Female Genital Mutilation in Sierra Leone: Forms, Reliability of Reported Status, and Accuracy of Related Demographic and Health Survey Questions

Owolabi Bjälkander,Donald S Grant,Lars Almroth,Heli Bathija,Vanja Berggren

doi:10.1155/2013/680926

Abstract

Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This cross-sectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12–47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn closed. Conclusion. Types I and II are the main forms of FGM, with labia majora alterations in almost 5% of cases. Self-reports on FGM status could serve as a proxy measurement for FGM prevalence but not for FGM type. The DHS FGM questions are inaccurate for determining cutting extent.

Highlights

Female genital mutilation (FGM), known as female genital cutting or female circumcision, is the term used to describe the non therapeutic, surgical alteration of female genitalia which is a traditional practice in mainly African countries [1]
This study describes anatomical changes to the genitals following FGM, classifies them using the World Health Organisation (WHO) FGM classification, and compares the findings from genital inspection with reported FGM status and responses from the Demographic and Health Surveys (DHS) FGM module
Six of the clinics were located in town hospitals: Kambia Town Hospital located in Kambia District; Makeni Regional Hospital located in Bombali District; Port Loko Town Hospital located in Port Loko District; Magburaka Town Hospital located in Tonkolili District; and Kono Town Hospital located in Kono District, as well as the Princess Christian Margaret Hospital (PCMH) located in the Western Urban Area of the Capital

Summary

Introduction

Female genital mutilation (FGM), known as female genital cutting or female circumcision, is the term used to describe the non therapeutic, surgical alteration of female genitalia which is a traditional practice in mainly African countries [1].The term “mutilation” is controversial and rejected by members of practising communities whose intention is not to mutilate [2]. Female genital mutilation (FGM), known as female genital cutting or female circumcision, is the term used to describe the non therapeutic, surgical alteration of female genitalia which is a traditional practice in mainly African countries [1]. The term “female genital cutting” has been argued to be more value neutral and nonjudgemental than FGM [3]. It does, not accurately describe what has taken place, the removal of parts of the body. The term “female circumcision” is likely to cause the erroneous comparison with male circumcision which would be wrong both from anatomical and religious aspects

Methods

Results

Conclusion