Prevalence and adverse obstetric outcomes of female genital mutilation among women in rural Northern Ghana

Abstract

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM.

Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis

“…Geographic focus is likely to be another source of heterogeneity. For example, in pooled analyses of episiotomy, of the 22 contributing studies, only 4 focused on populations in western Africa: Frega and colleagues (2013) [65], which focused on Burkina Faso; Kaplan and colleagues (2013) [46], which focused on The Gambia; Ndiaye and colleagues (2010) [66], which focused on Burkina Faso; and Nonterah and colleagues (2019) [37], which focused on Ghana. These studies contributed some of the largest effect sizes.…”

It’s a Woman’s Thing: Gender Roles Sustaining the Practice of Female Genital Mutilation Among the Kassena-Nankana of Northern Ghana

“…-Mayoro adolescent woman, aged [20][21][22][23][24][25] In contrast, male groups discuss the signi cance of undergoing circumcision, not in respect to parental burial rites but for rather for the girl's own burial and ultimately, her role in the after life:…”

“…--Gomongo adolescent boys, aged [20][21][22][23][24][25] It could also be your colleagues. They can mock at you and that will compel you to go in for FGM since you will not like to be a laughing stock and branded as weak…They refer to you as a man and call you 'long clitoris'.…”

“…In a more recent study, 29% of 5071 deliveries in the Kassena-Nankana district were FGM associated. There is a shift in age in prevalence of FGM as 61.5% of FGM practice was among women who were over 40 years and 14.4% among those less than 20 years [21].…”

It’s a woman’s thing: Gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana

“…In the past, circumcision status was an important prerequisite to marriage. However, this has changed: "[Before]…it is only when the girl is circumcised that she can get married but now the men are impatient and do not wait for all the customs [FGM] to be done" -Pungu man, aged [26][27][28][29][30][31][32][33][34] Once a girl has been circumcised, either before or after marriage, her father is eligible to receive a full bride wealth payment. "In the past when an uncircumcised woman got married, her parents could not claim her dowry.…”