Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM). METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage. RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06–0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50–0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12–0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02–0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05–0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01–0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy. CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed

HRFOR Update on the Human rights situation during April 1996

Document collected by the University of Texas Libraries from the web-site of the Reseau Documentaire International Sur La Region Des Grands Lacs Africains (International Documentation Network on the Great African Lakes Region). The Reseau distributes "gray literature", non-published or limited distribution government or NGO documents regarding the Great Lakes area of central Africa including Rwanda, Burundi, and the Democratic Republic of Congo.UT Librarie

Constructing Rights? Human Rights Education and the State

ABSTRACT. What role have states played in promoting human rights education? While nongovernmental organizations have been at the forefront of human rights education, scholars have neglected the increased activism of states, especially national human rights commis-sions. This article addresses this gap by sketching the relationship between states and human rights education, examining cross-regional trends and presenting a case study of South Africa’s Human Rights Commission. The article concludes by considering the critical gap between state promotion and implementation of human rights education, as well as the limits of state involvement in constructing a culture of human rights

Migration, environmental change, and the ‘challenges of governance’

This paper provides a framework for the theme issue by exploring links between environmental change and human migration. We review evidence that demonstrates that millions of people have moved or are likely to move towards and not away from environmental risk and hazard by moving from rural areas to rapidly growing urban areas. Moreover, some people may choose not to move or be unable to move. Environmental change may further erode household resources in such a way that migration becomes less and not more likely, even in the context of quite significant environmental change posing serious threats to the sustainability of livelihoods. This creates the possibility that populations will be trapped in areas that expose them to serious risk. We argue that the links between environmental change, migration, and governance are of significant importance, and directly influence the modes and efficacy of migration governance at different levels