Introduction
Type I | Partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals, with the function of providing sexual pleasure to the woman), and/or the prepuce/clitoral hood (the fold of skin surrounding the clitoral glans). |
Type Ia | Removal of the prepuce/clitoral hood only |
Type Ib | Removal of the clitoral glans with the prepuce/clitoral hood |
Type II | Partial or total removal of the clitoral glans and the labia minora, with or without removal of the labia majora. |
Type IIa | Removal of the labia minora only |
Type IIb | Partial or total removal of the glans of the clitoris and the labia minora |
Type IIc | Partial or total removal of the glans of the clitoris, the labia minora and the labia majora |
Type III (Infibulation) | Narrowing of the vaginal opening with the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora. The covering of the vaginal opening is done with or without removal of the clitoral prepuce/clitoral hood and glans. |
Type IIIa | Removal and apposition of the labia minora |
Type IIIb | Removal and apposition of the labia majora |
Type IV | All other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization. |
Methods
Country of origin | ZürichTotal | Lausanne Total | Geneva Total | Bern Total | Total |
---|---|---|---|---|---|
Benin | 2 | 12 | 18 | 5 | 37 |
Burkina Faso | 3 | 12 | 54 | 21 | 90 |
Cameroon | 52 | 256 | 261 | 274 | 843 |
Central African Republic | 1 | 1 | 3 | 3 | 8 |
Chad | 2 | 1 | 2 | 13 | 18 |
Djibouti | 0 | 4 | 3 | 0 | 7 |
Egypt | 20 | 15 | 107 | 101 | 243 |
Eritrea | 167 | 295 | 362 | 1881 | 2705 |
Ethiopia | 59 | 100 | 123 | 287 | 579 |
Gambia | 7 | 3 | 8 | 16 | 34 |
Ghana | 42 | 6 | 53 | 79 | 180 |
Guinea | 8 | 41 | 101 | 31 | 181 |
Guinea-Bissau | 0 | 14 | 9 | 2 | 25 |
Indonesia | 20 | 12 | 33 | 64 | 129 |
Iraq | 66 | 74 | 164 | 481 | 785 |
Ivory Coast | 41 | 47 | 146 | 72 | 306 |
Kenya | 41 | 6 | 63 | 125 | 235 |
Liberia | 2 | 3 | 5 | 5 | 15 |
Mali | 2 | 1 | 32 | 6 | 41 |
Mauritania | 0 | 1 | 27 | 1 | 29 |
Niger | 0 | 4 | 23 | 11 | 38 |
Nigeria | 42 | 36 | 88 | 169 | 335 |
Senegal | 5 | 42 | 195 | 29 | 271 |
Sierra Leone | 4 | 3 | 20 | 23 | 50 |
Somalia | 101 | 157 | 233 | 523 | 1014 |
Sudan and South Sudan | 30 | 2 | 79 | 63 | 174 |
Tanzania | 7 | 1 | 33 | 13 | 54 |
Togo | 3 | 61 | 78 | 36 | 178 |
Uganda | 3 | 1 | 28 | 24 | 56 |
Yemen | 12 | 7 | 21 | 20 | 60 |
Grand Total | 742 | 1218 | 2372 | 4388 | 8720 |
Variables | 2016 (n = 42) | 2017 (n = 69) | 2018 (n = 96) | P value |
---|---|---|---|---|
Center, n (%) | < 0.001a | |||
Geneva | 20 (47.6) | 24 (34.8) | 67 (69.8) | |
Lausanne | 13 (31.0) | 10 (14.5) | 19 (19.8) | |
Bern | 3 (7.1) | 23 (33.3) | 6 (6.3) | |
Zurich | 6 (14.3) | 12 (17.4) | 4 (4.2) | |
Country of origin, n (%) | 0.097a | |||
Benin | 0 (0) | 0 (0) | 1 (1.0) | |
Burkina Faso | 1 (2.4) | 2 (2.9) | 0 (0) | |
Cameroon | 1 (2.4) | 0 (0) | 0 (0) | |
Egypt | 0 (0) | 0 (0) | 5 (5.2) | |
Eritrea | 12 (28.6) | 37 (53.6) | 36 (37.5) | |
Ethiopia | 2 (4.8) | 3 (4.4) | 2 (2.1) | |
Guinea | 0 (0) | 0 (0) | 6 (6.2) | |
Guinea-Bissau | 0 (0) | 0 (0) | 2 (2.1) | |
Ivory Coast | 1 (2.4) | 1 (1.5) | 1 (1.0) | |
Mali | 0 (0) | 0 (0) | 1 (1.0) | |
Mauritania | 0 (0) | 0 (0) | 1 (1.0) | |
Nigeria | 1 (2.4) | 1 (1.5) | 3 (3.1) | |
Senegal | 0 (0) | 0 (0) | 3 (3.1) | |
Somalia | 14 (33.3) | 18 (26.1) | 22 (22.9) | |
Sudan and South Sudan | 1 (2.4) | 1 (1.5) | 3 (3.1) | |
Unknown or other | 9 (21.4) | 6 (8.7) | 10 (10.4) | |
Service, n (%) | < 0.001a | |||
Gynecology | 13 (31.0) | 12 (17.4) | 9 (9.4) | |
Gynecology or Obstetrics* | 1 (2.4) | 23 (33.3) | 6 (6.3) | |
Obstetrics | 23 (54.8) | 33 (47.8) | 79 (82.3) | |
Others | 5 (11.9) | 1 (1.5) | 2 (2.1) | |
Mean age at first visit (±SD, median) | 30.7 (±12.0, 27) | 27.7 (±6.1, 27.4) | 29.8 (±6.7, 30) | 0.162b |
FGM/C type, n (%) | 0.116b | |||
Type I | 3 (7.1) | 13 (18.8) | 10 (10.4) | |
Type II | 8 (19.1) | 16 (23.2) | 33 (34.4) | |
Type III | 21 (50.0) | 33 (47.8) | 39 (40.6) | |
Type IV | 0 (0) | 1 (1.5) | 2 (2.1) | |
Unspecified or other | 10 (23.8) | 6 (8.7) | 12 (12.5) | |
FGM/C type, n (%) | ||||
N90.80 (Female genital mutilation, type unspecified) | 3 (7.1) | 0 (0) | 0 (0) | |
N90.81 (FGM, Type I) | 3 (7.1) | 0 (0) | 0 (0) | |
N90.82 (FGM, Type II) | 8 (19.1) | 0 (0) | 0 (0) | |
N90.83 (FGM, Type III) | 21 (50.0) | 0 (0) | 0 (0) | |
N90.88 Other specified non-inflammatory diseases of the vulva and perineum | 7 (16.7) | 0 (0) | 0 (0) | |
Z91.70 Personal history of female genital mutilation, type unspecified | 0 (0) | 6 (8.7) | 12 (12.5) | |
Z91.71 (FGM, Type I) | 0 (0) | 13 (18.8) | 10 (10.4) | |
Z91.72 (FGM, Type II) | 0 (0) | 16 (23.2) | 33 (34.4) | |
Z91.73 (FGM, Type III) | 0 (0) | 33 (47.8 | 39 (40.6) | |
Z91.74 (FGM, Type IV) | 0 (0) | 1 (1.5) | 2 (2.1) |
Results
Variables | Number of cases, n | N | Prevalence, % (95%CI) | P value |
---|---|---|---|---|
Category of age, n (%) | 0.001a | |||
< 18 years | 5 | 757 | 0.66 (0.21–1.53) | |
> =18 years | 195 | 7936 | 2.46 (2.13–2.82) | |
Hospital department, n (%) | < 0.001a | |||
Gynecology & obstetrics | 195 | 4163 | 4.68 (4.06–5.37) | |
Surgery | 2 | 1266 | 0.16 (0.019–0.57) | |
Medical department | 1 | 2362 | 0.042 (0.0011–0.24) | |
Emergency | 0 | 573 | 0 (0–0.64) | |
Pediatrics | 2 | 374 | 0.53 (0.065–1.92) | |
Center, n (%) | < 0.001b | |||
Geneva | 111 | 2390 | 4.64 (3.84–5.57) | < 0.001b |
Lausanne | 35 | 1218 | 2.87 (2.01–3.97) | |
Bern | 32 | 4388 | 0.73 (0.50–1.03) | |
Zürich | 22 | 742 | 2.96 (1.87–4.45) | |
Educational programme organised, n (%) | ||||
Yes (Geneva, Lausanne) | 146 | 3608 | 4.05 (3.43–4.74) | |
No or unknown (Bern, Zürich) | 54 | 5130 | 1.05 (0.79–1.37) |
Variables | 2016 | 2017 | 2018 | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Country of origin | 2016 FGM/C country prevalence (DHS/MICS) | Inpatients, N | FGM/C codes expected among inpatients, na | FGM/C codes among inpatients, n | FGM/C prevalence calculated among inpatients, % (95%CI) | 2017 FGM/C country prevalence (DHS/MICS) | Inpatients, N | FGM/C codes expected among inpatients, na | FGM/C codes among inpatients, n | FGM/C prevalence calculated among inpatients, % (95%CI) | 2018 FGM/C country prevalence (DHS/MICS) | Inpatients, N | FGM/C codes expected among inpatients, na | FGM/C codes among inpatients, n | FGM/C prevalence calculated among inpatients, % (95%CI) |
Benin | 0.092 | 10 | 1 | 0 | 0 (0–30.85) | 0.092 | 13 | 1 | 0 | 0 (0–24.71) | 0.092 | 14 | 1 | 1 | 7.14 (0.18–33.87) |
Burkina Faso | 0.758 | 35 | 27 | 1 | 2.86 (0.072–14.92) | 0.758 | 24 | 18 | 2 | 8.33 (1.03–26.99) | 0.758 | 31 | 23 | 0 | 0 (0–11.22) |
Cameroon | 0.014 | 268 | 4 | 1 | 0.37 (0.009–2.06) | 0.014 | 311 | 4 | 0 | 0 (0–1.18) | 0.014 | 264 | 4 | 0 | 0 (0–1.39) |
Central African Republic | 0.242 | 1 | 0 | 0 | 0 (NA) | 0.242 | 3 | 1 | 0 | 0 (0–70.76) | 0.242 | 4 | 1 | 0 | 0 (0–60.24) |
Chad | 0.384 | 7 | 3 | 0 | 0 (0–40.96) | 0.384 | 7 | 3 | 0 | 0 (0–40.96) | 0.384 | 4 | 2 | 0 | 0 (0–60.24) |
Djibouti | 0.931 | 3 | 3 | 0 | 0 (0–70.76) | 0.931 | 2 | 2 | 0 | 0 (0–84.19) | 0.931 | 2 | 2 | 0 | 0 (0–84.19) |
Egypt | 0.872 | 81 | 71 | 0 | 0 (0–4.45) | 0.872 | 79 | 69 | 0 | 0 (0–4.56) | 0.872 | 83 | 72 | 5 | 6.02 (1.98–13.50) |
Eritrea | 0.83 | 878 | 729 | 12 | 1.37 (0.71–2.38) | 0.83 | 910 | 755 | 37 | 4.07 (2.88–5.56) | 0.83 | 917 | 761 | 36 | 3.93 (2.76–5.39) |
Ethiopia | 0.652 | 210 | 137 | 2 | 0.95 (0.12–3.40) | 0.652 | 188 | 123 | 3 | 1.60 (0.33–4.59) | 0.652 | 181 | 118 | 2 | 1.10 (0.13–3.93) |
Gambia | 0.749 | 14 | 10 | 0 | 0 (0–23.16) | 0.749 | 15 | 11 | 0 | 0 (0–21.80) | 0.757 | 5 | 4 | 0 | 0 (0–52.18) |
Ghana | 0.038 | 59 | 2 | 0 | 0 (0–6.06) | 0.038 | 69 | 3 | 0 | 0 (0–5.21) | 0.038 | 52 | 2 | 0 | 0 (0–6.85) |
Guinea | 0.968 | 43 | 42 | 0 | 0 (0–8.22) | 0.968 | 63 | 61 | 0 | 0 (0–5.69) | 0.945 | 75 | 71 | 6 | 8.00 (2.99–16.60) |
Guinea-Bissau | 0.449 | 5 | 2 | 0 | 0 (0–52.18) | 0.449 | 5 | 2 | 0 | 0 (0–52.18) | 0.449 | 15 | 7 | 2 | 13.33 (1.66–40.46) |
Iraq | 0.367 | 265 | 97 | 0 | 0 (0–1.38) | 0.367 | 263 | 97 | 0 | 0 (0–1.39) | 0.367 | 257 | 94 | 0 | 0 (0–1.43) |
Ivory Coast | 0.21 | 88 | 18 | 1 | 1.14 (0.029–6.17) | 0.21 | 101 | 21 | 1 | 0.99 (0.025–5.39) | 0.21 | 117 | 25 | 1 | 0.85 (0.022–4.67) |
Kenya | 0.498 | 81 | 40 | 0 | 0 0–4.45) | 0.498 | 77 | 38 | 0 | 0 (0–4.68) | 0.498 | 77 | 38 | 0 | 0 (0–4.68) |
Liberia | 0.827 | 4 | 3 | 0 | 0 (0–60.24) | 0.827 | 4 | 3 | 0 | 0 (0–60.24) | 0.886 | 7 | 6 | 0 | 0 (0–40.96) |
Mali | 0.666 | 20 | 13 | 0 | 0 (0–16.84) | 0.666 | 11 | 7 | 0 | 0 (0–28.49) | 0.666 | 10 | 7 | 1 | 10.00 (0.25–44.50) |
Mauritania | 0.02 | 11 | 0 | 0 | 0 (0–28.49) | 0.02 | 10 | 0 | 0 | 0 (0–30.85) | 0.02 | 8 | 0 | 1 | 12.50 (0.32–52.65) |
Niger | 0.184 | 19 | 3 | 0 | 0 (0–17.65) | 0.184 | 7 | 1 | 0 | 0 (0–40.96) | 0.195 | 12 | 2 | 0 | 0 (0–26.46) |
Nigeria | 0.227 | 100 | 23 | 1 | 1.00 (0.025–5.45) | 0.24 | 124 | 30 | 1 | 0.81 (0.020–4.41) | 0.24 | 111 | 27 | 3 | 2.70 (0.56–7.70) |
Senegal | 0.896 | 96 | 86 | 0 | 0 (0–3.77) | 0.861 | 91 | 78 | 0 | 0 (0–3.97) | 0.861 | 84 | 72 | 3 | 3.57 (0.74–10.08) |
Sierra Leone | 0.979 | 17 | 17 | 0 | 0 (0–19.51) | 0.979 | 19 | 19 | 0 | 0 (0–17.65) | 0.979 | 14 | 14 | 0 | 0 (0–23.16) |
Somalia | 0.866 | 352 | 305 | 14 | 3.98 (2.19–6.58) | 0.866 | 358 | 310 | 18 | 5.03 (3.01–7.83) | 0.866 | 304 | 263 | 22 | 7.24 (4.59–10.75) |
Sudan and South Sudan | 0.1 | 58 | 6 | 1 | 1.72 (0.044–9.24) | 0.1 | 65 | 7 | 1 | 1.54 (0.039–8.28) | 0.1 | 51 | 5 | 3 | 5.88 (1.23–16.24) |
Tanzania | 0.047 | 19 | 1 | 0 | 0 (0–17.65) | 0.047 | 18 | 1 | 0 | 0 (0–18.53) | 0.047 | 17 | 1 | 0 | 0 (0–19.51) |
Togo | 0.003 | 69 | 0 | 0 | 0 (0–5.21) | 0.003 | 53 | 0 | 0 | 0 (0–84.19) | 0.003 | 56 | 0 | 0 | 0 (0–6.38) |
Uganda | 0.185 | 15 | 3 | 0 | 0 (0–21.80) | 0.185 | 21 | 4 | 0 | 0 (0–16.11) | 0.185 | 20 | 4 | 0 | 0 (0–16.11) |
Yemen | 0.092 | 24 | 2 | 0 | 0 (0–14.25) | 0.092 | 15 | 1 | 0 | 0 (0–21.80) | 0.092 | 21 | 2 | 0 | 0 (0–16.11) |
Total | NA | 2892 | 1648 | 33 | NA | NA | 2973 | 1671 | 63 | NA | NA | 2855 | 1628 | 86 | NA |