Female genital mutilation and other harmful practices
Treatment of persons with female genital mutilation
The link between female genital mutilation and perinatal death
This study took place in Sweden where it examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990–1996 to women who were immigrants women from the Horn of Africa and who had undergone FGM [1]. Because perinatal mortality among women who had emigrated to Sweden from sub-Saharan Africa (predominantly Somalia) was greater than that of their Swedish counterparts, the study set out to test the hypothesis that FGM was a contributing factor in the increased rate of perinatal death among infants of immigrant women who gave birth in a community with a high standard of obstetric care.
The researchers found no evidence that FGM was related to perinatal death in the 63 cases they examined. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. The researchers point out that “for infibulated women there is a major risk of severe perineum tearing unless defibulation is performed”, but they add that in the cases they studied “defibulation or episiotomy were always performed when needed, which may account for the lack of correlation between circumcision and obstructed labour”.
In some of the cases that were examined, fetal distress was noted as related to perinatal death because the mother refused emergency caesarean section. Because of fear of delivery complications and maternal death, the mothers often delayed or refused caesarean section, even when experiencing severe symptoms such as vaginal haemorrhage or if there was a risk of fetal distress. The researchers comment that “women’s experiences in their countries of origin, where maternal mortality rates are high, resulted in maternal behaviours and pregnancy strategies that the Swedish caregivers had not considered”. They add that “these factors, combined with miscommunication because of a lack of interpreters and suboptimal medical care (e.g. misinterpretation of CTG signs of fetal distress), heightened the risk of perinatal mortality. The high observed incidence of intrapartal or neonatal death was thus not related to maternal circumcision in this study.”
References
1. Essén B, Bödker B, Sjöberg N-O, Gudmundsson S, Östegen P-O, Langhoff-Roos J. Is there an association between female circumcision and perinatal death? Bulletin of the World Health Organization 2002; 80:629-632.