A Prospective Cohort Study of the Relationship Between Female Genital Mutilation and Birth Outcomes in Somalia | BMC Women’s Health

Female Genital Mutilation (FGM) is defined as the partial or complete removal of the external female genitalia for non-medical reasons such as social pressure, belief in ancestors, being an indicator of virginity before marriage, the belief that women’s libido decreases with FGM, and being influenced by other communities in the immediate vicinity [1]. The reasons for its application vary according to regions and times. [2]. FGM is practiced due to social pressure, being accepted by society, being a sign of chastity, preparing children for marriage, getting rid of the male structure of women, being recommended by some religious leaders and considered a tradition cultural [1]. In sub-Saharan African countries, it was once mainly performed by village midwives, but today it is mainly performed by health professionals. [3]. According to UNICEF, statistics on FGM are not precisely known, however, more than 200 million women are thought to be affected in at least 30 countries. [4].

The classification of FGM according to the World Health Organization (WHO) has been given in Table 1 [1].

Table 1 Classification of FGM according to the World Health Organization

In a 2018 study by WHO covering 27 countries, they reported that the annual cost of FGM complications was around $1.4 billion. If the application of FGM can be completely stopped, this cost will decrease by 60% within 30 years. [1].

Some FGM-related complications, both long-term and short-term, have been described. While bleeding, pain, fever, infection, and urinary problems are short-term complications, long-term complications include dyspareunia, clitoral cyst, keloid, chronic pelvic infection, anorgasmia, and dystocia. [1, 5, 6]. Long-term complications have often been associated with type 3 FGM [7]. After some FGM applications, deinfibulation is required before intercourse or childbirth.

According to 2016 data, the frequency of FGM among Somali women aged 15-49 is 98%, but there are no data between the ages of 0-15. [4]. Most FGM is type 2 and type 3 FGM in Somalia[4]. However, there is no information in the literature on the current prevalence and types of FGM in Somalia.

In addition to these short and long-term complications, FGM has birth-related complications that affect both mother and baby. In one review, prolonged maternal hospitalization, increased frequency of caesarean sections, obstructed labor, prolonged 2nd stage of labor and low birth weight of the baby were associated with FGM [8]. In the meta-analysis of 11 articles, the relative risk of postpartum hemorrhage with FGM, particularly in African countries, was 2.59 [1.28, 5.25] [7].

There are many studies on the maternal and neonatal complications of FGM. However, these studies are retrospective studies that include few participants, do not have a proper control group, are conducted on immigrant populations, or in places with better health care providers. [7, 9, 10]. Our study is the first study in Somalia to prospectively assess the relationship between female genital mutilation and birth complications. Additionally, we believe it is important that our study be conducted on local populations with limited access to health services, rather than immigrants, to reflect reality.

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