Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn

Abstract

Adriana Kaplan,1–3 Mary Forbes,4 Isabelle Bonhoure,2 Mireia Utzet,5 Miguel Martín,5 Malick Manneh,4 Haruna Ceesay41Chair of Social Knowledge Transfer/ Parc de Recerca UAB - Santander, Department of Social and Cultural Anthropology, Universitat Autònoma de Barcelona, Barcelona, Spain; 2Interdisciplinary Group for the Study and Prevention of Harmful Traditional Practices, Department of Social and Cultural Anthropology, Universitat Autónoma de Barcelona, Barcelona Spain; 3Wassu Gambia Kafo, Fajara F Section, Banjul, The Gambia; 4School of Enrolled Community Health Nurses and Midwives, Ministry of Health, Mansakonko, Lower River Region, The Gambia; 5Africa and Latin America Research Group, Unit of Biostatistics, Faculty of Medicine, Autonomus University of Barcelona, Barcelona, SpainBackground: Female genital mutilation/cutting (FGM/C) is a harmful traditional practice deeply rooted in 28 Sub-Saharan African countries. Its prevalence in The Gambia is 76.3%. The objective of this study was to gain precise information on the long-term health consequences of FGM/C in The Gambia as well as on its impact on delivery and on the health of the newborns.Methods: Data were collected from 588 female patients examined for antenatal care or delivery in hospitals and health centers of the Western Health Region, The Gambia. The information collected, both through a questionnaire and medical examination, included sociodemographic factors, the presence or not of FGM/C, the types of FGM/C practiced, the long-term health consequences of FGM/C, complications during delivery and for the newborn. Odds ratios, their 95% confidence intervals, and P values were calculated.Results: The prevalence of patients who had undergone FGM/C was 75.6% (type I: 75.6%; type II: 24.4%). Women with type I and II FGM/C had a significantly higher prevalence of long-term health problems (eg, dysmenorrhea, vulvar or vaginal pain), problems related to anomalous healing (eg, fibrosis, keloid, synechia), and sexual dysfunction. Women with FGM/C were also much more likely to suffer complications during delivery (perineal tear, obstructed labor, episiotomy, cesarean, stillbirth) and complications associated with anomalous healing after FGM/C. Similarly, newborns were found to be more likely to suffer complications such as fetal distress and caput of the fetal head.Conclusion: This study shows that FGM/C is associated with a variety of long-term health consequences, that women with FGM/C are four times more likely to suffer complications during delivery, and the newborn is four times more likely to have health complications if the parturient has undergone FGM/C. These results highlight for the first time the magnitude of consequences during delivery and for the newborn, associated with FGM/C in The Gambia.Keywords: female genital mutilation/cutting, The Gambia, sexual and reproductive health, Africa