The first large medical study of female genital cutting has found that the
procedure has deadly consequences when the women give birth, raising by more
than 50 percent the likelihood that the woman or her baby will die.
Rates of serious medical complications surrounding childbirth, such as
bleeding, also rose substantially in women who had undergone genital cutting,
according to new research being published today in The Lancet, a British medical
journal.
“Reliable evidence about its harmful effects, especially on reproduction,
should contribute to the abandonment of the practice,” wrote the study’s
authors, all members of the World Health Organization Study Group on Female
Genital Mutilation and Obstetrical Outcome.
While women’s groups and human rights organizations have long campaigned
against genital cutting as a rights issue, the study provides the first
conclusive medical evidence of long-term physical harm, moving the debate
further into the public health arena.
“Finally we have data to prove what health workers have long known: that
female genital mutilation is a health issue, a killer of women and children, as
well as a human rights issue,” said Adrienne Germain, president of the
International Women’s Health Coalition, in New York.
“This should greatly help advocates overcome arguments that genital
mutilation is an untouchable cultural practice.”
More than 100 million women worldwide have undergone genital cutting, mostly
in childhood, often without anesthesia or sterile technique. Pain, bleeding and
infection are immediate consequences. Doctors suspect that the procedure is also
linked to a risk of urinary infection.
The procedure varies in severity, from a full excision of the clitoris and
labia, to a lesser procedure in which only the former is removed. In a number of
African cultures, genital mutilation is part of a coming-of-age ceremony, and
defenders have contended that it is a cultural practice, like male circumcision
among Jews, with few, if any, proven long-term health consequences.
Previous studies to document the long-term medical effects of genital cutting
— also called female circumcision — were far smaller and produced inconsistent
or unreliable results, largely because of the logistical difficulties of
collecting large amounts of hard data in the poor countries where the practice
is traditional.
In a commentary accompanying the study in The Lancet, Ndubuisi Eke and Kanu
E. O. Nkanginieme, doctors at the University of Port Harcourt, in Nigeria, called the study group’s report “a landmark.”
With new, concrete evidence of the procedure’s deadly aftereffects, they suggest
that genital mutilation “should now be included among critical health indices
for less developed countries.”
The study was conducted with the help of more than 28,000 women in six
African nations from 2001 through 2003. The women were examined to document the
degree of genital damage and were followed until after they had given birth.
The study found that the women who had undergone genital cutting of any
degree of severity and their babies were more likely to die during childbirth.
More extensive genital cutting produced the highest rates of maternal and infant
death during childbirth, even many years later.
The lesser forms of cutting caused about a 20 percent increase in death
rates, while extensive procedures caused increases of more than 50 percent.
By almost all measures studied by the World Health Organization, a history of
genital cutting put both mother and baby at risk. Mothers who had had the
procedure had longer hospital stays, experienced more blood loss, and were more
likely to need a Caesarean section. Babies were nearly twice as likely to
require resuscitation at birth.
The researchers noted that the study almost certainly underestimated the
potential for death and damage, because it only tracked women who delivered
their babies in hospitals.
Many women in the African nations where genital cutting is practiced deliver
their babies at home, where typically it is not possible to treat medical
complications like severe bleeding or to resuscitate an ailing newborn.
Although the exact reason for the rise in mortality was not clear, the
researchers noted that it made anatomical sense: Genital cutting results in
severe scarring of the vagina and surrounding area, so it might make it more
difficult for babies to emerge.
In the study countries, rates of genital cutting ranged from a high of 83
percent, in Sudan, to a low of about 40 percent, in Ghana. One
country involved in the study, Senegal, outlawed the more extensive form of the
procedure in 1998.
Dr. Eke and Dr. Nkanginieme expressed hope that the new medical evidence
would push others to follow. “There is hope that female genital mutilation will
face the fate of past cultural rituals such as the rejection of twins, the
African slave trade, Chinese foot-binding and Victorian chastity belts,” they
wrote.
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