For a couple of decades, a small, underfunded nonprofit organization in New York called Equality Now has bolstered community groups in Africa that are making steady progress against the painful and destructive practice of female genital mutilation (FGM). But there is concern that an Equality Now-led campaign that has cost an unknown number of advocates their lives is meeting new resistance not only in traditional societies but also among Western anthropologists and other cultural apologists who put a higher value on a harmful practice than on the well-being of girls. Taina Bien-Aimé, Equality Now's executive director, calls it a "rites or rights" dilemma.
The United Nations has taken a surprising lead in publicly advocating for an end to the practice, in which a girl or woman's clitoris and sometimes surrounding vaginal areas are cut away to make her "more marriageable." The World Health Organization estimates that about 100 million to 140 million women worldwide have been subjected to FGM. The practice is most prevalent in Africa but also occurs among immigrants in Europe, Australia, Canada, New Zealand and the United States. Genital cutting is also reported in India, Indonesia, Malaysia, Iraq, Jordan, Saudi Arabia and Yemen. According to Unicef, about 3 million girls are at risk of being mutilated each year, some in infancy, in countries where the prevalence of the practice can be as high as 90 percent. In August the Population Fund, UNFPA, published a technical report on the scope of the practice.
There is often more action internationally than in the United States to curb the practice, although 17 American states have passed laws against the procedure since it began to appear in immigrant communities. In the United States, an analysis of census data by the African Women's Health Center at Brigham and Women's Hospital in Boston shows that (based on families' countries of origin) more than nearly 228,000 females have been or are at risk of being subjected to FGM, with more than 38,000 of them in California and nearly 26,000 in New York State. Only one person in the United States, an Ethiopian-born resident of Georgia, has gone to jail, charged with cruelty after he cut off his 2-year-old daughter's clitoris with scissors.
On November 3 Equality Now will kick off a campaign  in the United States to refocus attention on FGM, with Meryl Streep appearing as a spokeswoman for the cause at the first screening of the documentary Africa Rising. That screening, at NYU, sold out weeks in advance, but it will be followed by programs on the West Coast and in Boston.
By early next year a distribution agreement with Women Make Movies, a multicultural feminist nonprofit, should make the documentary, featuring activists from Africa and international rights organizations, widely available to any group interested in presenting a program on the issue.
Bien-Aimé said that from the beginning in the early 1990s, Equality Now, which also campaigns against sex tourism and trafficking in the United States, followed the lead of grassroots activists against FGM in Africa at a time when the subject was taboo in the United States. "We met with and were actually fascinated by the work of individuals who were literally risking their lives to talk about female genital mutilation, to break the silence and raise awareness," Bien-Aimé observes.
Equality Now stepped in to help forge a network and give it an international platform, but the programs and pace were always left to the people on the scene, men as well as women. In 2000 a fund was created to funnel support to the local groups. A newsletter, Awaken, is published in English, French and Arabic.
Many of the women who have been helped in their advocacy were survivors of the practice. "They were indigenous to their communities," Bien-Aimeé said. "They know best how to address the issue."
"Just the fact that FGM is now a household word is an enormous success," she said. "Fifteen of twenty-eight African countries have laws; an African protocol on the rights of women is the first legal instrument mandating governments to legislate against FGM."
But the practice goes on, and resistance to the prohibition of FGM has led to increasingly younger girls being cut on the apparent theory that this will pass unnoticed. During the political upheaval in Kenya in 2008, while police forces were overstretched or in disarray, mass cuttings were reported. Equality Now heard of the forcible cutting of about 600 girls in the Kenyan city of Eldoret during the school Christmas break.
Bien-Aimé said that last year in Burkina Faso, where there is a hot line to report cases, about 200 infants were rushed to hospitals after being subjected to the practice. FGM, apart from causing girls to bleed to death and eliminating sexual pleasure from the lives of survivors, can lead to high levels of infection and disease, later difficult births and maternal deaths.
The resistance to ending FGM or creating less harmful rites of passage for girls is not confined to developing countries. "For reasons that I don't understand, there's this resurgence of debate around 'rites or rights' in this country," Bien-Aimé said. "It's extremely disturbing." Campaigns against the practice are being challenged on cultural sensitivity by anthropologist and other academics. Some leading American anthropologists, including Richard Shweder of the University of Chicago and Bettina Shell-Duncan, a specialist in biocultural and medical anthropology at the University of Washington, argue that activists who advocate against genital cutting tend to overemphasize the most harmful versions of the practice and fail to appreciate the importance of this rite in many families and communities, where damage to a girl or young woman may be slight.
FGM has fallen off the radar of many health officials. "What is the CDC doing, what is Health and Human Services doing?" Bien-Aimé asked. By comparison, Britain, Sweden and France have special programs in immigrant communities.
"It is critically important for voices from the ground to be heard now," she said.