Female Genital Mutilation (FGM): Background and Issues for Congress

CRS Report for Congress
Female Genital Mutilation (FGM): Background
Information and Issues for Congress
Tiaji Salaam, Coordinator
Analyst in Foreign Affairs
Foreign Affairs, Defense, and Trade Division
Erin D. Williams and Ruth Ellen Wasem
Specialists in Social Legislation
Domestic Social Policy Division
Summary
Congress has acted to help prevent female genital mutilation (FGM) in several
ways. Broadly, it has passed legislation that targets women and aims to improve health
conditions around the globe. Specifically, Congress has passed language protecting
victims of FGM and criminalizing the practice in the United States in the FY1997
Omnibus Consolidated Appropriations, P.L. 104-208. It has also passed the Foreign
Affairs Operations, Export Financing, and Related Programs Appropriations Act, 2001,
P.L. 106-429, which contains language requiring the U.S. Department of State to
compile statistics on FGM.
FGM is a term that refers to the removal or alteration of the female genitalia. It is
estimated that 2 million girls in the Middle East and Africa are subjected to the
procedure per year. The practice occurs most often in Yemen, Egypt, Oman, United
Arab Emirates, Saudi Arabia, Iraq, Jordan, Syria, Southern Algeria, and 28 African
countries. In addition, it has been reported that certain Muslim populations in Indonesia,
Sri Lanka, Malaysia, and India practice FGM in varying levels. Although the United
States and a number of industrialized countries have banned FGM, they continue to
contend with it among immigrant communities who may use doctors from their home
countries to perform the surgery or send their children to home countries to receive the
procedure. This report discusses the prevalence of FGM, highlights programs that seek
to counter its occurrence and describes the debate on FGM-related policies. This report
will be updated as needed.
Female genital mutilation (FGM) is a term that refers to the removal or alteration of
the female genitalia. Some advocate using the term female circumcision to respect the
culture of those who use the procedure. In Western nations, the term FGM is most often
used. In this report, the term FGM will be used as reflected in U.S. legislation.

Congressional Research Service ˜ The Library of Congress

FGM occurs in varying degrees. “Sunna circumcision,” the mildest form, entails the
removal of the prepuce — the loose fold of skin that covers the tip of the clitoris. The
second form, “clitoridectomy,” involves the partial or entire removal of the clitoris, and
can include the scraping off of the labia majora and minora — the outer folds of skin that
surround the clitoris, the opening of the urethra, and the opening of the vagina.
“Infibulation,” the most severe form representing 15% of all FGM cases, includes the first
two forms followed by the sewing of the scraped sides of the vulva. A small opening is
left to allow the flow of urine and menstrual blood. Girls who have been infibulated must
be cut in order to have intercourse, and may be repeatedly opened and closed at the
husband’s will to ensure fidelity.¹
Between 8 and 10 million girls in the Middle East and Africa are at risk of
undergoing FGM, and another 10,000 are estimated to be at risk in the United States.²
About 135 million girls and women have already undergone the procedure with
approximately 2 million girls subjected to the procedure each year, about 6,000 per day.³
Circumcision is usually performed on girls between the ages of four and 13.⁴ According
to a variety of sources, FGM occurs most frequently in Yemen, Egypt, Oman, United
Arab Emirates, Saudi Arabia, Iraq, Jordan, Syria, Southern Algeria, and 28 African
countries. Also, certain Muslim populations in Indonesia, Sri Lanka, Malaysia, and India
reportedly practice FGM in varying levels. Western countries, including the United
States, also contend with the practice among immigrant populations who sometimes use
doctors from their home countries to perform the surgery.
FGM reportedly is still most often performed with crude instruments, such as broken
glass, scissors, kitchen knives, and razor blades. The same tool is often used on a
succession of girls during rite of passage ceremonies, which facilitates the transmission
of viruses, including HIV. Antiseptics and anesthesia are rarely used. The effects of
FGM are numerous, and immediate consequences can include excruciating pain and
hemorrhaging.⁵ Infections of the genitals and urinary tract are common. Girls have also
died from hemorrhage and septicemia, an infection of the blood. An affected woman can
face chronic pelvic infections and inflammation, genital malformation, delayed menarche,
and recurrent urinary tract infections over the term of her life. She may also develop scar
tissue that damages her birth canal and increases her chances of having stillbirths and

¹ Amnesty International, Female Genital Mutilation: A Human Rights Information Pack, 1998,
at [http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm] and USAID website, “USAID:
Working to Eradicate Female Genital Cutting,” cited on Mar. 15, 2004. (Hereafter cited as
Amnesty International, Female Genital Mutilation.)
² Marianne Sarkis, Female Genital Cutting: An Introduction, The Female Genital Cutting
Education and Networking Project, accessed on Apr. 29, 2004, at [http://www.fgmnetwork.org/
intro/fgmi ntro.html ].
³ Amnesty International, Female Genital Mutilation.
⁴ BBC News, Female Circumcision ‘on the Rise’, Mar. 24, 2004, at [http://news.bbc.co.uk/1/hi/
uk/3564203.stm].
⁵ USAID Office of Women in Development, Female Genital Mutilation, Information Bulletin,
Mar. 1997, at [http://www.usaid.gov/wid/pubs/fgm97.htm].

developing obstetric fistula, a condition that causes incontinence.⁶ During labor, an
infibulated woman is often cut again to prevent her child’s head from being crushed by
her damaged birth canal.
U.S. and International Response
An international consensus to end FGM has been growing. The United Nations
(UN), United Nations Children’s Fund (UNICEF), and the World Health Organization
(WHO) have expressed their views that FGM is a violation of human rights, and have
made a number of recommendations designed to end the practice. In addition, a number
of international declarations and conventions have deemed female genital mutilation to
be a violation of human rights, including the Universal Declaration of Human Rights; the
International Covenant on Civil and Political Rights; the Convention Against Torture and
Other Cruel, Inhuman or Degrading Treatment or Punishment; and the Declaration on
the Elimination of Violence Against Women.⁷ The United States considers FGM a crime,
and U.S. immigration courts recognize it as a form of persecution in asylum adjudications.
It appears, however, that only a few women have been granted asylum in the United States
and elsewhere under these terms.
The United States, largely through the U.S. Agency for International Development
(USAID), seeks to eliminate FGM through a number of strategies. First, in September

2000, the Agency incorporated FGM eradication into its general development agenda,

particularly within its family planning initiatives. Second, USAID collaborates with other
groups to advocate for research, policy change, and public awareness on the harmful
effects of FGM. Finally, it advocates behavior change and alternative rituals.⁸
Despite the international efforts, anti-FGM legislation has not ended the practice in
many countries. For example, although Britain banned the practice almost 20 years ago,
an estimated 74,000 African women have undergone FGM and 7,000 girls are at risk in
the country.⁹ In Niger, FGM was made illegal in 2001, but still the practice continues and
no one has been prosecuted for performing the procedure.¹⁰ Ghanaian women’s rights
advocates complain that while a few have been prosecuted under that country’s law, anti-
FGM laws are not strong enough. The Ghanaian Association for Women’s Welfare

⁶ For more information on obstetric fistula and what the U.S. government has done to combat it,
see CRS Report RS21773, Reproductive Health Problems in the World: Obstetric Fistula:
Background Information and Responses, by Tiaji Salaam.
⁷ Article 24 (3) of the United Nations Convention on the Rights of the Child; Article 21 of the
African Charter on the Rights and Welfare of the Child (1990); Article 2 of the Declaration on
the Elimination of Violence Against Women (1993); and paragraphs 4.22 and 7.40 of the
Programme of Action of the United Nations International Conference of Population and
Development (1994). For more information on other international agreements that condemn
FGM see [http://www.usaid.gov/wid/pubs/fgm97.htm].
⁸ USAID website, “USAID: Working to Eradicate Female Genital Cutting” at
[http://www.usaid.gov/our_work/ gl obal_health/pop/publications/ docs/eradicateFGM.html ]
⁹ BBC News, “Female Circumcision ‘On the Rise’,” Mar. 24, 2004, at [http://www.bbc.co.uk].
¹⁰ UN Office for the Coordination of Humanitarian Affairs, “Niger: Legal Ban on Female
Circumcision Widely Ignored,” Feb. 6, 2004, at [http://www.irinnews.org].

(GAWW) advocates for stiffer penalties, including the prosecution of parents who force
or allow their daughters to undergo FGM.¹¹
Analysts contend that current laws are not wholly effective in combating the practice,
because they are rarely enforced and are limited in scope and jurisdiction. Some argue
that the laws should be expanded to punish those who help the practitioners, such as
parents, extended family members, and community members. Additionally, advocates
call for greater regional cooperation. Critics of legislation-only approaches to combat
FGM point out that while the African Union has created a legal framework to help
countries enforce anti-FGM laws, only 16 African countries have adopted such laws.¹²
Proponents of anti-FGM initiatives argue that the inability of women and girls to
make decisions about their own health and bodies contributes to the continuation of the
practice. FGM is a cultural practice that is traditionally established and strongly protected
in many areas. Many women and girls fear that uncircumcised girls will be considered
unmarriageable. In response, some countries have tried a variety of initiatives, including
creating alternative rites of passage, and educating midwives to become trained health
care workers who receive monthly stipends. In parts of Ghana and Kenya, some groups
have begun to replace FGM with other practices, such as pricking other parts of the body
to let out a small drop of blood, or eliminating bloodletting entirely.
Congressional Actions and Issues
Domestic Policies. In the mid-1990s, Congress debated and enacted provisions
aimed at preventing FGM in the United States. Most importantly, §645 of the Illegal
Immigration Reform and Immigrant Responsibility Act (IIRIRA) of 1996 (P.L. 104-208)
criminalized the practice of FGM.¹³ IIRIRA further required in §644 that all intending
immigrants and foreign visitors be provided information concerning the potential legal
consequences in the United States for performing FGM, or allowing a child under his or
her care to be subjected to female genital mutilation (under criminal or child protection
statutes or as a form of child abuse). Anyone who is convicted of circumcising a girl
under the age of 18 in any form is to be fined and/or imprisoned for up to five years.
Noncitizens who are convicted under this provision, moreover, are subject to¹⁴
deportation.
While some maintain that these provisions impose sufficient penalties, others argue
that they should be strengthened. The latter note that the law does not include punishment
for those who send the girls abroad to be circumcised. Advocates argue that if the law
were expanded to punish those who attempted to circumvent U.S. law, then it might deter
parents from sending their children abroad to have the procedure done. Opponents of this

¹¹ U.N. Office for the Coordination of Humanitarian Affairs, “Ghana: Women Call for Stiffer
Female Circumcision Laws,” Feb. 2, 2004, at [http://www.irinnews.org].
¹² U.N. Office for the Coordination of Humanitarian Affairs, “Africa: Conference Delegates in
Ethiopia Call for End to FGM,” Feb. 6, 2004, at [http://www.irinnews.org].
¹³ §116 of USC 18, Crimes and Criminal Procedure.
¹⁴ CRS Report RL32480, Immigration Consequences of Criminal Activity, by Michael John
Garcia and Larry M. Eig.

expansion assert that young girls are sometimes circumcised against the parents’ wishes
while visiting relatives, and such a law might unfairly punish innocent parents. Others
point out that establishing intent to violate the law would be virtually impossible to prove,
rendering such an expanded provision unenforceable. Proponents of current law maintain
that, regardless of where the procedure took place, child protective services would remove
the child from the home for extreme child abuse if FGM is reported.
The Immigration and Nationality Act (INA) provides immigration protections to
aliens who have a well-founded fear of persecution, most notably in the form of refugee
and asylum status. Aliens seeking asylum must demonstrate a well-founded fear that if
returned home, they will be persecuted based upon one of five characteristics: race,
religion, nationality, membership in a particular social group, or political opinion.¹⁵ The
asylum process differs from refugee processing, which is wholly outside of the United
States, although both refugees and asylees must demonstrate a well-founded fear of
persecution.¹⁶ Legal guidance for Asylum Officers issued in 1995 stated that “severe
sexual abuse does not differ analytically from beatings, torture, or other forms of physical
violence that are commonly held to amount to persecution.”¹⁷ Most importantly, the U.S.
Board of Immigration Appeals held In Matter of Kasinga, that a subjective ‘punitive’ or
‘malignant’ intent is not required for harm to constitute persecution and — in the
landmark case — granted asylum on the basis of FGM in1996.¹⁸
Some advocate amending the INA’s definition of refugee and asylee to expressly
mention FGM, as was done for resistance to coercive population control policies.¹⁹
Proponents argue that such a provision would strengthen the policy and speed up the
lengthy asylum adjudication process. Others argue against changes to refugee and asylum
law that would “itemize” the grounds for granting relief, warning that specifying the types
of persecution could limit future grants to only those types of persecution specified in the
law. They maintain that current law affords adequate protections for females fleeing
FGM.
International Policies. The 106^th Congress passed language requiring the U.S.
Department of State to compile statistics on FGM in P.L. 106-429, Foreign Affairs

¹⁵ In 1968, the United States became party to the 1967 United Nations Protocol Relating to the
Status of Refugees. The Refugee Act of 1980 codified the U.N. Refugee Protocol’s definition
of a refugee (§207 of INA), included provisions for asylum (§208 of INA), and instructed the
Attorney General to establish uniform procedures for the treatment of asylum claims of aliens
within the United States.
¹⁶ For a discussion of refugee policy, see CRS Report RL31269, Refugee Admissions and
Resettlement Policy, by Andorra Bruno.
¹⁷ U.S. Department of Justice memorandum to all INS Asylum Officers, Considerations for
Asylum Officers Adjudicating Asylum Claims from Women, from Phyllis Coven, Office of
International Affairs, May 26, 1995.
¹⁸ To read this case, see [http://www.usdoj.gov/eoir/library/intdec/id_pdf/3278.pdf]. For
background, see [http://news.bbc.co.uk/2/hi/africa/394345.stm].
¹⁹ The coercive family planning provision was added by §601 of IIRIRA (P.L. 104-208). See
CRS Congressional Distribution Memorandum, Asylum Granted on the Basis of Coercive Family
Planning, by Ruth Ellen Wasem (available from author).

Operations, Export Financing, and Related Programs Appropriations Act, 2001.²⁰ As
these data are now being included in the State Department country reports, more people
are becoming aware of the prevalence of FGM. Some suggest that existing legislation
could be used more creatively to raise awareness about the dangers of the practice. For
example, some propose amending P.L. 108-25, United States Leadership Against
HIV/AIDS, Tuberculosis, Malaria Act of 2003, to integrate FGM awareness-raising into
§ 304, Pilot Program for the Placement of Health Care Professionals in Overseas Areas
Severely Affected by HIV/AIDS, Tuberculosis, and Malaria. Proponents of this idea argue
that combating FGM is an integral part of the global fight against HIV/AIDS, particularly
in heavily affected countries. U.S. health care professionals participating in the pilot
program could train health care workers in target areas to raise awareness about the
intersecting risks of HIV/AIDS and FGM. Residents of the area could also be sensitized
on how HIV can be transmitted through the practice. Opponents of further changes in the
law maintain that the Administration may accomplish efforts such as these within current
law. Still others object to any U.S. policies that might be perceived to interfere with
cultural norms and indigenous practices in other parts of the world.

²⁰ Requirement is discussed in Conference Report H.Rept. 106-199.