The first large medical study of female genital cutting has found that the procedure has deadly consequences when the women give birth, raising by more than 50 percent the likelihood that the woman or her baby will die.
Rates of serious medical complications surrounding childbirth, such as bleeding, also rose substantially in women who had undergone genital cutting, according to new research being published today in The Lancet, a British medical journal.
“Reliable evidence about its harmful effects, especially on reproduction, should contribute to the abandonment of the practice,” wrote the study’s authors, all members of the World Health Organization Study Group on Female Genital Mutilation and Obstetrical Outcome.
And just so we’re clear on the what’s involved in the practice, the World Health Organization classifies the types of female genital mutilation thusly:
Type I – excision of the prepuce, with or without excision of part or all of the clitoris;
Type II – excision of the clitoris with partial or total excision of the labia minora;
Type III – excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation);
Type IV – pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue;
scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts);
introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it; and any other procedure that falls under the definition given above.
The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases; the most extreme form is infibulation, which constitutes about 15% of all procedures.
In short, this is in no way analogous to removal of the foreskin on males.* Excision of the clitoris would be analogous, perhaps, to the excision of the glans of the penis, or to the entire penis. Excision of the labia would be analogous to excision of the scrotal sac.
FGM survives and is defended because it is viewed as a cultural practice similar to scarification or male circumcision. But this study shows that the harm it does is so great that it should go the way of foot-binding:
While women’s groups and human rights organizations have long campaigned against genital cutting as a rights issue, the study provides the first conclusive medical evidence of long-term physical harm, moving the debate further into the public health arena.
“Finally we have data to prove what health workers have long known: that female genital mutilation is a health issue, a killer of women and children, as well as a human rights issue,” said Adrienne Germain, president of the International Women’s Health Coalition, in New York.
“This should greatly help advocates overcome arguments that genital mutilation is an untouchable cultural practice.”
Earlier, smaller, studies had been inconclusive or had conflicting results. This is the first large study of the effects of FGM on maternal and child health.
The study was conducted with the help of more than 28,000 women in six African nations from 2001 through 2003. The women were examined to document the degree of genital damage and were followed until after they had given birth.
The study found that the women who had undergone genital cutting of any degree of severity and their babies were more likely to die during childbirth. More extensive genital cutting produced the highest rates of maternal and infant death during childbirth, even many years later.
The lesser forms of cutting caused about a 20 percent increase in death rates, while extensive procedures caused increases of more than 50 percent.
By almost all measures studied by the World Health Organization, a history of genital cutting put both mother and baby at risk. Mothers who had had the procedure had longer hospital stays, experienced more blood loss, and were more likely to need a Caesarean section. Babies were nearly twice as likely to require resuscitation at birth.
The researchers noted that the study almost certainly underestimated the potential for death and damage, because it only tracked women who delivered their babies in hospitals.
Many women in the African nations where genital cutting is practiced deliver their babies at home, where typically it is not possible to treat medical complications like severe bleeding or to resuscitate an ailing newborn.
The scarring caused by genital mutilation likely makes it more difficult for babies to emerge, which is a factor in obstetric fistulas. Nicholas Kristoff has written pretty extensively about the Fistula Hospital, which repairs these fistulas, which generally occur in young girls giving birth for the first time, at home, who tear after many hours or days of labor due to narrow pelvises and genital scarring. Often, the child is born dead, and if the mother survives, she often has a fistula, which results in inability to control her bodily wastes and being cast out because of the smell.
Let’s hope that this study provides the impetus to outlaw this practice once and for all.
*Discussions of FGM always bring out trolls who want to derail the conversation to whine about how they were mutilated by being circumcised. Yes, Patriarchy Hurts Men, Too. However, this post is about Female Genital Mutilation and its role in maternal and child deaths. Unless you’re giving birth through your urethra, I don’t want to hear it. Any attempts to derail the discussion into issues of male circumcision will be summarily deleted.
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