Sarah was 7 years old when her parents took her to visit their family in India. Born in Iowa and raised in California, Sarah remembers taking trips to see relatives abroad frequently. But this time was different.

“I wish it didn’t happen to me,” Sarah said, referring to an event that occurred on this specific trip. “I think the things that do stick out, the bits and pieces, are the parts that might traumatize you.” ABC News has changed Sarah’s name to protect her privacy.

That summer in Mumbai, Sarah, who is now in her 30s, remembers her mother taking her to a brown building where there were older women wearing saris. She remembers the women being friendly, but shortly after she arrived she was held down, and her skirt was lifted up.

“I remember feeling pain,” Sarah said. “I was crying, so I was scared during it because it hurt.”

That day Sarah underwent female genital mutilation (FGM), also known as female genital cutting (FGC), which is the practice of cutting a woman’s genitals.

There are four types of FGM, according to the World Health Organization (WHO). They range in severity, from removing parts of a woman’s genitals to sealing closed the vaginal opening, also known as infibulation. WHO classifies harmful procedures as ones involving piercing, incising, scraping and cauterizing the area.

FGM is often associated with Africa and some communities in the Middle East, Asia and South America. The origins of FGM are unclear. But experts say the ancient practice is not officially linked to religion in any way. It’s done for a variety of reasons, with supporters saying it carries on tradition, protects a woman’s honor and ensures she will stay a virgin until marriage. In some places a woman can’t get married unless she has undergone the procedure.
On the Rise in the U.S.

More than half a million women and girls in the U.S. are estimated to be affected or at risk of FGM, according to the Population Reference Bureau (PRB), a nonprofit organization that released statistics on FGM earlier this year. The number of those at risk has more than doubled in roughly the past decade, according to the PRB.

Officials from various organizations say the main reasons include population growth, and the fact that more families are immigrating to America, and bringing their traditions with them.

Sarah’s parents are immigrants from India, and she said her mother is the one who wanted her to undergo the procedure.

“I don’t know if I can change her mind still,” Sarah said. “She really believes that this is a practice you have to undergo. … Her mom had it done, her grandma had it done. She thought she was doing what was the best for her children.”

“There haven't been new numbers made available for more than a decade,” said Mark Mather, a demographer with the PRB. “We knew the immigrant population had grown considerably over the past 10 years, so for a population changing so rapidly, it’s important not to wait to get more updated estimates.”

Mather explained that to compile the information the PRB looked at immigrant families coming from countries with a high prevalence rate of FGM, including places where 80% to 90% of women undergo the procedure.

Mather said the PRB collaborated with the Centers for Disease Control and Prevention when it was analyzing data, and that the CDC is independently conducting its own research on FGM. The CDC has not released a report on FGM in nearly 20 years, but the agency told ABC News it is working to update estimates on the number of women and girls in the U.S. who may be at risk for FGM.

“This step is necessary to understand the possible extent of the problem in the United States,” the CDC said in a written statement to ABC News. “The CDC is part of an interagency effort, coordinated by the White House, to explore ways the U.S. Government can reduce the occurrence of female genital cutting in this country and abroad.”

The CDC told ABC News that its preliminary findings on FGM are very similar to the PRB’s statistics, but those numbers can change pending publication of its report.

Performing FGM on U.S. soil has been illegal since 1996. A federal law against sending girls abroad to have the procedure done, also known as vacation cutting, was passed in 2013.

U.S. Women and Girls Potentially Affected or at Risk of FGM
(Rate per 10,000 female residents)*
*Source: Population Reference Bureau, analysis of data from the 2013 American Community Survey, Public Use Microdata Sample. Estimates are subject to both sampling and nonsampling error. Rate of women at risk calculated by total female residents of each state.

Understanding FGM

The numbers are staggering worldwide. Between 100 million and 140 million girls and women are estimated to have undergone genital cutting, according to Equality Now, a legal advocacy organization that fights to protect and promote the human rights of women and girls around the world. A girl is usually cut between infancy and 15 years old.

In the U.S., only 24 states have anti-FGM laws, according to Equality Now, which launched a campaign today calling for all states to enact their own version of the federal law.

“It’s not legal, it’s harmful, it’s violence against girls,” said Shelby Quast, policy director of Equality Now. “In this country I think sometimes we don’t want to think things happen here. It’s hidden, you don’t see it, it’s not always discussed.”

Equality Now campaigned with activist and survivor Jaha Dukureh to ask the U.S. government to conduct a report on the number of women and children in America impacted by FGM, and to come up with a national action plan to end the practice. Dukureh started a petition on that has more than 220,000 signatures. She has also become a leading advocate in the Guardian's Global Media Campaign to help end FGM.

“I actually believe that we can end FGM in a generation, not only in the U.S. but throughout the world,” Dukureh told ABC News.
Dukureh, who lives in Atlanta, works to raise awareness about FGM and its harmful effects through her organization Safe Hands for Girls. She is also working to build a women's center that will help prevent the practice in the Gambia, where almost 80% of the women experience FGM.

Dukureh said she underwent FGM as a baby in the Gambia. Her clitoris was cut off and her vagina stitched up. At 15, she was brought to New York for an arranged marriage with an older man. Dukureh said she was taken to a doctor on Fifth Avenue who operated on her to remove the stitches, so her husband could have sex with her.

“Even if it's just one girl in America that has gone through FGM I think that's one girl too many,” she said. “It's wrong. It's a human rights violation. It's child abuse.”

FGM is sometimes called female circumcision. However, experts say the name is inaccurate because it’s different than male circumcision.

“They aren’t the same thing at all,” said Quast, of Equality Now. “It’s an unfortunate use of the same term because it’s confusing to people. Male circumcision is removal of foreskin. Female circumcision is an actual removal of the sex organ, the genitalia of a woman.”

And the consequences can be life-long. According to WHO, complications as a result of FGM can include infertility, bladder infections, cysts and childbirth complications. Removing certain reproductive organs can also deprive some women of sexual pleasure for the rest of their lives.

“When you go through FGM, no one ever tells you that you’re going to feel the pain forever,” Dukureh said. “You feel pain during sex, you feel pain during childbirth. It's just that pain that never stops.”
Women in America

FGM is part of a hidden ritual continuing to impact Americans, as well as millions of women and girls overseas. There are generally three types of cases that affect women in the U.S.

The most well-known cases involve immigrant women, like Dukureh, who move to America, but already had FGM performed in their birthplace.

Vacation Cutting:
Sarah is an example of someone who has experienced vacation cutting. These survivors are usually American-born, but their parents or guardians are immigrants. When the girls are old enough they will be sent abroad, often being told they are going on “vacation.” That is when they have the procedure done.

Underground in America:
Experts and survivors say even though FGM is illegal to perform, it does happen to children on U.S. soil.

“My sister had it done in the U.S.,” Sarah said. “I remember her crying. I didn’t see her until after she got it done. At that point I was still in the innocent area like this is something that happens to all of us and now it’s happened to my sister.”

In some communities in the U.S., experts say medical professionals will perform the procedure at the request of parents. Other times, they say parents will have someone come to the home to cut the child.

“If in the United States we saw families mutilating their child's ears or nose or mouth, we would scream child abuse and we would make sure it would stop the same day,” Dukureh said. “But because this is in Africa, and we are worried people will call us racist, or people will call us anti-immigration or anti-religion, we want to say it's okay. No, it's not okay.”

ABC News’ Charlotte Bellis, Freda Kahen-Kashi, Serena Marshall, Avianne Tan, Hae Young Yoo and Jamie Zimmerman contributed to this report.

Join the conversation using the hashtag #UndergroundFGM
Or tweet at the reporters Olivia Smith and Teri Whitcraft

Published on July 20, 2015

Additional Credits
Video Editor/Graphics Animator LUIS YORDAN
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