Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?

Abstract

While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women’s health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, (n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among ‘No FGM/C’ (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the ‘quadruple jeopardy’ of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination—and not FGM/C status per se—is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649

Child genital cutting and surgery across cultures, sex, and gender. Part 2: assessing consent and medical necessity in “endosex” modifications

“…If there is a difference in health risks currently, this may largely be due to the fact that one set of procedures is illegal in many countries (and so cannot be done openly in a medically controlled way), while the other is not (and so can be done in a relatively safe manner) [77]. As an additional consideration, the question of whether certain negative health outcomes, commonly associated with "ritual" female GGMs, are in fact causally attributable to the cutting itself, as opposed to other factors (e.g., discrimination in healthcare or other settings), is a matter of ongoing debate among experts, as seen in this issue [78][79][80].…”

Comment on: “Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?”

“…FGM/C-related health morbidity was, as they state, "analyzed dichotomously based on whether the participant had experienced any of 28 gynecological, sexual, or obstetric health concerns in the past 2 years. Examples include difficulty passing urine, recurrent urinary tract or genital infections, pain with intercourse, difficulty getting pregnant, emergency C-section, and postpartum hemorrhage" [1]. Finally, to assess everyday experiences of discrimination, participants were asked to report the frequency with which they recalled having had certain experiences, as follows: "treated with less courtesy/respect than other people; poorer service than others at restaurant/store; people act afraid of you; threatened/harassed; people act as if they think you are not smart" (https://doi.org/ 10.1017/S1742058X11000087).…”