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Obstetrics and Gynecology International
Volume 2013 (2013), Article ID 680926, 14 pages
Research Article

Female Genital Mutilation in Sierra Leone: Forms, Reliability of Reported Status, and Accuracy of Related Demographic and Health Survey Questions

1Division of Global Health, Department of Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
2Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
3Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 117, 221 00 Lund, Sweden
4Geneva Foundation for Medical Education and Research, 1290 Versoix, Switzerland

Received 29 March 2013; Revised 10 July 2013; Accepted 2 August 2013

Academic Editor: Birgitta Essen

Copyright © 2013 Owolabi Bjälkander et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone. Methods. This cross-sectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12–47 from eleven antenatal clinics in northeast Sierra Leone. Data on demography, FGM status, and self-reported anatomical descriptions were collected. Genital inspection confirmed the occurrence and extent of cutting. Results. All participants reported FGM status; 4 refused genital inspection. Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc. There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.). There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn closed. Conclusion. Types I and II are the main forms of FGM, with labia majora alterations in almost 5% of cases. Self-reports on FGM status could serve as a proxy measurement for FGM prevalence but not for FGM type. The DHS FGM questions are inaccurate for determining cutting extent.