Female Genital Mutilation on the Rise in the U.S.

Awatef Mohamed Ali with her son and daughter, Shahd, at an NGO in Assiut, Egypt, Feb. 1st, 2015. Christina Rizk/UNFPA

The number of women and girls at risk for female genital mutilation (FGM) in the United States has more than doubled in the past 10 years, according to new figures released on Friday.

The data, the first on FGM in the U.S. for a decade, is being published to coincide with the United Nations' International Day of Zero Tolerance for FGM.

More than half a million women and girls in the U.S. are at risk of undergoing FGM in the U.S. or abroad, or have already undergone the procedure, including 166,173 under the age of 18, according to the Population Reference Bureau (PRB). Immigration to the U.S. from African and Middle Eastern countries—where the practice of FGM is a deeply entrenched cultural tradition—is the sole factor for the rise in numbers, says Mark Mather, a demographer at PRB who led the data analysis. There has not been an increase in the practice happening in the U.S. itself, he says.

Of importance, says Mather, is that these are estimates of the number of women and girls who are at risk of having FGM sometime in their life, or have already had it: "Not all of these women and girls have undergone the procedure, we're just trying to come up with our best estimate of potential risk," says Mather. "Given that we've seen a lot of new immigrants, especially from Africa, it's become a more important issue here in the U.S. and in Europe as well."

African immigration to the U.S. has doubled every decade since 1970, with more than 1.8 million African-born people now living in the U.S., according to Census data. Immigrants from Ghana, Nigeria, Ethiopia and Egypt, all countries that perform FGM (also known as female circumcision), accounted for 41 percent of total African immigrants. According to the latest numbers, nearly one in five girls at risk for FGM in the U.S. are from Egypt, which tops Somalia as the most at-risk country.

The last large-scale study of FGM in the U.S. was released by the African Women's Health Center at Brigham and Women's Hospital in 2004 and found more than 227,000 American women were at risk of or had undergone FGM. The Centers for Disease Control and Prevention (CDC) is set to publish long overdue federal data in the coming months; the last federal survey on the FGM in the U.S. was done by the Department of Health and Human Services in 1997 and found roughly 168,000 women had undergone or were at risk from FGM, based on census data from 1990.

An unpublished draft of the impending CDC report seen by Newsweek more or less matches the PRB study, counting 513,000 women and girls living with FGM in the U.S. today.

Mansoura Mohamed with her husband Ragab and young daughter near their home in Assiut, Egypt, Jan. 31st, 2015. Christina Rizk/UNFPA

According to the PRB, California is the state with the largest number of at-risk women and girls, with 56,872, followed by New York, with 48,418, and Minnesota, with 44,293. In terms of cities in the U.S., New York, Washington and Minneapolis-St. Paul are the metropolitan areas with the largest numbers of at-risk women and girls. Hawaii is the only state with zero women and girls at risk, according to the data. However, Mather points that while there may be some at risk in the state, the number is so small that it didn't show up in the sample data.

Included in the data are girls at risk of being sent back to their family's origin country to undergo FGM—a practice widely known as "vacation cutting"—or having a traditional midwife or cutter sent to perform FGM in the U.S.

Globally, around 130 million women and girls are living with the effects from FGM and around 3 million undergo the procedure annually, according to the United Nations Population Fund (UNFPA). The practice, known to be performed in 29 countries and usually at the hands of midwives or physicians, involves cutting the external female genitalia for non-medical reasons. Depending on local customs, it could also include additional modifications ranging from cutting away part of the clitoris to removing the inner and outer vaginal lips before sewing the remaining skin together, leaving a small hole for urination and menstrual blood.

The practice predates religion and has no religious significance in either Islam nor Christianity. However, communities of both faiths continue to circumcise their daughters, believing it will cleanse or purify the girl, ensure she remains sexually chaste, prevent cheating on her future husband and keep her behaving well.

In the past year, FGM has come under greater scrutiny in the international community. In Egypt, where female circumcision is illegal, a doctor named Raslan Fadl was sentenced to two years in prison for manslaughter in January for performing an FGM operation that killed 13-year-old Sohair al-Batea in 2013. This was the country's first FGM conviction. The U.K. also had its first-ever FGM trial this year, but Dr. Dhanuson Dharmasena, who was accused of illegally performing FGM on a woman in London days after she gave birth, was acquitted on Wednesday.

Immigration to Western countries where FGM is not traditionally practiced means health care providers have had to adapt to the harmful medical consequences of FGM. Greater awareness, along with better data—last month, Heartlands Hospital in Birmingham, U.K., reported treating 1,500 cases of FGM in the past five years—has led to acknowledgement of the specialized health care needs of women have had FGM, like psychological trauma and greater attention during childbirth due to pain, possible genital tears and the danger posed to the unborn child.

The case of Dharmasena only came about because the midwife noticed what he was doing—restitching the patient after she had given birth—and warned him it could be constituted as FGM.

FGM has been illegal in the U.S. since 1996, but an amendment to the law banning vacation cutting wasn't passed until 2012. In 2006, Khalid Adem, an Ethiopian immigrant, was the first person convicted of performing FGM in the U.S. after prosecutors alleged he cut his daughter's clitoris with a pair of scissors.

On Thursday Rep. Joe Crowley, D-New York, and Rep. Sheila Jackson Lee, D-Texas, introduced new legislation, supported by international human rights group Equality Now, that aims to create a national strategy to protect girls in the U.S. from FGM. Crowley, who has a 14-year-old daughter, passed a law in 2012 that helped close a loophole that allowed parents to take their children abroad for vacation cutting. He says the new bill will take further action, like establishing a hotline for at-risk girls and better education for teachers and health care workers. FGM is a sensitive subject, he says, but one that needs to be talked about, especially because it robs girls of a chance at a normal life.

"I want my daughter to experience fulfilled life at its whole. I want it not only for my daughter but for all girls to have that opportunity," says Crowley. "For millions of girls that's been taken away from them, often by their own family."

The introduction of the law was timed to coincide with the U.N.'s Zero Tolerance Day, held annually to celebrate the progress that's been made toward FGM elimination—like the passing of legislation banning it in countries like Kenya, Guinea-Bissau and Uganda—but also recognize what still needs to be done.

"It's an important moment for everybody to reflect on the harms of this practice, on the commitments that have been done at the international level," says Nafissatou Diop, the coordinator of the UNFPA-UNICEF joint program on FGM. "We have girls fighting for their rights, we have communities, religious leaders, women, men, who are saying no to the practice of FGM."

The focus of this year's Zero Tolerance Day is the medicalization of FGM, which is on the rise in several countries. Around 20 percent of those who undergo FGM will endure it at the hands of a medical practitioner, says Diop. While many parents know it's harmful, they think there's a reduced risk if their daughters are cut by a health professional who is trained in saving lives and knows how to stop bleeding.

According to Diop, many health providers are pressured into providing FGM services by their communities. But, she adds, FGM performed by a doctor "is not safer. FGM cannot be safe."

In some parts of the world, medicalized FGM is even more common. For example, in Egypt around 77 percent of girls who undergo FGM are cut by health personnel. Prevalence there is so widespread that in many rural areas and villages, doctors, for whom FGM is a source of income, earning them between 100 and 200 Egyptian pounds per case, have never seen an uncut woman.

Medical schools in the country—where cutting off part of the clitoris is the main form of FGM—do not cover it in any curriculum, but groups like UNFPA and the Egyptian Ministry of Health are training doctors on what to do when a family brings them a girl and ask for her to be circumcised.

"The challenge is that you need to work on many levels. You need to work on people's convictions, that this practice does not do what they think it does," says Germaine Haddad, program officer at the UNFPA Egypt office.

Changing deep-seated cultural customs and behaviors will be tough where pressure from society and family members to continue tradition is intense. Without being circumcised, many parents believe their daughter won't be a good wife and, more importantly, a good person.

"[A girl] has to go through this because [if she doesn't] she's going to face more consequences," says Diop, "because what is worse than being rejected by your community?"

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