Female genital mutilation/cutting in The Gambia: long-term health consequences and complications during delivery and for the newborn

Figures & data

Table 1 Characteristics of women with no FGM/C, type I FGM/C, and type II FGM/C

	No FGM/C		Type I FGM/C		Type II FGM/C		Total
Age (years)
Range	15–41		12–42		15–45		12–45
Mean	25.6		26.3		25.4		25.9
Living children (n)
Range	0–6		0–9		0–9		0–9
Mean	1.9		2.4		2.0		2.2
	n	%	n	%	n	%	n	%
Casesa	139	24.4	326	57.2	105	18.4	570	100
Reason for attending hospital or health centerb
Delivery	94	71.2	205	68.1	82	80.4	381	71.2
Antenatal care	38	28.8	93	30.9	19	18.6	150	28.0
Other	0	0	3	1.0	1	1.0	4	0.7
Total	132	100	301	100	102	100	535	100
Ethnic groupc
Mandinka	10	5.7	139	79.4	26	14.9	175	100
Wolof	99	82.5	16	13.3	5	4.2	120	100
Fula	8	6.9	80	69.0	28	24.1	116	100
Sarahole	1	3.3	12	40.0	17	56.7	30	100
Djola	3	3.9	54	71.1	19	25.0	76	100
Serer	7	53.8	3	23.1	3	23.1	13	100
Other	7	36.8	12	63.2	0	0	19	100

Notes:

a Of total cases (n = 570)

b of total cases in each group (no FGM/C, type I FGM/C, type II FGM/C, total)

c of total cases in each ethnic group (Mandinga, Wolof, Fula, Saraholes, Djola, Serer, other).

Abbreviation: FGM/C, female genital mutilation/cutting.

Table 2 Prevalence and 95% confidence intervals of the affirmative category of the clinical variables collected by questionnaire and clinical examination

	No FGM/C			Type I FGM/C			Type II FGM/C			χ^2 (P value)
	n	%	95% CI	n	%	95% CI	n	%	95% CI
Cases (n)	139			326			105
Common symptoms
Dysmenorrheaa	48	34.5	26.3–42.8	188	58.2	52.7–63.7	71	67.6	58.2–77.1	31.4 (<0.001)
Recurrent urinary tract infectiona	20	14.4	8.2–20.6	63	19.6	15.0–24.0	46	44.2	34.2–54.3	34.6 (<0.001)
Vulvar or vaginal paina	7	5.0	1.0–9.0	56	17.4	13.1–21.7	41	39.8	29.9–49.7	48.1 (<0.001)
Vaginal dischargea	40	28.8	20.9–36.7	166	51.4	45.8–57.0	63	60.6	50.7–70.5	28.6 (<0.001)
Painful intercoursea	18	12.9	7.0–18.9	95	29.3	24.2–34.4	60	57.1	47.2–67.1	55.6 (<0.001)
Bleeding during or after intercoursea	3	2.2	0.5–6.2	17	5.3	2.7–7.9	33	31.4	22.1–40.8	75.3 (<0.001)
Difficult penetration during intercoursea	8	5.8	1.5–10.0	49	15.1	12.0–19.2	53	50.5	40.4–60.5	85.3 (<0.001)
Presentation
Fibrosisa	0	0	0–2.7	51	15.8	11.7–19.9	20	19.4	11.3–27.5	26.5 (<0.001)
Keloid of clitorisa	0	0	0–2.7	43	13.3	9.4–17.1	37	35.6	25.9–45.3	61.3 (<0.001)
Keloid of labiaa	1	0.8	0.02–1.1	8	2.5	0.6–4.3	22	21.6	13.1–30.0	61.7 (<0.001)
Synechia of vulvaa	1	0.8	0.02–1.1	23	7.1	4.2–10.1	31	30.4	21.0–39.8	63.8 (<0.001)
Synechia of labia minoraa	1	0.8	0.02–1.1	34	10.5	7.0–14.0	56	54.4	44.3–64.5	141.4 (<0.001)
Clitoral neuromaa	2	1.5	0.18–5.3	26	8.1	4.9–11.2	21	20.6	12.3–28.9	26.9 (<0.001)

Note:

a Of the total number of answers for each question and for each group (no FGM/C, type I FGM/C, type II FGM/C), that may be less than or equal to the total number of cases.

Abbreviations: FGM/C, female genital mutilation/cutting; CI, confidence interval.

Table 3 Prevalence and 95% confidence intervals of the affirmative category of complications during delivery and in newborn collected by clinical examination

	No FGM/C			Type I FGM/C			Type II FGM/C			χ^2 (P value)
	n	%	95% CI	n	%	95% CI	n	%	95% CI
Delivery cases (n)	94			205			82
Complicationsa	11	11.7	4.7–18.7	80	39.0	32.1–45.9	54	65.9	55.0–76.7	75.4 (<0.001)
Type of complication
Perineal teara	9	9.6	3.1–16.1	57	27.8	21.4–34.2	40	48.8	37.4–60.2	51.6 (<0.001)
Prolonged labora	8	8.5	2.3–14.7	32	15.6	10.4–20.8	30	36.6	25.6–47.6	53.5 (<0.001)
Need for episiotomya	3	3.2	0.7–9.1	41	20.0	14.3–25.7	25	30.5	19.9–41.1	35.5 (<0.001)
Need for cesarean sectiona	1	1.1	0.03–5.8	1	0.5	0.01–2.7	5	6.1	2.0–13.7	12.0 (0.003)
Fresh stillbirtha	0	0	0–3.9	6	2.9	0.4–5.5	5	6.1	2.7–16.8	17.8 (<0.001)
Neonatal complications (n)a	5	5.3	1.8–12.0	32	15.6	10.4–20.8	31	37.8	26.7–48.9	44.5 (<0.001)
Fetal distressa	3	3.2	0.7–9.1	18	8.8	4.7–12.9	22	26.8	16.6–37.0	31.6 (<0.001)
Caput of fetal heada	1	1.1	0.03–5.8	30	14.6	9.6–19.7	28	34.2	23.3–45.0	46.8 (<0.001)

Notes:

a Of total number of deliveries for each group (no FGM/C, type I FGM/C, type II FGM/C).

Abbreviations: CI, confidence interval; FGM/C, female genital mutilation/cutting.

Table 4 Prevalence and OR (95% CI) of the affirmative category of the clinical variables and of the delivery and newborn complications, for the no FGM/C and FGM/C (type I and II) groups

Maternal symptoms	n (%)		OR (95% CI)	P value
	No FGM/C	Type I and II FGM/C
Dysmenorrheaa	64 (34.5)	260 (60.5)	2.91 (1.95–4.33)	<0.001
Recurrent urinary tract infectiona	20 (14.4)	109 (25.5)	2.05 (1.21–3.45)	0.07
Vulvar or vaginal paina	7 (5.0)	99 (22.8)	5.58 (2.52–12.33)	<0.001
Vaginal dischargea	40 (28.8)	230 (53.6)	2.86 (1.89–4.33)	<0.001
Painful intercoursea	18 (12.9)	156 (36.1)	3.80 (2.23–6.48)	<0.001
Bleeding during or after intercoursea	3 (2.2)	51 (11.7)	5.99 (1.84–19.54)	<0.001
Difficult penetration during intercoursea	8 (5.8)	103 (24.0)	5.12 (2.42–10.79)	<0.001
Complications during deliveryb	11 (11.7)	134 (46.9)	6.70 (3.42–13.1)	<0.001
Perineal tearb	9 (9.6)	97 (33.8)	4.82 (2.33–10.00)	<0.001
Prolonged laborb	8 (8.6)	62 (21.6)	2.96 (1.36–6.44)	0.003
Need for episiotomyb	3 (3.2)	66 (24.7)	9.06 (2.78–29.56)	<0.001
Need for cesareanb	1 (1.1)	6 (2.3)	–	–
Fresh stillbirthb	0 (0.0)	11 (3.8)	–	–
Neonatal complicationsb	5 (5.3)	63 (22.5)	5.17 (2.01–13.28)	<0.001
Fetal distressb	3 (3.2)	40 (13.9)	4.91 (1.48–13.27)	0.005
Caput of fetal headb	1 (1.1)	58 (20.6)	–	–

Notes:

a Of total number of answers for each question and for each group (no FGM/C, type I and II FGM/C), that may be less than or equal to the total number of cases

b of the total number of deliveries for each group (no FGM/C, type I and II FGM/C); (−) not calculated because of insufficient number of cases.

Abbreviations: CI, confidence interval; FGM/C, female genital mutilation/cutting; OR, odds ratio.