Female genital mutilation in the United States

Tools used in education and community outreach.

During the 19th century, FGM was frequently performed by doctors as a treatment for many sexual and psychological conditions. During the 19th and 20th centuries, the clitoris was considered the center of female sexuality.[4] In addition, Victorian concepts of female sexuality resulted in a widely-held belief that women were less sexual than men.[24] Female sexuality was typically thought of only within the constructs of heterosexual marriage, and behaviors that strayed from this schema, such as masturbation, were deemed symptomatic, and often resulted in operation on the clitoris.[25][4]

Depending on the symptoms and diagnosis, physicians performed four different procedures of varying invasiveness on women.[4] Doctors would either remove the smegma surrounding the clitoris, lacerate adhesions restricting the clitoris, or remove the clitoral hood altogether (female circumcision).[4] In the most extreme cases, doctors would perform a clitoridectomy, removing the clitoris entirely.[4]

Reflex neurosis was a common diagnosis in the 19th century.[4] Characterized by excessive nervous stimulation, this condition could often manifest in an overstimulation of the clitoris that women would attempt to quell with masturbation.[4] Women diagnosed with reflex neurosis were often circumcised in an effort to remove the irritant.[4]

From the 1880s to 1950s, excision was often performed to prevent and treat lesbianism, masturbation, depression, hysteria, and nymphomania.[26][27] These procedures continued well into the 1970s, and were covered by Blue Cross Blue Shield Insurance until 1977.[7]

Dr. James Burt, a physician from Ohio, performed a so-called "surgery of love" on over 170 women throughout the 1960s and 1970s.[28] During the nonconsensual procedure, Burt would cut around, move, and reshape the clitoris of women who had been admitted for other operations.[28] This continued well into the 1970s, when a former coworker served witness to several of Burt's victims, and he was fired and cast out of the medical community.[28]

  State law criminalizes FGM

  State law does not criminalize FGM (as of June 2020)

As of April 2020, 38 states had passed legislation making FGM illegal.[14] Several of these states passed legislation that made it illegal to perform FGM on anyone, while the federal law (the Female Genital Mutilation Act 1996) only protected those under 18.[3] On November 20, 2018, Federal Judge Barnard A. Friedman ruled the Female Genital Mutilation Act 1996 unconstitutional because it exceeds the enumerated powers of Congress and cannot be justified by the commerce clause.[29][30] The Department of Justice decided not to appeal the ruling,[12] but the US House of Representatives has appealed it.[13]

Prior to being declared unconstitutional, performing FGM on anyone under the age of 18 had become a felony in the United States with the passage of the Female Genital Mutilation Act in 1996.[8] The law was introduced by former congresswoman Pat Schroeder in October 1993.[31][32] The Female Genital Mutilation Act included education and community outreach programs that provide information about the physical and emotional harm caused by FGM.[8][31][33] In addition to community outreach programs, the U.S. Congress also required the Department of Health and Human services to provide information for medical students about treatment recommendations.[34] Education policy was also included in the Illegal Immigration Reform and Immigrant Responsibility Act of 1996.[35] The IIRARA mandated that visa recipients from 28 high-risk countries receive culturally appropriate information on the personal and legal repercussions of FGM in the United States at or before the time of entry.[35][36] In 2013, Transport for Female Genital Mutilation Act specifically prohibited the practice of "vacation cutting", the transport of a girl outside of the United States with the intention of performing FGM.[2]

In addition to policies within the U.S., FGM has been condemned by international organizations and bodies that the U.S. is a part of. The UN's 1948 Universal Declaration of Human Rights and 1989 Convention on the Rights of the Child both include statements against the practice of FGM.[15][3][16] In 1979, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) required participating State parties to work to "abolish customs and practices which constitute discrimination against women".[15][37] In 1990, CEDAW's General Recommendation 14 included many suggested actions for participating State parties to eradicate FGM, including the collection of data on the prevalence of FGM, education and outreach programs to prevent and discourage FGM, incorporating information on the eradication of FGM into public health programs, and encouraging politicians and public figures to speak out against FGM.[37] In 1999, CEDAW's General Recommendation recommended that participating State parties enact laws to prohibit FGM.[37] In 2007, the United Nations Children's Emergency Fund (UNICEF) and the United Nations Population Fund (UNPF) created a joint UN initiative with the goal of ending FGM within a generation.[3] In 2015, the UN's Sustainable Development Goals included the end of practices that prevent gender equality, including FGM.[3]

The first conviction of FGM in the US occurred in 2006. Khalid Adem, an Ethiopian American, was both the first person prosecuted and first person convicted for FGM in the United States. Adem, an Ethiopian immigrant, circumcised his two-year-old daughter with a pair of scissors. He was found guilty of aggravated battery and cruelty to children by the State of Georgia, which had no specific law on FGM at the time.[38][39] In 2010, Georgia successfully passed a law criminalizing FGM.[40]

In April 2017, Jumana Nagarwala, a doctor working at the Henry Ford Hospital in Detroit, was charged with allegedly performing FGM at the Burhani Medical Clinic in Livonia, Michigan.[41][42] This was the first federal prosecution for female genital mutilation in US history.[43] Nagarwala, who denied the charges, was accused of performing FGM on two girls who had traveled from Minnesota with their mothers.[41] The owners of the clinic where it was performed, Dr. Fakhruddin Attar and his wife, Farida Attar, were also arrested and charged with FGM for conspiring with Nagarwala and letting her use their clinic.[44][41]

On November 20, 2018, the judge in the case, U.S. District Judge Bernard A. Friedman, ruled that the federal Female Genital Mutilation Act of 1996 was unconstitutional. The defendants had argued successfully that the practice does not pertain to the Commerce Clause under which the federal law was passed.[45] The Department of Justice decided not to appeal the ruling.,[12] but the US House of Representatives has appealed it.[13]

In 1996, Fauziya Kasinga was granted political asylum by the United States Board of Immigration Appeals.[32] Kasinga, a 19-year-old member of the Tchamba-Kunsuntu tribe of Togo, was granted asylum on the grounds that she would be at risk of FGM if she returned to her arranged marriage in Togo.[32] This set a precedent in U.S. immigration law because it was the first time FGM was accepted as a form of persecution.[46] In addition, this was the first situation in which asylum was granted based on gender.[47]

In 2010, the American Academy of Pediatrics came under fire for advising doctors to consider offering patients the option of "a ritual nick as a possible compromise to avoid greater harm"[48] The Academy stated that although harmful genital mutilation is illegal in the United States, physicians could consider this option in countries where FGM is more widely practiced. This advice appeared in a journal section entitled "Education of patients and parents".[48] After facing backlash from medical institutions worldwide, the AAP retracted their statement. The organization also subsequently clarified in a statement released in May 2010 that it "opposes all types of female genital cutting" and "counsels its members not to perform such procedures".[49]