Dr Mustapha Bittaye, Chief Medical Director of Edward Francis Small Teaching Hospital (EFSTH), testified before the Supreme Court that female genital mutilation (FGM) substantially elevates the risk of serious obstetric complications, presenting quantified evidence of heightened danger in labour outcomes, postpartum bleeding, and neonatal survival.
Dr Bittaye is a defence (state) witness in Almameh Gibba & 7 Others v. Attorney General, the constitutional challenge against Sections 32A and 32B of the Women’s (Amendment) Act 2015. A five-judge panel led by Justice C. Jallow is hearing the case.
Dr Bittaye, who has practised medicine for more than 15 years, adopted his witness statement as evidence-in-chief and confirmed his co-authorship of the Obstetric Outcomes of FGM Report, a document the court admitted into evidence despite objections from counsel J. Darboe for the plaintiffs.
Under cross-examination by Counsel L.J. Darboe, Dr Bittaye acknowledged that childbirth complications, including prolonged labour, postpartum haemorrhage, and Caesarean section, can occur in women who have not undergone female circumcision/FGM. However, he maintained that research demonstrates the risks are substantially higher among women who have undergone
“The evidence is overwhelming that female circumcision/FGM is a significant contributor,” he told the court.
He explained that female circumcision/FGM can prolong labour, increase the likelihood of Caesarean delivery, raise the incidence of episiotomy, and contribute to severe postpartum bleeding, which he identified as one of the leading causes of maternal death.
During re-examination by Counsel Yassin Senghore, Dr Bittaye elaborated on findings from the obstetric outcomes study, presenting comparative risk data.
He testified that women who underwent Type I FGM faced a higher risk of postpartum haemorrhage than women without FGM. On the risk of a Caesarean section, he presented the following multipliers:
Women with Type I FGM: 2.6 times higher risk
Women with Type II FGM: 3.1 times higher risk
Women with Types III and IV FGM: 2.7 times higher risk
All figures were compared to those of women who had not undergone FGM.
Dr Bittaye also testified that circumcision/FGM increases the likelihood of prolonged labour. Women without circumcision/FGM recorded shorter labour durations than those who had undergone the practice, with labour duration becoming progressively longer as the severity of circumcision/FGM increased.
Addressing outcomes for newborns, Dr Bittaye testified that babies born to mothers who had undergone circumcision/FGM were more likely to require resuscitation at birth. He also cited increased risks of perinatal death associated with circumcision/FGM.
Dr Bittaye rejected suggestions that circumcision/FGM and male circumcision are comparable procedures or present equivalent health profiles. He explained the anatomical distinction: male circumcision involves removing only the foreskin covering the glans of the penis, whereas circumcision/FGM involves cutting or removing parts of the female genitalia, including the clitoris.
When asked whether female genital mutilation has any health benefits, Dr Bittaye responded that he was not aware of any. By contrast, he stated that studies have shown male circumcision offers certain health benefits, including reducing the risk of some sexually transmitted infections.
Earlier in his testimony, Dr Bittaye told the court that while circumcision/FGM is usually carried out with the knowledge of parents or guardians, a child can undergo the procedure without such consent.
He recounted an incident he had witnessed in which a relative circumcised a child while the parents were away at work. The child’s mother discovered what had occurred after returning home, and Dr Bittaye described her distress.
The case continues in the session before the five-judge panel of judges with the testimony of the defendant’s (State) witnesses.
