Female genital mutilation (FGM) is practised in more than 30 countries. The World Health Organisation estimates that more than 132 million women and girls in Africa have undergone FGM, and that about 2 million procedures are done every year. Few previous studies have been appropriately designed to measure the health effects of the practice.
Lars Almroth (Karolinska Institutet, Stockholm, Sweden) and colleagues investigated whether FGM could lead to infertility. Between March 2003 and June 2004, the team recruited 99 infertile women and 180 women, pregnant for the first time, from two hospitals in Khartoum, Sudan. All participants had undergone FGM in childhood. Women were included in the infertile group if their infertility was not caused by hormonal factors, previous abdominal surgery, or the result of their partner's infertility. The researchers examined the genitalia of each woman to record the extent of FGM. They also tested the women for sexually transmitted infections that may cause infertility. They found that infertile women had a significantly higher risk of having undergone the most extensive form of FGM, involving the labia majora (female external genitalia), than controls. The incidence of sexually transmitted infections was low in both groups.
Dr Almroth concludes: "Our findings show a strong positive association between the anatomical extent of FGM and primary infertility. The association is not only statistically highly significant, but also highly relevant for preventive work against this ancient practice."
In an accompanying comment Layla M Shaaban (United States Agency for International Development, Washington, DC, USA) states: "Infertility is a social concern as well as a biological one. It threatens the basic structures of traditional society, marriage, and the family. The way to overcome female genital mutilation is through multiple strategic approaches with various different messages, which collectively tip the weight of public opinion. Legitimate concern about impairment of fertility can certainly weigh in heavily and help achieve the attainable goal of ending female genital mutilation."
Contact: Dr Lars Almroth, IHCAR Division of International Health, Karolinska Institutet, SE-17176 Stockholm, Sweden. T) 46-705-495-195 l.almroth@telia.com
Comment: Layla Shaaban, Research, Technology & Utilization, Office of Population and Reproductive Health, USAID/Bureau for Global Health, Washington, DC 20523, USA. T) 1-202-661-0383 Ishaaban@usaid.gov
Journal
The Lancet