Female genital mutilation seems like something that happens over there. Not in the United States. But in Africa, in the Middle East, in Asia.
That's not the case.
More than half a million girls now living in the U.S. are considered at risk for female genital mutilation. The procedure can range in severity from removing or cutting the clitoris — a sexual organ primarily responsible for female sexual pleasure — to sewing the vagina shut.
"It can be extraordinarily severe," says Shelby Quast, policy director of Equality Now, a women's rights advocacy group. "There are lifelong implications for health, both emotional and physical." The estimated number of girls at risk is based on the number of daughters of immigrants from countries, mostly in Africa and from some communities in Asia, living in the U.S.
"It's against the law in the U.S. to perform FGM, or to take the woman outside the country to perform the procedure," says Quast. In 1996, a federal law was passed outlawing the procedure in the U.S., and in 2013 it became illegal to send a girl to another country — so-called "vacation cutting."
But 26 states do not have their own laws criminalizing the procedure, and state laws could increase protection. "It's important because states are where people live," says Quast. "When women are looking to get services, or a girl is scared that this is going to happen to her, it's important to have those services and laws available at the local level."
The U.S. isn't the only developed country where FGM is a concern. An estimated 137,000 women and girls in the United Kingdom have had the procedure, according to a report released this week by City University London and Equality Now.
The developed world can learn from the efforts in Africa to eliminate female genital mutilation. At least 18 African countries have criminalized the practice with penalties ranging from monetary fines to prison time, according to the Center for Reproductive Rights.
Kenya, for example, is experimenting in communities with Alternative Rites of Passage for girls, usually age 12 to 17. Cutting occurs at coming-of-age celebrations. With this program, the girls are secluded for a week of celebration and gift-giving, and both traditional and medical instructors teach about courtship and marriage — and provide information on the dangers and the criminality of FGM.
Senegal has begun a program called the Grandmother Project, which promotes intergenerational dialogue about tradition and cultural values along with education about the harm of cutting. The program is still in its development stage, but the hope is that grandmothers, once considered the guardians of the tradition of mutilation, can be educated about its harms and become a matriarchal force in ending it.
The challenge for developed nations, Quast says, is to get the discussions going among immigrants who don't want to talk about genitalia. And to get their own citizens to realize that female genital mutilation is a problem in their countries. "People in [the U.S.] don't want to think it happens here. But their daughters might be sitting next to a best friend who can be subjected to a violent, cultural procedure," she says. "If it were cutting the nose or the ear off — something everyone could see — there'd be a different response. We can't continue to hide this away."
The mutilation was once considered a traditional practice in some cultures but is now recognized by the World Health Organization and human rights groups as a violation of women's rights. It has been performed on an estimated 100 million to 140 million girls and women in the world. Some 3 million girls are thought to be at risk for the cutting each year, according to a 2014 report by the Population Reference Bureau, which does population and health research.
The reasons for the procedure vary across cultures. Some people believe that Islam promotes the procedure, but according to the Population Reference Bureau report, "many Islamic scholars publicly assert that it is not found in Islamic doctrine."
Quast lays much of the blame on societies where women do not have rights equal to those of men. "The reasons are different across cultures," she says. "They can be anything from believing a girl will not be accepted in her community if this is not performed, or that she will not be marriageable. It's patriarchy, it's about control. Sometimes, people believe the ancestors require it. Some believe that without it, girls will grow a penis. Or it's part of a broader ceremony that ensures virginity. It's closely linked to early, enforced marriage and to preventing girls from wanting to have sex."
Without a clitoris, often destroyed in the procedure, a woman can have sex, get pregnant and give birth (once the vagina is re-opened, if it was sewn shut), but she typically can't experience orgasm. And there are risks of complications during pregnancy and childbirth and lifelong health consequences, including infections and urinary incontinence.