Summary of included studies
| Study | Region | Study design, setting, | FGM/No FGM | Mean age (years) | Type of FGM (assessment) | Outcome (assessment) | Adjustment/Matching for confounding variables | Quality (score) |
| Andro et al22 | France | Case-control, health centres and hospitals | 678/1076 | 30 | 57% FGM I or II, 2% FGM III, 40% uncertain (self-reported, medical exam) | A, B, C, D, E, G (self-reported) | Age, education, occupation, years since migration, miscarriage/stillbirth, parity, pain at first intercourse | Good (7/9) |
| Balachandran et al17 | UK | Case-control, specialised clinic | 121/121 | 29 (FGM) 30 (no FGM) | 31% FGM I, 45% FGM II, 16% FGM III, 1% FGM IV (medical exam) | A, B, C, D, E (medical records) | Age, ethnicity, parity and gestational age | Good (8/9) |
| Gebremicheal et al25 | Ethiopia | Cohort, hospital | 142/139 | 25 (FGM) 26 (no FGM) | 26% FGM I, 32% FGM II, 42% FGM III (medical exam) | F (medical records) | Parity, age, birth weight, education, antenatal care visit, height, distance travelled and nutritional status | Good (8/9) |
| Kasim et al21 | Egypt | Case-control, maternal clinics | 200/200 | N/A | Type not precised (self-reported) | D (self-reported) | Age, sex, education, occupation and residence | Moderate (5/9) |
| Larsen, Okonofua19 | Nigeria | Cross-sectional, family planning and antenatal services | 827/1009 | N/A | 71% FGM I, 24% FGM II (self-reported, medical exam) | B, C, E, G (self-reported) | Age, education, residence, region, ethnicity, religion, age at first pregnancy, marital status, place at delivery, parity | Good (7/9) |
| Milogo-Traore et al24 | Burkina Faso | Case-control, antenatal services | 227/227 | 25 | 27.7% FGM I, 69.6% FGM II, 2.6% FGM III (assessment N/A) | A, C, E, F, G (medical records) | Age and parity | Good (7/9) |
| Morison et al27 | Gambia | Cross-sectional, rural areas | 668/489 | N/A | 0.4% FGM I, 98% FGM II, 1% FGM III (medical exam) | G (self-reported) | Age, marital status and parity | Good (7/9) |
| Slanger et al26 | Nigeria | Cross-sectional, family planning and antenatal services | 621/486 | 34 | 72% FGM I, 24% FGM II, 4% FGM III or IV (medical exam) | B, C, D, E (self-reported) | Sociodemographic correlates | Moderate (6/9) |
| Thera et al23 | Mali | Case-control, rural health centre | 280/130 | 18 (FGM) 19 (no FGM) | 6% FGM I, 91% FGM II, 3% FGM III (assessment N/A) | A, B, E, G (medical records) | Age, parity and number of fetus | Good (7/9) |
| Wagner20 | African countries* | Cross-sectional, households and family planning | 57 332/45 763 | 31 | N/A | B (self-reported) | Age, education and marriage status | Moderate (5/9) |
| Wuest et al18 | Switzerland | Case-control, specialised hospital | 122/110 | 27 (FGM) 29 (no FGM) | 17% FGM I, 24% FGM II, 47% FGM III, 11% FGM IV (medical exam) | A, B, C, E, F (medical records) | Maternal age | Good (7/9) |
Outcomes: A indicates instrumental delivery, B indicates caesarean delivery, C indicates episiotomy, D indicates postpartum haemorrhage, E indicates perineal laceration, F indicates 5 min Apgar score <7, G indicates miscarriage or stillbirth.
*Benin, Burkina Faso, Cameroon, Chad, Ethiopia, Ghana, Guinea, Kenya, Mali, Nigeria, Niger, Senegal, Sierra Leone.
FGM, female genital mutilation; N/A, not available.