Missed opportunities for diagnosis of female genital mutilation

Objective

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Methods

In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

Results

In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

Conclusion

Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.     

The relationship between female genital cutting and women’s autonomy in Eritrea

Objective

To investigate the relationship between women’s autonomy and attitudes toward female genital cutting (FGC) and having a daughter with FGC in Eritrea.

Methods

Data from a nationally representative sample of 8754 women aged between 15 and 49 years from the 2002 Eritrea Demographic and Health Survey were analyzed. Multivariate logistic regression was used to determine significant predictors of the practice of and attitudes toward FGC, including women’s autonomy.

Results

Sixty-three percent (n = 3168) of women sampled had at least one daughter who had undergone FGC and 50.1% (n = 4848) of women believed FGC should continue. When controlling for sociodemographic characteristics, the odds of supporting the continuation of FGC were greater among women who justified wife beating (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.23–1.66). Among women who participated in household decisions, the odds of them supporting the continuation of FGC were less than among women who did not participate in household decisions (aOR 0.87; 95% CI, 0.75–0.99).

Conclusion

Interventions addressing women's autonomy, specifically attitudes toward gender norms and increasing women’s involvement in household decisions that carry a greater responsibility, may be a useful approach to reduce the support for and practice of FGC.     

Estimates of first-generation women and girls with female genital mutilation in the European Union,Norway and Switzerland

Background: Female genital mutilation (FGM) is the practice of partial or total removal of female genitalia for non-medical reasons. The procedure has no known health benefits but can cause serious immediate and long-term obstetric, gynaecological and sexual health problems. Health workers in Europe are often unaware of the consequences of FGM and lack the knowledge to treat women adequately.

Objective: Our goal was to estimate the number of first-generation girls and women in the European Union, Norway and Switzerland who have undergone FGM. Before migration from FGM-practicing countries began, FGM was an unknown phenomenon in Europe.

Methods: Secondary analysis of data from the 2011 EU census and extrapolation from age-specific FGM prevalence rates in the immigrants’ home countries to these data were used to provide our estimates. Estimates based on census and other demographic data were compared to our results for Belgium.

Results: In 2011 over half a million first-generation women and girls in the EU, Norway and Switzerland had undergone FGM before immigration. One in two was living in the UK or France, one in two was born in East-Africa.

Conclusions: For the first time, scientific evidence gives a reliable estimate of the number of first-generation women and girls in Europe coming from countries where FGM is practiced. The use of census data proves reliable for policy makers to guide their actions, e.g., regarding training needs for health workers who might be confronted with women who have undergone FGM, or the need for reconstructive surgery.     

Factors determining whether Ethiopian women support continuation of female genital mutilation

Objective

To examine the factors influencing the opinions of women about whether female genital mutilation (FGM) should continue in Ethiopia.

Methods

Data from questionnaire surveys of women (n = 11 375) collected during the Ethiopia Demographic and Health Survey were analyzed. Factors influencing the opinions of women concerning whether FGM should continue as a practice in Ethiopia were examined using multiple logistic regression.

Results

Women who believed that FGM should continue were more likely to be aged 15-24 years (adjusted odds ratio [OR] 1.21; 95% confidence interval [CI],1.05-1.41); rural residents (OR, 2.73; CI, 2.38-3.12); Muslim (OR, 1.98; CI,1.80-2.17); married (OR, 1.26; CI, 1.09-1.46); uneducated (OR, 2.85; CI, 2.51-3.23); circumcised (OR, 3.46 CI, 2.94-4.06); and to have had no exposure to mass media (OR,1.57; CI,1.41-1.75).

Conclusion

To change the opinions of women regarding FGM, specific education and prevention programs should be designed to target these demographic groups of women.     

Female genital mutilation in Nigeria.

OBJECTIVES: To determine the prevalence and distribution of female genital mutilation (FGM) procedures in a Nigerian population. METHODS: Five hundred consecutive women were evaluated for evidence of FGM. The WHO classification system was utilized. Demographic and sociocultural information was collected. RESULTS: Thirty-four percent of women were found to have some type of FGM. Type I and Type II procedures were the most common. Fifty-five percent of women were unaware they had FGM and 62% with FGM did not know the reason. Twenty-one percent of women said they were going to have FGM on their daughters. CONCLUSIONS: FGM is still broadly practiced among ethnic and religious groups in Nigeria. Educational efforts need to be directed at eliminating this practice.     

Female genital cutting (mutilation/circumcision): ethical and legal dimensions.

The practice better described as female genital cutting (FGC) is of long standing in some communities, and has spread to non-traditional countries by immigration. It is of varying degrees of invasiveness, often including clitoridectomy, but all raise health-related concerns, which can be of considerable physical and/or psychological severity, and compromise gynecological and obstetric care. The practice is not based on a requirement of religious observance, although parents usually seek it for their daughters in good faith. It is directed to the social control of women's sexuality, in association with preservation of virginity and family honor. FGC is becoming increasingly prohibited by law, in countries both of its traditional practice and of immigration. Medical practice prohibits FGC. In compromising women's health and negating their sexuality, FGC is a human rights abuse that physicians have a role in eliminating by education of patients and communities.     

Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Objective

To record and compare obstetric and neonatal complication rates in women with reversed and non-reversed type III female genital mutilation (FGM).

Methods

A retrospective observational study comparing cesarean delivery rates and neonatal outcomes of primiparous and multiparous women who had or had not undergone reversal of FGM III.

Results

Of the 250 women, 230 (92%) had an FGM reversal. Of these, 50 (21.7%) were primiparous (cesarean delivery rate 17/50; 34%) and 180 (78.3%) were multiparous (cesarean delivery rate 28/180; 15.6%). Of the 20 women who had not had an FGM reversal, 7 (35%) were primiparous (cesarean delivery rate 5/7; 71.4%) and 13 (65%) were multiparous (cesarean delivery rate 7/13; 53.8%). The cesarean delivery rates for primiparae and multiparae were 32.9% and 25%, respectively. Multiparous women with FGM III reversal had a lower possibility of cesarean delivery compared with the hospital multiparous population (P = 0.003) and multiparae who had not undergone FGM III reversal (P = 0.007). There was no significant association between Apgar scores or blood loss at vaginal delivery and FGM reversal.

Conclusion

Reversal of FGM III significantly reduced the increased risk of cesarean delivery seen with multiparae who have FGM III.     

Attitudes toward the discontinuation of female genital cutting among men and women in Guinea.

OBJECTIVE: To investigate socioeconomic correlates of and gender differences in attitudinal support for the discontinuation of FGC in Guinea. METHOD: Data from structured interviews of men aged 15-59 and women aged 15-49 years in the 1999 Demographic and Health Survey and multiple logistic regression methods were used to examine the relationship of socioeconomic factors and gender to attitudinal support for the discontinuation of FGC. RESULT: More than 9 out of 10 women had undergone FGC. Attitudinal support for FGC discontinuation was more prevalent among men than women. The odds of supporting the discontinuation of FGC were negatively related to beliefs in social approval of and religious support for FGC and its enhancement of women's marriageability, the number of perceived advantages of FGC, and women's low socioeconomic status. CONCLUSION: Community education, improvements in women's socioeconomic status and traditional and religious leader involvement would be critical for FGC eradication.     

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

Abstract

Objectives: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

Methods: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15–49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

Results: Catholic women were significantly more likely to have misconceptions compared with Muslim women (β?=?1.09; 95% confidence interval [CI] 0.58, 1.60; p?<?.001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β=??0.06; 95% CI ?0.96, ?0.29; p?<?.001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p?>?.05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p?<?.001).

Conclusion: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.     

The impact of female genital cutting on health of newly married women.

OBJECTIVE: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. METHODS: Randomly selected (264) newly married women were the subjects of this work. RESULTS: Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's dissatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001). CONCLUSION: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.     

Predictors of female genital cutting among university students in northern Nigeria

Female genital cutting (FGC) is a harmful cultural practice that is perpetrated against women and children. Little is known about the extent of this custom among university students in northern Nigeria. Using self-administered questionnaires, we studied the prevalence and determinants of FGC among female university students in Kano, Nigeria (n =359). The prevalence of FGC was 12.1% (95% confidence interval =8.8-15.8%). Awareness and disapproval of FGC among the study population was very high (96% and 91%, respectively). In multivariate regression models, ethnicity and geographic origin were significant predictors of female circumcision. A comprehensive legal and educational framework and the support of civil society, governments and development partners is required to address this form of gender discrimination.     

Epidemiological and gynecological correlates with female genital mutilation among Beni-Suef University students; cross sectional study

Objective

This study aims to evaluate the prevalence of FGM/C among university students in Beni-Suef, Egypt and detect the possible socio-demographic and gynaecological associations.

Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden

OBJECTIVE: to explore Eritrean immigrant women's experiences of female genital mutilation (FGM) during pregnancy, childbirth and the postpartum period. DESIGN: qualitative study using an ethnographic approach. Data were collected via tape-recorded interviews. SETTING: interviews in the Eritrean women's homes located in and around Uppsala, Sweden. PARTICIPANTS: 15 voluntary Eritrean immigrant women. DATA COLLECTION AND ANALYSIS: Semi-structured interview and open-ended questions were used. The interviews were tape-recorded, transcribed verbatim and then analysed. FINDINGS: six themes of experiences of FGM among Eritrean women during pregnancy and childbirth were identified. They are (1) fear and anxiety; (2) extreme pain and long-term complications; (3) health-care professionals' knowledge of circumcision and health-care system; (4) support from family, relatives and friends; (5) de-infibulation; and (6) decision against female circumcision of daughters. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: the Eritrean women had experiences of FGM and had suffered from its complications during pregnancy, childbirth and the postpartum period. Midwives and obstetricians should have competence in managing women with FGM, and they need increased understanding of cultural epistemology in order to be able to provide quality care to these women. At antenatal centres, circumcised women should be advised to de-infibulate before pregnancy. Special courses about anatomical differences should be offered to these women and their husbands. It is also important to inform them about Swedish law, which prohibits all forms of FGM.     

Female genital mutilation/cutting: knowledge,attitude and training of health professionals in inner city London

Objectives

To assess the knowledge, attitude and training on female genital mutilation/cutting (FGM/C) amongst medical and midwifery professionals working in an area of high prevalence of the condition.

Study design

Prospective observational study using a questionnaire designed to assess knowledge, attitude and training received by health care professionals on the practice of FGM/C. Factors which may affect knowledge, attitude and training were compared between groups.

Results

92.9% (n = 79) questionnaires were returned. All respondents were aware of FGM/C but only 27.8% correctly identified the grade from a simple diagram. Three quarters (72.4% and 77.2% respectively) were aware of the complications of FGM/C and of the legislation in the United Kingdom. Of the respondents, 13.9% agreed that a competent adult should be allowed to consent to FGM/C if requested but only 8.9% agreed that the procedure should be medicalised to reduce the associated morbidity. Less than 25% of respondents had received formal training in recognising or managing this condition.

Conclusion

Although the majority of respondents were aware of FGM/C, their ability to identify the condition and its associated morbidity remain suboptimal; more training is recommended in larger cities with a higher prevalence of this condition.     

Venous malformations of the female lower genital tract

Objectives

Vascular malformations are rarely located in the female lower genital tract. We present the specific clinicopathologic features of venous malformation in the lower genital tract and highlight the surgical management of these lesions.

Study design

Between the years 1998 and 2008, 8 of 646 female patients were retrospectively defined as venous malformation in the lower genital tract according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA). Clinical and pathologic information was analyzed according to the medical records and archived pathological sections.

Results

Venous malformations were located in the vagina in three women, and in two of these cases extended to the cervix, and were found at the vulva in five patients. The age of the patients ranged from 15 to 85. The clinical presentations were abnormal vaginal bleeding or vaginal mass in cases with cervicovaginal lesions, and non-specific vulvar nodules in women with vulvar lesions. The abnormalities were found shortly after birth and increased in size gradually thereafter, or become significantly enlarged during or following pregnancy. Postmenopausal episodes could occur, although rarely. Doppler ultrasound, MRI and angiography were available to help define the type of vascular anomalies. The therapeutic approach consisted of interventional embolization and surgical excision. In rare cases of refractory and diffuse cervicovaginal lesions, hysterectomy might be ultimately inevitable.

Conclusion

Venous malformations in the lower female genital tract are rarely reported. Their clinical presentations mimic other genital tract neoplasms, including malignancies. Surgical excision is the curative procedure and is helpful to reach a definite pathological diagnosis.     

Management of type III female genital mutilation in Birmingham,UK: A retrospective audit

Objectivesto audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation.Designretrospective audit.Settinga hospital midwifery-led FGM specialist service in Birmingham, UK.Participants253 women with type III FGM who gave birth between January 2008 and December 2009Methodsretrospective case analysis using patient records.Main outcome measuresproportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section.Findings91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant.Conclusions and implications for practicealternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation.