Exploring the association between FGM/C and fistula: A review of the evidence

Abstract

The Evidence to End FGM/C programme consortium generates evidence to inform and influence investments, policies, and programs for ending female genital mutilation/cutting in different contexts. Evidence to End FGM/C is led by the Population Council in partnership with the Africa Coordination Centre for

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

“…Multivariate logistic regression was used to assess associations between fistula and FGM/C, adjusting for other possible covariates. The choice of independent variables (possible covariates of fistula) was informed by an extensive literature review that identified underlying socioeconomic and contextual factors, including gender and sociocultural norms that affect both FGM/C and fistula 32. The review, for instance, showed that poverty, unemployment, living in a rural area, limited access to health services and malnutrition (stunting) increased the likelihood of women undergoing FGM/C and developing fistula.…”

“…The review, for instance, showed that poverty, unemployment, living in a rural area, limited access to health services and malnutrition (stunting) increased the likelihood of women undergoing FGM/C and developing fistula. In addition, the level of education has been associated with a family’s choice to continue or abandon FGM/C and improves awareness about the importance of antenatal care (ANC) and facility delivery to prevent fistula 32…”

“…Based on the literature review conducted by Sripad et al 32 exploring the association between FGM/C and fistula,32 we conducted multivariate logistic regression analysis to explore the relationship between FGM/C and fistula symptoms using data from DHS. We hypothesised that FGM/C status predisposes women to fistula symptoms (Logit Model I), but that this relationship can be confounded by socioeconomic factors (Logit Model II) and a woman’s geographical context and access to health services (Logit Model III).…”

“…A meta-analysis on the obstetric consequences of FGM/C demonstrated that despite methodologically low quality studies, effect sizes of exposure to FGM/C show elevated associated risk of childbirth complications including prolonged labour, obstetric lacerations, instrumental delivery, obstetric haemorrhage and difficult delivery 11. Some studies have suggested that the pathway through which FGM/C is linked to fistula is through its association with prolonged/obstructed labour, particularly types I, II and III where FGM/C-induced scarring can cause obstructed labour 32 34–36…”

Health Consequences of the Female Genital Mutilation: A Systematic Review Running title: Health Consequences of Female Genital Mutilation

“…Other studies reported indirect mechanisms through, which FGM affected fistula in relation to health consequences including those that might occur at childbirth, and get moderated by the levels of clinical management. Some studies found that at the time of, and immediately following, cutting procedures (particularly infibula-tion), women were at the risk of urinary, and traumatic fistula [19].…”