This corrigendum is being published to correct a co-author's erroneous degree in the following article: McKinnon B, MacMillan HL, Vandermorris A, Georgiades K, Nolan E, Catley C, Lévesque I, Tonmyr L. Child maltreatment in Canada: prevalence and gender differences among youth. Health Promot Chronic Dis Prev Can. 2026;46(2):61-6. https://doi.org/10.24095/hpcdp.46.2.02.
Background Female genital mutilation/cutting (FGM/C) is a health and human rights concern for women and girls globally, and illegal to perform in the United States (US). FGM/C is associated with negative immediate and long-term health consequences such as pain, infections, and obstetric complications. Recent US estimates of the numbers of women and girls impacted by FGM/C are unknown but increasing immigration to the US from countries where FGM/C is prevalent suggests an increased population. We describe the health characteristics, experiences, and attitudes about FGM/C among Women's Health Needs Study (WHNS) participants. Methods The WHNS cross-sectional survey interview collected information from 1,132 women ages 18 to 49 years living in the US who were born, or whose mothers were born, in a country where FGM/C is a prevalent practice. During November 2020 through June 2021, study participants were identified in four US metropolitan areas using a hybrid venue-based and respondent-driven sampling approach. We analyzed WHNS data to describe respondents' characteristics, FGM/C experiences (FGM/C status, type of FGM/C, age at FGM/C, communication with health care providers about FGM/C) and attitudes about continuance of FGM/C. Analyses were conducted using SAS version 9.4. Results Of the 1,132 women interviewed, over half (55%) had experienced FGM/C. Of those, 29% said their vagina had been sewn closed (infibulated), almost two-thirds (64%) reported that FGM/C occurred before age 10, and fewer than one third of women with FGM/C (31%) had ever discussed it with a health care provider. Most women interviewed thought FGM/C should be stopped (92%). Conclusions Our results provide insights into FGM/C-related experiences and attitudes among 1,132 US women from FGM/C-practicing countries, among whom just over half reported having experienced FGM/C. Social and health care services that provide care to potentially affected US women can use this knowledge about women's FGM/C experiences and attitudes to heighten awareness, improve clinical care, and promote interventions and strategies for prevention.
Abstract Background Female genital mutilation/cutting affects over 230 million women and girls globally, with growing numbers of affected individuals now residing in the United States. Despite this, clinical awareness and physician training in restorative procedures, such as defibulation and clitoral reconstructive surgery remain limited. While clitoral reconstructive surgery (CRS), particularly via the Foldès technique, has shown promise in restoring clitoral function and improving psychosocial outcomes, concerns over limited outcome data and ethical implications continue to fuel debate. This case report aims to expand the limited U.S.-based literature on CRS for individuals affected by female genital mutilation/cutting and introduces a new counseling framework that incorporates peer-to-peer support as a component of the preoperative decision-making process. Case Presentation: We present the case of a 35-year-old cisgender female with Type IIb FGM/C who presented with chronic pelvic pain, dyspareunia, anorgasmia, and significant psychosocial distress. After evaluation, the patient was deemed a candidate for CRS. As part of the counseling process, the patient was connected with a prior CRS patient who shared her postoperative experience. Post-surgical outcomes were monitored at 1 week, 1 month, 4 months, and 1 year following the procedure. The patient’s postoperative course was uncomplicated. Pain resolved within 48 hours, with minimal discharge reported at early follow-up intervals. One month post-op, the reconstructed clitoris was visible. At one-year follow-up, the patient reported achieving orgasm for the first time and expressed substantial psychological improvement. No complications were noted, and the patient’s satisfaction with surgical and psychological outcomes was high. This case stresses the impact of including culturally sensitive, peer-based counseling in improving surgical confidence and shared decision-making. Conclusions While ongoing ethical concerns warrant careful consideration, CRS can give meaningful restoration for patients suffering from chronic pain, sexual dysfunction, and trauma. Integrating peer-to-peer counseling into the preoperative process provides a new and culturally resonant strategy to support informed decision-making and manage expectations. As the prevalence of FGM/C in the United States increases, there is an urgent need to expand physician education, increase research relating to FGM/C, and create national guidelines to standardize care and counseling for this underserved population.
Background Female genital mutilation/cutting (FGM-C) affects more than 230 million women and girls worldwide and carries increased risk of adverse obstetrical outcomes, including obstetrical anal sphincter injury (OASIS). With growing global migration, obstetrical care providers may increasingly encounter individuals affected by FGM-C in historically low-prevalence settings such as the United States. Therefore, it is essential to understand the association between FGM-C and adverse obstetrical outcomes in settings such as the United States to inform evidence-based practice. Objective To estimate the association between FGM-C and OASIS, among inpatient, singleton, vaginal deliveries among people delivering in-hospital in the United States. The secondary objectives were to estimate the association between FGM-C and postpartum hemorrhage and prolonged second stage of labor in this population and the role of episiotomy in mitigating risk of OASIS in this population. Study design We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses in the United States using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database (2016-2019, inclusive). Exposure and outcome variables were derived using International Classification of Diseases-10 disease and procedure codes. Weighted multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between FGM-C and OASIS and secondary outcomes. Results During the study period, 2020,780 delivery-related discharges were captured, representing an estimated 10,168,193 singleton vaginal deliveries nationwide using the complex survey design of the NIS. A total of 795 (0.03%) individuals were diagnosed with FGM-C and 39,668 with OASIS (1.4%) during the study period. After adjusting for potential confounders, vaginal deliveries affected by FGM-C had 3.02 times the odds of sustaining OASIS (95% CI: 2.23-4.07), 1.99 times the odds of experiencing postpartum hemorrhage (95% CI: 1.45-2.73), and 2.33 times the odds of a prolonged second stage of labor (95% CI: 1.23-4.39) compared to unaffected individuals. Performance of episiotomy attenuated the risk of OASIS (aOR 1.12, 95% CI: 0.59-2.11). Conclusion Singleton vaginal deliveries complicated by FGM-C have significantly increased odds of experiencing adverse obstetric outcomes, including OASIS, postpartum hemorrhage, and prolonged second stage of labor. Episiotomy may be protective against OASIS in this population.
Female genital mutilation/cutting (FGM/C) remains prevalent worldwide and has lasting physical and psychological consequences. In the United States, an estimated 513,000 women and girls have undergone or are at risk of FGM/C, yet clitorolabial reconstruction is rarely offered and performed by few specialists. This study aimed to identify barriers to accessing reconstructive surgery. Patients who underwent FGM/C reconstruction by a single plastic surgeon at a quaternary academic center between 2017 and 2024 were surveyed. The survey assessed access to care, perceived barriers, social support, and satisfaction with surgical outcomes. Of 38 eligible patients, 21 completed the survey (55.3% response rate). Median age was 37 years (IQR: 32.1-46.5). The majority identified as Black/African American (81.0%) or Middle Eastern/North African (14.3%) and as cisgender female (85.7%). Type 2 FGM/C was most common (85.7%). Over half (57.1%) had considered reconstruction for more than 3 years before pursuing care. Most (81.0%) independently located their surgeon online, and 85.7% had never consulted another provider regarding FGM/C. Patients in this cohort frequently considered reconstruction for several years before accessing surgical care. Although 92.5% had insurance, 57.1% reported financial hardship. Additional barriers included travel burden and limited emotional support. Despite these challenges, most respondents reported satisfaction with their surgical outcomes. Persistent financial, geographic, and social barriers highlight the need for increased provider awareness, improved referral pathways, and expanded reconstructive services to ensure timely and comprehensive care for individuals affected by FGM/C.
Background The COVID-19 pandemic caused widespread disruptions to social relationships and caregiving responsibilities, potentially modifying risks for child maltreatment (CM) and harsh parenting (HP). However, the impact of the pandemic on the epidemiology of CM and HP is unclear. Objective The objectives of this scoping review were to summarize evidence on the epidemiology of CM and HP in Canada during the COVID-19 pandemic, assess the quality of the included evidence to support the interpretation of the findings, and synthesize published recommendations to strengthen data. Methods We conducted a systematic search of five bibliographic databases and Statistics Canada's website for relevant Canadian studies published between January 1, 2020 and July 4, 2024. We summarized the findings with descriptive statistics and a narrative review, and assessed study quality using an adapted version of the Evidence-Based Social Services Critical Thinking Tool. Results Twenty-seven studies were included; 81.5% reported on CM. Administrative data indicated fewer referrals to child protection services and hospital visits, but increases in police-reported family violence against children. The quality of studies was negatively impacted by non-representative samples, unstandardized measures, and limited use of pre-pandemic baseline data. Conclusions Due to the lack of reliable and continuous data about CM/HP, governments and researchers in Canada collaborated to improve data infrastructure and better understand the pandemic's impact on the health and wellbeing of children and youth. New data sources were developed to enhance the quality of CM/HP measures and support ongoing public health surveillance. Sustained collaboration among interest-holders and continued efforts to strengthen existing data are necessary to assess the pandemic's long-term effects and prepare to monitor the impacts of future public health emergencies.
Structured Abstract Introduction More than a third of women in the United States are estimated to experience abuse by an intimate partner, and blows to the head and strangulation are common in such instances. Yet the cognitive consequences of partner-inflicted brain injuries remain poorly characterized relative to brain injuries from other mechanisms, such as athletics and military service, and study sample sizes have tended to be small. The degree to which these injuries accumulate into measurable cognitive harm, whether the harm of such injuries can be quantified in a meaningful way, and how that harm compares with better-recognized causes of repetitive head injury, has not been established. Rationale We administered ten cognitive tests, scored across sixteen domains, to 207 women with lifetime exposure to physical intimate partner violence, of whom 67% ( n = 139) reported at least one partner-inflicted brain injury. Since standardized scores are difficult to interpret clinically, we also expressed performance as cognitive age, the age at which the typical person in the general population performs equivalently. Finally, we compared women with brain injuries against women with no brain injury history from the same cohort, as this isolates injury from exposure to violence itself, since both groups experienced physical partner violence. Results Women who had sustained any partner-inflicted brain injury performed below the general population mean on 11 of the 16 cognitive abilities measured, from reasoning ( d = 0.32) to reaction time ( d = 0.80), all P ≤ 0.011. Women reporting ten or more injuries demonstrated an overall cognitive function worse than nearly 80% of the general population ( d = 0.82, P < 0.0001). Translating these deficits to cognitive age, women with ten or more brain injuries performed at a cognitive age more than two decades older than the general population on eight domains, the largest gaps being for simple attention (28.1 years, 95% CI [14.9, 41.4]; d = 0.78, P = 0.0002) and reaction time (27.8 years, 95% CI [18.1, 37.4]; d = 1.08, P < 0.0001). On psychomotor speed they also performed over a decade older than women exposed to physical intimate partner violence who had never sustained a brain injury (11.3 years, P = 0.033). After adjustment for eleven covariates, cognitive ability declined as injury count rose in six domains: psychomotor speed, reaction time, processing speed, motor speed, global cognition and verbal memory (partial r = −0.14 to −0.22, all P < 0.05), and 14 of the 16 coefficients were negative (two-sided sign test P = 0.004). We excluded scores flagged as invalid by the cognitive assessment per convention, yet observed that these flags fell disproportionately on the most impaired women, who scored 11 to 13 points lower ( d = 0.60 to 0.84, all P < 0.001) on every domain the assessment did accept as valid. Conclusion Women experiencing partner-inflicted brain injuries demonstrated cognitive aging of over 20 years, and yet, the true cognitive harms of such injury are likely more severe than those reported here. These results are particularly grave because partner-inflicted injuries may compromise the very cognitive capacities women must rely on to leave abusive relationships, care for their children, sustain employment, navigate legal proceedings, and remain safe post-violence. Taken together, these findings underscore partner-inflicted brain injury as a major, under-recognized source of cognitive harm, potentially affecting more women than brain injury in professional football or the military while lacking comparable clinical recognition and care. Summary Abstract More than a third of women in the United States are estimated to experience abuse from an intimate partner, in which blows to the head, strangulation, and therefore brain injuries are common. Among 207 survivors of such physical violence, two-thirds reported a partner-inflicted brain injury. These women performed substantially worse than the general population across most cognitive measures, including memory and reaction time. Cognitive performance declined as injury count increased. Translated into cognitive age, survivors with the most partner-inflicted brain injuries performed over two decades older than the general population, and a decade older than survivors with no history of brain injury. Importantly, the cognitive assessment discards scores it judges unreliable, yet these came primarily from the most impaired women, suggesting that the true harm is likely greater than reported here. Such cognitive deficits may limit these women’s capacity to live to their potential, including keeping safe from abuse. These findings underscore partner-inflicted brain injury as a major, under-recognized source of cognitive harm, potentially affecting more women than brain injury in professional football or the military while lacking comparable clinical recognition and care.
Background Although sexual violence against children and adolescents is a global public health imperative, its manifestation in Brazil reveals a critical gap between international protocols and the socioeconomic complexity of urban peripheries. The present study aimed to analyze the characteristics of sexual violence against children and adolescents living in the outskirts of São Paulo, Brazil. Method A cross-sectional study with data from mandatory reports of sexual violence, extracted from the mandatory notification forms of the Notifiable Diseases Information System (SINAN), occurring between 2016 and 2024. The sample consisted of victims aged between 1 and 17 years, residing in 23 administrative districts considered to be on the outskirts of the city of São Paulo. Univariate statistical analysis and the chi-square test were applied to verify possible relationships between types of violence and variables with a significance level of 5% (alpha = 0.05). A total of 21,576 cases of sexual violence were identified during the period outlined. Female victims were most common, concentrated in the 11-14 age group. Rape was the most prevalent type of violence, accounting for 87.8% of cases involving female victims and 85.5% of cases involving male victims. Results The home was the most frequent location for these types of violence. Sexual harassment, in particular, occurred mainly at home (76.6%) and at school (84.7%). The likely perpetrator was predominantly male. The home was the most frequent location for these types of violence. Sexual harassment, in particular, occurred mainly at home (76.6%) and at school (84.7%). The likely perpetrator was predominantly male and in the adult age group (25-59 years). The father was the most frequent perpetrator of sexual harassment (80.8%), and the boyfriend/intimate partner was the most frequent perpetrator of rape (71.9%) in cases involving a relationship. Rape was reported in 92.7% of cases involving pregnant women. Victims with disabilities suffered more sexual harassment (69.3%) than rape (23.8%). The predominant motive was sexism. Suspicious alcohol consumption by the perpetrator was a trend in rape cases. Conclusions The study indicates that the types of sexual violence in the outskirts of São Paulo are marked by a predominance of younger female adolescent victims and a high prevalence of rape within the family environment. The findings reinforce the urgency of interventions to identify forms of sexual violence in public health services to ensure the comprehensive protection of this doubly vulnerable group. The high number of blank or incomplete fields in the notification forms suggests a need for training and awareness among the professionals who fill them out.
Background Children exposed to intimate partner violence (IPV) face an elevated risk of foster care placement, yet the structural conditions shaping this pathway remain insufficiently understood. Objective This study examines whether caregiver housing instability increases the likelihood of foster care entry among IPV-exposed children and whether state-level eviction protection policies in the United States moderate this association. Participants and setting The sample comprised 53,159 children with documented IPV exposure across 17 jurisdictions, drawn from linked administrative data from the National Child Abuse and Neglect Data System (NCANDS) and the Adoption and Foster Care Analysis and Reporting System (AFCARS). Methods Multilevel logistic regression models were estimated to assess the relationship between caregiver housing instability and foster care entry, and to test whether U.S. state eviction protection policies moderated this association. Results Caregiver housing instability was associated with substantially higher odds of foster care entry (OR = 5.26, p < .001). This association was significantly attenuated in states with eviction protection policies (interaction OR = 0.47, p < .001). Conclusions U.S. state-level housing policies may serve as a structural buffer against foster care placement among IPV-affected families, highlighting the potential of housing stability interventions to reduce unnecessary child welfare involvement.
Violence against women is a preventable public health problem that causes harm in many ways. When experienced around the time of pregnancy, violence is an important contributor to pregnancy-associated morbidity and mortality in the United States. Survivors may experience extensive short- and long-term impacts on their physical health, mental health, and overall well-being. Violence victimization around the time of pregnancy can also lead to pregnancy complications and poor pregnancy outcomes. The harmful effects extend beyond the woman to her baby, other children in the home, additional family members, and her larger community. A comprehensive prevention approach is needed that includes collection of high-quality data to characterize the problem and inform prevention programs, primary prevention to stop violence before it begins, and effective trauma-informed programs, policies, and practices to respond effectively to violence when it happens and reduce further harm. This article summarizes the Centers for Disease Control and Prevention (CDC)'s work related to preventing violence affecting pregnant and postpartum women, aligning with the CDC priority to protect life and the family. We describe surveillance and programmatic activities across different organizational units at CDC, as well as gaps and opportunities to expand collaboration with the goal of improving health outcomes for women, infants, and families by preventing violence.
