Female Genital Mutilation in Sierra Leone : Forms, Reliability of Reported Status, and Accuracy of Related Demographic and Health Survey Questions

Abstract EN

Objective.

To determine forms of female genital mutilation (FGM), assess consistency between self-reported and observed FGM status, and assess the accuracy of Demographic and Health Surveys (DHS) FGM questions in Sierra Leone.

Methods.

This cross-sectional study, conducted between October 2010 and April 2012, enrolled 558 females aged 12–47 from eleven antenatal clinics in northeast Sierra Leone.

Data on demography, FGM status, and self-reported anatomical descriptions were collected.

Genital inspection confirmed the occurrence and extent of cutting.

Results.

All participants reported FGM status; 4 refused genital inspection.

Using the WHO classification of FGM, 31.7% had type Ib; 64.1% type IIb; and 4.2% type IIc.

There was a high level of agreement between reported and observed FGM prevalence (81.2% and 81.4%, resp.).

There was no correlation between DHS FGM responses and anatomic extent of cutting, as 2.7% reported pricking; 87.1% flesh removal; and 1.1% that genitalia was sewn closed.

Conclusion.

Types I and II are the main forms of FGM, with labia majora alterations in almost 5% of cases.

Self-reports on FGM status could serve as a proxy measurement for FGM prevalence but not for FGM type.

The DHS FGM questions are inaccurate for determining cutting extent.