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B. Essen, senior OGBYN: "My clinical evidence does not support @WHO claims about maternal mortality/complications due to FGM/C. I support WHO policy generally, but as a professional, I have a duty to raise my critical voice when I see research or policy not adding up."
muscles, not scar are what prolong/obstruct labor. The perineum is where obstruction may occur, not where FGC happens. Obstructed labor is not related to scars on the vulva. How might a causal relation be established? If X associated w. death & different management would avoid.
Essen: factors in Somalia that make big difference: socio-economic factors: no pre-natal care, lack of financial resources, lack of trust in health system, late arrival of doc, accessibility/delay in transport, lack of resources to treat eclampsia, stop bleeding, life-saving CS.
But lack of management of obstructed labor and lack of management of FGM/C are NOT associated with mortality, suggesting not causal factor. In Sweden, NOT USING INTERPRETER was biggest factor in maternal death. Essen: I ask @WHO to re-allocate resources to a holistic approach
for maternal care: by focusing just on FGM/C, and not putting comparable resources on the socio-economic factors leading to maternal mortality, we fail to avoid preventable deaths. We need social competence, better communication, and *evidence-based* research.
J. Abdulcadir (moderator): REASONS for complications need to be studied, not just saying "increased risk" - in many cases, risk is from *unnecessary, risky C-sections* by providers who don't know how to manage infibulation (via de-infibulation), rather than prior cutting itself.
Essen: my claim is not that symptoms, complications from some forms of FGM/C don't occur or matter; the claim is that proportionally to the other (confounding) factors, the other factors are much more important & likely causal in maternal deaths, bleeding, and obstruction.
