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As part of our Mother’s Day and International Women’s Day blog series, HART Ambassador, Katie Morris, writes on Female Genital Mutilation and Maternal Mortality Rates in Sudan.
In November 2015, the World Health Organisation (WHO) published data which demonstrates that worldwide maternal mortality rates have dropped by nearly 44% since 1990. Despite this improvement, maternal mortality remains a big problem in less developed countries. In particular, Sub-Saharan Africa has the highest maternal mortality ratio of all the Millennium Development Goal regions, with a ratio of 546 deaths to every 100,000 live births. In Sudan, maternal mortality rates have decreased by just over 8% between 2011 and 2015, but still remain high with 311 maternal deaths per 100,000 live births.
Experts have attributed this high death rate to a number of variables, including low government funding for healthcare, high numbers of childbirths and limited access to reproductive health services. Another factor that is gathering more coverage is female genital mutilation (FGM) and the complications it can cause in the perinatal period (the period before and after birth).
As well as having a high maternal mortality rate, Sudan is also notorious for high rates of FGM. UNICEF reports that 87% of women aged 15-49 had undergone some form of FGM in Sudan between 2004-2015. The link between maternal mortality and FGM has been more extensively investigated in the last decade, with the WHO producing guidelines for the management of pregnancy and childbirth in the presence of FGM. In 2010, Waris Dirie, a campaigner against the practice of FGM, released the following statement:
‘It is very important that this aspect [FGM] is not ignored when discussing the problem of maternal mortality in Africa. Genitally mutilated women face a much higher risk of serious complications and death during childbirth than women who have not been mutilated.’
FGM in Sudan
It is generally accepted that there are three main types of FGM, the most extreme of these being Type III, known as infibulation or pharaonic circumcision. Infibulation is the practice of narrowing the vaginal opening by creating a covering seal from cutting and sewing over the outer labia. The opening that is left is so small that it often has to be cut for intercourse and childbirth. All three types of FGM occur in Sudan, but the most predominant practice is infibulation. A study carried out by LandInfo found that 90% of women in Somalia and Northern Sudan that underwent genital mutilation were subjected to infibulation.
The degree of complications during pregnancy increases according to the extent and severity of genital mutilation. Sudanese women who have experienced infibulation are therefore more at risk of a number of complications throughout the perinatal period, the most serious of which can result in death.
Postpartum haemorrhages and maternal mortality
FGM has been linked to a number of complications that occur during pregnancy. For one, it is much harder to carry out vaginal examinations during pregnancy on women who have undergone mutilation. Infibulation is also a factor contributing to the prevalence of obstetric fistula, a debilitating condition which makes a woman incontinent after childbirth. The most serious complication that occurs as the result of infibulation is the risk of postpartum haemorrhages which are the most common cause of maternal mortality in developing countries. A recent study carried out by WHO researchers found that women who have undergone infibulation face a 70% greater risk of haemorrhage compared with women who have not had any form of FGM.
Women who have undergone infibulation therefore need constant care and supervision from trained medical professionals during and after childbirth. However, many women who have undergone infibulation are not receiving medical care after childbirth, leading to high mortality rates. Although many infibulated women simply do not have access to hospitals, there may also be family and cultural pressure on these women to give birth at home. Traditionally, many infibulated women are re-infibulated in the post-natal period. However, recently hospitals across Sudan have made conscious efforts to ban midwives from performing re-infibulation on women after childbirth. This strict policy is often a factor in ‘scaring’ women off attending hospitals. Re-infibulation is therefore a large problem in the battle against FGM, as it not only adds to the cycle of mutilation of Sudanese women, but also plays a part in preventing them from accessing and receiving proper medical care.
Over 60% of maternal deaths in Sudan are caused by preventable and treatable complications. Although they can be serious, postpartum haemorrhages can be treated by the administration of oxytocin, and in extreme cases by the surgical removal of placenta tissue. They become more serious when women more at risk of postpartum haemorrhages (such as those who have undergone infibulation) do not receive proper medical attention during the perinatal period.
In regions where more extreme forms of FGM are common, such as sub-Saharan Africa, it is imperative that governments work towards eradicating the practice of infibulation and re-infibulation by working with local communities on female empowerment projects. Eradicating these practices should go some way to contributing to a decline in maternal mortality rates, and most especially those caused by postpartum haemorrhages.
Please consider donating £5 to HART’s work which could provide life-saving equipment and healthcare to mums worldwide. Text MUMS05 £5 to 70070 today to donate £5 or donate through the website: www.hart-uk.org/donate
Read the rest of our Mother’s Day Campaign series here!
Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.