The Obstetric Consequences of Female Genital Mutilation/Cutting: A Systematic Review and Meta-Analysis

Table 1

Included comparative studies reporting on obstetric events (𝑛=28).

Author, year	Method study quality	Population; total 𝑁 (cut)	Country/origin	Age	FGM/C characteristics	Outcomes (self-report or clinical verification)
Adinma 1997 [28]	Low	𝑁=256 (124)	Nigeria	16–40	Type: 22% TI, 78% TII (gyn exam); Age cut/by: 97% in childhood/not stated	Episiotomy (self-report)
Berardi et al. 1985 [29]	Low	𝑁=852 (71)	France	Not stated	Type: 100% TII (gyn exam); Age cut/by: not stated	Tears; cesarean section; episiotomy (clinical)
Bohoussou et al. 1986 [30]	Low	𝑁=4935 (1099)	Ivory Coast	Not stated	Type: 29% TI, 73% TII (gyn exam); Age cut/by: not stated	Prolonged labor; tears; cesarean section; episiotomy; instrumental delivery (not stated)
Browning et al. 2010 [31]	High	𝑁=492 (255)	Ethiopia	Mean 28.5	Type: 100% TI and TII (gyn exam); Age cut/by: not stated	Prolonged labor (clinical)
Chibber et al. 2011 [32]	Low	𝑁=4800 (1842)	Not stated	Not stated	Type: “type I to III most common” (gyn exam); Age cut/by: not stated	Prolonged labor; cesarean section; hemorrhage (clinical)
De Silva 1989 [33]	Low	𝑁=2157 (167)	Saudi Arabia	Not stated	Type: 9% TI, 34% TII, 32% TIII (gyn exam); Age cut/by: not stated	Prolonged labor; tears; cesarean section; episiotomy; instrumental delivery; hemorrhage (clinical)
Diop et al. 1998 [34]	Low	𝑁=5390 (4359)	Mali	Mean 27.0	Type: 21% TI, 73% TII, 6% TIII (gyn exam); Age cut/by: not stated	Tears; episiotomy; hemorrhage (clinical)
Elnashar and Abdelhady 2007 [35]	Low	𝑁=264 (200)	Egypt	Not stated	Type: “circumcised” (self-report); Age cut/by: not stated	Tears; cesarean section; episiotomy (self-report)
Essén et al. 2005 [36]	Moderate	𝑁=2554 (68)	Sweden	Not stated	Type: most TIII (gyn exam); Age cut/by: not stated	Prolonged labor (clinical)
Hakim 2001 [14]	Low	𝑁=1481 (1225)	Ethiopia	Mean 25.9	Type: 12% TI, 85% TII, 3% TIII (not stated); Age cut/by: not stated	Prolonged labor; tears; episiotomy; hemorrhage (clinical)
Johnson 2005 [37]	Low	𝑁=5416 (579)	USA	Most 20–34	Type: most likely type III (assumed, unverified).; Age cut/by: not stated	Tears; cesarean section; instrumental delivery; hemorrhage (clinical)
Jones et al. 1999 [15]^b	Low	𝑁=1920 (1787)	Burkina Faso	Mean 26.6	Type: 56% TI, 39% TII, 5% TIII (gyn exam); Age cut/by median 9.5 yrs/not stated	Difficult labor (self-report)
Jones et al. 1999 [15]^b	Moderate	𝑁=5337 (5017)	Mali	Mean 25.0	Type: 21% TI, 74% TII, 5% TIII (gyn exam); Age cut/by: not stated	Difficult labor (clinical)
Larsen and Okonofua 2002 [16]	Low	𝑁=1836 (1009)	Nigeria	15–49	Type: 71% TI, 25% TII, 3% TIII, 1% TIV (gyn exam).; Age cut/by: not stated	Prolonged labor; tears; cesarean section; episiotomy (self-report)
Lupo and Marcotte 1999 [38]	Low	𝑁=114 (38)	USA	Not stated	Type: “female circumcision” (not stated); Age cut/by: not stated	Tears (not stated)
Millogo-Traore et al. 2007 [39]	Low	𝑁=454 (227)	Burkina Faso	Median 25	Type: 28% TI, 69% TII, 3% TIII (gyn exam); Age cut/by: not stated	Prolonged labor; tears; episiotomy; instrumental delivery (clinical)
National Statistics Office 1995 [40]	Low	𝑁=4775^a	Eritrea	15–49	Type: 62% TI, 4% TII, 34% TIII (self-report); Age cut/by: 60% ≤5 yrs/91% tc	Problems during delivery (self-report)
NSEO 2003 [41]	Low	𝑁=7765^a	Eritrea	15–49	Type: 4% TI-II, 39% TIII, 46% TIV (self-report); Age cut/by: 62% ≤1 yr/84% tc	Problems during delivery (self-report)
Ndlaye et al. 2010 [42]	Low	𝑁=354 (210)	Burkina Faso	Mean 24.0	Type: 47% TI, 47% TII, 6% TIII (gyn exam); Age cut/by: not stated	Tears; cesarean section; episiotomy; hemorrhage (clinical)
Oduro et al. 2006 [43]	High	𝑁=5071 (1466)	Ghana	Mean 25.8	Type: “type II is the commonest form” (gyn exam).; Age cut/by: not stated	Cesarean section (clinical)
Orji and Babalola 2006 [17]	Low	𝑁=500 (423)	Nigeria	Mean 27.5	Type: 87% TI, 13% TII (gyn exam); Age cut/by: 95% cut in childhood/80% tc, 14% hcp	Cesarean section; episiotomy (self-report)
Slanger et al. 2002 [44]	Moderate	𝑁=1107 (621)	Nigeria	Mean 33.7	Type: 72% TI, 24% TII, 4% TIII + IV (gyn exam),; Age cut/by: 95% cut in childhood/80% tc, 14% hcp	Tears; cesarean section; episiotomy; instrumental delivery; hemorrhage; fever (self-report)
Small et al. 2008 [45]	Low	𝑁=2179322 (10431)	Multiple^c	Most 20–34	Type: most likely type III (assumed, unverified).; Age cut/by: not stated	Cesarean section; instrumental delivery (clinical)
Vangen et al. 2002 [18]	Low	𝑁=703925 (1733)	Norway	Not stated	Type: most likely type III (assumed, unverified).; Age cut/by: not stated	Prolonged labor; tears; cesarean section; hemorrhage (clinical)
WHO study group 2006 [19]	High	𝑁=28393 (21222)	Multiple^d	Mean 26.3	Type: 32% TI, 37% TII, 31% TIII (gyn exam); Age cut/by: not stated	Tears; cesarean section; episiotomy; hemorrhage (clinical)
Wuest et al. 2009 [20]	Low	𝑁=232 (122)	Switzerland	Mean 28.0	Type: 17% TI, 24% TII, 48% TIII, 11% TIV (gyn exam).; Age cut/by: not stated	Prolonged labor; tears; cesarean section; episiotomy; instrumental delivery; hemorrhage (clinical)
Yount and Abraham 2007 [46]	Moderate	𝑁=3167 (1071)	Kenya	15–49	Type: “had undergone FGC” (self-report); Age cut/by: not stated	Cesarean section (self-report)
Yount and Carrera 2006 [47]	Low	𝑁=1700^a	Egypt	17–55	Type: 4% TI, 73% TII, 23% TIV (self-report); Age cut/by: mode 9-10 yrs/93% tc, 4% hcp	Pregnancy loss (self-report): 39% TI, 42% TII, 43% TIV

Legend: Method: Methodological; TI: FGM/C type I; TII: FGM/C type II; TIII: FGM/C type III; TIV: FGM/C type IV; gyn exam: FGM/C status verified through gynecological examination; self-report: FGM/C status based on self-report; hcp: health care provider; tc: traditional circumciser; ^adifferent types of FGM/C were compared; ^bJones et al. 1999 [15] consists of two studies, reported in same publication; ^cAustralia, Belgium, Canada, Finland, Norway, and Sweden; ^dBurkina Faso, Ghana, Kenya, Nigeria, Sudan, and Senegal.