Female Genital Mutilation/Cutting: Existing Federal Efforts to Increase Awareness Should Be Improved
Highlights
What GAO Found
The Centers for Disease Control and Prevention (CDC) estimated that 513,000 women and girls in the United States were at risk of or had been subjected to female genital mutilation/cutting (FGM/C) in 2012, a threefold increase from its 1990 estimate. CDC attributes this change primarily to increased immigration from countries where FGM/C is practiced, rather than an increase in the occurrence of FGM/C. Agency estimates were not able to distinguish between those who have already been subjected to FGM/C and those who are at risk.
CDC Estimates of the Number of Women and Girls in the United States at Risk of or Who Have Been Subjected to Female Genital Mutilation/Cutting, 1990 and 2012
Women and girls at risk of or who have been subjected to FGM/C in their home country may seek federal protection in the United States through different avenues of the immigration process, and GAO found that there have been few U.S. investigations and prosecutions. According to Department of Homeland Security officials, protection is most commonly provided through the asylum process, where individuals must demonstrate that they have been persecuted or fear persecution in their home country on account of protected grounds such as religion or nationality. While FGM/C is a crime under federal and many state laws, law enforcement officials identified few investigations and prosecutions related to FGM/C. Officials said that this may be due, in part, to underreporting.
Federal agencies and others provide education and assistance regarding FGM/C, but gaps exist and agencies lack documented plans for future efforts. The Department of State (State) directly provides information on FGM/C in a fact sheet only to certain types of visa recipients who apply in countries where FGM/C is practiced. State does not provide the fact sheet to nonimmigrant visa recipients as these visas are for temporary stays; however, some of these visas permit stays in the United States for multiple years. In addition, State does not directly provide the fact sheet to visa recipients who are nationals of countries where FGM/C is common, but apply at posts in other countries. Visa recipients who do not directly receive the fact sheet may be unaware of the health and U.S. legal consequences of FGM/C. Federal agencies have made efforts to increase awareness of FGM/C among stakeholder groups, including hosting roundtables and developing educational materials. However, the agencies lack documented plans for future efforts. Internal controls state that agencies should establish plans and document activities. Absent this, the federal government may be unable to ensure that its activities meet the needs of and that it communicates effectively with external parties, such as key stakeholder groups.
Why GAO Did This Study
FGM/C comprises all procedures that involve partial or total removal of the external female genitalia, or other harm to the female genitals for non-medical reasons. The rationale for FGM/C often includes cultural, religious, and social factors in families and communities. In the United States, women and girls believed to be most at risk of FGM/C are those from immigrant families from countries where FGM/C is practiced.
GAO was asked to review the federal response to address FGM/C in the United States. In this report, GAO examines (1) what is known about the number of women and girls at risk of or subjected to FGM/C, (2) the protections available and actions taken to protect women and girls, and (3) the extent to which actions are taken to educate and assist immigrant communities and key stakeholders. GAO analyzed documents and spoke to officials from five relevant federal agencies; spoke with officials from local law enforcement, health care, education, and social services sectors; and assessed agency actions against federal internal control standards.
Recommendations
GAO recommends that State provide information to additional visa recipients and that each federal agency document its domestic FGM/C awareness efforts. The agencies generally agreed with the recommendations; however, State disagreed with documenting its awareness efforts, noting that it is not responsible for domestic outreach and education. GAO maintains that the recommendation is valid as discussed in the report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of State | To increase awareness of the health and legal consequences of FGM/C among visa recipients, the Secretary of State should update the Foreign Affairs Manual to require posts located in countries where FGM/C is commonly practiced to directly provide information about FGM/C to nonimmigrant visa recipients in the same manner as is done for immigrant visa recipients. |
The Department of State (State) took action to address our recommendation by expanding the pool of visa applicants who will receive information on FGM/C. Specifically, State finalized its transition to providing paperwork electronically during the visa application process in May 2019, which resulted in its ability to directly distribute the fact sheet on FGM/C to both immigrant and nonimmigrant visa recipients. According to State, both immigrant and nonimmigrant visa recipients will have to certify that they have read and understood the fact sheet on FGM/C before signing and submitting their respective visa applications.
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| Department of State | To increase awareness of the health and legal consequences of FGM/C among visa recipients, the Secretary of State should update the Foreign Affairs Manual to require posts located outside of the countries where FGM/C is commonly practiced to directly provide information on FGM/C to immigrant and nonimmigrant visa recipients who are nationals of countries where FGM/C is commonly practiced. |
The Department of State (State) took action to address our recommendation by expanding the pool of visa applicants who will receive information on FGM/C. Specifically, State finalized its transition to providing paperwork electronically during the visa application process in May 2019, which resulted in its ability to directly distribute the fact sheet on FGM/C to both immigrant and nonimmigrant visa recipients who are from or were nationals of a country where FGM/C is commonly practiced. State noted that this change will ensure the widest distribution possible by providing all individuals from countries where FGM/C is commonly practiced with access to the fact sheet on FGM/C regardless of place of application or visa recipient type.
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| Department of Homeland Security | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C. |
The Department of Homeland Security (DHS) took action to address our recommendation in January 2017 by creating an outreach strategy on female genital mutilation/cutting (FGM/C) awareness efforts. DHS's outreach strategy describes both the general approach and specific actions it plans to take to educate and reach key stakeholders in the United States with relevant information about FGM/C. To create the strategy, DHS noted that it convened regular meetings with stakeholders throughout the department through its Council on Combatting Violence Against Women. DHS also noted that its efforts will involve continued strategic planning and coordination across DHS components and offices, as well as consultation and coordination with other relevant federal agencies and stakeholders.
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| Department of Education | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C. |
The Department of Education (Education) concurred with this recommendation. In March 2022, Education provided its plan for conducting FGM/C education and outreach to key stakeholders in the United States. The plan included details about an information campaign it began in September 2020 to collect data and information on FGM/C through surveys, school data, and conference calls. It also included its efforts to develop a fact sheet that highlights strategies that educators, school-based health staff, and school administers can use to identify and help girls who have experienced or are at risk of experiencing FGM/C. Finally, the plan describes Education's efforts to post the fact sheet on its website in 2021, along with other related resources that individuals can use to find more information.
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| Department of Health and Human Services | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C. |
In December 2019, the Department of Health and Human Services (HHS) provided documentation of its Office on Women's Health FGM/C activities. In this written plan that was last updated in April 2018, the Office on Women's Health describes its key activities, including 3-year grant funding for eight organizations to address FGM/C in their communities, data collection through a multi-site study to better assess the characteristics and impact of FGM/C among potentially at-risk women, and participation in the federal interagency workgroup devoted to FGM/C.
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| Department of Justice | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C. |
The Department of Justice (DOJ) took action to address our recommendation in January 2017 by creating an outreach strategy on its female genital mutilation/cutting (FGM/C) awareness efforts. DOJ's outreach strategy notes the importance of educating stakeholders about laws prohibiting FGM/C and described how it will continue its outreach and the activities in which that would occur. For example, DOJ described how it will continue to disseminate a multi-language brochure on laws prohibiting FGM/C that also lists options for reporting possible violations of the law.
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| Department of State | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C. |
The Department of State (State) took action that met the intent of our recommendation in February 2018 by releasing a statement for the International Day of Zero Tolerance to Female Genital Mutilation that described how it partners with a broad range of stakeholders and other governments to raise awareness of female genital mutilation/cutting's (FGM/C) harm to society. Its statement also described State's future plans, such as its support for survivor-centered programs in countries where FGM/C is most prevalent.
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| Department of Homeland Security | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate. |
The Department of Homeland Security (DHS) took action to address our recommendation in January 2017 by creating an outreach strategy on female genital mutilation/cutting (FGM/C) awareness efforts and sharing the strategy online. DHS's outreach strategy describes both the general approach and specific actions it plans to take to educate and reach key stakeholders in the United States with relevant information about FGM/C. DHS subsequently posted the plan on its U.S. Citizenship and Immigration Services (USCIS) website pertaining to FGM/C. USCIS also communicated the plan through an email blast to its subscribers.
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| Department of Education | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate. |
The Department of Education (Education) concurred with this recommendation. In March 2022, Education described its participation with other federal agencies and key stakeholders to develop and exchange materials on resources available to assist women and girls who have been subjected to FGM/C. Specifically, Education said that it identified a staff member who participates in regularly scheduled meetings of an interagency working group comprised of agencies throughout the federal government, including the Departments of Health and Human Services, Homeland Security, Justice, and State. The materials Education shared with this group included its plan for conducting FGM/C education and outreach to key stakeholders in the United States, such as its efforts to develop a fact sheet that it posted on its website in 2021.
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| Department of Health and Human Services | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate. |
The Department of Health and Human Services's (HHS) Office on Women's Health developed a written plan that describes its key activities, including 3-year grant funding for eight organizations to address FGM/C in their communities. In January 2020, HHS provided documentation of a March 2018 meeting where officials spoke about this grant funding and its early takeaways with various officials from other federal agencies and relevant stakeholders such as medical providers and educators. In addition, HHS told us that it has also shared the key activities in its written plan in a August 2019 public meeting where the eight organizations that received grant funding presented summaries of their work to officials from relevant federal agencies.
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| Department of Justice | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate. |
The Department of Justice (DOJ) took action to address our recommendation in October 2017 by sharing its outreach strategy on female genital mutilation/cutting (FGM/C) awareness efforts. Specifically, DOJ officials reported that they communicated their plan with an interagency working group comprised of agencies throughout the federal government, including the Departments of Education, Health and Human Services, Homeland Security, and State.
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| Department of State | To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate. |
The Department of State (State) took action that met the intent of our recommendation in February 2018 by publishing a statement on its female genital mutilation/cutting (FGM/C) awareness efforts online. State's statement for the International Day of Zero Tolerance to Female Genital Mutilation described how it partners with a broad range of stakeholders and other governments to raise awareness of FGM/C's harm to society. Its statement also described State's future plans, such as its support for survivor-centered programs in countries where FGM/C is most prevalent. State posted this statement on the press releases section of its www.state.gov website.
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