100 Owing to gaps in the evidence towards base, precise estimation of frequency and risk of complications is not possible. However, irrespective of the exact size of the greater risk from FGM/C, the consistency of results with increased risk of several physical harms in women with genital modification is robust, and even the lowest increase in risk of complications is undesirable from a woman’s health perspective. Conclusion The evidence base on the physical health complications of FGM/C, which covers over half a century of research from more than 20 countries in Africa and beyond, shows that FGM/C is associated

with an increased risk of health complications, especially urinary tract infections, bacterial vaginosis, painful sexual intercourse and obstetric difficulties. Further research into this question is unlikely to produce practical value. Rather, efforts should be expended

in safeguarding girls and women against the physical risks of FGM/C and caring for those who suffer from its consequences. Supplementary Material Author’s manuscript: Click here to view.(6.1M, pdf) Reviewer comments: Click here to view.(137K, pdf) Acknowledgments The authors gratefully acknowledge the support and financial assistance received from Norad and the WHO. They are also grateful to librarian Sari S. Ormstaad who designed and conducted the literature search and to the experts who reviewed early versions of our technical reports. Footnotes Contributors: RCB planned the study; collected, analysed, and synthesised the data; and wrote the article. VU assisted in data collection and synthesis; and contributed to the writing of the article. GEV and AF assisted in data synthesis and contributed to the writing of the article. JO-J assisted in data analysis and contributed to the writing of the article. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Three technical reports available for all at http://www.kunnskapssenteret.no/publikasjoner.
Self-rated

AV-951 health (SRH) is an important health status indicator. It has been consistently found to be associated with socioeconomic and demographic indicators,1 2 use of health services,3 4 morbidity5 6 and mortality7–9 in various populations. Unlike objective health indicators (eg, medical diagnoses, laboratory examination results), SRH is a subjective measure that reflects an individual’s perception of health, including its biological, psychological and social dimensions.10 Many epidemiological studies suggest a socioeconomic gradient related to SRH in which low educational attainment,1 2 low income11 12 and low-paying occupations13 14 are strongly associated with poor perceived health.