PUBLI : Fatoumata Sylla, Caroline Moreau et Armelle Andro « A systematic review and meta-analysis of the consequences of female genital mutilation on maternal and perinatal health outcomes in European and African countries », BMJ Global Health, Dec 2020

  • Liste des auteurs : Fatou­mata Sylla, Caro­line Moreau, Armelle Andro
  • Article en accès libre sur le site de la revue


Intro­duc­tion : Key know­ledge gaps remain to improve repro­duc­tive health outcomes for millions of women living with female genital muti­la­tion (FGM). We aimed to update previous reviews and quan­tify more rigo­rously maternal and perinatal compli­ca­tions related to FGM across different settings.

Methods : In this syste­matic review and meta-analysis, we sear­ched 15 elec­tronic data­bases for studies publi­shed between 1 August 1995 and 15 March 2020, repor­ting on maternal and perinatal compli­ca­tions related to FGM. We included studies compa­ring women with and without FGM while accoun­ting for confoun­ders. Pooled rela­tive risks (RR) were calcu­lated, using fixed-effects and random-effects models, for a range of maternal and perinatal outcomes, adjus­ting for indi­vi­dual charac­te­ris­tics and accor­ding to deli­very settings and study design.

Results : We iden­ti­fied 106 unique refe­rences, assessed 72 full-text articles and included 11 studies. We found non-signi­fi­cant elevated risks of instru­mental deli­very, caesa­rean deli­very, episio­tomy, post­partum haemor­rhage, perineal lace­ra­tion, low Apgar score and miscarriage/​stillbirth related to FGM. Hete­ro­ge­neity was present for most outcomes when combi­ning all studies but reduced in subgroup analyses. The risk of caesa­rean deli­very was increased among primi­pa­rous women (1.79, 95% CI 1.04 to 3.07) such as the risk of episio­tomy in Euro­pean specia­lised settings for women with FGM (1.88, 1.14 to 3.09). In Africa, subgroup analyses revealed elevated risks of post­partum haemor­rhage (2.59, 1.28 to 5.25). The most common reported type was FGM II. However, few studies provided stra­ti­fied analyses by type of FGM, which did not allow an assess­ment of the impact of the seve­rity of typo­logy on studied outcomes.

Conclu­sion : This review suggests maternal and perinatal morbi­dity related to FGM vary by study design, context and by subgroup of women. Our study also draws atten­tion to the compli­ca­tions that may extend to the post­partum period. This work contri­butes to shaping a refe­rence frame­work for future research and clinical guidelines.

Keywords : epide­mio­logy ; maternal health ; obste­trics ; syste­matic review.