By: Isatou Sarr
Female genital mutilation (FGM) significantly increases the risk of serious complications during childbirth, including prolonged labour, excessive bleeding after delivery and poor newborn outcomes, the Chief Medical Director of The Gambia’s main referral hospital told the Supreme Court on Wednesday.
Dr Momodou Bittaye, head of the Edward Francis Small Teaching Hospital (EFSTH), made the disclosure while testifying as a state witness in the constitutional case of Almameh Gibba & 7 Others v. Attorney General, which challenges Sections 32A and 32B of the Women’s (Amendment) Act, 2015 that criminalise FGM.
The case is being heard by a five-member panel of the Supreme Court headed by Justice C. Jallow.
Dr Bittaye, who has more than 15 years of medical experience, adopted his written witness statement as evidence and confirmed that he co-authored the Obstetric Outcomes of FGM Report, which was admitted into evidence despite objections from lead counsel for the plaintiffs, L.J. Darboe.
During cross-examination, the medical expert acknowledged that complications such as prolonged labour, postpartum haemorrhage and Caesarean delivery can occur among women who have not undergone FGM. However, he told the court that extensive medical research shows such complications occur more frequently among women who have undergone the procedure.
“The evidence is overwhelming that female circumcision/FGM is a significant contributor,” Dr Bittaye said.
He testified that FGM increases the likelihood of prolonged labour, Caesarean delivery, episiotomy and severe postpartum haemorrhage, which he described as one of the leading causes of maternal deaths.
During re-examination by state counsel Yassin Senghore, Dr Bittaye presented findings from the obstetric outcomes study, explaining that health risks differ depending on the type of FGM performed.
According to the study, women who underwent Type I FGM had a higher likelihood of experiencing postpartum haemorrhage compared with those who had not undergone the procedure.
He also told the court that the risk of Caesarean delivery increased among women who had undergone different forms of FGM, with Type I associated with a 2.6 times higher risk, Type II with a 3.1 times higher risk, and Types III and IV with a 2.7 times higher risk compared with women who had not undergone FGM.
Dr Bittaye further testified that the duration of labour increased with the severity of the procedure, while newborns delivered by mothers who had undergone FGM were more likely to require resuscitation and faced a higher risk of perinatal death.
Responding to questions comparing female and male circumcision, Dr Bittaye rejected the suggestion that the two procedures were medically equivalent.
He explained that male circumcision involves the removal of the foreskin covering the penis, while FGM involves cutting or removing parts of the female genitalia, including the clitoris.
The medical expert said he was unaware of any recognised health benefits associated with FGM, while noting that some studies have identified health benefits linked to male circumcision, including reduced risks of certain sexually transmitted infections.
Earlier in his testimony, Dr Bittaye told the court that although FGM is often carried out with the knowledge of parents or guardians, there are cases where it occurs without their consent.
He cited an instance in which a child was circumcised by a relative while the parents were away at work, saying the mother returned home unaware of the procedure and was distressed upon discovering what had happened.
The hearing continues before the Supreme Court, with the state expected to call additional witnesses in support of the law.