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 = 4775a | 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 = 7765a | 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) | Multiplec | 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) | Multipled | 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 = 1700a | 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.