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There is an underregistration in the clinical history of the women who gave birth at the Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA) and who could have suffered ablation between 2012 and 2015, according to the studies of Dr. Laura Gombau Giménez.
The research is based on the premise of detecting the consequences of delivery (obstetric-gynecological) in women from countries at risk of ablation and compares them with those suffered by Spanish women.
Since, according to Gombau, "there is a relationship, probably causal, in terms of an increased risk of adverse obstetric outcomes (problems in pregnancy and childbirth) in women who have suffered mutilation and those who have not."
Of the 245 women in the sample, 89 could be mutilated
However, Gombau Giménez finds that in the hospital registry there was only one case of ablation in the period between 2012 and 2015. Therefore, he makes a statistical estimate to know how many of the 245 sub-Saharan women in his sample could have suffered this practice.
"We take women from our sample and based on the prevalence of mutilation in their countries of origin, according to UNICEF in 2016, the probability is calculated, the result was striking, that statistical probability told us that of the 245 women from my sample, 89 could be mutilated, "says Laura Gombau.
Based on these data, it concludes that it is necessary to create a regional map of women and girls who are genitally mutilated and at risk, in order to apply the Prevention Protocol for FGM (Female Genital Mutilation), which already exists in the Region since 2017.
Hospital registration and regional map
There is a protocol at the state level of action and prevention of female genital mutilation since 2015. In addition, the Region has its own since 2017, but Gombau asks: "How is it possible that I have only registered one case?", To continue saying that "the main problem is that there is no exact area in the clinical history where it can reflect that the woman is mutilated, and that makes it very difficult to detect new cases." The protocol is, but it can not be applied if you do not have a previous map of mutilated women in the Region and of girls at risk ".
The expert proposes a solution through the creation of a field in the clinical history of women at risk (ablation) where it is reflected if it has been mutilated or not, to avoid under-registration.
Currently, the proposal has already been approved, and it has been agreed to include an indicator "Mutilation of genitals (Yes / No)" to detect cases of maternal genital mutilation and, thus, activate the mutilation prevention protocol in their daughter.
In addition, the teacher of the UMU emphasizes the urgency of training health personnel, because "it is necessary that professionals are not only sensitized to this issue, but trained through the acquisition of cultural competencies, so that they are able to act systematized and protocolized form, informing, above all, of the health risks that this practice triggers, through a multidisciplinary approach with standardized guidelines for action, focused primarily on prevention. "
For the researcher it is also important to establish the ethnicity in that registry: "One of the keys, what will tell us if it is a woman at risk (mutilated) or not, is the ethnic group from which it comes. If they are included in the clinical history, they will tell us if there is a greater risk or not, and on the basis of all that, we can elaborate the regional map, "he concludes.
Obstetric-gynecological complications
"The complications that prevail in sub-Saharan women in my sample coincide with those that usually occur in mutilated women," says the doctor in Nursing.
Although the statistical probability says that 89 women in the sample could be mutilated, Gombau Giménez can only affirm that there is one according to the existing registry.
Therefore, it is limited to see the complications in pregnancy and delivery (of the possible mutilated): intra-part and urgent caesarean sections;
second and third degree tears and episiotomies in the same birth;
intense hemorrhages and increased placental retention.
In addition, it highlights that "the only three cases that we detected of intrauterine dead fetus corresponded to sub-Saharan women, and this complication usually coincides with mutilated women, where the fetus dies inside the mother before giving birth, due to the obstruction of the canal of the birth caused by the keloid (lump in the skin due to poor healing) that usually remains as a result of poor healing after mutilation.
Methodology and current situation
To carry out the comparative analysis, the 245 women who had given birth at the Murcia hospital in a specific period (2012-2015) are taken from sub-Saharan countries that, according to UNICEF, have high rates of ablation.
"The 245 sub-Saharan women in our study belonged to 15 of the 27 countries declared at risk of ablation (FGM / C), predominantly Nigeria, Senegal and Mali," says Gombau.
Of the Spanish women, 490 of a total of 18225 were selected. Thus, Laura Gombau states that "to give it more statistical weight and to make a sample of a more homogeneous comparative study, it is decided to compare 2 Spanish women for each sub-Saharan woman, based on the age and number of pregnancies. "
The age range is between 18 and 44 years, with an average of 31 years.
This UMU study belongs to Laura Gombau's thesis 'Obstetric-Gynecological Complications in Women from Countries of Risk of Ablation / Female Genital Mutilation: Comparative Study', directed by Pilar Almansa and Ismael Jiménez.
Gombau explains that "as a result of communicating to the Arrixaca the results of the thesis, and proposing to add a field in the obstetric forms of the clinical history of every woman who passed through our hospital, where you could specify the status of external genitalia He applauded the idea and proposed it to the Central Services making it available to the rest of the hospitals with perinatal care in the Region ".
Source: Universidad de Murcia
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