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

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      Abstract

      Background

      Female 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.

      Methods

      Data 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.

      Results

      The 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.

      Conclusion

      This 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.

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      Most cited references 51

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      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.
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        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.
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          Posttraumatic stress disorder and memory problems after female genital mutilation.

          This pilot study investigated the mental health status of women after genital mutilation. Although experts have assumed that circumcised women are more prone to developing psychiatric illnesses than the general population, there has been little research to confirm this claim. It was predicted that female genital mutilation is associated with a high rate of posttraumatic stress disorder (PTSD). The psychological impact of female genital mutilation was assessed in 23 circumcised Senegalese women in Dakar. Twenty-four uncircumcised Senegalese women served as comparison subjects. A neuropsychiatric interview and further questionnaires were used to assess traumatization and psychiatric illnesses. The circumcised women showed a significantly higher prevalence of PTSD (30.4%) and other psychiatric syndromes (47.9%) than the uncircumcised women. PTSD was accompanied by memory problems. Within the circumcised group, a mental health problem exists that may furnish the first evidence of the severe psychological consequences of female genital mutilation.
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            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

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