Female genital mutilation: Obstetric outcomes in metropolitan Sydney

Abstract

Background: Female genital mutilation (FGM) and its impact on women's health are becoming relevant in Australia due to increases in numbers of refugees and migrants from affected countries. Notwithstanding the psychological trauma from FGM, there is a broad range of sequelae relevant to obstetrics and gynaecology, particularly related to maternal morbidity from labour and delivery. Aims:To assess the prevalence of FGM in our unit and document its effect on maternal and neonatal outcomes. Methods:Retrospective cohort study of women affected by FGM who delivered at a metropolitan hospital in Sydney over a five-year period. The primary outcome was mode of delivery and secondary outcomes addressed maternal morbidity and neonatal nursery admission compared with women unaffected by FGM. Results:A full data set was available for 141/142 women affected by FGM. The overall prevalence of FGM was 1.64%. The majority of women affected by FGM were documented to have FGM 3 (41.1%). There was no difference in caesarean section rate. Women with FGM were less likely to be delivered by vacuum or forceps (11.1% vs 2.8%; P = 0.0009). There was no difference in perineal trauma, postpartum haemorrhage and neonatal nursery admission. Women with FGM 3 were more likely to have an episiotomy (4.8% vs 25.9%; P = 0.0007) without an increase in anal sphincter injury (P = 0.7). Documentation complying with local policy and guidelines was poor.Conclusions: FGM is increasingly common in Australia. This study adds to the Australian literature quantifying the effects on obstetric outcomes in these high-risk women.

Female genital mutilation/cutting, timing of deinfibulation, and risk of cesarean section

“…Data were extracted from medical files with descriptions of FGM type, deinfibulation, and indication for cesarean section. The sample size was larger than in previous clinical studies in western countries 6‐8,22 . The cohort comprised population‐based uptake areas in both urban and rural settings, so we assume that there was minimum selection bias with respect to inclusion.…”

“…The impact of female genital mutilation/cutting (FGM/C) on obstetric outcomes remains unclear, as research findings differ. Most studies conducted in Africa have reported associations between FGM/C and adverse obstetric outcomes; 1‐5 however, several investigations in high‐income countries have reported that outcomes among women with FGM/C are comparable to the general population 6‐10 . Some African studies that accounted for delivery setting and medical and socioeconomic risk factors have reported that FGM/C shows no associations with severe adverse outcomes 11,12 .…”

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

“…Some studies investigating health consequences of FGC group all types of FGC together 54 . Many studies, however, differentiate types of FGC in their methods, using the WHO classification, but still make broad generalizations in their conclusion, stating that FGC causes a certain health outcome, without specifying which type of FGC 5557 …”

“A lot of them have scary tears during childbirth…” experiences of healthcare workers who care for genitally mutilated females

“…However, the practice of FGM/C is found to a lesser degree in other parts of the world [4], such as in certain ethnic groups in Central and South America [5], as well as the developed world. This is due to the rise in international migration, which has increased the number of girls and women living in the various diaspora populations, including in Europe, North America and Australia, who have undergone or may undergo this practice [4,6].…”