Study of the effectiveness of training Malian social and health agents in female genital cutting issues and in educating their clients

Obstetrics and Gynecology International

Underland

2013

158

138

Various forms of female genital mutilation/cutting (FGM/C) have been performed for millennia and continue to be prevalent in parts of Africa. Although the health consequences following FGM/C have been broadly investigated, divergent study results have called into question whether FGM/C is associated with obstetric consequences. To clarify the present state of empirical research, we conducted a systematic review of the scientific literature and quantitative meta-analyses of the obstetric consequences of FGM/C. We included 44 primary studies, of which 28 were comparative, involving almost 3 million participants. The methodological study quality was generally low, but several studies reported the same outcome and were sufficiently similar to warrant pooling of effect sizes in meta-analyses. The meta-analyses results showed that prolonged labor, obstetric lacerations, instrumental delivery, obstetric hemorrhage, and difficult delivery are markedly associated with FGM/C, indicating that FGM/C is a factor in their occurrence and significantly increases the risk of delivery complications. There was no significant difference in risk with respect to cesarean section and episiotomy. These results can make up the background documentation for health promotion and health care decisions that inform work to reduce the prevalence of FGM/C and improve the quality of services related to the consequences of FGM/C.

Section: Figurementioning

confidence: 65%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Obstetric Consequences of Female Genital Mutilation/Cutting: A Systematic Review and Meta-Analysis

Obstetrics and Gynecology International

Underland

2013

158

138

“…In these studies, exposure data were gathered from female study participants during an antepartum examination, followed by an assessment of outcome data during the delivery situation. In two additional studies it was unclear whether data were collected prospectively [24, 26]. Adjusted estimates were reported in eight of the 28 studies [7, 8, 22, 27–29, 37, 39].…”

Section: Resultsmentioning

confidence: 99%

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

Obstetrics and Gynecology International

Odgaard‐Jensen

Fretheim

et al. 2014

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.

“…The studies formed five broad categories of intervention: (i) training,19 (ii) formal classroom education,20 (iii) media communication,21 (iv) outreach and advocacy,22 and (v) informal adult education 23 – 31. All eight studies compared an intervention group with a group that received no intervention, except one in which the control group received education 22.…”

Section: Resultsmentioning

confidence: 99%

A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls

Paediatrics and International Child Health

Denison

2013

Background: Female genital mutilation/cutting (FGM/C) is a traditional practice which involves the partial or total removal or other injury to the female genital organs for non-medical reasons. Although current trends indicate that the practice is becoming less prevalent, as many as 30 million girls may still be at risk of FGM/C. Given the associated risks and violation of the human rights of girls and women, the practice is discouraged through preventative interventions.Aims: To systematically review the effectiveness of anti-FGM/C interventions, applying a realist perspective.Methods: The realist synthesis approach addressed context-mechanisms-outcomes (CMO) underlying intervention in an attempt to explain interventions’ success or lack thereof. The process involved exposed the usefulness of strategies in different contexts.Results: Eight effectiveness studies and 27 context studies were included. All of the effectiveness studies employed a controlled, before-and-after study design. They formed five broad categories of intervention: training, formal classroom education, media communication, outreach and advocacy, and informal adult education. The CMO configurations showed that the proposed engine behind changing behaviours regarding FGM/C appeared largely to be dissemination of information. Some interventions’ acceptability and success rested on the incorporation of FGM/C abandonment efforts within a larger set of related issues. However, greater success of the interventions could have materialised with systematic pre-planning involving thorough community analyses and securing religious leaders’ commitment to halting FGM/C.Conclusion: The results of this analysis point to conditions that facilitate the success of FGM/C abandonment programmes in different contexts and can be used in future prevention efforts to reduce the risk of girls being subjected to FGM/C.