The association between female genital cutting and time-to-pregnancy among women of reproductive age - applying the current duration approach in demographic and health survey data from Nigeria.

Female genital cutting (FGC) may lead to clinical infertility (failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse) through gynaecologic morbidity and reduced sexual frequency, but previous studies were inconclusive. Therefore, we examined if FGC and FGC severity were associated with longer time-to-pregnancy (TTP) in Nigeria. We restricted 2013 Nigeria Demographic Health Survey (NDHS) data to women at risk of pregnancy at the time of the interview (18-44 years, married/cohabiting, sexually active, not using contraception, and not sterilised) with self-reported FGC status (n = 4,431). Using the current duration approach, we conducted weighted accelerated-failure-time regression survival modelling to estimate time ratios for TTP by FGC status/severity, stratified by parity as a proxy for primary (nulliparous) and secondary (parous) infertility. Thirty-three percent of women reported having undergone FGC (severity: Type I: 2.9%, Type II: 17.7%, Type III: 1.6%, Unknown/missing severity: 10.9%). Overall, there were no differences in TTP between those with and without FGC. However, nulliparous women with Type III FGC had longer TTP (adjTR = 11.80, 95% CI: 4.09-34.01). FGC was not significantly associated with longer TTP for other severity groups or among parous women.