Abstract
BackgroundIn Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth.MethodsFacility based cohort study, involving 142 parturients with FGM and 139 parturients without FGM, was conducted in Jijiga town from October to December, 2014. The study participants were recruited by consecutive sampling technique. Data were collected using a structured interviewer administered questionnaire and observational checklists. Data were analyzed using SPSS version 16 and STATA version 11.ResultsThe existence of FGM was significantly associated with perinealtear [RR = 2.52 (95% CI 1.26–5.02)], postpartum blood loss [RR = 3.14 (95% CI 1.27–7.78)], outlet obstruction [RR = 1.83 (95% CI 1.19–2.79)] and emergency caesarean section [RR = 1.52 (95% CI 1.04–2.22)]. FGM type I and FGM type II did not demonstrate any association with prolonged 2nd stage of labour, emergency caesarean section, postpartum blood loss, and APGAR score < 7. FGM type III however was significantly associated with prolonged 2nd stage of labour [RR = 2.47 (95% CI 1.06–5.76)], emergency caesarean section [RR = 3.60 (95% CI 1.65–7.86)], postpartum blood loss [RR = 6.37 (95% CI 2.11–19.20] and APGAR score < 7 [RR = 4.41 (95% CI, 1.84–10.60)]. FGM type II and type III were significantly associated with perinealtear [RR = 2.45(95% CI 1.03–5.83)], [RR = 4.91(95% CI 2.46–9.77)] and outlet obstruction [RR = 2.38(95% CI 1.39–4.08)], [RR = 2.94(95% CI 1.84–4.71)] respectively.ConclusionWomen with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive form of FGM. Adverse obstetric outcomes can therefore be added to the known harmful immediate and long-term effects of FGM.
Highlights
In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state
Socio-demographic characteristics The study sample consisted of 281 parturients, of which 142 with FGM and 139 without FGM (Table 1)
This study demonstrated no association between FGM and low Appearance Pulse Grimace Activity and Respiration (APGAR) score
Summary
In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. The World Health Organization (WHO) classified FGM into four broad categories: namely Type I or Clitoridectomy, removal of the prepuce with or without excision of the clitoris.; Type II or Excision:, Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora; type III or Infibulation, excision of labia minora and/or labia majora, with or without excision of the clitoris and stitching of the exposed walls of the labia majora together leaving only a small hole for the passage of urine and menstrual flow; and type IV or unclassified, refers to any other damage to the female genitalia including, pricking, piercing, incising, scraping and cauterization [3]. Type III, the most drastic form of FGM, is high prevalent among Afar and Somali, but it is practiced to lesser extent in Harari. Type IV is carried out mainly by the Amhara population
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