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Female Genital Mutilation and Implications for Sexual, Reproductive and Maternal Health

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Female genital mutilation (FGM), sometimes called “female genital cutting” or “female circumcision,” refers to “procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.” FGM is practiced in many parts of the world, generally on girls under 15 years-old. The World Health Organization, UNICEF and the United Nations Population Fund have categorized FGM into four types:

Type I: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy)

Type II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)

Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)

Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization

As of 2010, an estimated 100-140 million women have undergone FGM globally. While FGM is often associated with African and Muslim majority countries, variations of the practice have been recorded all over the world, including in AustraliaIndonesia, ColombiaThailand, India, the United States, the European Union, Norway and Switzerland. There is substantial variation in the prevalence of FGM: Within sub-Saharan Africa, the percentage of women who have undergone FGM ranges from less than 1% in Uganda to 98% in Somalia. However, trend data indicate that the practice is becoming less common over time in some places. Many international organizations have declared that FGM is a human rights violation and have called for its immediate elimination.

Sexual, reproductive and maternal health implications

Women with FGM types I, II and III are at greater risk of experiencing numerous short-term and long-term sexual, reproductive and maternal health outcomes.

Immediate risks Long-term risks
Severe pain Chronic pain
Excessive bleeding/ hemorrhage Infections
Difficulty in passing urine Keloid
Infections Reproductive tract infections
HIV if unsterile tools are used HIV, other sexually-transmitted diseases
Psychological trauma Decreased sexual pleasure
Unintended labia fusion Birth complications
Repeated FGM due to difficulty healing Mental health issues
Death

Birth complications include cesarean section, postpartum hemorrhage, tearing, obstructed labor (which can cause obstetric fistula), stillbirth, extended hospital stay, delivery of a low birthweight infant and newborn death. Women with FGM type III are also more likely to require surgery later in life, develop urinary and menstrual problems, suffer from pain during sexual intercourse and experience infertility. Less is known about FGM type IV.

Call to action

Efforts to eliminate FGM around the globe have gained momentum in recent years. However, further research is needed to fill existing knowledge gaps, particularly related to sexual, reproductive and maternal health consequences. Women who have undergone FGM in diverse contexts are uniquely positioned to help identify sustainable, culturally sensitive solutions.

Learn more by reading these key papers:

Eliminating female genital mutilation: An interagency statement
OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO | 2008

Research gaps in the care of women with female genital mutilation: An analysis
BJOG | February 2015

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries
The Lancet | June 2006

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience
Midwifery | January 2015

Learn more about the International Day of Zero Tolerance for Female Genital Mutilation.

Access resources related to adolescent sexual and reproductive health.

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