Female genital mutilation (FGM) affects almost all dimensions of the health of women and girls, according to a new study published today from the World Health Organization (WHO) together with the United Nations' Human Reproduction Programme (HRP). Health complications of the practice can be severe and life-long, causing both mental and physical health risks.
Published in BMC Public Health, the publication analyzes evidence from more than 75 studies in around 30 countries to paint a comprehensive picture of the ways that FGM impacts survivors' health at different life stages.
It shows that women with FGM are significantly more likely to experience a wide range of complications during childbirth compared to those without, for instance. They have more than double the risk of enduring prolonged or obstructed labour or haemorrhage, while being significantly more likely to require emergency caesarean sections or forceps delivery.
In addition, women with FGM have an almost three-times greater risk of depression or anxiety, and a 4.4 times higher likelihood of experiencing post-traumatic stress disorder.
There is a critical need to ensure timely, high-quality health care for survivors, to engage communities for prevention and ensure families are aware of FGM's harmful effects, alongside serious political commitment to stop the practice and educate and empower women and girls.
"This study paints a devastating picture of the manifold health implications of female genital mutilation, spanning mental and physical health and undermining emotional well-being," said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO and head of HRP. "There is a critical need to ensure timely, high-quality health care for survivors, to engage communities for prevention and ensure families are aware of FGM's harmful effects, alongside serious political commitment to stop the practice and educate and empower women and girls."
FGM is a harmful practice that involves the partial or total removal of the external female genitalia, or other injury to the female genital organs such as cutting or burning. It is an extreme form of gender discrimination and a stark violation of women and girls' human rights.
It is estimated that around 230 million women and girls alive today have undergone FGM. While evidence shows the overall proportion of those who experience FGM is declining, absolute numbers could increase given rising youth populations in countries where it is practiced. Abandonment of FGM is challenging, given that it is driven by deep-set cultural beliefs and norms.
Also of concern, evidence shows more cases of FGM are now performed by health workers – its so-called medicalization – due in part to misperceptions that their involvement makes it safer and reduces risks. In fact, some studies have shown that longer-term damage from "medicalized" FGM may be greater, since it can result in deeper, more severe cuts.
FGM's immediate risks can be life-threatening and include severe infections, heavy blood loss, as well as extreme pain and emotional trauma. Longer-term consequences for survivors include, as well as those described above, menstrual difficulties; urological complications, including urinary tract infections and difficulty urinating; and painful sexual intercourse.
In addition to various obstetric risks for women, the paper highlights that FGM can also have impacts on babies during or following childbirth. Babies born to women who had FGM are more likely to experience birth complications like fetal distress or asphyxia, resulting in lower newborn survival rates.
Recognizing FGM's devastating health impacts, WHO supports efforts to strengthen prevention efforts within the health sector, engaging health workers to educate communities and family members, while providing clinical guidance on effective care for survivors.
Understanding the range of complications FGM can cause – spanning acute risks as well as impacts on obstetric and neonatal, gynaecological, urological, sexual and mental health – is critical for ensuring survivors receive appropriate treatment and support. Drawing on this evidence, WHO will shortly release a new guideline covering both FGM prevention and clinical care for affected women and girls. FGM is currently common in around 30 countries across Africa and Asia.
About
The present study, titled Exploring the health complications of female genital mutilation through a systematic review and meta-analysis , updates and expands previous reviews, compiling all available data on health complications from studies with comparison groups of women with and without FGM, and by the different types of FGM. The result of this process is a comprehensive summary of its various health complications.
The study was supported by the Governments of Norway and the United Kingdom of Great Britain and Northern Ireland alongside HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction). HRP is the main research institution within the United Nations system for sexual and reproductive health.
