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Female genital mutilation, obstetric outcomes and primary infertility.

Reliable evidence concerning the effect of female genital mutilation (FGM) on obstetric outcome is scarce. To address this, a study was conducted from November 2001-March 2003 with 28,393 women in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. Participants were examined before delivery to ascertain whether or not they had undergone FGM and the type classified. Participants and infants were followed up after hospital discharge. Compared with women who had not undergone FGM, women with FGM I, II and III were at greater risk of certain obstetric complications: caeserean section, post-partum haemorrhage, extended maternal hospital stay, infant resuscitation, stillbirth or early neonatal death and low birthweight. Parity did not significantly affect these relative risks. FGM is estimated to lead to an additional 1-2 perinatal deaths per 100 deliveries. Study outcomes were limited to those occurring within hospital settings. Longer-term outcomes such as post-partum infections, fistulae and later neonatal or infant mortality could therefore not be investigated. (1) A commentary summarises the study findings as: "the more brutal the procedure, the worse the complications". There is an apparent decline of the practice, and it is hoped that these findings will be combined with legislation, public education and sustained campaigning for the elimination of FGM. (2)

A case-control study of 99 infertile women in Khartoum, Sudan, investigated the possible association between female genital mutilation (FGM) and primary infertility. The women underwent diagnostic laparoscopy. Of the 99 women with primary infertility examined, 48 had adnexal pathology indicative of previous inflammation. After controlling for other risk factors, these women had significantly higher risk than a control group of having undergone the most extensive form of FGM, that involves the labia majora. The anatomical extent of FGM, rather than whether or not the vulva had been sutured or closed, was associated with primary infertility. (3)

(1.) WHO Study Group on Female Genital Mutilation and Obstetric Outcome. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 2006;367:1835-41.

(2.) Eke N, Nkanginieme KEO. Female genital mutilation and obstetric outcome (Comment]. Lancet 2006;367: 1799-80.

(3.) Almroth L, Elmusharaf S, El Hadi N, et al. Primary infertility after genital mutilation in girlhood in Sudan: a case-control study. Lancet 2005;366:385-91.
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Title Annotation:ROUND UP: Research
Publication:Reproductive Health Matters
Geographic Code:6KENY
Date:Nov 1, 2006
Words:372
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