An Updated Systematic Review and Meta-Analysis of the Obstetric Consequences of Female Genital Mutilation/Cutting

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.

Epidemiology, Regional Characteristics, Knowledge, and Attitude Toward Female Genital Mutilation/Cutting in Southern Iran

“…Chronic urinary and reproductive tract infections and PID are also linked with FGM. These problems are of particular importance because they are among the leading causes of infertility [8,25]. We also found that UTI and bleeding were the most common reported complications, while cyst formation and infertility were the least common complications.…”

“…FGM/C has been associated with several health consequences including long‐term and short‐term complications [8,25,26]. As many women undergo FGM in infancy, they may not experience any immediate adverse effects.…”

Urological complications in women with genital mutilation

“…Patients underwent Type III FGM (narrowing of the vaginal opening through the creation of a covering seal formed by cutting and repositioning through suturing the labia minora or labia majora) or Type IV FGM (all other procedures as pricking, piercing, incising, scraping and cauterizing the genital area) were more prone to develop recurrent UTIs. In these cases the etiology is bladder outlet obstruction and incomplete bladder emptying [10][11][12].…”

Preventing female genital mutilation in high income countries: a systematic review of the evidence

“…This is a more detailed description of practices than the one offered by UNICEF [2]. FGM, also known as female genital cutting or female circumcision, has serious health consequences that may lead to death from haemorrhage and/or infection, urinary and genital tract infections, gynaecological, obstetric, sexual and psycho-social complications or death from haemorrhage [3–5]. While the prevalence of FGM is decreasing and varies across countries [6] UNICEF has estimated that more than 200 million of girls and women have undergone Female Genital Mutilation (FGM) globally and three million girls may be at risk of undergoing FGM every year [7].…”