This text introduces the systematic review and meta-analysis titled “Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis”. Published in BMJ Open in 2014, this significant work was authored by Rigmor C Berg, Vigdis Underland, Jan Odgaard-Jensen, Atle Fretheim, and Gunn E Vist. The study was commissioned by Norad and the WHO, with partial funding from the latter.
Purpose and Methodology: The primary objective of this comprehensive review was to systematically evaluate the available evidence regarding the physical health risks associated with female genital mutilation/cutting (FGM/C). To achieve this, the authors conducted a rigorous systematic review, searching 15 international electronic literature databases for studies published up to January 2012. Their selection criteria focused on empirical quantitative studies reporting physical health outcomes from any type of FGM/C, regardless of ethnicity, nationality, or age.
Out of 5109 initial results, 185 studies involving an estimated 3.17 million women were included. The majority of these studies (129) were from Africa, with 43 from Western countries and 13 from the Middle East. The authors independently screened, assessed methodological quality, and extracted data from these studies. For analysis, they combined data using the Mantel-Haenszel method for unadjusted data and the generic inverse-variance method for adjusted data, employing a random-effects model to account for heterogeneity. Particular focus was given to key outcomes from the 57 studies with the best available evidence. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument was applied to assess confidence in effect estimates.
Key Findings and Impacts: The review provides clear evidence that FGM/C leads to harms to women’s physical health throughout their lives, from infancy or childhood cutting to issues in adulthood related to sexuality and childbirth.
- Immediate Complications: The most common immediate complications observed were excessive bleeding (median 32%), urine retention (median 31%), and genital tissue swelling (median 15%). Problems with wound healing (13%) and pain (11%) were also frequently reported. The study indicated a potentially greater risk of immediate harms with FGM/C type III compared to types I–II.
- Long-term Physical Sequelae: The most statistically significant associations for long-term physical health problems linked to FGM/C included:
- Urinary tract infections (unadjusted RR=3.01).
- Bacterial vaginosis (adjusted OR (AOR) =1.68).
- Dyspareunia (painful sexual intercourse) (RR=1.53).
- Obstetric Complications:
- Prolonged labour (AOR=1.49).
- Caesarean section (AOR=1.60), particularly when limiting analysis to prospective studies.
- Difficult delivery (AOR=1.88).
- Other obstetric issues like obstetric tears/lacerations (AOR=1.39), episiotomy (unadjusted RR=1.38), instrumental delivery (AOR=1.56 for primiparous women), and obstetric haemorrhage (AOR=1.50) also showed increased risks.
- Inconclusive Findings: The evidence was inconclusive for other potential sequelae such as scarring, keloids, abscesses, fistulae, various tissue damages, vaginal obstruction, cysts, long-term urological complications, and most types of chronic pelvic, reproductive tract, or genital infections. Importantly, the review could not establish a clear association between FGM/C and infertility or HIV/STIs.
Conclusion and Implications: Despite some limitations in precise estimation due to varying methods and small sample sizes, the study’s authors conclude that the consistency of results indicating an increased risk of several physical harms in women with genital modification is robust. The findings weigh against the continuation of FGM/C and underscore the importance of diagnosing and managing the physical risks faced by girls and women affected by this practice. The authors emphasize that efforts should be directed towards safeguarding girls and women from these physical risks and providing care for those who suffer from its consequences.
Reference: Berg, R. C., Underland, V., Odgaard-Jensen, J., Fretheim, A., & Vist, G. E. (2014). Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open, 4(11), e006316. https://doi.org/10.1136/bmjopen-2014-006316
