Abstract Valentina Vargas

Primary Infertility After Female Genital Mutilation (FGM) Type I-III in Somaliland: A Case-
Control Study

Background:
It is estimated that 200 million girls in the world today have experienced female genital mutilation (FGM)
(UNFPA). FGM is harmful to the physical, emotional, and psychological health of girls and women.
Physical consequences could be severe pain, hemorrhage, urinary tract infections, tetanus, painful sexual
relations, loss of sexual pleasure, increased risk of HIV transmission, infertility, and birth complications.
(WHO) FGM is commonly practiced in Sub-Saharan Africa and parts of the Middle East and Southeast
Asia, with Somalia having the highest prevalence of FGM victims at 98% (UNFPA, 2019). Efforts to
address FGM in other countries have primarily focused on preventing the practice, with little attention to
treating the associated health complications, caring for survivors, and engaging health care providers as
key stakeholders.

Objective(s):
This study’s objective is to fill this knowledge gap by investigating the possible relationship between the
different types and severity of FGM (Type 1 being the least severe and Type III being the most severe)
and primary infertility. We hypothesize that more severe types of FGM are associated with primary
infertility among females living in Hargeisa, Somaliland.

Methods: (Study Population; Data Source; Measurement of Exposure and Outcome; Analysis Plan
Anticipated Results)
This will be a case-control study in Hargeisa, Somaliland, where we will enroll women with the different
types of FGM who will be randomly selected. We are going from outcome to exposure so we will recruit
200 infertile women (cases) which are defined as unable to conceive despite cohabitation and exposure to
the risk of pregnancy for a period of 12 months or more in a sexually active noncontracepting women in
the reproductive age period 15 to 49-year-old. We will also recruit 200 fertile women (controls) which is
defined as fertile women in the reproductive age period 15–49 years old, who have had at least two
successful pregnancies with no history of assistive reproductive techniques and who were not known to
have clinical infertility during their lifetime. Logistic regression will be done, in addition to stratifying for
age and controlling for socioeconomic status, and level of education. These data will inform policies and
culturally sensitive training for healthcare providers who may care for patients who have experienced
FGM and have experienced infertility.

Discussion: Strengths/Limitations of Study Design; Potential Sources of Bias; Anticipated Impact

A limitation of case-control studies is the potential for recall bias. Recall bias is the increased likelihood
that those with the outcome will recall and report exposures compared to those without the outcome. Due
to their typically retrospective nature, can be used to establish a correlation between exposures and
outcomes, but cannot establish causation. Additionally, there is a potential for failing to identify
confounding variables or exposures, introducing the possibility of confounding bias,

References
Abstract Valentina Vargas

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