The first large medical study of female genital cutting has found that the procedure has deadly consequences when the women give birth, raising by more than 50 percent the likelihood that the woman or her baby will die.

Rates of serious medical complications surrounding childbirth, such as bleeding, also rose substantially in women who had undergone genital cutting, according to new research being published today in The Lancet, a British medical journal.

"Reliable evidence about its harmful effects, especially on reproduction, should contribute to the abandonment of the practice," wrote the study's authors, all members of the World Health Organization Study Group on Female Genital Mutilation and Obstetrical Outcome.

While women's groups and human rights organizations have long campaigned against genital cutting as a rights issue, the study provides the first conclusive medical evidence of long-term physical harm, moving the debate further into the public health arena.

"Finally we have data to prove what health workers have long known: that female genital mutilation is a health issue, a killer of women and children, as well as a human rights issue," said Adrienne Germain, president of the International Women's Health Coalition, in New York.

"This should greatly help advocates overcome arguments that genital mutilation is an untouchable cultural practice."

More than 100 million women worldwide have undergone genital cutting, mostly in childhood, often without anesthesia or sterile technique. Pain, bleeding and infection are immediate consequences. Doctors suspect that the procedure is also linked to a risk of urinary infection.

The procedure varies in severity, from a full excision of the clitoris and labia, to a lesser procedure in which only the former is removed. In a number of African cultures, genital mutilation is part of a coming-of-age ceremony, and defenders have contended that it is a cultural practice, like male circumcision among Jews, with few, if any, proven long-term health consequences.

Previous studies to document the long-term medical effects of genital cutting — also called female circumcision — were far smaller and produced inconsistent or unreliable results, largely because of the logistical difficulties of collecting large amounts of hard data in the poor countries where the practice is traditional.

In a commentary accompanying the study in The Lancet, Ndubuisi Eke and Kanu E. O. Nkanginieme, doctors at the University of Port Harcourt, in Nigeria, called the study group's report "a landmark." With new, concrete evidence of the procedure's deadly aftereffects, they suggest that genital mutilation "should now be included among critical health indices for less developed countries."

The study was conducted with the help of more than 28,000 women in six African nations from 2001 through 2003. The women were examined to document the degree of genital damage and were followed until after they had given birth.

The study found that the women who had undergone genital cutting of any degree of severity and their babies were more likely to die during childbirth. More extensive genital cutting produced the highest rates of maternal and infant death during childbirth, even many years later.

The lesser forms of cutting caused about a 20 percent increase in death rates, while extensive procedures caused increases of more than 50 percent.

By almost all measures studied by the World Health Organization, a history of genital cutting put both mother and baby at risk. Mothers who had had the procedure had longer hospital stays, experienced more blood loss, and were more likely to need a Caesarean section. Babies were nearly twice as likely to require resuscitation at birth.

The researchers noted that the study almost certainly underestimated the potential for death and damage, because it only tracked women who delivered their babies in hospitals.

Many women in the African nations where genital cutting is practiced deliver their babies at home, where typically it is not possible to treat medical complications like severe bleeding or to resuscitate an ailing newborn.

Although the exact reason for the rise in mortality was not clear, the researchers noted that it made anatomical sense: Genital cutting results in severe scarring of the vagina and surrounding area, so it might make it more difficult for babies to emerge.

In the study countries, rates of genital cutting ranged from a high of 83 percent, in Sudan, to a low of about 40 percent, in Ghana. One country involved in the study, Senegal, outlawed the more extensive form of the procedure in 1998.

Dr. Eke and Dr. Nkanginieme expressed hope that the new medical evidence would push others to follow. "There is hope that female genital mutilation will face the fate of past cultural rituals such as the rejection of twins, the African slave trade, Chinese foot-binding and Victorian chastity belts," they wrote.

____________________________________________________________________