Using electronic maternity records to estimate female genital mutilation in Lothian from 2010 to 2013

Abstract Background Female genital mutilation (FGM) is most commonly encountered in Africa and the Middle East, with migration from FGM-practicing countries meaning it is increasingly seen in Europe. Addressing FGM requires accurate information on who is affected but ascertainment is notoriously dif...

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Bibliographic Details
Published in:European journal of public health 2018-08, Vol.28 (4), p.657-661
Main Authors: Ford, C M, Darlow, K, Massie, A, Gorman, D R
Format: Article
Language:English
Subjects:
Birth
Childbirth & labor
Country of birth
Data analysis
Estimation
Extrapolation
Female circumcision
Females
Genital mutilation
Investment
Investments
Matching
Maternal child nursing
Migration
Obstetrics
Patients
Polls & surveys
Pregnancy
Public health
Registration
Sensitivity
Training
Women
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Summary:Abstract Background Female genital mutilation (FGM) is most commonly encountered in Africa and the Middle East, with migration from FGM-practicing countries meaning it is increasingly seen in Europe. Addressing FGM requires accurate information on who is affected but ascertainment is notoriously difficult. This study estimated FGM prevalence in women presenting for maternity care in the Lothian region of Scotland and compared this with that expected by extrapolation of survey data from women’s country of birth. Methods Electronic clinical records were linked to birth registration data to estimate FGM in the obstetric patients in Lothian from 2010 to 2013. Results Among all, 107 women affected by FGM were detected, at a rate of 2.8/1000 pregnancies. Of 487 women from UNICEF-recognized FGM-practicing countries who accessed care, 87 (18%) had documented evidence of FGM (three quarters of whom came from Nigeria, Sudan or The Gambia). The prevalence was 54% of the level expected from the extrapolation method. Country of birth had a sensitivity of 81% for FGM. Conclusion Women from FGM-practicing countries commonly access maternity care in Lothian. This confirms the need for ongoing training and investment in identifying and managing FGM. Matching electronic clinical records with birth registration data was a useful methodology in estimating the level of FGM in the maternity population. In a European country like Scotland with modest migrant numbers, asking country of birth during pregnancy and making sensitive enquiries could detect 81% of women with FGM. Extrapolation from maternal country of birth surveys grossly overestimates the true prevalence.
ISSN:1101-1262
1464-360X
DOI:10.1093/eurpub/cky045