Female genital mutilation (FGM) affects more than 230 million girls and women globally and poses substantial public health, human rights, and gender-equality challenges. While community and legislative initiatives remain central to elimination efforts, emerging evidence underscores the pivotal role of health systems in prevention, clinical management, and rights-based support for survivors.
This editorial synthesizes findings from six systematic and mixed-method reviews that inform the 2025 WHO guideline on the prevention of FGM and the management of its complications, with a focus on community interventions, health-worker capacity building, legal and policy frameworks, deinfibulation, clitoral reconstructive surgery, and non-surgical sexual-health interventions.
Evidence suggests that community education may shift knowledge and attitudes supporting abandonment. Training improves provider knowledge and confidence but requires stronger ethical and regulatory alignment. Laws and professional codes influence provider behavior but may generate unintended harms without clear guidance. Clinical interventions, including deinfibulation and reconstructive surgery, show potential benefits but are supported by low-certainty and methodologically limited evidence. Research on non-surgical sexual-health interventions is minimal.
Eliminating FGM and improving survivor care require an integrated health-systems approach, aligned legal and professional frameworks, and survivor-centered, methodologically robust research to guide prevention, clinical management, and ethical practice.
Objective: This study compares rates of menopausal hormone therapy (MHT) initiation between perimenopausal and postmenopausal women with moderate-severe vasomotor symptoms (VMS) with and without substance use in a longitudinal cohort of diverse US women with or without HIV.
Methods: Using menopause symptoms, hormone use, and substance use data from Women's Interagency HIV Study biannual visits (10/2008-9/2019), we compared initiation of and breaks in MHT among participants with moderate-severe VMS (1) with or without current substance use and (2) with or without ever using substances. We calculated unadjusted rates and adjusted rate ratios (RR) for demographics and health variables using Poisson regression.
Results: The median age of participants (n = 1579) with moderate-severe VMS was 50 years old, with 73% living with HIV, and 68% identifying as Black. They reported ever using tobacco (76%), heavy alcohol (39%), cannabis (45%), and other drugs (43%). Few reported hormonal contraception (5%) or MHT (9%) during the study period. Hormone initiation (overall 3.53 per 100 person-years; 95% confidence interval [CI]: 2.93, 4.26) was less likely with current tobacco use (RR: 0.67, 95% CI: 0.45, 0.99) or ever using other drugs (RR: 0.61; 95% CI: 0.40, 0.91). Hormone breaks (overall 52.58 per 100 person-years [95% CI: 44.52, 61.90]) were not associated with substance use.
Conclusion: The rate of MHT initiation was low and the rate of MHT breaks was high in this sample of perimenopausal and postmenopausal participants with moderate-severe VMS. Patients and providers might benefit from specific guidance regarding MHT use among individuals with current tobacco use and those who have ever used other drugs.
Objectives: This paper examines the incidence, risk factors, and clinical variables of lower urinary tract symptoms (LUTS) following vaginal delivery and evaluates the diagnostic accuracy of urethral angles and bladder neck descent (BND) in stress urinary incontinence using two dimensional (2D) transperineal ultrasoufnd.
Methods: Four hundred and eight low-risk women at ≥37 weeks gestation undergoing vaginal delivery were recruited. On day 2 postpartum, the ICIQ-FLUTS questionnaire was applied for presence of urinary symptoms. Cases were defined as women having LUTS on day 2 postpartum (n = 82). An equal number of controls were taken from the cohort without LUTS as per nested case-control study design (n = 82). At 6 weeks, subjects were re-evaluated for resolution or persistence of urinary symptoms. In addition, Pelvic Floor Distress Inventory 20 (PFDI 20) score and Oxford grading were performed for pelvic floor dysfunction. 2D transperineal ultrasound was performed to compare the pubourethral angle (α), the posterior urethrovesical angle (β) at rest, and Valsalva.
Results: Incidence of LUTS on day 2 postpartum was 20.1%, nocturia being the most common symptom. Approximately 43% of these subjects reported persistence of symptoms at 6 weeks. Multivariate logistic regression analysis revealed prolonged second stage of labor (odds ratio [OR], 1.054; P = <0.001) and higher birth weight (OR, 3.132; P = 0.026) as risk factors. Cutoffs obtained for Rα, Rβ, and BND were >10°, >13°, and 12 mm, respectively, with almost equal accuracy in diagnosing stress urinary incontinence and posterior urethrovesical rotation angle (Rβ) being the best predictor.
Conclusion: Incidence of LUTS postpartum is high and urinary symptoms might persist for several weeks after vaginal delivery. Careful attention in the postnatal clinics, counseling, appropriate management, and follow-up should be offered.
Female genital mutilation (FGM) is a harmful practice that violates the human rights of women and girls. Education plays a crucial role in stopping and preventing FGM by raising awareness through individual counseling, as well as group education at health facilities.
To assess the effectiveness of group education or one-on-one FGM prevention counseling or information sharing in preventing FGM in communities that practice FGM.
We searched electronic databases from inception to May 2023 for published and gray literature, without language restrictions.
Controlled studies, including before-and-after studies were included.
Studies were independently assessed for inclusion, data extraction, risk of bias, and grading of the evidence.
Four observational studies were included. Very low-certainty evidence showed that a higher proportion of individuals in group education plus information sharing had improved knowledge about FGM and its complications (relative risk [RR] 3.09, 95% confidence interval [CI] 2.56–3.74; 816 participants), attitude against FGM (RR 1.92, 95% CI 1.59–2.32; 816 participants), and commitment not perform FGM (RR 1.95, 95% CI 1.74–2.19; 816 participants) compared with “no intervention”. Group education plus advocacy may improve knowledge about FGM and its complications (RR 1.22, 95% CI 1.14–1.31; 819 participants), attitude (RR 2.16, 95% CI 1.79–2.61; 819 participants) and commitment to not perform FGM (RR 2.59, 95% CI 1.95–3.43; 819 participants) versus “no intervention”.
Community-based educational interventions may improve knowledge of FGM, its complications, and decrease support for FGM.
Despite declining prevalence in some regions, female genital mutilation (FGM) remains a major public health issue, causing both immediate and long-term health complications.
The objective of this present study was to determine the effect of training healthcare workers, providing access to resources for capacity-building, such as job aids, and its impact on knowledge, skills, and attitudes toward FGM and the quality of healthcare service delivery.
The following major databases were searched from inception to May 2023: CINAHL Plus, IRIS, MEDLINE, PsycINFO, SCOPUS, and Web of Science, without language restrictions.
Controlled studies based on predefined objectives.
Studies were independently assessed for eligibility and risk of bias. Data were extracted for meta-analyses and the evidence assessed using the GRADE approach.
Eight studies, including one cluster randomized controlled trial (RCT), were included The RCT showed moderate-quality evidence that training plus information, education, and communication (IEC) materials significantly improved knowledge, care practices, and confidence compared to IEC materials alone (P < 0.001). Similar trends were reported in the observational studies (very low-quality evidence). Point-of-care flip chart visual aids helped providers communicate messages more effectively to clients.
This review found that providing FGM training to healthcare workers, in addition to capacity-building resources, may improve knowledge, care for women and girls with FGM, communication skills, and reduce their support for the practice. However, the limited number of studies and the overall low quality of evidence weaken the strength and limit the generalizability of the findings.
Background: Every day, over 5000 stillbirths and more than 6000 newborn deaths are estimated to occur worldwide, the majority in sub-Saharan Africa and South Asia. Estimates, however, rely on data that might underestimate these deaths. Further, outside major categories such as preterm birth, infection, and complications at delivery, little is known about the causes of death for newborns and even less for stillbirths.
Objectives: This systematic review and meta-analysis aimed to synthesize evidence on the incidence, causes, and risk factors for perinatal mortality in East Africa to inform public health policy.
Method: We searched major databases: Medline, Web of Science, EMBASE, Global Health, SCOPUS, Cochrane Library, CINAHL, HINARI, African Index Medicus, African Journals Online (AJOL), DHS website, and the World Health Organization African Regional Office (AFRO) Library. The search was conducted without imposing any language restrictions. Studies published 2010-2022 reporting perinatal mortality (incidence/causes/risk factors) in East African countries were included. We included all observational studies (cross-sectional, case-control, prospective cohort, and retrospective studies) and community-based trials. We performed meta-analyses with random effects to estimate pooled perinatal mortality rates for the population and health facility settings. We investigated and reduced heterogeneity where appropriate. We summarized causes of death descriptively and synthesized risk factors narratively.
Results: We included 99 out of 22 889 studies. The pooled population-based perinatal mortality rate was 33.1/1000 births (95% confidence interval [CI]: 29.3-37.1, I2 = 96.9%), and for health facility settings 67.1/1000 (95% CI: 47.5, 89.7, I2 = 98.9%). The major reported causes of perinatal deaths were infections and intrapartum-related events. However, our understanding of the specific causes of death was limited by the lack of detailed information necessary for diagnosing specific causes. Risk factors for perinatal mortality were demographic (low socioeconomic status), related to care (lack of antenatal care, obstetric complications), and maternal comorbidities. Protective factors included women's empowerment and supporting access to care through maternity waiting homes.
Conclusion: Perinatal mortality remains high in East Africa. Many deaths were preventable through addressing modifiable risk factors and strengthening health systems to provide quality antenatal and intrapartum care. Consistent use of standardized cause-of-death classification and improved data quality are needed to enhance the understanding of specific causes of death and target interventions.
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