Table 2 Impact of female genital mutilation (FGM) on stillbirth and perinatal mortality

Essen et al. 2002 [15]

Sweden.

Cohort of perinatal deaths (N = 63) born in Sweden from 1990–1996 to immigrant women from the Horn of Africa with FGM.

Examined the association between FGM and perinatal death.

Perinatal mortality rate (PMR): [NS^a]

FGM was associated with obstructed and prolonged labour.

Hakim 2001 [17]

Ethiopia (Addis Ababa). Hospital-based.

Cross-sectional study of mothers with FGM (N = 1225) and without FGM (256) who had spontaneous, term, singleton and vertex vaginal deliveries in 1997 in 3 urban hospitals.

Assessed the impact of FGM on labour duration and pregnancy outcomes

PMR: [NS]

FGM was associated with delayed second stage labour among women with FGM (P < 0.05) and the first and tenth minute mean Apgar scores were lower for women with FGM (p < 0.05)

Larsen and Okonofua

2002 [14]

Nigeria (Southwest). Hospital setting.

Prospective cohort study of mothers seeking family planning or ANC at 3 hospitals, including uncircumcised women and women with FGM Types I and II (N = 1851).

Examined the association of obstetric complications with FGM. Women were interviewed and had a medical exam, and were followed for pregnancy outcome.

SB: Increased risk in circumcised women (statistically significant).

Increased risk of tearing among women with FGM.

Oduro et al. 2006 [13].

Ghana (Navrongo). War Memorial Hospital.

Retrospective study of hospital deliveries from 1996 – 2003 (N = 5071). 29% of women (N = 1466) with FGM.

Examined the association of FGM with stillbirth incidence.

SB: Incidence doubled in mothers with vs. mothers without FGM (6%; 89/1466 vs. 123/3605, respectively). No statistical significance data.

Vangen et al. 2002 [16]

Norway, Medical Birth Registry of Norway.

Cross-sectional population-based registry study of all births in Norway from 1986–1998 to primarily infibulated women born in Somalia (N = 1733) and to ethnic Norwegians (N = 702192)

Compared the risk of perinatal complications among Somali women with FGM with that of ethnic Norwegians using univariate and multivariate methods.

Early neonatal death (ENND): Odds Ratio (OR) = 1.4 [95% confidence interval (CI): 0.7–3.0] [NS]

Antepartum SB: OR = 2.5 (95% CI: 1.7–3.7).

Intrapartum SB: OR = 1.2 (95% CI: 0.2–8.3) [NS]

Elevated risk in women with FGM of perinatal complications including induction of labour, fetal distress, secondary arrest, prolonged 2nd stage, and operative delivery.

World Health Organization (WHO) study group on female genital mutilation and obstetric outcome 2006 [8]

Burkina Faso, Ghana, Kenya, Nigeria, Senegal, Sudan. 28 obstetric centres

Multi-country, multi-centre prospective study of women attending for singleton delivery (N = 28 393) between 2001–2003 with various types of FGM.

Compared relative risk of stillbirth for women with different types of FGM in reference to no FGM. Women were examined before delivery for evidence of FGM and typed by WHO classification.

PMR:

[FGM I] OR = 1.15 [NS]

[FGM II]: OR = 1.32 (95% CI: 1.08–1.62)

[FGM III] OR = 1.55 (95% CI: 1.12–2.16)

compared with uncircumcised women (reference group).