be beneficial, in terms of both enhanced sexual function and body image. However, prospective studies on the impact of reconstructive surgery are limited, and safety issues should be addressed. Conclusion: Although it is clear that FGM/C can cause devastating immediate and long-term health consequences for girls and women, high-quality data on these issues are limited. Psychosexual complications need to be further analyzed to provide evidence-based guidelines and to improve the health care of women and girls with FGM/C. The best treatment approach involves a multidisciplinary team to deal with the multifaceted FGM/C repercussions.
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Affiliation(s)
- Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Chiappa
- Health Director, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Unit, General Surgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi Milano, Italy
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11
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Gebremicheal K, Alemseged F, Ewunetu H, Tolossa D, Ma'alin A, Yewondwessen M, Melaku S. Sequela of female genital mutilation on birth outcomes in Jijiga town, Ethiopian Somali region: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:305. [PMID: 30029634 PMCID: PMC6053719 DOI: 10.1186/s12884-018-1937-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth. Methods Facility based cohort study, involving 142 parturients with FGM and 139 parturients without FGM, was conducted in Jijiga town from October to December, 2014. The study participants were recruited by consecutive sampling technique. Data were collected using a structured interviewer administered questionnaire and observational checklists. Data were analyzed using SPSS version 16 and STATA version 11. Results The existence of FGM was significantly associated with perinealtear [RR = 2.52 (95% CI 1.26–5.02)], postpartum blood loss [RR = 3.14 (95% CI 1.27–7.78)], outlet obstruction [RR = 1.83 (95% CI 1.19–2.79)] and emergency caesarean section [RR = 1.52 (95% CI 1.04–2.22)]. FGM type I and FGM type II did not demonstrate any association with prolonged 2nd stage of labour, emergency caesarean section, postpartum blood loss, and APGAR score < 7. FGM type III however was significantly associated with prolonged 2nd stage of labour [RR = 2.47 (95% CI 1.06–5.76)], emergency caesarean section [RR = 3.60 (95% CI 1.65–7.86)], postpartum blood loss [RR = 6.37 (95% CI 2.11–19.20] and APGAR score < 7 [RR = 4.41 (95% CI, 1.84–10.60)]. FGM type II and type III were significantly associated with perinealtear [RR = 2.45(95% CI 1.03–5.83)], [RR = 4.91(95% CI 2.46–9.77)] and outlet obstruction [RR = 2.38(95% CI 1.39–4.08)], [RR = 2.94(95% CI 1.84–4.71)] respectively. Conclusion Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive form of FGM. Adverse obstetric outcomes can therefore be added to the known harmful immediate and long-term effects of FGM. Electronic supplementary material The online version of this article (10.1186/s12884-018-1937-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kiros Gebremicheal
- Department of Public Health, Jijiga Health Science College, PO Box 504, Jijiga, Ethiopia.
| | - Fisehaye Alemseged
- Department of Epidemiology and Biostatistics, College of Public Health and Medical Sciences, Jimma University, PO.Box 1104, Jimma, Ethiopia
| | - Haimanot Ewunetu
- Department of Epidemiology and Biostatistics, College of Public Health and Medical Sciences, Jimma University, PO.Box 1104, Jimma, Ethiopia
| | - Daniel Tolossa
- Department of Medical Laboratory Technology, Jijiga Health Science College, PO Box 504, Jijiga, Ethiopia
| | - Abdibari Ma'alin
- Department of Public Health, Jijiga Health Science College, PO Box 504, Jijiga, Ethiopia
| | - Mahlet Yewondwessen
- Department of Public Health, Jijiga Health Science College, PO Box 504, Jijiga, Ethiopia
| | - Samuel Melaku
- Department of Clinical Nursing, Jijiga Health Science College, PO Box 504, Jijiga, Ethiopia
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12
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Varol N, Hall JJ, Black K, Turkmani S, Dawson A. Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting. Reprod Health 2017; 14:63. [PMID: 28521830 PMCID: PMC5437421 DOI: 10.1186/s12978-017-0324-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background The physical and psychological impact of female genital mutilation / cutting (FGM/C) can be substantial, long term, and irreversible. Parts of the health sector in Australia have developed guidelines in the management of FGM/C, but large gaps exist in community and professional knowledge of the consequences and treatment of FGM/C. The prevalence of FGM/C amongst Australian women is unknown. Our article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice. Main body Midwives and doctors in Australia acknowledged a lack of knowledge on FGM/C, clinical guidelines and consequences for maternity care. In a metropolitan Australian hospital with specialised FGM/C care, women with FGM/C had similar obstetric outcomes as women without FGM/C, underlining the importance of holistic FGM/C clinics. Greater focus on integration of refugee and migrant populations into their new cultures may be an important way of facilitating the abandonment of this practice, as is education of communities that practise FGM/C, and experts involved in the care and protection of children. Men could be important advocates for protecting women and girls from violence and FGM/C through a man-to-man strategy with programs focussing on men’s health and other personal issues, education, and communication. The Australian Government has identified gender-based violence as an area of priority and has been implementing a National plan to reduce violence against women and their children 2010–2022. A multidisciplinary network of experts on FGM/C could be established within this taskforce to develop well-defined and rapid referral pathways to care for and protect these children, as well as coordinate education and prevention programs to help communities abandon this harmful practice. Conclusion Countries of migration can be part of the solution for abandonment of FGM/C through community interventions and implementation of national and coordinated training in FGM/C of experts involved in the care and protection of children and women. The global focus on collaboration on research, training and prevention programs should be fostered between countries of FGM/C prevalence and migration.
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Affiliation(s)
- Nesrin Varol
- Sydney Medical School, Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, 2006, Australia.
| | - John J Hall
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, UNSW Sydney, 2052, NSW, Australia
| | - Kirsten Black
- Sydney Medical School, Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Angela Dawson
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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13
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Esu E, Udo A, Okusanya BO, Agamse D, Meremikwu MM. Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis. Int J Gynaecol Obstet 2017; 136 Suppl 1:21-29. [DOI: 10.1002/ijgo.12055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ekpereonne Esu
- Department of Public Health; College of Medical Science; University of Calabar; Calabar Nigeria
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
| | - Atim Udo
- Department of Obstetrics and Gynecology; College of Medical Science; University of Calabar; Calabar Nigeria
| | - Babasola O. Okusanya
- Experimental and Maternal Medicine Unit; Department of Obstetrics and Gynecology; Faculty of Clinical Sciences; College of Medicine; University of Lagos; Idi-Araba, Lagos Nigeria
| | - David Agamse
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
| | - Martin M. Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
- Department of Pediatrics; University of Calabar Teaching Hospital; Calabar Nigeria
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14
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Varol N, Dawson A, Turkmani S, Hall JJ, Nanayakkara S, Jenkins G, Homer CSE, McGeechan K. Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006-2012: a descriptive study. BMC Pregnancy Childbirth 2016; 16:328. [PMID: 27793119 PMCID: PMC5084319 DOI: 10.1186/s12884-016-1123-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/21/2016] [Indexed: 11/19/2022] Open
Abstract
Background Women, who have been subjected to female genital mutilation (FGM), can suffer serious and irreversible physical, psychological and psychosexual complications. They have more adverse obstetric outcomes as compared to women without FGM. Exploratory studies suggest radical change to abandonment of FGM by communities after migration to countries where FGM is not prevalent. Women who had been subjected to FGM as a child in their countries of origin, require specialised healthcare to reduce complications and further suffering. Our study compared obstetric outcomes in women with FGM to women without FGM who gave birth in a metropolitan Australian hospital with expertise in holistic FGM management. Methods The obstetric outcomes of one hundred and ninety-six women with FGM who gave birth between 2006 and 2012 at a metropolitan Australian hospital were analysed. Comparison was made with 8852 women without FGM who gave birth during the same time period. Data were extracted from a database specifically designed for women with FGM and managed by midwives specialised in care of these women, and a routine obstetric database, ObstetriX. The accuracy of data collection on FGM was determined by comparing these two databases. All women with FGM type 3 were deinfibulated antenatally or during labour. The outcome measures were (1) maternal: accuracy and grade of FGM classification, caesarean section, instrumental birth, episiotomy, genital tract trauma, postpartum blood loss of more than 500 ml; and (2) neonatal: low birth weight, admission to a special care nursery, stillbirth. Results The prevalence of FGM in women who gave birth at the metropolitan hospital was 2 to 3 %. Women with FGM had similar obstetric outcomes to women without FGM, except for statistically significant higher risk of first and second degree perineal tears, and caesarean section. However, none of the caesarean sections were performed for FGM indications. The ObstetriX database was only 35 % accurate in recording the correct FGM type. Conclusion Women with FGM had similar obstetric outcomes to women without FGM in an Australian metropolitan hospital with expertise in FGM management. Specialised FGM services with clinical practice guideline and education of healthcare professionals may increase the detection rate of FGM and improve obstetric management of women with FGM. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1123-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nesrin Varol
- Discipline of Obstetrics and Gynaecology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Angela Dawson
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - John J Hall
- Centre for Clinical Epidemiology & Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Sydney, NSW, Australia
| | - Susie Nanayakkara
- Department of Obstetrics and Gynaecology, Auburn Hospital, Sydney, NSW, Australia
| | - Greg Jenkins
- Department of Obstetrics and Gynaecology, Auburn Hospital, Sydney, NSW, Australia.,Discipline of Obstetrics and Gynaecology, School of Medicine, Notre Dame University, Sydney, NSW, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
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15
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Belihu FB, Small R, Davey MA. Variations in first-time caesarean birth between Eastern African immigrants and Australian-born women in public care: A population-based investigation in Victoria. Aust N Z J Obstet Gynaecol 2016; 57:294-301. [DOI: 10.1111/ajo.12491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Fetene B. Belihu
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
| | - Rhonda Small
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
| | - Mary-Ann Davey
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; Monash University; Clayton Vic. Australia
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16
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Andro A, Lesclingand M. Les mutilations génitales féminines. État des lieux et des connaissances. POPULATION 2016. [DOI: 10.3917/popu.1602.0224] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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17
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Cultural change after migration: Circumcision of girls in Western migrant communities. Best Pract Res Clin Obstet Gynaecol 2015; 32:15-25. [PMID: 26644059 DOI: 10.1016/j.bpobgyn.2015.10.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 01/25/2023]
Abstract
This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the 'Pharaonic' type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using--in a cautious way--the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.
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18
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Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center. Int J Gynaecol Obstet 2015; 132:174-8. [DOI: 10.1016/j.ijgo.2015.06.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022]
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19
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Farage MA, Miller KW, Tzeghai GE, Azuka CE, Sobel JD, Ledger WJ. Female genital cutting: confronting cultural challenges and health complications across the lifespan. ACTA ACUST UNITED AC 2015; 11:79-94. [PMID: 25581057 DOI: 10.2217/whe.14.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Female genital cutting affects over 140 million women worldwide. Prevalent in certain countries of Africa and the Middle East, the practice continues among immigrants to industrialized countries. Female genital cutting is a deeply rooted tradition that confers honor on a woman and her family, yet also a traumatic experience that creates significant dermatological, gynecological, obstetric and infectious disease complications. Little is known about postmenopausal health in cut women. The international community views this practice as a human rights violation. In addition to genital health complications, the medical community must confront an understudied concern of what happens as this population ages. These challenges must be addressed to provide optimal care to women affected by female genital cutting.
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Affiliation(s)
- Miranda A Farage
- The Procter & Gamble Company, Winton Hill Business Center, 6110 Center Hill Road, Cincinnati, OH 45224, USA
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20
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Filippi MK, Faseru B, Baird M, Ndikum-Moffor F, Greiner KA, Daley CM. A pilot study of health priorities of Somalis living in Kansas City: laying the groundwork for CBPR. J Immigr Minor Health 2015; 16:314-20. [PMID: 23124631 DOI: 10.1007/s10903-012-9732-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
African immigrant and refugee communities remain medically underserved in the United States. Formative efforts are being directed to address the local needs of communities by researchers, community agencies, and local populations. However, there is a paucity of data and sparse documentation regarding these efforts. The objectives for this pilot study were to identify the health priorities of the Kansas City Somali community and to establish a working relationship between an academic medical university and the local Somali community. Our team used community-based participatory research principles and interviewed Somali community members (n = 11). Participants stated that chronic and mental health conditions were of primary concern. Medical system navigation and literacy struggles were identified as barriers. Participants offered possible solutions to some health issues, e.g., using community health workers and Qur'anic readers. Preliminary findings will help guide future research and inform strategies to improve the health and well-being of this community.
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Affiliation(s)
- Melissa K Filippi
- Department of Family Medicine, University of Kansas Medical Center, MS 1030, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA,
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21
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Albert J, Bailey E, Duaso M. Does the timing of deinfibulation for women with type 3 female genital mutilation affect labour outcomes? ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.6.430] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Juliet Albert
- Specialist FGM Midwife Imperial College Healthcare NHS Trust
| | - Elizabeth Bailey
- Midwife Research Fellow Coventry University and University Hospitals Coventry Warwickshire NHS Trust
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22
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Bakken KS, Skjeldal OH, Stray-Pedersen B. Higher risk for adverse obstetric outcomes among immigrants of African and Asian descent: a comparison study at a low-risk maternity hospital in Norway. Birth 2015; 42:132-40. [PMID: 25847218 DOI: 10.1111/birt.12165] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immigrants have higher risks for some adverse obstetric outcomes, and 40 percent of women giving birth at the low-risk maternity ward in Baerum Hospital, Norway, are immigrants. This study compared obstetric outcomes between immigrants and ethnic Norwegians giving birth in a low-risk setting. METHODS This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period to immigrant and ethnic Norwegian women at Baerum Hospital from 2006 to 2010. The main outcome measures were onset of labor, operative vaginal delivery, cesarean delivery, episiotomy, postpartum bleeding > 500 mL, epidural analgesia, labor dystocia, gestational age, meconium-stained liquor, 5-minute Apgar score, birthweight, and transfer to a neonatal intensive care unit. RESULTS A total of 11,540 women originating from 141 countries were divided into seven groups. Compared with Norwegians, women from East, Southeast, and Central Asia had increased risk for operative vaginal delivery, postpartum bleeding, and low Apgar score. The African women had increased risk for postterm birth, meconium-stained liquor, episiotomy, operative vaginal delivery, emergency cesarean delivery, postpartum bleeding, low Apgar score, and low birthweight. Women from South and Western Asia had increased risk for low birthweight. CONCLUSION Obstetric outcomes of immigrants differ significantly from those of Norwegians, even in a low-risk maternity unit. Thus, immigrant women would benefit from more targeted care during pregnancy and childbirth, even in low-risk settings.
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Affiliation(s)
- Kjersti S Bakken
- Department of Gynecology and Obstetrics, Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola H Skjeldal
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Ghotenburg, Sweden
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Women and Children's Division, Oslo University Hospital, Oslo, Norway.,Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway
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23
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Female Genital Mutilations: Genito-Urinary Complications and Ethical-Legal Aspects. Urologia 2015; 82:151-9. [DOI: 10.5301/uro.5000115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/20/2022]
Abstract
Many women in the world are still undergoing female genital mutilations (FGMs) even if in almost all the countries, the practice of FGM is illegal. The increase of immigration, particularly from African Countries, to Europe, and Italy too, led to consider this phenomenon with particular attention and skill. All the operators in health services need to know the different types of FGMs and the related complications and the psychological and sexual sequels. Urological complications, in particular, are not rare and the changing anatomy of the external genital apparatus can also make the catheter insertion sometimes difficult. This review analyzes the epidemiology of FGMs, the reasons why the practice is still made, the complications, the ethical, and the principal legal aspects of this practise that must be hopefully early banned.
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24
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Abdulcadir J, Rodriguez MI, Say L. Research gaps in the care of women with female genital mutilation: an analysis. BJOG 2014; 122:294-303. [DOI: 10.1111/1471-0528.13217] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J Abdulcadir
- Department of Obstetrics and Gynaecology; Geneva University Hospitals; Geneva Switzerland
- Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - MI Rodriguez
- Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - L Say
- Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
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25
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An updated systematic review and meta-analysis of the obstetric consequences of female genital mutilation/cutting. Obstet Gynecol Int 2014; 2014:542859. [PMID: 25505915 PMCID: PMC4258320 DOI: 10.1155/2014/542859] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022] Open
Abstract
In our recent systematic review in Obstetrics and Gynecology International of the association between FGM/C and obstetric harm we concluded that FGM/C significantly increases the risk of delivery complications. The findings were based on unadjusted effect estimates from both prospective and retrospective studies. To accommodate requests by critics, we aimed to validate these results through additional analyses based on adjusted estimates from prospective studies. We judged that 7 of the 28 studies included in our original systematic review were prospective. Statistical adjustments for measured confounding factors were made in eight studies, including three prospective studies. The adjusted confounders differed across studies in number and type. Results from meta-analyses based on adjusted estimates, with or without data from retrospective studies, consistently pointed in the same direction as our earlier findings. There were only small differences in the sizes or the level of statistical significance. Using GRADE, we assessed that our confidence in the effect estimates was very low or low for all outcomes. The adjusted estimates generally show similar obstetric harms from FGM/C as unadjusted estimates do. Thus, the current analyses confirm the findings from our previous systematic review. There are sufficient grounds to conclude that FGM/C, with respect to obstetric circumstances, involves harm.
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26
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Berg RC, Underland V, Odgaard-Jensen J, Fretheim A, Vist GE. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open 2014; 4:e006316. [PMID: 25416059 PMCID: PMC4244458 DOI: 10.1136/bmjopen-2014-006316] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Rigmor C Berg
- Norwegian Knowledge Center for the Health Services, Oslo, Norway
| | - Vigdis Underland
- Norwegian Knowledge Center for the Health Services, Oslo, Norway
| | | | - Atle Fretheim
- Norwegian Knowledge Center for the Health Services, Oslo, Norway
| | - Gunn E Vist
- Norwegian Knowledge Center for the Health Services, Oslo, Norway
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27
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Minsart AF, N'guyen TS, Ali Hadji R, Caillet M. Maternal infibulation and obstetrical outcome in Djibouti. J Matern Fetal Neonatal Med 2014; 28:1741-6. [DOI: 10.3109/14767058.2014.967676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Andro A, Cambois E, Lesclingand M. Long-term consequences of female genital mutilation in a European context: self perceived health of FGM women compared to non-FGM women. Soc Sci Med 2014; 106:177-84. [PMID: 24565761 DOI: 10.1016/j.socscimed.2014.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 12/02/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
Female genital mutilation (FGM) concerns an estimated half a million women in Europe. The studies based in countries where migrant women have settled highlight the need for more accurate information on FGM health consequences, in a European health care context. Excision and Handicap (ExH) is a multi-centric survey based on case-control methodology and conducted in France to assess the long-term consequences of FGM, sampling both FGM and non-FGM adult women. The interviews were conducted in 74 mother-and-child health centres and hospital departments providing gynaecological and family planning services in five French regions. The two groups were compared on health indicators (self-perceived health, illnesses, symptoms) and functioning indicators (daily, sexual and reproductive life) for cases (n = 678) and controls (n = 1706). Multivariate logistic models highlighted FGM-related health problems. Among women living in France, FGM was significantly associated with poor health indicators: gynaecological and urinary infections (OR = 2.0), sleep disorders (OR = 1.4), intense pain (OR = 1.5), difficulties in daily life (OR = 1.5) and in sexual life (OR = 1.7) or tearing during childbirth (OR = 1.6). Our results suggest that, even in a favourable healthcare context, FGM exposes women to long-term health problems, including in areas neglected in previous research. They confirm the need to establish recommendations to help physicians understand these women's needs.
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Affiliation(s)
- Armelle Andro
- Demography Institute Pantheon-Sorbonne University, Paris, France; National Institute for Demographic Studies, Paris, France.
| | | | - Marie Lesclingand
- National Institute for Demographic Studies, Paris, France; Nice Sophia Antipolis University, Nice, France
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29
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Paliwal P, Ali S, Bradshaw S, Hughes A, Jolly K. Management of type III female genital mutilation in Birmingham, UK: A retrospective audit. Midwifery 2014; 30:282-8. [DOI: 10.1016/j.midw.2013.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/10/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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30
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Female genital circumcision/mutilation: implications for female urogynaecological health. Int Urogynecol J 2013; 24:2021-7. [PMID: 23857065 DOI: 10.1007/s00192-013-2160-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
"Female genital circumcision" or "female genital mutilation", as it is called more often, is an operation that is primarily carried out in Africa. Owing to migration, physicians are increasingly confronted with this issue in Western countries as well. A range of negative effects may result from this operation and this article aims to address consequences for female pelvic health. Special emphasis is placed on urogynaecological health consequences; in particular, on "voiding difficulties", "recurrent urinary tract infections" and "vesicovaginal fistula". All of these occur mostly in infibulated women, i.e. in women whose genitalia are sealed by the most severe form of circumcision. Some of the problems that may emerge as a result of the operation can be resolved by defibulation (i.e. surgical reopening of the sealed vulva). Female genital circumcision is a sensitive topic even in the area of research and reliable data are therefore scarce.
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Råssjö EB, Byrskog U, Samir R, Klingberg-Allvin M. Somali women's use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali immigrants with native-born Swedish women. SEXUAL & REPRODUCTIVE HEALTHCARE 2013; 4:99-106. [PMID: 24041730 DOI: 10.1016/j.srhc.2013.06.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 05/14/2013] [Accepted: 06/18/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe how Somali immigrant women in a Swedish county use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies. STUDY DESIGN Retrospective, case-control study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009. MAIN OUTCOME MEASURES Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality). RESULTS Compared to the 523 Swedish-born women the 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and a few patients were found to have very serious health conditions. Emergency caesarean section (OR 1.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent. CONCLUSION Pregnant Somali immigrant women still constitute a vulnerable group, which implicates that there is a missing link in the surveillance system that needs attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.
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Affiliation(s)
- Eva Britta Råssjö
- Department of Obstetrics and Gynaecology, Falun Hospital, Falun, Sweden; Center for Clinical Research, Dalarna, Sweden.
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Berg RC, Underland V. The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstet Gynecol Int 2013; 2013:496564. [PMID: 23878544 PMCID: PMC3710629 DOI: 10.1155/2013/496564] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022] Open
Abstract
Various forms of female genital mutilation/cutting (FGM/C) have been performed for millennia and continue to be prevalent in parts of Africa. Although the health consequences following FGM/C have been broadly investigated, divergent study results have called into question whether FGM/C is associated with obstetric consequences. To clarify the present state of empirical research, we conducted a systematic review of the scientific literature and quantitative meta-analyses of the obstetric consequences of FGM/C. We included 44 primary studies, of which 28 were comparative, involving almost 3 million participants. The methodological study quality was generally low, but several studies reported the same outcome and were sufficiently similar to warrant pooling of effect sizes in meta-analyses. The meta-analyses results showed that prolonged labor, obstetric lacerations, instrumental delivery, obstetric hemorrhage, and difficult delivery are markedly associated with FGM/C, indicating that FGM/C is a factor in their occurrence and significantly increases the risk of delivery complications. There was no significant difference in risk with respect to cesarean section and episiotomy. These results can make up the background documentation for health promotion and health care decisions that inform work to reduce the prevalence of FGM/C and improve the quality of services related to the consequences of FGM/C.
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Affiliation(s)
- Rigmor C. Berg
- Norwegian Knowledge Center for the Health Services, P.O. Box 7004, St. Olavsplass, N-0130 Oslo, Norway
| | - Vigdis Underland
- Norwegian Knowledge Center for the Health Services, P.O. Box 7004, St. Olavsplass, N-0130 Oslo, Norway
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BERGGREN VANJA, GOTTVALL KARIN, ISMAN ELISABETH, BERGSTRÖM STAFFAN, EKÉUS CECILIA. 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 2012; 92:101-8. [DOI: 10.1111/aogs.12010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Defibulation During Vaginal Delivery for Women With Type III Female Genital Mutilation. Obstet Gynecol 2012; 120:98-103. [DOI: 10.1097/aog.0b013e3182590343] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brown E, Carroll J, Fogarty C, Holt C. "They get a C-section...they gonna die": Somali women's fears of obstetrical interventions in the United States. J Transcult Nurs 2011; 21:220-7. [PMID: 20519725 DOI: 10.1177/1043659609358780] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors explore sources of resistance to common prenatal and obstetrical interventions among 34 Somali resettled adult women in Rochester, New York. Results of individual interviews and focus groups with these women revealed aversion to or outright fear of cesarean sections because of fear of death and substantial resistance regarding other obstetrical interventions. Because Somali women expressed resistance to many common U.S. prenatal/obstetrical care practices, educating health professionals about Somali women's fears and educating Somali women about common obstetrical practices are both necessary to improve maternity care for non-Bantu and Bantu Somali women.
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Affiliation(s)
- Elizabeth Brown
- University of Rochester Medical Center, Rochester, NY 14620, USA.
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Johnsdotter S, Essén B. Genitals and ethnicity: the politics of genital modifications. REPRODUCTIVE HEALTH MATTERS 2010; 18:29-37. [PMID: 20541081 DOI: 10.1016/s0968-8080(10)35495-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The discrepancy in societal attitudes toward female genital cosmetic surgery for European women and female genital cutting in primarily African girl children and women raises the following fundamental question. How can it be that extensive genital modifications, including reduction of labial and clitoral tissue, are considered acceptable and perfectly legal in many European countries, while those same societies have legislation making female genital cutting illegal, and the World Health Organization bans even the "pricking" of the female genitals? At present, tensions are obvious as regards the modification of female genitalia, and current legislation and medical practice show inconsistencies in relation to women of different ethnic backgrounds. As regards the right to health, it is questionable both whether genital cosmetic surgery is always free of complications and whether female genital cutting always leads to them. Activists, national policymakers and other stakeholders, including cosmetic genital surgeons, need to be aware of these inconsistencies and find ways to resolve them and adopt non-discriminatory policies. This is not necessarily an issue of either permitting or banning all forms of genital cutting, but about identifying a consistent and coherent stance in which key social values - including protection of children, bodily integrity, bodily autonomy, and equality before the law - are upheld.
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Abstract
OBJECTIVE To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor. METHODS A comparison was made between 255 fistula patients who had undergone type I or type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age; parity; length of labor; labor outcome (stillbirth or not); type of fistula; site, size, and scarring of fistula; outcomes of surgery (fistula closed; persistent incontinence with closed fistula; urinary retention with overflow; site, size, and scarring of any rectovaginal fistula; and operation outcomes), and specific methods used during the operation (use of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure. RESULTS The only statistically significant differences between the two groups (P=.05) were a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, a slightly higher use of a pubococcygeal sling at the time of fistula repair, and a slightly longer length of labor (by 0.3 day) in women who had undergone genital cutting. CONCLUSION Type I and type II female genital cutting are not independent causative factors in the development of obstetric fistulae from obstructed labor.
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Wuest S, Raio L, Wyssmueller D, Mueller MD, Stadlmayr W, Surbek DV, Kuhn A. Effects of female genital mutilation on birth outcomes in Switzerland. BJOG 2009; 116:1204-9. [PMID: 19459862 DOI: 10.1111/j.1471-0528.2009.02215.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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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Affiliation(s)
- S Wuest
- Department of Obstetrics and Gynaecology, University of Berne and Inselspital Berne, Berne, Switzerland
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