, 8 tweets, 3 min read Read on Twitter
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."
@WHO in @LancetGH: "FGM is associated with increased maternal mortality and this is likely to be causal. FGM done to young girls leading to scar. This causes obstruction." Essen: remember those words: "causal," "scar," and "obstruction." (1) Placenta/uterus bleeds, not scar; (2)
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.
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Brian D. Earp
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!