Estimates of female genital mutilation/cutting in the Netherlands: a comparison between a nationwide survey in midwifery practices and extrapolation-model

Ramin Kawous,Femke Hilverda,Kyra R M Hendriks,Alex Burdorf,Livia E Ortensi,Diana Geraci,Maria E T C Van Den Muijsenbergh

doi:10.1186/s12889-020-09151-0

Abstract

BackgroundOwing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands.MethodsTwo methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands.ResultsA nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C.ConclusionsThe current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.

Highlights

Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar
The indirect estimation of FGM/ C in an extrapolation-model resulted in an estimated prevalence of 1.55%
Given the lack of information regarding the countries of origin of women whose FGM/C status was provided by the midwifery practices, it was not possible to control for differences between the compositional differences between the population covered in the direct estimation exercise and data provided by the Statistics Netherlands

Summary

Introduction

Female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. Female Genital Mutilation or Cutting (FGM/C) refers to ‘all procedures involving the partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’ [1]. FGM/ C has harmful health consequences [2,3,4,5,6,7], especially for women during pregnancy and childbirth [8, 9]. Other obstetric consequences of FGM/C include fear of childbirth, difficulty in intrapartum monitoring, difficulty in catheterization during labor, wound infection and retention of lochia [8]. In addition to obstetric complications, infants born from women with FGM/C are at increased risk of stillbirth and early neonatal death [8]

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