Title: A prospective cohort study of the relationship of female genital mutilation with birth
outcomes in Somalia
Version: 1 Date: 17 Apr 2022
Reviewer:  Ismael Jiménez-ruiz
Reviewer's report:
First of all, I would like to thank you for the opportunity to review this article. After reading
and broadly speaking, it provides valid information to know the consequences of FGM on the
process of childbirth. The results are interesting and confirm the link between FGM and these
complications.
Formal aspects.
Review of bibliographic references. The study would benefit from an update of the bibliographic
review that supports the study. Those bibliographic citations older than 5 years should be
reviewed and updated whenever possible.
Background
Addresses the main issues of the study, although it does so in a very superficial manner. This
section would benefit from a brief explanation of the causes of FGM. It is necessary to address
the cause and explain the reason for this type of actions on women's bodies.
On the other hand, the consequences on the birthing process are discussed, but the study would
benefit from the argued relationship between FGM and problems in childbirth and postpartum.
This explanation may help readers understand the objective and its scope.
At the beginning of the section the types of FGM are listed, it would be interesting to include
information on the main types of FGM performed in Somalia, as this has a direct bearing on
the consequences experienced. The background would benefit from further contextualization of
where the study was conducted.
Methods:
For a more agile reading it would be advisable to create subsections and organize the content in
this section. It is currently disorganized and needs more information on:
- Report that women were included until the desired sample size was reached. How was the
sample size calculation performed? You must describe the process.
- Final number of participants.
- For the creation of the groups, I assume that a 1-1 pairing is performed. Indicate the pairing
criteria and the number of exposed and unexposed. Similarly, you should describe the treatment
that was done with the losses in the study and the confounding variables such as type of FGM.
- Organize the description of the variables performed in the methodology section.
- The study design should be included at the beginning of the section.
- Ethics committee approval is discussed at the beginning. Explain the ethical considerations
that were applied during the study.
Discussion and conclusions
The discussion runs through the main results of the study, although it would benefit from a
comparison with updated literature.
Although some limitations are named and acknowledged they are limited to describing them.
The section would benefit from a more in-depth reflective analysis of these aspects.
The conclusions are limited to summarizing the study and include a generic sentence on the
benefits of reducing FGM. It would be relevant to do some reflective work on how these data
may influence prevention, how they may help anti-FGM policies, and how they may influence
the decision to perform FGM.
In short, the results corroborate known information and improve the understanding of the
phenomenon. However, the manuscript needs to be more reflective in its writing and to include
the implications that the results may have on the approach to FGM.