Blog
About

  • Record: found
  • Abstract: found
  • Article: not found

Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn

Read this article at

ScienceOpenPublisherPMC
Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      BackgroundFemale genital mutilation/cutting (FGM/C) is a harmful traditional practice deeply rooted in 28 Sub-Saharan African countries. Its prevalence in The Gambia is 76.3%. The objective of this study was to gain precise information on the long-term health consequences of FGM/C in The Gambia as well as on its impact on delivery and on the health of the newborns.MethodsData were collected from 588 female patients examined for antenatal care or delivery in hospitals and health centers of the Western Health Region, The Gambia. The information collected, both through a questionnaire and medical examination, included sociodemographic factors, the presence or not of FGM/C, the types of FGM/C practiced, the long-term health consequences of FGM/C, complications during delivery and for the newborn. Odds ratios, their 95% confidence intervals, and P values were calculated.ResultsThe prevalence of patients who had undergone FGM/C was 75.6% (type I: 75.6%; type II: 24.4%). Women with type I and II FGM/C had a significantly higher prevalence of long-term health problems (eg, dysmenorrhea, vulvar or vaginal pain), problems related to anomalous healing (eg, fibrosis, keloid, synechia), and sexual dysfunction. Women with FGM/C were also much more likely to suffer complications during delivery (perineal tear, obstructed labor, episiotomy, cesarean, stillbirth) and complications associated with anomalous healing after FGM/C. Similarly, newborns were found to be more likely to suffer complications such as fetal distress and caput of the fetal head.ConclusionThis study shows that FGM/C is associated with a variety of long-term health consequences, that women with FGM/C are four times more likely to suffer complications during delivery, and the newborn is four times more likely to have health complications if the parturient has undergone FGM/C. These results highlight for the first time the magnitude of consequences during delivery and for the newborn, associated with FGM/C in The Gambia.

      Related collections

      Most cited references 51

      • Record: found
      • Abstract: found
      • Article: not found

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

      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. 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. 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. 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.
        Bookmark
        • Record: found
        • Abstract: found
        • Article: found
        Is Open Access

        Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

        Background Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. Methods We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. Conclusion Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.
          Bookmark
          • Record: found
          • Abstract: found
          • Article: not found

          The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey.

          This paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15-54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25-2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46-6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin's cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.
            Bookmark

            Author and article information

            Affiliations
            [1 ]Chair of Social Knowledge Transfer/Parc de Recerca UAB – Santander, Department of Social and Cultural Anthropology, Universitat Autònoma de Barcelona, Barcelona, Spain
            [2 ]Interdisciplinary Group for the Study and Prevention of Harmful Traditional Practices, Department of Social and Cultural Anthropology, Universitat Autónoma de Barcelona, Barcelona Spain
            [3 ]Wassu Gambia Kafo, Fajara F Section, Banjul, The Gambia
            [4 ]School of Enrolled Community Health Nurses and Midwives, Ministry of Health, Mansakonko, Lower River Region, The Gambia
            [5 ]Africa and Latin America Research Group, Unit of Biostatistics, Faculty of Medicine, Autonomus University of Barcelona, Barcelona, Spain
            Author notes
            Correspondence: Adriana Kaplan Departamento de Antropología Social y Cultural, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain Tel +346 9679 0197 Email adriana.kaplan@ 123456uab.cat
            Journal
            Int J Womens Health
            Int J Womens Health
            International Journal of Women's Health
            International Journal of Women's Health
            Dove Medical Press
            1179-1411
            2013
            17 June 2013
            : 5
            : 323-331
            23843705
            3702244
            10.2147/IJWH.S42064
            ijwh-5-323
            © 2013 Kaplan et al, publisher and licensee Dove Medical Press Ltd

            This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

            Categories
            Original Research

            Comments

            Comment on this article