Genital cutting tied to later abuse risk

NEW YORK Mon Sep 24, 2012 12:05pm EDT

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NEW YORK (Reuters Health) - Women who underwent genital cutting as young girls may be at increased risk of physical, sexual or emotional abuse from their husband, a study of women in Mali suggests.

The study, of nearly 7,900 women, found that 22 percent of those with genital mutilation said they'd been physically abused by a husband or male partner. That compared with 12 percent of women who'd never been subjected to the procedure.

It's estimated that more than 130 million women worldwide have undergone genital mutilation, also known as female "circumcision." The centuries-old practice, which involves removing part or all of a girl's clitoris and labia, and sometimes narrowing the vaginal opening, remains a common practice in some countries, mainly in sub-Saharan Africa.

It's well-known that genital cutting has long-term consequences for women - including sexual dysfunction, childbirth complications, incontinence and psychological disorders.

In the new study, researchers looked at whether there's a link between genital mutilation and a woman's odds of suffering abuse from her partner.

In Mali, where the vast majority of women have undergone genital mutilation, the government has taken steps to raise awareness of the consequences of the practice. But genital mutilation has not been outlawed.

The difficulty is that genital cutting is widely seen as an important cultural tradition, rather than a form of abuse.

"If something is entrenched in a culture, it is difficult to change," said Dr. Hamisu Salihu of the University of South Florida in Tampa, the lead researcher on the new study.

On the other hand, physically abusing your wife - though common in Mali and other African countries - does not have that cultural acceptance, Salihu told Reuters Health.

So being able to frame genital cutting in the context of domestic violence might help change people's views on the practice.

The study, reported in the obstetrics and gynecology journal BJOG, included 7,875 Malian women. The large majority - 6,919 women - had genital mutilation.

Of those women, 22 percent said they'd suffered physical abuse from their partner, while five percent reported sexual abuse and 12 percent emotional abuse.

When the researchers accounted for other factors - like education level and poverty - genital mutilation was linked to two- to three-fold increases in the risk of all three types of abuse.

One of the possible limitations of the study, according to Salihu's team, is that women were asked about sensitive issues. The actual levels of abuse may have been higher than women reported.

Past studies have suggested that across sub-Saharan Africa, half of all women have been abused by a husband or partner.

Salihu said these latest findings suggest that women with genital cutting may be in particular need of screening and counseling for abuse.

When pregnant women with genital mutilation see a healthcare provider, they are already considered "high risk" because of their increased odds of pregnancy and childbirth complications.

Those visits offer a "window of opportunity" for women to get counseling about domestic violence, Salihu said.

Right now, though, that is not usually done.

SOURCE: bit.ly/NCx4Kw BJOG: An International Journal of Obstetrics and Gynaecology, online August 24, 2012.

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