Female genital mutilation and other harmful practices
Research studies on the prevalence and classification of female genital mutilation
Reliability of self-reported female genital mutilation and the WHO classification
The aim of this cross-sectional study [1] was to assess the reliability of women’s reports of their FGM and to compare the actual extent of genital cutting, as verified by clinical examination, with the corresponding WHO classification. The study took place during 20032004 at a paediatric hospital and at a gynaecological outpatient clinic in Khartoum, Sudan, and involved 255 girls aged 49 years and 282 women aged 17-35 years.
Earlier studies of reported FGM in several African countries revealed some extent of inconsistency: some women did not really know what had been done to them, some claimed not to have undergone the procedure although examination revealed that they had, and still others claimed to have undergone it when they had not.
In this study, all girls and women who reported that they had undergone FGM had this verified by genital inspection. All who said they had not undergone FGM were indeed found not to have undergone it. A large proportion of those who said they had undergone so-called "sunna circumcision" (i.e. excision of the prepuce and all or part of the clitoris, equivalent to type I FGM) were found on examination to have a form of FGM that extended beyond the clitoris. This applied to 10 out of 23 girls (43%) and 20 out of 35 women (57%). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) in fact had type III FGM (infibulation plus excision of part or all of the external genitalia).
The anatomical extent of forms classified as type III FGM (under the 1997 classification) was found to vary widely. In 12 out of 32 girls (38%) and 27 out of 245 women (11%) classified as having type III FGM, the labia majora were not involved in the procedure. Thus the researchers say there is a substantial overlap anatomically between types II and III.
The researchers conclude that the reliability of reported forms of FGM is low and that there is “considerable underreporting” of the extent of the procedure. They suggest that “the WHO classification fails to relate the defined forms to the severity of the operation” and indeed WHO and its partners published a revision of the classification of FGM types in 2008.
References
1. Elmusharaf S, Elhadi N, Almroth L. Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study. British Medical Journal 2006; 333:124 (doi: 10.1136/bmj.38873.649074.55).