Female Genital Mutilation and Adverse Obstetric Outcomes Among Pregnant Women Seen in Select Hospitals in Freetown, Sierra Leone

Abstract

Background: Female genital mutilation/cutting (FGM/C) is a commonly occurring exercise in most parts of the world. This practice is linked with adverse short term and long-term complications to the victims. Around 3 million women are at increased risk of FGM with more than 200 million undergoing the procedure across the globe annually. Sierra Leone is one of the countries that record very high rate of FGM with 81% in urban and 94% in rural settings. Sierra Leone has high mortality rate of around 1,165 deaths per 100,000 live births. Thus, there need to compare the occurrence of obstetric complication in women who have undergone FGM and those without FGM. Objective: The main objective is to determine the types of Female genital mutilation and the associated adverse obstetric outcomes among pregnant women seen in a select hospital in Western Area, Freetown Sierra Leone Methodology: The study adopted a prospective cohort design. The study targeted all women aged 15 to 49 years going for a spontaneous vaginal delivery for singleton babies in both active and latent phase of labor in Princess Christiana Maternity Hospital (PCMH), Lumley, Kingharma Road Government Hospital and Aberdeen women Hospital between age 15 to 49years. The study included 357 FGM exposed and 119 FGM non-exposed. A structured questionnaire was used for data collection. SPSS version 26 software was used for the analysis. The level of significant used to assessed was at 0.05. Results: The mean age of the respondents was 24 years, 58.4% were married, 61.6% were Muslims. Education level analysis revealed that, 38.4% had secondary level education, 31.1% were self-employed. Majority of the respondents, 70.8% had less or equal to four antenatal visits, 95.6% (455) had between para 1 and para 4. Bivariable analysis revealed that, delivery complications (RR =2.24, 95%CI: 1.6 – 3.14, p<0.001), perineal tear, (RR =2.58, 95%CI: 1.72 – 3.85, p <0.001), cervical tear, (RR =6.00, 95%CI (1.47 – 24.54, p = 0.001), PPH, (RR =2.32, 95%CI: 1.27 – 4.19, p<0.001), outlet obstruction, (RR= 1.47, 95%CI: 1.14 – 1.91, p = 0.001). Management of outlet obstruction by episiotomy was higher among women with FGM, (RR = 2.5, 95%CI: 1.46 – 3.81, p<0.001), Duration of second stage ≥45 minutes, (RR = 1.69, 95%CI: 1.32 – 2.15, p <0.001) were significantly associated with FGM. Apgar score of less than 7 at 1st minute, (RR = 1.38, 95%CI:1.03 – 1.86, p=0.024), Apgar score less than 7 at 5th minute (RR = 2.93, 95%CI:1.63 – 5.29, p<0.001), admission to NICU, (RR = 2.14, 95%CI: 1.14 – 4.04, p = 0.009) were significantly associated with FGM.

Multivariable analysis conducted revealed that, perineal tear (aRR = 2.45, 95%CI: 1.09 – 5.6, p = 0.031), delay second stage, (aRR =2.49, 95%CI: 1.47 – 4.22, p = 0.001), Apgar score (less than 7) (aRR = 3.71, 95%CI:1.58 – 8.7, p = 0.003) were independently associated with FGM. Conclusion and Recommendations: The findings have shown that type II was the most common type of FGM while the risk of adverse outcomes increases with increase in the severity of type of FGM. Thus, to control these adverse outcomes, it is essential to conduct clinical examination to identify women with FGM in order to advice for the appropriate mode of delivery to control adverse outcomes.