Dr. Bittaye Tells Gambia’s Supreme Court FGM Raises Risk of Childbirth Complications

Female genital mutilation significantly increases the risk of serious complications during childbirth, including prolonged labor, excessive bleeding after delivery, and poor outcomes for newborns, the chief medical director of The Gambia’s main referral hospital told the Supreme Court on Wednesday.

Dr. Momodou Bittaye, chief medical director of the Edward Francis Small Teaching Hospital, testified as a witness for the state in Almameh Gibba & 7 Others v. Attorney General, a constitutional challenge to Sections 32A and 32B of the Women’s (Amendment) Act, 2015, which criminalize female genital mutilation (FGM). The case is being heard by a five-judge panel led by Justice C. Jallow.

Drawing on more than 15 years of medical practice, Dr. Bittaye adopted his written witness statement as his evidence and confirmed that he co-authored the Obstetric Outcomes of FGM Report. The report was admitted into evidence despite objections from lead counsel for the plaintiffs, L.J. Darboe.

Under cross-examination, Dr. Bittaye agreed that complications such as prolonged labor, postpartum hemorrhage, and Caesarean delivery can occur in women who have not undergone FGM. But he said extensive medical research shows those complications occur more frequently among women who have.

“The evidence is overwhelming that female circumcision/FGM is a significant contributor,” Dr. Bittaye told the court.

He testified that FGM increases the likelihood of prolonged labor, Caesarean delivery, episiotomy, and severe postpartum hemorrhage, describing excessive bleeding after childbirth as one of the leading causes of maternal mortality.

During re-examination by state counsel Yassin Senghore, Dr. Bittaye presented findings from the obstetric outcomes study, outlining how the risks varied by the type of FGM performed.

According to the study, women who had undergone Type I FGM were more likely to experience postpartum hemorrhage than women who had not undergone the procedure. He also testified that the likelihood of Caesarean delivery increased substantially across different forms of FGM:

• Type I FGM: 2.6 times higher risk
• Type II FGM: 3.1 times higher risk
• Types III and IV FGM: 2.7 times higher risk

Each comparison was measured against women who had not undergone FGM.

Dr. Bittaye said the duration of labor also increased with the severity of the procedure, with women who had not undergone FGM generally experiencing shorter labor than those who had.

He further testified that newborns delivered by mothers who had undergone FGM were more likely to require resuscitation at birth and faced a higher risk of perinatal death.

Responding to questions about comparisons between female and male circumcision, Dr. Bittaye rejected the suggestion that the two procedures are medically equivalent.

He told the court that male circumcision involves the removal of the foreskin covering the glans of the penis, while FGM entails cutting or removing parts of the female genitalia, including the clitoris. He said he was unaware of any established health benefits associated with FGM, adding that medical studies have identified certain health benefits linked to male circumcision, including a reduced risk of some sexually transmitted infections.

Earlier in his testimony, Dr. Bittaye said that although FGM is commonly performed with the knowledge of a child’s parents or guardians, it can also occur without their consent.

He recounted a case in which a relative circumcised a child while the parents were away at work. According to Dr. Bittaye, the child’s mother returned home unaware that the procedure had been carried out and was deeply distressed when she discovered what had happened.

The hearing is continuing before the Supreme Court, with the state expected to call additional witnesses in defense of the law.