The Lancet
GENEVA -- A new study published by the World Health Organization (WHO) has shown that women who have had Female Genital Mutilation (FGM) are significantly more likely to experience difficulties during childbirth and that their babies are more likely to die as a result of the practice.
Serious complications during childbirth include the need to have a caesarean section, dangerously heavy bleeding after the birth of the baby and prolonged hospitalization following the birth. The study showed that the degree of complications increased according to the extent and severity of the FGM.
A new study published by the World Health Organization (WHO) has shown that women who have had Female Genital Mutilation (FGM) are significantly more likely to experience difficulties during childbirth and that their babies are more likely to die as a result of the practice.
In the case of caesarean section, women who have been subjected to the most serious form of FGM ("FGM III") will have on average 30 per cent more caesarean sections compared with those who have not had any FGM. Similarly there is a 70 per cent increase in numbers of women who suffer from postpartum haemorrhage in those with FGM III compared to those women without FGM.*
"As a result of this study we have, for the first time, evidence that deliveries among women who have been subject to FGM are significantly more likely to be complicated and dangerous," said Joy Phumaphi, Assistant Director-General, Family and Community Health, WHO. " FGM is a practice steeped in culture and tradition but it should not be allowed to carry on. We must support communities in their efforts to abandon the practice and to improve care for those who have undergone FGM. We must also steadfastly resist the medicalization of FGM. WHO is totally opposed to FGM being carried out by medical personnel."
The study also found that FGM put the women's babies in substantial danger during childbirth. Researchers found there was an increased need to resuscitate babies whose mother had had FGM (66% higher in women with FGM III). The death rate among babies during and immediately after birth is also much higher for those born to mothers with FGM: 15% higher in those with FGM I, 32% higher in those with FGM II, and 55% higher in those with FGM III. It is estimated that in the African context an additional 10 to 20 babies die per 1000 deliveries as a result of the practice.
"This research was carried out in hospitals where the obstetric staff are used to dealing with women who have undergone FGM. The consequences for the countless women and babies who deliver at home without the help of experienced staff are likely to be even worse," added WHO's Dr Paul Van Look, Director of the Special Programme for Human Reproduction Research (HRP) which organized the study.
The study involved 28,393 women at 28 obstetric centres in six countries, where FGM is common - Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. The centres varied from relatively isolated rural hospitals to teaching hospitals in capital cities. They were chosen to provide appropriate diversity of types of FGM.
"These findings are of great importance for countries," said Professor Saad M El Fadil, the study Principal Investigator in Sudan. "This high-quality research was carried out in numerous hospitals in African countries where FGM is common and for the first time gives clear evidence of its harmful effects for women and babies."
FGM is a common practice in a number of countries, predominantly in Africa. It involves partial or total removal of the external female genitalia or other deliberate injury to the female genital organs whether for cultural or non- therapeutic reasons. Over 100 million women and girls are estimated to have had FGM worldwide.
Although practices vary from country to country, FGM is generally performed on girls under 10 years of age and leads to varying amounts of scar formation. It is not entirely clear why FGM leads to increased complications during childbirth, but one possible explanation is that this scar tissue is relatively inelastic and can lead to obstruction and tearing of the tissues around the vagina during childbirth. Obstruction can lead to prolonged labour, which increases the risk of caesarean section, heavy bleeding, distress in the infant and stillbirth. Women with FGM are also more likely to undergo episiotomy (surgical cut during delivery to prevent vaginal tears).
According to Associate Professor Emily Banks of the Australian National University, "This study shows that where around 5.0% of babies born to women without FGM were stillborn or died shortly after delivery, this figure increased to 6.4% in babies born to women with FGM. In many parts of Africa death rates are even higher and the impact of FGM is likely to be even greater."
The authors of the study say that this new evidence is of crucial importance to communities where FGM is practiced, both for the women who have had FGM and to protect future generations of women and girls from FGM. FGM remains a pressing human rights issue and reliable evidence regarding its harmful effects, both for mothers and their babies, should contribute to the abandonment of the practice. WHO is committed to work with international partners and countries to eliminate FGM. It is in direct violation of young girls’ rights, has both short-term and long-term adverse health consequences, and is an unnecessary procedure.
*Note: Female genital mutilation (FGM), often referred to as 'female circumcision', covers all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons. There are different types of female genital mutilation known to be practised today. They include:
- Type I (FGM 1) - excision of the prepuce, with or without excision of part or all of the clitoris;
- Type II (FGM II) - excision of the clitoris with partial or total excision of the labia minora;
- Type III (FGM III) - excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)
