Exploring the health complications of female genital mutilation through a systematic review and meta-analysis.

BACKGROUND

Female genital mutilation (FGM) is a harmful practice that affects an estimated 230 million women and girls. Previous research indicates that FGM is associated with increased risk of short- and long-term health complications. Understanding the health complications is important in ensuring high quality care for women and girls already affected and for advocating for prevention of the practice.

OBJECTIVE

The objective of this study was to conduct a systematic review and meta-analysis of all existing evidence on the association between FGM and a range of health complications.

METHODS

We conducted a systematic review of the literature on the health complications of FGM published between February 2009 and December 2022, applying search strategies and terms aligned with previous reviews. We identified studies that compared women with various types of FGM versus those without for six domains of health complications (i.e., immediate, obstetric & neonatal, gynecological, urological, sexual and mental). Random effects meta-analysis was conducted by health condition and FGM type. Immediate health complications were analysed separately based on data from population-based surveys.

RESULTS

We analysed data from 78 studies (n = 486,949), of which 67 informed the meta-analyses comparing women with and without FGM and 11 informed analyses on the immediate health complications. Most of the studies (N = 68) were conducted in high FGM prevalence countries. Among women and girls living with FGM compared to those without, we found an increased risk for obstetric complications, including prolonged/obstructed labor, obstetric tears, caesarean birth, postpartum hemorrhage, episiotomy, fetal distress, extended maternal hospital stay, neonatal asphyxia, and stillbirth/neonatal death; gynecological complications, including genital tissue damage, genitourinary tract infections, and menstrual difficulties; urological complications, including urinary tract infections and difficulty urinating; sexual complications including dyspareunia and sexual dysfunction; and mental health complications including depression or anxiety and somatoform disorder.

CONCLUSION

These results support results from previous research finding an association between FGM and a range of health complications over the life course. This calls for strengthening health systems to provide high-quality care for women and girls at-risk of or affected by FGM and ensuring that FGM prevention and care services are included in essential health service packages.