THE IMPACT OF FEMALE GENITAL MUTILATION ON THE INCIDENCE AND BURDEN OF OBSTETRIC FISTULA IN NIGERIA: A MIXED-METHODS SECONDARY DATA ANALYSIS AND EVIDENCE SYNTHESIS.

Abstract

Female genital mutilation (FGM) remains a major public health and human rights concern, affecting the health of millions of women and girls worldwide. Nigeria continues to bear a high burden of FGM and obstetric fistula, yet evidence on their relationship remains fragmented. This study examined the relationship between female genital mutilation and the incidence and burden of obstetric fistula in Nigeria through a synthesis of available evidence. A secondary data analysis and qualitative evidence synthesis were conducted using nationally representative datasets, including the 2018 Nigeria Demographic and Health Survey and the 2021 Multiple Indicator Cluster Survey, together with reports from the World Health Organization, the United Nations Children's Fund, the United Nations Population Fund, and peer-reviewed studies published between 2000 and 2025. Evidence was critically appraised and synthesised using descriptive, comparative, and thematic approaches.The evidence revealed marked regional and socio-economic disparities in FGM prevalence across Nigeria. FGM was consistently associated with prolonged and obstructed labour, severe perineal trauma, postpartum haemorrhage, and adverse neonatal outcomes. Although obstetric fistula is primarily caused by prolonged obstructed labour, severe forms of FGM may increase susceptibility by contributing to childbirth-related injuries. Women living with obstetric fistula experience substantial physical, psychological, social, and economic burdens, compounded by inadequate access to emergency obstetric and specialised fistula care. Eliminating FGM should be integrated into broader maternal health strategies to reduce preventable obstetric complications and obstetric fistula in Nigeria. Strengthening legislation, community engagement, public health education, and access to quality emergency obstetric care is essential.