FEMALE GENITAL 

MUTILATION/ 

CUTTING

U.S. Assistance to 

Combat This Harmful 

Practice Abroad is 

Limited

Report to the Minority Leader, U.S. 

Senate

April 2016

GAO-16-485

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-16-485, a report to the 

Minority Leader, U.S. Senate

April 2016

FEMALE GENITAL MUTILATION/CUTTING

U.S. Assistance to Combat This Harmful Practice

Abroad Is Limited 

Why GAO Did This Study

More than 200 million girls and women 

alive today have undergone FGM/C in 

the 30 countries where available data 

show this harmful practice is 

concentrated. More than 3 million girls 

are estimated to be at risk for FGM/C 

annually in Africa. FGM/C comprises 

all procedures that involve partial or 

total removal of the external female 

genitalia, or other injury to the female 

genital organs. It is rooted in the 

cultural traditions of many communities 

but has several adverse health 

consequences and the UN identifies it 

as a violation of human rights. In 2015, 

the UN General Assembly adopted a 

set of 17 Sustainable Development 

Goals for 2030 that included the 

elimination of FGM/C among its 

targets. UNFPA and UNICEF

implement the Joint Program on 

FGM/C in 17 countries—the largest 

current international assistance effort 

to address FGM/C. State and USAID 

include FGM/C as part of their global 

strategy to respond to gender-based 

violence. 

GAO was asked to review State’s and 

USAID’s efforts to address FGM/C 

abroad. This report (1) summarizes 

findings from recent U.S. and UN 

studies about factors contributing to 

FGM/C and approaches to addressing 

this practice and (2) examines State’s 

and USAID’s current efforts to address 

FGM/C abroad. GAO reviewed recent

UN and USAID studies on assistance 

efforts to address FGM/C, analyzed 

related strategies and policies, and 

interviewed State and USAID officials. 

GAO also analyzed information on 

FGM/C-related projects and activities 

from USAID’s overseas missions, and 

State and USAID bureaus. 

GAO is making no recommendations in 

this report.

What GAO Found

U.S. and United Nations (UN) studies since 2010 have identified a variety of 

factors contributing to the persistence of female genital mutilation/cutting 

(FGM/C). In many communities where FGM/C is prevalent, FGM/C is an 

influential social norm that ensures social acceptance and is commonly 

perceived as a religious obligation. In addition, medicalization of the practice—

when it is performed by health care providers rather than traditional 

practitioners—increases the perception of legitimacy in some countries. Although 

the United Nations Children’s Fund (UNICEF) reports that many countries where 

FGM/C is prevalent have passed laws banning the practice, enforcement is a 

challenge. The studies also have identified key approaches to addressing 

FGM/C, including efforts to implement community education programs, outreach 

and training for medical professionals, and the inclusion of FGM/C in broader 

gender equality and human rights programs.

Percentages of Girls and Women Aged 15 to 49 Who Have Undergone Female Genital 

Mutilation/Cutting in Africa, 2004—2015

U.S. assistance efforts to address FGM/C are limited. The Department of State

(State) and the U.S. Agency for International Development (USAID) each had 

one active standalone project in 2014, and the agencies also undertook some 

FGM/C-related efforts as components of projects with broader assistance goals. 

In addition, the U.S. government provides funding to the United Nations

Population Fund (UNFPA) and UNICEF but, to date, has not contributed funds to 

the UN agencies’ Joint Program on FGM/C. If congressional restrictions for 

UNFPA funding (such as the requirement for UNFPA to maintain U.S. funds in a 

separate account) are met, there are currently no specific legal restrictions that 

would prohibit U.S. funding provided to UNFPA from being available for the Joint 

Program on FGM/C. Competing development priorities, such as HIV/AIDS, leave 

little funding specifically for FGM/C, according to USAID officials. View GAO-16-485. For more information, 

contact David B. Gootnick at (202) 512-3149

or gootnickd@gao.gov.
Page i GAO-16-485 Female Genital Mutilation/Cutting

Letter 1

Background 3

U.S. and UN Studies Have Identified Factors Contributing to the 

Persistence of FGM/C and Approaches to Address It 13

State’s and USAID’s Efforts to Address FGM/C Abroad Are 

Limited 21

Agency Comments 30

Appendix I Objectives, Scope, and Methodology 32

Appendix II Percentage Distribution of Girls Who Have Undergone Female Genital 

Mutilation/Cutting by Type of Procedure 35

Appendix III List of Countries Where Female Genital Mutilation/Cutting Is 

Concentrated with Decrees or Legislation Related to the Practice, 

According to the United Nations Children’s Fund 37

Appendix IV GAO Contacts and Staff Acknowledgments 39

Tables

Table 1: Examples of USAID Projects Active in 2014 with Efforts 

Related to Female Genital Mutilation/Cutting (FGM/C) 29

Table 2: Percentage Distribution of Girls Who Have Undergone 

Female Genital Mutilation/Cutting (FGM/C) by Type of 

Procedure 35

Table 3: The United Nations Children’s Fund’s (UNICEF) List of 

Countries Where Female Genital Mutilation/Cutting 

(FGM/C) Is Concentrated with Decrees or Legislation 

Related to This Practice 37

Figures

Figure 1: Percentages of Girls and Women Aged 15 to 49 Who 

Have Undergone Female Genital Mutilation/Cutting 

(FGM/C) in High-Prevalence Countries, 2004–2015 6

Contents
Page ii GAO-16-485 Female Genital Mutilation/Cutting

Figure 2: United Nations Population Fund and United Nations 

Children’s Fund Joint Program Countries 10

Figure 3: Campaign against Female Genital Mutilation/Cutting in 

Uganda 18

Figure 4: Girls Participating in Alternative Rite of Passage in 

Kenya 20

Abbreviations

ACCAF Africa Coordinating Center for the Abandonment of FGM/C

FGM/C Female genital mutilation/cutting

PRB Population Reference Bureau 

PRM Bureau of Population, Refugees, and Migration

State Department of State

UN United Nations

UNFPA United Nations Population Fund 

UNICEF United Nations Children's Fund 

USAID U.S. Agency for International Development 

WHO World Health Organization

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-16-485 Female Genital Mutilation/Cutting

441 G St. N.W.

Washington, DC 20548

April 27, 2016

The Honorable Harry Reid

Minority Leader

United States Senate

Dear Senator Reid:

At least 200 million girls and women alive today have undergone female 

genital mutilation or cutting (FGM/C)1 in 30 countries where available data

show FGM/C is concentrated.2 More than 3 million girls are estimated to 

be at risk for FGM/C annually in Africa. In 2015, the United Nations (UN) 

General Assembly adopted a set of 17 Sustainable Development Goals 

for 2030 that includes the elimination of FGM/C as a target. Although 

many countries where FGM/C is known to be concentrated have passed 

laws banning this practice, enforcement is a challenge, according to U.S.

and UN studies. The reasons why FGM/C persists include a mix of 

cultural, religious, and social factors within families and communities. The 

Department of State (State) and the U.S. Agency for International 

Development (USAID) include FGM/C as part of their global strategy to 

respond to and prevent gender-based violence.

3 In addition, the United 

Nations Population Fund (UNFPA) and the United Nations Children's 

 1

In this report, we use the term FGM/C, consistent with the practice of the United Nations 

(UN) and U.S. agencies. According to the UN, the term FGM/C conveys that these 

practices, as a form of mutilation, are a human rights violation, while the term “cutting”

recognizes the terminology used by agencies when working with practicing communities.

2

See United Nations Children’s Fund (UNICEF), Female Genital Mutilation/Cutting: A 

Global Concern (New York, N.Y.: 2016). UNICEF’s prevalence data are based on 

nationally representative surveys conducted from 2004 to 2015. UNICEF noted that the 

exact number of girls and women who have undergone FGM/C remains unknown. FGM/C 

occurs in other countries, including Colombia, India, Jordan, Malaysia, Oman, Saudi 

Arabia, and the United Arab Emirates; however, no nationally representative data on 

FGM/C are available for these countries, according to UNICEF. 

3

State and USAID define gender-based violence as violence that is directed at an 

individual based on his or her biological sex, gender identity, or perceived adherence to 

socially defined norms of masculinity and femininity, including physical, sexual, and 

psychological abuse. Forms of gender-based violence include female infanticide; child 

sexual abuse; sex trafficking and forced labor; sexual coercion and abuse; neglect; 

domestic violence; elder abuse; and harmful traditional practices such as early and forced 

marriage, “honor” killings, and FGM/C. 

Letter
Page 2 GAO-16-485 Female Genital Mutilation/Cutting

Fund (UNICEF) carry out a Joint Program in 17 countries to work toward 

ending FGM/C. 

You asked us to review U.S. government agencies’ efforts to address 

FGM/C at home and abroad. This is the first of two reports responding to 

your request. In this report, we (1) summarize findings from recent U.S. 

and UN studies about the factors contributing to FGM/C and approaches 

to addressing this practice internationally and (2) examine State’s and 

USAID’s current efforts to address FGM/C abroad. A second report will 

review U.S. efforts to address FGM/C domestically.

To identify factors contributing to FGM/C and current approaches to 

address this practice, we reviewed recent U.S. and UN studies of 

international efforts to accelerate the abandonment of FGM/C and 

respond to victims of this practice. We selected studies published in 2010 

or later. We examined a USAID-funded Population Reference Bureau 

(PRB) study,4 reports on the first phase of the UNFPA-UNICEF Joint 

Program on FGM/C,5 a UNICEF statistical overview of FGM/C,6 and a 

UNICEF review of efforts to accelerate FGM/C abandonment in five 

African countries.7

 

To determine State’s and USAID’s current efforts to address FGM/C 

abroad, we analyzed applicable strategy and policy documents and 

interviewed State and USAID officials involved in issues related to 

FGM/C. We collected information from USAID missions in countries 

where FGM/C is known to be prevalent to identify development 

 4

Population Reference Bureau, Ending Female Genital Mutilation/Cutting: Lessons from a 

Decade of Progress (Washington, D.C.: 2013). The Population Reference Bureau is a 

nonprofit organization, based in Washington, D.C., that studies population, health, and 

environmental issues for research or academic purposes. Its funders include private 

foundations, government agencies, and individual donors.

5

UNFPA-UNICEF, Joint Evaluation, UNFPA-UNICEF Joint Programme on Female Genital 

Mutilation/Cutting: Accelerating Change 2008-2012 (New York, N.Y.: September 2013), 

and UNFPA-UNICEF, UNFPA-UNICEF Joint Programme on Female Genital 

Mutilation/Cutting: Accelerating Change Summary Report of Phase I 2008-2013 (New 

York, N.Y.: 2014).

6

UNICEF, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the 

Dynamics of Change (New York, N.Y.: July 2013).

7

The UNICEF Innocenti Research Centre, The Dynamics of Social Change Towards the 

Abandonment of Female Genital Mutilation/Cutting in Five African Countries (Florence, 

Italy: 2010).
Page 3 GAO-16-485 Female Genital Mutilation/Cutting

assistance efforts related to this practice. In addition, we examined a 

State-supported FGM/C prevention program in Guinea and selected 

State-funded gender-based violence projects in refugee settings to 

determine if these projects had any FGM/C-related components.8 We 

also reviewed U.S. contributions to UNFPA and UNICEF. Additionally, we 

reviewed how State tracks FGM/C prevalence and countries’ prevention 

efforts in its annual Country Reports on Human Rights.

We conducted this performance audit from June 2015 to April 2016 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. (See app. I for more 

information on our scope and methodology.)

FGM/C comprises all procedures that involve partial or total removal of 

the external female genitalia, or other injury to the female genital organs 

for non-medical reasons.9 The World Health Organization (WHO) 

classifies FGM/C into four major types:

10 

• Type I (clitoridectomy) partially or totally removes the clitoris and/or 

the skin around it; 

• Type II (excision) partially or totally removes the clitoris and the labia 

minora, with or without excision of the labia majora; 

 8

State provided funding for 54 projects in fiscal year 2014—the most recent year in which 

information was available during our review—specifically addressing gender-based 

violence in overseas refugee settings. We examined 9 of 10 projects in countries where 

FGM/C is known to be prevalent with at least $500,000 in State funding in fiscal year 

2014. We were unable to contact project implementers for 1 of the 10 projects.

9

World Health Organization, Eliminating Female Genital Mutilation: An Interagency 

Statement, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, 

UNIFEM, WHO (Geneva, Switzerland: 2008).

10Ibid. 

Background

Definition and Types of 

FGM/C
Page 4 GAO-16-485 Female Genital Mutilation/Cutting

• Type III (infibulation) narrows the vaginal opening through the creation 

of a covering seal formed by cutting and repositioning the labia 

minora and/or labia majora, sometimes through stitching, with or 

without removal of the clitoris; and

• Type IV (other) includes all other harmful procedures, including 

pricking, piercing, incising, and scraping the genital area for nonmedical purposes. 

According to the WHO, it is estimated that 90 percent of cases are Types 

I, II, or IV; 10 percent are Type III, the most extreme form of FGM/C.

The type of FGM/C commonly practiced varies by country, according to 

survey data presented by UNICEF.11 For example, survey data show that 

more than 20 percent of girls who underwent FGM/C in Djibouti, Eritrea,

Niger, Senegal, and Somalia, experienced Type III (infibulation), whereas 

Type III represented 1 or 2 percent of cases in other countries, such as 

Egypt. Appendix II presents UNICEF data showing the percentage 

distribution of girls subjected to FGM/C by type of procedure in countries 

where data were available. 

The WHO notes that in every society where it is practiced, FGM/C is a 

manifestation of gender inequality that is deeply entrenched in traditional 

social, economic, and political structures.12 The practice is often 

considered a necessary part of raising a girl properly, and a way to 

prepare her for adulthood and marriage. FGM/C is often motivated by 

beliefs about what is considered proper sexual behavior and is linked to 

premarital virginity and marital fidelity. 

FGM/C has no health benefits and can have numerous short- and longterm adverse health consequences, according to the WHO.13 Short-term 

consequences can include severe pain, swelling, delayed or incomplete 

healing, and shock, as well as infections and excessive bleeding, which 

can lead to death. Long-term consequences may include chronic pain 

 11Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the 

Dynamics of Change.

12Eliminating Female Genital Mutilation: An Interagency Statement.

13World Health Organization, Health Risks of Female Genital Mutilation, accessed Feb. 

19, 2016, 

http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en/. 

Causes and 

Consequences of FGM/C
Page 5 GAO-16-485 Female Genital Mutilation/Cutting

and infections, scar tissue, and menstrual and urinary tract problems. In 

addition, FGM/C can lead to sexual problems and obstetric complications, 

which increase the need for Caesarean sections and risks to the health of 

newborns. Transmission of HIV remains a longer-term risk because of 

increased risk of bleeding during intercourse as a result of FGM/C. 

Available data from nationally representative surveys show that FGM/C is 

concentrated in 30 countries and at least 200 million girls and women 

alive today have undergone some form of FGM/C, according to UNICEF 

(see fig. 1).14 Evidence suggests that FGM/C exists in some places in 

South America, such as Colombia, and elsewhere in the world including 

in India, Malaysia, Oman, Saudi Arabia, and the United Arab Emirates; 

however, no nationally representative data on FGM/C were available for 

these countries, according to UNICEF. The practice is also found in 

Europe, Australia, and North America, which are destinations for migrants 

from countries where the practice still occurs. UNICEF also estimates 

that more than 3 million girls annually are at risk for FGM/C in Africa. In 

some countries, including Djibouti, Guinea, and Somalia, the percentage 

of girls and women, aged 15 to 49, who have undergone FGM/C is over 

90 percent. In most of the countries with available data, the majority of 

girls are cut before the age of 5, according to UNICEF. However, in 

Somalia, Egypt, Chad, and the Central African Republic, at least 80 

percent of girls who have undergone FGM/C were cut between the ages 

of 5 and 14.

 14See Female Genital Mutilation/Cutting: A Global Concern.

Prevalence of FGM/C
Page 6 GAO-16-485 Female Genital Mutilation/Cutting

Figure 1: Percentages of Girls and Women Aged 15 to 49 Who Have Undergone Female Genital Mutilation/Cutting (FGM/C) in 

High-Prevalence Countries, 2004–2015

Note: United Nations Children’s Fund (UNICEF) prevalence data are based on nationally 

representative surveys, conducted from 2004 to 2015. The map does not include Indonesia because 

data on prevalence for girls and women aged 15 to 49 were not available for Indonesia. However, 

UNICEF data show that prevalence in Indonesia was 49 percent for girls aged 11 and under. In 

addition, according to UNICEF, evidence suggests that FGM/C also occurs in other countries, 
Page 7 GAO-16-485 Female Genital Mutilation/Cutting

including Colombia, India, Jordan, Malaysia, Oman, Saudi Arabia, and the United Arab Emirates;

however, no nationally representative data on FGM/C were available for these countries.

UNICEF data show that the practice is becoming less common in many 

high-prevalence countries. For example, in Kenya and Tanzania, women 

aged 45 to 49 are approximately three times more likely to have 

undergone FGM/C than girls aged 15 to 19. In most countries where 

FGM/C is practiced, the majority of girls and women think it should end, 

and the percentage of females who support FGM/C is substantially lower 

than the share of girls and women who have undergone the procedure, 

according to UNICEF.

15

In addition, UNICEF reported in 2013 that 24 countries where FGM/C is 

prevalent have enacted legislation related to FGM/C (see app. III).16

These laws reportedly vary in their scope. UNICEF reports that some ban 

the practice only in medical facilities; others ban the practice anywhere.

In 1993, the World Conference on Human Rights in Vienna recognized 

violence against women as a human rights violation,

17 and the UN 

General Assembly included FGM/C in the definition of violence against 

women, stating that it violates women’s right to be free from cruel,

inhuman, or degrading treatment.

18 FGM/C also deprives girls and 

women from making the decision about a procedure that has a lasting 

effect on their bodies and infringes on their autonomy and control over 

their lives, according to the WHO.19

In December 2012, the UN General Assembly adopted a resolution 

urging member states to condemn and work to eliminate all harmful 

 15Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the 

Dynamics of Chang.

16Ibid.

17World Conference on Human Rights, Vienna, Declaration and Programme of Action

(June 25, 1993). The UN General Assembly subsequently endorsed the Vienna 

Declaration; see UN Doc. A/Res/48/121 (Dec. 20, 1993).

18UN General Assembly Resolution A/RES/48/104, Declaration on the Elimination of 

Violence Against Women (Feb. 23, 1994).

19Eliminating Female Genital Mutilation: An Interagency Statement.

International Response to 

FGM/C
Page 8 GAO-16-485 Female Genital Mutilation/Cutting

practices that affect women and girls, in particular FGM/C, and to take all 

necessary measures, including enacting and enforcing legislation to 

prohibit FGM/C.

20 Two years later, the UN General Assembly adopted 

another resolution calling upon member states to develop, support, and 

implement comprehensive and integrated strategies for the prevention of 

FGM/C, including training of medical personnel, social workers, and 

community and religious leaders to ensure that they provide competent, 

supportive services and care to women and girls who are at risk of or who 

have undergone FGM/C.21

In September 2015, the UN General Assembly formally adopted the 2030 

Agenda for Sustainable Development, along with a set of 17 Sustainable 

Development Goals and 169 associated targets.22 One of the 17 goals is 

“achieve gender equality and empower all women and girls” and one of 

the targets for this goal is to “eliminate all harmful practices, such as child, 

early and forced marriage and female genital mutilation.”

In 2008, UNFPA and UNICEF established the Joint Program on FGM/C,

which represents the largest international effort to accelerate 

abandonment of this practice. The UNFPA-UNICEF Joint Program brings 

together both agencies’ expertise, often with grassroots community 

organizations, using a human rights-based approach to engage 

communities to act collectively to abandon the practice. The Joint 

Program also supports health and protective services for those who have 

undergone FGM/C. Donor countries make annual contributions directly to 

the Joint Program.23 

During phase I of the Joint Program (2008-2013), 15 countries 

participated (see fig. 2). According to the 2013 evaluation of the Joint 

Program, funding limitations reduced the number of countries involved 

during phase 1. The overall budget for phase I was about $41 million over 

 20UN General Assembly Resolution A/RES/67/146, Intensifying Global Efforts for the 

Elimination of Female Genital Mutilations (Mar. 5, 2013).

21UN General Assembly Resolution A/RES/69/150, Intensifying Global Efforts for the 

Elimination of Female Genital Mutilations (Feb. 17, 2015).

22UN General Assembly Resolution A/Res/70/1, Transforming Our World: The 2030 

Agenda for Sustainable Development (Oct. 21, 2015).

23In 2014, donor countries were Germany, Iceland, Ireland, Italy, Luxembourg, Norway, 

Sweden, and the United Kingdom, contributing a total of $22,413,497.
Page 9 GAO-16-485 Female Genital Mutilation/Cutting

its 5 years. Phase II (2014-2017) currently is under way in 17 countries—

the original 15 countries, as well as Yemen and Nigeria. Phase II aims for 

a 40 percent decrease in prevalence among girls 14 and younger in at 

least 5 countries, with at least 1 country declaring total elimination of the 

practice, by the end of 2017. The Joint Program estimated its budget for 

phase II to be $54 million over 4 years.
Page 10 GAO-16-485 Female Genital Mutilation/Cutting

Figure 2: United Nations Population Fund and United Nations Children’s Fund Joint Program Countries
Page 11 GAO-16-485 Female Genital Mutilation/Cutting

Under the U.S. foreign policy framework, FGM/C is identified as a form of 

gender based-violence. In March 2012, USAID released its Gender 

Equality and Female Empowerment Policy,

24 which provides guidance on 

incorporating gender issues—including gender-based violence—into 

development programming.25 In addition, State and USAID jointly 

developed the U.S. Strategy to Prevent and Respond to Gender-Based 

Violence Globally, released in August 2012.26 These two documents 

identify FGM/C as a form of gender-based violence but do not provide 

any specific guidance on assistance related to FGM/C.27 In addition, the 

Secretary of State announced in March 2016 the release of the United 

States Global Strategy to Empower Adolescent Girls, which includes the 

goal of reducing girls’ vulnerability to gender-based violence.28 The 

strategy highlights FGM/C as a form of gender-based violence.29 

State’s and USAID’s set of standard indicators, developed to assess 

foreign assistance, includes nine standard indicators related to gender 

 24U.S. Agency for International Development, Gender Equality and Female Empowerment 

Policy (Washington, D.C.: March 2012). USAID also developed guidance for implementing 

this policy in 2013. See U.S. Agency for International Development, Automated Directives 

System Chapter 205: Integrating Gender Equality and Female Empowerment in USAID’s 

Program Cycle (Washington, D.C.: July 17, 2013).

25A Presidential memorandum in 2013 created the role of the USAID Senior Coordinator 

for Gender Equality and Women’s Empowerment, with responsibility for providing strategic 

guidance to the USAID Administrator and the agency to ensure that gender equality and 

women’s empowerment are integrated throughout USAID’s programming.

26Department of State and U.S. Agency for International Development, United States 

Strategy to Prevent and Respond to Gender-based Violence Globally (Washington, D.C.: 

August 2012).

27In addition, the Consolidated Appropriations Act, 2016, requires State and USAID 

gender programs to incorporate coordinated efforts to combat a variety of forms of 

gender-based violence, including FGM/C, in conflict and non-conflict settings. See Pub. L. 

No. 114-113, § 7059(c)(2), Dec. 18, 2015.

28Department of State, U.S. Agency for International Development, Peace Corps, 

Millennium Challenge Corporation, United States Global Strategy to Empower Adolescent 

Girls (Washington, D.C.: March 2016).

29State’s Office of Global Women’s Issues also began an effort in January 2016 to 

develop an “engagement guide” for embassies on FGM/C-related diplomacy, policy, and 

programming, according to State officials.

State and USAID 

Strategies and Policies

Related to FGM/C
Page 12 GAO-16-485 Female Genital Mutilation/Cutting

issues.30 Three of the nine indicators cover gender-based violence, which 

includes FGM/C; however, the indicators do not specify the type of 

gender-based violence addressed.31 

In 2000, USAID released guidance on FGM/C, incorporating this issue 

into its development agenda. USAID updated the guidance in February 

2016, during the course of our review.32 The guidance recognizes FGM/C 

as a harmful, traditional practice that reflects deep-rooted gender 

inequalities and constitutes an extreme form of discrimination against 

women. The guidance states that USAID will support the integration of 

efforts to combat FGM/C into all aspects of the USAID program cycle 

where feasible and appropriate. It also states that USAID will assist 

countries in implementing their laws prohibiting FGM/C and support 

community-based programming to raise awareness of the harmful effects 

of this practice to reduce demand. USAID officials stated that the agency 

also plans to develop a resource guide on FGM/C that provides 

information for USAID missions and staff on how best to incorporate 

efforts to address FGM/C into their programming.

 30State and USAID have jointly developed a set of standard indicators across all program 

areas to measure annually what is being accomplished with foreign assistance. Standard 

foreign assistance indicators are intended to measure outputs that are directly attributable 

to the U.S. government’s programs, projects and activities, as well as outcomes and 

impacts to which the U.S. government contributes.

31USAID officials noted in March 2016 that, in a recent update to the indicators, posts are 

now being asked to specify the type of gender-based violence involved, including FGM/C, 

when reporting on these indicators. Therefore, USAID may be able to track FGM/Cspecific efforts going forward.

32U.S. Agency for International Development, USAID Guidance on Female Genital 

Mutilation/Cutting, (Washington, D.C.: Updated Feb. 11, 2016).
Page 13 GAO-16-485 Female Genital Mutilation/Cutting

FGM/C has persisted into the 21st century despite UN resolutions 

condemning this practice and the passage of laws banning it in many 

countries where it is prevalent, as UNICEF has reported. Recent U.S. and 

UN studies of efforts to address FGM/C have identified several factors 

contributing to its prevalence, including its power as a social norm, the 

belief that FGM/C is a religious obligation, the medicalization of the 

practice, and challenges enforcing existing laws. 

FGM/C is a powerful social norm—what communities believe and how 

they act and expect other members of that community to act—making its 

abandonment difficult, according to PRB and UNICEF.33 FGM/C is 

embedded in the culture and beliefs of many communities and ensures 

membership in these communities, according to PRB. If most families in a

community practice FGM/C, it is difficult for an individual family to 

abandon the practice, according to UNICEF. UNICEF also reported that, 

among surveyed girls and women aged 15 to 49, the most commonly 

reported benefit of FGM/C is that it ensures social acceptance. 

Because some communities view FGM/C as a social norm, it is viewed as 

a caring act. Parents may believe that FGM/C is in the best interest of 

their daughter, despite the physical harm it causes, in order to avoid 

social exclusion, according to UNICEF. In addition, the practice is 

exacerbated by poverty and poor education. FGM/C may signal that a 

girl is ready for marriage, which can spare a family the girl’s school 

expenses. Parents also may rely on the money received for marriages, 

 33The definition of “community” varies. It can be geographic (e.g., a village) or a broader 

and geographically dispersed ethnic or religious group with shared values and norms, 

according to the Joint Program evaluation.

U.S. and UN Studies 

Have Identified 

Factors Contributing 

to the Persistence of 

FGM/C and 

Approaches to 

Address It

Factors Contributing to the 

Persistence of FGM/C

Influential Social Norm
Page 14 GAO-16-485 Female Genital Mutilation/Cutting

according to an evaluation of the UNFPA and UNICEF Joint Program on 

FGM/C. In addition, prevalence is highest among daughters of women 

with no education and declines as the mother’s education level rises, 

according to UNICEF. 

The common belief that FGM/C is a religious obligation is a 

misconception, but one that contributes to its continued use, according to 

UNICEF. UNICEF notes that FGM/C is not mandated in any religious 

texts and predates the birth of Islam and Christianity. Scholars and 

activists have concentrated on demonstrating the lack of support within 

scriptures. However, the religious motivation for FGM/C is often 

intertwined with social norms and tradition, according to UNICEF. In 

addition, some communities believe the practice is a religious

requirement that makes a girl spiritually “pure,” according to UNICEF. 

Thus, many who continue practicing FGM/C often cite religion as their 

motivation. In 4 of 14 countries surveyed, more than 50 percent of girls 

and women aged 15 to 49 regard FGM/C as a religious obligation,

according to UNICEF. These countries were Mali, Eritrea, Mauritania, and 

Guinea.

Another challenge in encouraging abandonment of FGM/C is the 

medicalization of the practice, which contributes to its perceived 

legitimacy, according to PRB. Medicalization refers to the performance of 

FGM/C by health care providers rather than traditional practitioners. 

According to PRB, 18 percent of girls and women worldwide who have 

been cut had the procedure performed by medical professionals. UNICEF 

reports that this percentage can be much higher in certain countries; for 

example, 77 percent of girls in Egypt and 41 percent of girls in Kenya who 

underwent FGM/C were cut by medical professionals.34 UNICEF found 

that medicalization of FGM/C may have increased as a result of the 

assistance community’s earlier focus on the harmful health risks of the 

practice to encourage abandonment of FGM/C without also framing it as 

a human rights issue. Thus, early FGM/C prevention campaigns may 

have inadvertently contributed to the perception that FGM/C would be 

 34UNICEF reported these rates of medicalization in Egypt and Kenya based on household 

surveys from 2008 and 2008-2009, respectively. See Female Genital Mutilation/Cutting: A 

Statistical Overview and Exploration of the Dynamics of Change. In addition, UNICEF 

reported in 2016 that more than half of girls in Indonesia subjected to FGM/C, had the 

procedure performed by a trained medical professional. See Female Genital 

Mutilation/Cutting: A Global Concern.

Religious Obligation

Medicalization 
Page 15 GAO-16-485 Female Genital Mutilation/Cutting

acceptable if performed by medical professionals, thus institutionalizing 

the practice within the medical community, according to UNICEF. 

Although many countries have passed laws addressing FGM/C, enforcing 

these laws is a challenge, according to the Joint Program evaluation. The 

evaluation found that in many countries, there is a lack of resources, 

difficulty reaching remote areas, and limitations on the capacities of law 

enforcement agents. In addition, the implementation of anti-FGM/C laws 

may be undermined by a lack of awareness by local officials and law 

enforcement, and a lack of community buy-in, according to PRB. Further, 

the threat of social exclusion from being uncut may be more influential 

than the threat of legal punishment, according to UNICEF. 

U.S. and UN studies have identified a variety of approaches to 

accelerating FGM/C abandonment. These include efforts to increase 

awareness and enforcement of laws against FGM/C; establish community 

education programs; and provide outreach to a variety of community 

members, including religious leaders, elders, men and boys, and medical 

practitioners. Studies also highlight the importance of incorporating 

FGM/C into broader gender equality and human rights programs, and 

encouraging community actions such as alternative rites of passage and 

public declarations for abandonment. 

The existence of a law can help abandonment efforts, but other 

interventions at the community level must also be undertaken for the law 

to be effective, according to PRB and UNICEF. PRB noted that resources 

are needed after the adoption of anti-FGM/C policies to ensure 

awareness and enforcement of the law. For example, in Burkina Faso, 

the Joint Program helped raise awareness of FGM/C laws for personnel 

in the justice sector, informing them about current policies and their 

implications for their work. In addition, in Uganda, the Joint Program 

supported six community policing sessions that provided communities 

with information on existing laws and helped ensure their implementation. 

The growing interest and understanding of the law within the communities 

Law Enforcement Challenges

Approaches to Addressing 

FGM/C

Increasing Awareness and 

Enforcement of FGM/C Laws
Page 16 GAO-16-485 Female Genital Mutilation/Cutting

led to the arrest of two cutters, according to the program’s focal point in 

Uganda.

35 

Education is an important way to raise awareness about the dangers of 

FGM/C and its impact as a social norm. Community education programs 

play an essential role in encouraging communities to reconsider the 

practice, according to UNICEF. A community education project could last 

for a number of years and include a wide range of participants such as 

government officials, media, health professionals, and at-risk girls. 

Communities are encouraged to reflect on the role of women and girls 

and how FGM/C affects their lives. Educational activities and community 

dialogues create a safe, non-threatening environment where people can 

evaluate their beliefs regarding FGM/C, according to the Joint Program 

evaluation. Events may focus on FGM/C specifically or may combine 

information on FGM/C with information on health, religion, or human 

rights. 

Efforts to abandon FGM/C are strengthened when a wide range of 

actors—including religious leaders, and boys and men—are included in 

community education, according to PRB. Because religion is often cited 

as a reason for continuing the practice, engaging religious leaders in 

public education can be effective in encouraging abandonment, according 

to a Joint Program evaluation. Religious leaders often already have the 

community’s respect and can be a powerful influence on dispelling the 

belief that there is a religious obligation. Religious leaders in one 

Ethiopian community participated in public discussions about 

abandonment, according to a UNICEF study. By the end of the sessions, 

six of seven villages pledged to abandon the practice, and religious 

leaders led a special prayer binding the decision. Working with religious 

leaders is a core strategy and a critical component of community 

engagement in the Joint Program as well. For example, the Joint Program 

reported that, through its efforts, 304 religious leaders were educated 

about FGM/C in Mauritania. 

Involving boys and men in outreach efforts is also essential in ending 

FGM/C. In about half of the countries where FGM/C is prevalent, men 

outnumber women in their opposition to FGM/C, according to a Joint 

 35The Joint Program evaluation cited this example based on a web-based survey it 

conducted of program focal points as part of the evaluation methodology. See Joint 

Evaluation, UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting.

Community Education on 

Ending FGM/C

Engaging Religious Leaders, 

Males, and Elders in Dialogue
Page 17 GAO-16-485 Female Genital Mutilation/Cutting

Program report. For example, 42 percent of boys and men in Guinea 

think FGM/C should stop, compared to 19 percent of girls and women, 

according to UNICEF. The Joint Program increased its efforts to engage 

men and boys in 2014, resulting in their voices against FGM/C becoming 

more prominent on social media, according to a Joint Program report. For 

instance, male advocacy emerged in Somalia where men have posted 

their support of uncut women on Facebook, stating, “Don’t do it for us.” 

Often, women are misinformed about their husbands’ opinions on FGM/C. 

Men may not talk about FGM/C because it is considered a “women’s 

issue.” Open dialogue between the sexes could reduce this ignorance,

according to UNICEF. 

Intergenerational dialogue is another approach to changing behaviors, 

according to PRB. This approach recognizes that the older generations’ 

full engagement is needed, given their role as decision-makers and 

gatekeepers, and because they are likely to feel threatened by changing 

traditions. For example, the Grandmother Project in Senegal increased 

participants’ appreciation of positive cultural traditions and changing 

attitudes towards harmful traditions, according to PRB. Because senior 

women are viewed as valuable cultural resources and influential 

members of their communities, communities are more comfortable with 

an approach that includes dialogue between elders and youth, according 

to PRB. 

Media campaigns can also educate the public on the harmful effects of 

the practice and can shape the public discourse around FGM/C, 

according to the Joint Program evaluation. They can help spread 

information on decreasing support for FGM/C. Radio, in particular, 

enables the dissemination of information to remote villages and illiterate 

populations. Forums for discussion can include talk shows, 

documentaries, and educational TV. Social media is particularly effective 

with adolescents and can be instrumental in spreading information. In all 

15 countries in the Joint Program’s first phase, programs used media to 

increase awareness of the practice’s harmful effects and encourage 

abandonment. Media campaigns, like other approaches, have the 

greatest impact when they are part of a larger effort, according to PRB. 

Figure 3 shows a road sign promoting the campaign against FGM/C in

Uganda.

Media Campaigns
Page 18 GAO-16-485 Female Genital Mutilation/Cutting

Figure 3: Campaign against Female Genital Mutilation/Cutting in Uganda

Education and training for medical professionals can encourage them to 

help prevent FGM/C and also prepare them to provide appropriate 

treatment for those who have undergone FGM/C procedures. In response 

to medicalization, the Joint Program began working with the WHO to 

ensure medical professionals’ support for FGM/C abandonment. The 

Joint Program’s first phase prioritized integrating FGM/C prevention into 

antenatal and neonatal care and immunization services in countries 

where a large portion of girls are cut between birth and age 5. 

Specifically, during phase I, a total of 5,571 health facilities integrated 

FGM/C prevention into their antenatal and postnatal care, and more than 

100,000 doctors, midwives, and nurses have participated in training on 

integrating FGM/C prevention, response, and care into their services. In 

all 15 Joint Program countries, medical staff were trained on the negative 

consequences of FGM/C and, in many cases, how to treat medical 

complications from the practice. Such training has strengthened the 

medical community’s capacities for preventing and responding to FGM/C. 

In 2014, about 200,000 girls and women received prevention, protection, 

or care services relating to FGM/C through the Joint Program, according 

to the Joint Program report. The report also noted that, as a result of an 

initiative led by the Joint Program, Djibouti is the first African country 

Outreach and Training for 

Medical Professionals
Page 19 GAO-16-485 Female Genital Mutilation/Cutting

where girls are physically examined for evidence of FGM/C during routine 

check-ups.

FGM/C should be addressed as part of broader efforts to promote gender 

equality and female empowerment, according to PRB. In the Joint 

Program, FGM/C is approached as one of many forms of gender-based 

violence. In addition, the Joint Program highlights the intersection 

between FGM/C, women’s reproductive health, and girls’ education. By 

addressing the practice as part of broader issues, interventions are able 

to address how existing practices negatively affect opportunities for

women and girls. When FGM/C is incorporated into programming that 

challenges assumptions about gender relationships, it directly advances 

broader goals of reducing gender inequality and gender-based violence, 

according to UNICEF.

Increasingly, discussions about FGM/C have been shaped within a 

human rights approach, which can lead to public declarations against 

FGM/C in thousands of communities, according to UNICEF. Human rights 

vocabulary needs to be adapted for use by its program participants and it 

should include relevant symbols, narratives, or religious language so that 

it resonates with the local community. The Joint Program incorporates 

issues of gender equality and human rights in the design and 

implementation of its efforts. It has simultaneously conceptualized FGM/C 

as an abuse of human rights and a form of gender-based violence while 

also seeking to be culturally sensitive to the value the practice holds in 

many communities. 

A Joint Program report highlighted alternative rites of passage as an 

effective means of abandoning FGM/C. In certain communities, rites of 

passage have for centuries marked the transition from child to adult, 

according to the Joint Program evaluation. For girls, that rite of passage is 

often combined with FGM/C. Some communities may be reluctant to 

abandon FGM/C because they are reluctant to give up this rite of 

passage ceremony. In Kenya, thousands of girls have participated, since 

2008 in alternative rites of passage to encourage abandonment while 

preserving this tradition, according to a Joint Program report. The effort 

typically involves sending the girls away for a week to an orientation 

program that includes teaching about the harmful effects of FGM/C. The 

Joint Program report noted that in Kenya in 2014, the Joint Program

supported an alternative rites of passage program for more than 1600 

girls. This program involved final celebrations that included certificates of 

recognition for the commitment to stay uncut. Figure 4 shows an 

alternative rite of passage ceremony in Kenya.

Including FGM/C in Broader 

Gender Equality and Human 

Rights Efforts

Alternative Rites of Passage
Page 20 GAO-16-485 Female Genital Mutilation/Cutting

Figure 4: Girls Participating in Alternative Rite of Passage in Kenya

Expressing public commitment to stop the practice of FGM/C is a 

promising approach to abandonment, according to several studies. 

Village-level declarations are one way to measure a program’s impact on 

FGM/C, according to PRB. Public declarations encouraged by the Joint 

Program are typically preceded by community discussions and 

engagement with community leaders and members. Public declarations 

do not guarantee a change in behavior, but they do have an influence on 

social norms, according to the Joint Program evaluation. A public 

commitment applies social pressure that makes it difficult to return to old 

behaviors. In Egypt and Senegal, public commitments to end FGM/C 

occurred only after human rights discourse was introduced into basic 

education curricula, according to UNICEF. A 2008 UNICEF evaluation of 

a public declaration program in Senegal found that prevalence dropped 

by more than half in villages that had taken public pledges to abandon the 

practice. Since 2008, when the Joint Program was established, nearly 

10,000 communities in 15 countries, representing about 8 million people, 

have renounced the practice. 

Public Declarations
Page 21 GAO-16-485 Female Genital Mutilation/Cutting

State and USAID currently have limited international assistance efforts to 

address FGM/C. In 2014, State and USAID each had one active

standalone project to address FGM/C. In addition, we identified projects 

with broader goals that included components to address FGM/C but we 

were unable to determine the full extent of FGM/C-related efforts because 

State and USAID do not specifically track these efforts. USAID has 

competing development priorities, which leaves little funding available for 

FGM/C-related efforts, according to USAID officials. The largest current 

international assistance effort to address FGM/C is the UNFPA/UNICEF 

Joint Program on FGM/C. State provides funding to UNFPA and UNICEF

but, to date, has not contributed to this Joint Program. However, if the 

general restrictions for UNFPA funding are met, there are currently no 

specific legal restrictions that would prohibit U.S. funding provided to 

UNFPA from being available for the Joint Program on FGM/C. 

State’s one standalone FGM/C program is in Guinea, where 97 percent of 

girls and women aged 15 to 49 have undergone FGM/C. 36 This program 

is funded by about $1.5 million in grants from the Full Participation Fund, 

an initiative created by State and funded through various appropriations 

accounts to support gender integration efforts.

37 It began in the fall of 

2014 and will run through April 2016, according to State officials.

Through partnerships with the government of Guinea, UNICEF, and 26 

local civic and human rights organizations, the U.S. Embassy in Conakry 

established nationwide educational and media campaigns that engage 

 36See Female Genital Mutilation/Cutting: A Global Concern.

37The Full Participation Fund is intended to support State’s efforts to achieve gender 

equality, including efforts to prevent and respond to gender-based violence, such as 

FGM/C. The Fund is managed by State’s Office of Global Women’s Issues, which sends 

out requests for proposals twice a year; all posts, bureaus, and offices are eligible to 

apply. A senior State panel decides which projects merit funding. Since the Full 

Participation Fund’s launch in 2013, $20 million has been allocated through this initiative 

to support 50 projects in 50 countries, according to an official from State’s Office of Global 

Women’s Issues. The Fund was designed as a finite program, with fiscal year 2016 

intended as the final year of funding.

State’s and USAID’s 

Efforts to Address 

FGM/C Abroad Are 

Limited 

State Provides Limited 

Assistance to Combat 

FGM/C

State Has One Standalone 

FGM/C Program
Page 22 GAO-16-485 Female Genital Mutilation/Cutting

policymakers, health professionals, traditional excisors,

38 religious 

leaders, and the general public to abandon FGM/C. Activities include 

establishing a National Strategic Plan to abandon FGM/C in line with 

existing legal frameworks, capacity building and specialized training of 

institutions and individuals combating FGM/C, and support of multimedia 

information and communication awareness campaigns. 

U.S. embassy staff are responsible for monitoring the project, which has 

13 performance indicators. Examples of the performance indicators 

include the number of girls and women identified as abandoning FGM/C 

practices; the reduction in the number of group excision ceremonies held 

in targeted districts and villages; and the number of people trained by the 

U.S.-funded intervention providing gender-based violence services 

relating to FGM/C (e.g., law officers, judges, teachers, excision 

practitioners, health workers, religious leaders, policymakers, and 

potential victims). State reported in July 2015 that the campaign had led 

to approximately 265 villages in Guinea voluntarily and publicly 

denouncing this harmful practice since the start of 2015. State plans to

conduct a separate impact evaluation in 2017, according to State officials.

State provides funding to international organizations and nongovernmental organizations to provide assistance to vulnerable 

populations in refugee settings overseas to meet their basic needs, 

including programs providing water and sanitation, shelter, and 

healthcare, as well as programs to prevent and respond to gender-based 

violence.

39 In fiscal year 2014, State’s Bureau of Population Refugees 

and Migration (PRM) awarded about $35.7 million for 93 cooperative 

agreement awards to projects focused on or including gender-based 

violence activities.40 State officials told us that some of these projects may 

 38The term “traditional excisor” is used for those without professional medical training who 

perform FGM/C procedures.

39Targeted populations include refugees, internally displaced persons, vulnerable 

migrants, and other victims of conflict.

40Funding for this assistance comes from the Migration and Refugee Assistance account, 

according to State PRM officials.

State Supports Projects 

Addressing Gender-Based 

Violence in Refugee Settings 

That May Include FGM/C 
Page 23 GAO-16-485 Female Genital Mutilation/Cutting

include assistance related to FGM/C;41 however, State does not capture 

this level of programmatic detail for these projects.42 

We contacted project implementers for nine of the largest gender-based 

violence projects in countries where FGM/C is prevalent and found that 

two of them provided assistance related to FGM/C.43 One of these 

projects, which received $800,000 from State in fiscal year 2014, 

provided gender-based violence assistance to Central African Republic 

Refugees and Chadian returnees in Southern Chad, including education 

and awareness-raising about FGM/C with project beneficiaries and local 

law enforcement authorities. The project also provided specialist referral 

services to individuals who have undergone FGM/C. The other project, 

which received $1,000,000 from State in fiscal year 2014, was focused on 

prevention and response to gender-based violence for refugees in 

Uganda. This project included focus group discussions and interviews 

with selected members of the Somali refugee community in Uganda to 

raise awareness about the negative effects of FGM/C.

State provides annual funding to UNFPA and UNICEF but, to date, none

of this funding supports the Joint Program on FGM/C, the largest 

international effort to address FGM/C. In fiscal year 2014, the U.S. 

government provided funding to UNFPA and UNICEF that included 

general contributions to be used at the UN agencies’ discretion in support 

 41State PRM also supports child protection, education, and health activities in emergency 

settings, which may also include FGM/C prevention and response activities, according to 

State PRM officials. 

42Of the 93 projects, 54 used funding specifically targeted for the prevention of and 

response to gender-based violence, and 39 provided multi-sectoral assistance with 

integrated gender-based violence components.

43These were 9 of the 10 projects with fiscal year 2014 State funding levels of $500,000 or 

more in countries where FGM/C was known to be prevalent. We were unable to contact 

the project implementers for 1 of the 10 projects.

U.S. Contributions to UNFPA 

and UNICEF Have Not 

Supported Their Joint Program 

on FGM/C
Page 24 GAO-16-485 Female Genital Mutilation/Cutting

of their overall missions, as well as contributions pledged to specific 

projects such as humanitarian relief efforts, according to State officials.44 

Congress routinely places restrictions on U.S. funding in annual 

appropriations for UNFPA.45 However, if the general restrictions for 

UNFPA funding are met, there are currently no specific legal restrictions 

that would prohibit U.S. funding provided to UNFPA from being available 

for the Joint Program on FGM/C. State and UNFPA officials agree that 

the restrictions on UNFPA funding would not stop the U.S. government 

from funding the Joint Program if it chose to devote funds to it. State 

officials told us that the Joint Program, which is a long-term effort, may 

not have been considered for targeted contributions to UNFPA because 

those funds are generally provided in response to short-term 

humanitarian appeals.46 However, on March 15, 2016, the Secretary of 

State announced that State intends to contribute to the UNFPA – UNICEF 

Joint Program on FGM/C.

State depends on its embassies to use diplomacy to encourage 

abandonment of FGM/C, according to State officials. State officials from 

the Bureau of African Affairs provided several examples in which U.S. 

embassies engaged diplomatically with local communities to raise 

 44Of the approximately $49 million the U.S. government provided to UNFPA in fiscal year 

2014, about $31 million was appropriated for UNFPA from the International Organizations 

and Programs account and provided to UNFPA as a general contribution. UNFPA 

considers these “core funds.” About $18 million was provided through targeted 

contributions with funds appropriated from the Migration and Refugee Assistance account, 

which supported 10 projects, primarily in response to humanitarian appeals from the UN, 

such as support for Syrian refugees. UNFPA considers these targeted contributions to be 

“non-core funds.” Of the $672 million provided to UNICEF in fiscal year 2014, $132 million 

was provided as a general contribution. The balance was for specific programs and 

humanitarian relief, according to a State official.

45Annual appropriations laws have regularly included provisions limiting the availability of 

funds for UNFPA. Under these provisions, funds are not available for UNFPA unless 

UNFPA maintains U.S. funds in a separate account, does not commingle them with other 

funds, and does not fund abortions. In addition, U.S. funds may not be used for a country 

program in the People’s Republic of China. Any funds withheld from UNFPA because of 

the operation of any provision of law shall be transferred to the Global Health Programs 

account and made available for family planning, maternal, and reproductive health 

activities. For the fiscal year 2015 UNFPA appropriation and limiting provisions, see 

Consolidated and Further Continuing Appropriations Act, 2015, Pub. L. No. 113-235, § 

7063, Dec. 16, 2014.

46All of the funding for the UNFPA and UNICEF Joint Program on FGM/C comes from 

donors’ contributions targeted for this program, according to UNFPA officials.

Embassies Engage in 

Diplomatic Efforts to Raise 

Awareness about FGM/C
Page 25 GAO-16-485 Female Genital Mutilation/Cutting

awareness or provide training about FGM/C. For example, in Chad, 

Central African Republic, Ethiopia, and Niger, U.S. embassies hosted a 

screening of a film about FGM/C for student or women’s groups to 

encourage abandonment of this practice. Some of these screenings were 

held to commemorate the International Day of Zero Tolerance for FGM/C, 

which occurs every year on February 6th. In Eritrea, the embassy held a 

Zero Tolerance Day event, displaying posters and distributing brochures 

on FGM/C.

Since 2012, State’s annual Country Reports on Human Rights Practices 

have included information on FGM/C, according to State. State is 

required to report on the status of internationally recognized human rights 

for all countries receiving assistance and all United Nations member 

states. Since 2012, State has expanded the reports’ coverage to include 

multiple forms of gender-based violence, including FGM/C and child, 

early, and forced marriage. Among other things, the 2014 human rights 

reports we reviewed identified countries’ prevalence rates of FGM/C, 

common types of FGM/C, legal restrictions of FGM/C, and educational 

efforts undertaken to raise awareness about the dangers of this 

practice.

47 Tracking host government actions and policies related to 

FGM/C as part of human rights reporting helps State build the knowledge 

necessary to diplomatically encourage actions to end this practice, 

according to State officials. In addition, State officials noted that the

Department of the Treasury relies on this information to advise the United 

States Executive Director of each international financial institution, such 

as the World Bank, regarding whether they should support loans to 

countries where FGM/C is practiced.48

 47We reviewed the 2014 Country Reports on Human Rights Practices for the five 

countries with the highest FGM/C prevalence rates—Somalia, Guinea, Djibouti, Sierra 

Leone, and Mali.

4822 U.S.C. § 262k–2 directs that “Beginning 1 year after September 30, 1996, the 

Secretary of the Treasury shall instruct the United States Executive Director of each 

international financial institution to use the voice and vote of the United States to oppose 

any loan or other utilization of the funds of their respective institution, other than to 

address basic human needs, for the government of any country which the Secretary of the 

Treasury determines—(1) has, as a cultural custom, a known history of the practice of 

female genital mutilation; and 2) has not taken steps to implement educational programs 

designed to prevent the practice of female genital mutilation.” State has consistently 

determined each year since the law has been in effect that no country is subject to the 

directed voting provision of the statute, according to State officials.

State Human Rights Reporting 

Addresses FGM/C
Page 26 GAO-16-485 Female Genital Mutilation/Cutting

USAID has competing development priorities, which leave little funding 

available for FGM/C-related efforts, according to USAID officials. For 

example, all Global Health Programs account funds are programmed to 

achieve outcomes in three priority areas in the health sector—ending 

preventable child and maternal deaths, creating an AIDS-free generation, 

and protecting communities from other infectious diseases. In addressing 

these goals, funds are used first for programs expected to have the 

greatest impact in achieving them, according to USAID officials. 

Congressional reports accompanying appropriations laws for USAID 

funding included specific funding for FGM/C in 2000 and 2005, but no 

such report language currently exists. In 2000, a conference report 

included language directing USAID to make $1.5 million available to 

develop educational programs aimed at eliminating FGM/C.49 In 2005, 

the Senate Committee on Appropriations recommended that USAID 

spend $5 million to expand community-based efforts to combat FGM/C in 

high-prevalence countries.50 Recent congressional committee reports 

have directed that USAID provide funding to address obstetric fistula,51

which often occurs among populations of girls also at risk of FGM/C.52

 49H.R. Conf. Rep. 106-997, Oct. 24, 2000; House Conference Report accompanying the 

Foreign Operations, Export Financing, and Related Programs Appropriations Bill for Fiscal 

Year 2001.

50S. Rep. 109-96, Title III, June 30, 2005; Senate Committee on Appropriations Report 

accompanying the Department of State, Foreign Operations, and Related Programs 

Appropriations Bill, 2006.

51Obstetric fistula is a hole between the vagina and bladder or rectum, causing 

incontinence. This affliction occurs almost exclusively in developing countries and most 

often among girls aged 15-19 years old, whose pelvises have not finished growing. It is 

often caused by prolonged labor and therefore may also be a secondary result of birth 

complications caused by female genital mutilation, according to the WHO.

52For example, a House committee report accompanying the State, Foreign Operations, 

and Related Programs Appropriations Bill, 2015, directed USAID to provide not less than 

$14 million of its Maternal and Child Health funding to prevent and treat obstetric fistula. 

H.R. Rep. 113-499, June 27, 2014.

USAID’s Assistance 

Efforts to Combat FGM/C 

Are Limited

Competing Priorities Limit 

USAID Funding for FGM/C 
Page 27 GAO-16-485 Female Genital Mutilation/Cutting

We identified one free-standing FGM/C program that was active during 

calendar year 2014. USAID supported the start-up of Nairobi University's 

Africa Coordinating Center for the Abandonment of FGM/C (ACCAF) to 

advocate, educate, and create a supportive environment for cultural 

change; support networking and knowledge exchange between 

researchers, health professionals, and community workers on the 

abandonment of FGM/C; identify knowledge gaps and support and 

stimulate research in the field of FGM/C; and improve health care for 

women and children who have undergone FGM/C. 

The program runs from October 1, 2013, through September 30, 2016, 

and has a total funding level of $429,000 from the Global Health 

Programs appropriations account, according to USAID officials. It was 

funded as a subaward to the University of Nairobi from an existing 

implementing partner in Kenya.53 The Center carried out four community 

trainings in fiscal year 2014 involving 114 community leaders, community 

professionals, health care providers, FGM/C practitioners, FGM/C 

survivors, and youths, according to its 2014 annual report. These 2-day 

training sessions addressed the different dimensions of FGM/C and 

helped prepare community members to advocate FGM/C abandonment 

to the broader community. The Center also supported advocacy of 

FGM/C abandonment in the media, as well as networking between 

researchers and health professionals, and has initiated studies of various 

aspects of the issue. 

As required in the subaward agreement, the ACCAF developed a 

performance monitoring plan that included 20 indicators. Examples of 

these indicators include “number of advocacy teams created” and 

“number of community-based providers...trained or supported.” In 

addition, the award agreement requires the ACCAF to produce, among 

other things, an impact assessment within 90 days after the project end 

date, which includes a summary of lessons learned, success stories, and 

conclusions about areas in need of future assistance.

 53The implementing partner that provided the subaward to the University of Nairobi is JSI 

Research & Training Institute, Inc., which implements a project called Advancing Partners 

& Communities—a 5-year project to improve the overall health of communities and 

achieve other health-related impacts, especially relating to family planning.

USAID Had One Standalone 

FGM/C Program in 2014
Page 28 GAO-16-485 Female Genital Mutilation/Cutting

We found several examples of USAID projects—active in calendar year 

2014—addressing broader Global Health or Democracy and Governance 

objectives that had intervention elements related to FGM/C. USAID 

officials told us, however, that they could not separate the level of funding 

for FGM/C efforts from other project activities. In addition, USAID could 

not verify the extent to which these examples represented all FGM/Crelated efforts undertaken by missions in high-prevalence countries. 

USAID’s systems for tracking funding and programming gender-based 

violence efforts do not capture subactivities as specific as FGM/C efforts, 

according to USAID officials. For example, standard indicators developed 

by USAID and State to track the performance of assistance efforts include 

three indicators on gender-based violence prevention and response but 

do not specify the type of gender-based violence, such as FGM/C.54 

Table 1 shows countries where USAID missions identified having projects 

active in calendar year 2014 with FGM/C-related efforts.

55

 54USAID officials noted in March 2016 that, in a recent update to the indicators, posts are 

now being asked to specify the type of gender-based violence involved, including FGM/C, 

when reporting on these indicators. Therefore, USAID may be able to track FGM/Cspecific efforts going forward.

55In response to our request for information on FGM/C-related programming in high 

prevalence countries, USAID contacted relevant missions asking them to identify any 

projects with FGM/C-related components that were active in calendar year 2014. While 12 

missions reported having programs with FGM/C components, we only presented 

information on the 5 projects that we were able to independently confirm as having 

FGM/C-related components through searches on USAID missions’ websites, or the 

websites of USAID’s implementing partners.

Some USAID Missions 

Identified Broader 

Programming That Includes 

FGM/C
Page 29 GAO-16-485 Female Genital Mutilation/Cutting

Table 1: Examples of USAID Projects Active in 2014 with Efforts Related to Female Genital Mutilation/Cutting (FGM/C)

Dollars in millions

Country Program name

Program 

funding

Program 

dates

Appropriation 

account Program description FGM/C components

Ethiopia Enhancing the 

Status of Human 

Rights Protection 

and Systems of 

Good Governance 

in Ethiopia

 $3.9 Aug. 

2013-

Sept. 

2018

Economic Support 

Fund and 

Development 

Assistance

Improves human rights and 

justice sector service delivery. 

Improve the capacity of 

law enforcement agencies 

to investigate, prosecute, 

and adjudicate child 

marriage and FGM/C 

cases.

Ghana Elimination of 

Harmful Traditional 

Practices

$.45 Mar. 

2014-

Dec. 

2015

Development 

Assistance

Provides support to Ghana’s 

Ministry of Chieftaincy and 

Traditional Affairs and the 

National House of Chiefs to 

undertake field research and 

sensitization on harmful 

traditional practices with the 

goal of devising a strategy for 

their elimination.

FGM/C is one of three 

issues addressed, along 

with witchcraft and 

widowhood rights.

Kenya Peace Initiative 

Kenya

$5.1 Jun. 

2012-

Dec. 

2015

Economic Support 

Fund 

Focuses on improving national 

and county-level genderbased violence service 

delivery systems and policy 

implementation. 

A key partner is Kenya’s 

National Female Genital 

Mutilation Board.

Somalia Somali Joint Health 

and Nutrition 

Program

$3.4 Sept. 

2012-

Mar. 

2016

Economic Support 

Fund, and Global 

Health Programs

A Joint UN, multi-donor fund to 

strengthen health systems and 

service delivery across 

Somalia. The primary 

objective is to improve 

maternal and child health and 

reduce mortality by supporting 

quality and access to 

reproductive, maternal, 

newborn and child health, and 

nutrition services.

USAID’s contribution 

addresses gender-related 

health issues, including 

helping to develop 

legislation and policies 

related to FGM/C and 

efforts to change social 

behaviors related to 

FGM/C.

Tanzania Women in Law and 

Development in 

Africa

Not 

available

Oct. 

2009-

Dec. 

2016

Development 

Assistance

Increases access to justice for 

poor and marginalized groups 

and communities including 

women, youth, and people 

with disability in Tanzania. 

Informs communities about 

women’s human rights and 

increases access to legal 

aid/services to victims of 

gender-based violence. 

A subcontractor is the 

Children’s Dignity Forum, 

which works on FGM/C 

issues by working with 

community, government, 

and traditional leaders to 

encourage FGM/C 

abandonment.

Source: GAO analysis of U.S. Agency for International Development (USAID) information. | GAO-16-485
Page 30 GAO-16-485 Female Genital Mutilation/Cutting

USAID created a publicly available e-learning course on FGM/C designed 

for those implementing interventions to address this practice, including 

the staff of U.S. government agencies and nongovernmental 

organizations. The 2-hour and 30-minute course provides an overview of

FGM/C, including definitions, medical risks from undergoing the 

procedure, prevalence, promising interventions, and lessons learned from 

studies of intervention efforts to prevent and respond to FGM/C. The 

course was first published in October 2008 and was last updated in 

October 2015.56

We provided a draft of this report to State and USAID for their review. 

State and USAID did not provide formal comments but each provided 

technical comments that we incorporated as appropriate.

As agreed with your office, unless you publicly announce the contents of 

the report earlier, we plan no further distribution until 30 days after the 

report date. At that time, we will send copies of this report to interested 

congressional committees, the Secretary of State, and the USAID 

Administrator. We will also provide copies to others on request. In 

addition, the report will be available at no charge on the GAO website at 

http://www.gao.gov.

 56The course can be accessed at the following website, accessed April 8, 2016, 

https://www.globalhealthlearning.org/course/female-genital-mutilation-cutting-fgm-c. 

USAID Created an e-Learning 

Course on FGM/C

Agency Comments 
Page 31 GAO-16-485 Female Genital Mutilation/Cutting

If you or your staff have any questions about this report, please contact 

me at (202) 512-3149 or gootnickd@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix IV.

Sincerely yours,

David Gootnick, Director

International Affairs and Trade
Appendix I: Objectives, Scope, and 

Methodology

Page 32 GAO-16-485 Female Genital Mutilation/Cutting

This is the first of two reports examining U.S. agencies’ efforts to address 

Female Genital Mutilation/Cutting (FGM/C) at home and abroad. This 

report (1) summarizes findings from recent U.S. and United Nations (UN)

studies about the factors contributing to FGM/C and approaches to 

addressing this practice internationally and (2) examines the Department 

of State’s (State) and the United States Agency for International 

Development’s (USAID) current efforts to address FGM/C abroad. A 

second report will review U.S. efforts to address FGM/C domestically.

To identify factors contributing to FGM/C and current approaches to 

addressing this practice, we reviewed recent U.S. and UN studies of 

international efforts to accelerate the abandonment of FGM/C and 

respond to victims of the practice. We selected studies that examined 

assistance efforts to accelerate abandonment of FGM/C in countries 

where this practice is concentrated. The studies were published in 2010 

or later. We examined 

• a USAID-funded Population Reference Bureau study, released in 

2013;

1

• an evaluation of the United Nations Population Fund (UNFPA)-United 

Nations Children’s Fund (UNICEF) Joint Program on FGM/C,

released in 2013;

2

• a summary report of the first phase of the UNFPA-UNICEF Joint 

Program released in 2014;3

• a UNICEF statistical overview of FGM/C, released in 2013;

4 and 

• a UNICEF review of efforts to accelerate FGM/C abandonment in five 

African countries, released in 2010.5

 

 1

Population Reference Bureau, Ending Female Genital Mutilation/Cutting: Lessons from a 

Decade of Progress (Washington, D.C.: 2013).

2

UNFPA-UNICEF, Joint Evaluation UNFPA-UNICEF Joint Programme on Female Genital 

Mutilation/Cutting: Accelerating Change 2008-2012 (New York, N.Y.: September 2013). 

3

UNFPA-UNICEF, UNFPA-UNICEF Joint Programme on Female Genital 

Mutilation/Cutting: Accelerating Change Summary Report of Phase I 2008-2013 (New 

York, N.Y.: 2014). 

4

UNICEF, Female Genital Mutilation/Cutting: A statistical overview and exploration of the 

dynamics of change (New York, N.Y.: July 2013).

5

The UNICEF Innocenti Research Centre, The Dynamics of Social Change Towards the 

Abandonment of Female Genital Mutilation/Cutting in Five African Countries (Florence, 

Italy: 2010).

Appendix I: Objectives, Scope, and 

Methodology
Appendix I: Objectives, Scope, and 

Methodology

Page 33 GAO-16-485 Female Genital Mutilation/Cutting

To determine State’s and USAID’s current efforts to address FGM/C 

abroad, we analyzed applicable strategy and policy documents and 

interviewed State and USAID officials involved in issues related to 

FGM/C. These strategies and policies include:

• USAID’s Gender Equality and Female Empowerment Policy, March 

2012;

6

• State’s and USAID’s United States Strategy to Prevent and Respond 

to Gender-Based Violence Globally, August 2012;

7

 

• USAID’s Child, Early, and Forced Marriage Resource Guide, 

September 2015;8

• USAID’s USAID Guidance on Female Genital Mutilation/Cutting, 

updated February 2016; 9 and

• multiple agencies’ United States Global Strategy to Empower 

Adolescent Girls, March 2016.10

To identify State’s efforts, we interviewed State officials in the Office of 

Global Women’s Issues, and key bureaus including the Bureaus of 

Population, Refugees, and Migration; Democracy, Human Rights, and 

Labor; African Affairs; and Near Eastern Affairs. We reviewed documents 

related to a State-funded FGM/C prevention program in Guinea. We also 

reviewed a list of 54 projects addressing gender-based violence in 

refugee settings overseas that received State funding in fiscal year 2014. 

We identified the 10 largest of these projects (with State funding of 

$500,000 or more) in countries where FGM/C is prevalent. For 9 of these 

 6

U.S. Agency for International Development, Gender Equality and Female Empowerment 

Policy (Washington, D.C.: March 2012). USAID also developed guidance for implementing 

this policy in 2013. See U.S. Agency for International Development, Automated Directives 

System Chapter 205: Integrating Gender Equality and Female Empowerment in USAID’s 

Program Cycle (Washington, D.C.: July 17, 2013).

7

Department of State and U.S. Agency for International Development, United States 

Strategy to Prevent and Respond to Gender-based Violence Globally (Washington, D.C.: 

August 2012).

8

U.S. Agency for International Development, Child, Early, and Forced Marriage Resource 

Guide (Washington, D.C.: September 2015).

9

U.S. Agency for International Development, USAID Guidance on Female Genital 

Mutilation/Cutting, (Washington, D.C.: Updated Feb. 11, 2016).

10Department of State, U.S. Agency for International Development, Peace Corps, 

Millennium Challenge Corporation, United States Global Strategy to Empower Adolescent 

Girls (Washington, D.C.: March 2016).
Appendix I: Objectives, Scope, and 

Methodology

Page 34 GAO-16-485 Female Genital Mutilation/Cutting

projects, we contacted project implementers via e-mail to determine if the 

projects had any FGM/C-related components. We were unable to contact 

the project implementers for 1 of the 10 projects. We also met with 

officials from UNFPA and UNICEF to discuss U.S. funding for these

agencies and their Joint Program on FGM/C. In addition, we reviewed 

State’s Country Reports for Human Rights to determine how they 

addressed FGM/C issues.

To identify USAID’s efforts, we interviewed USAID’s Senior Coordinator 

for Gender Equality and Women's Empowerment and officials in key 

USAID bureaus including Global Health; Democracy, Conflict, and 

Humanitarian Assistance; Africa; and the Middle East. We also collected 

information on projects with FGM/C components from USAID’s overseas 

missions in countries where FGM/C is prevalent. To obtain this 

information, we worked with USAID staff in the Office of the Senior 

Gender Coordinator to ask relevant USAID missions via e-mail to identify 

any FGM/C-related programming that was active in calendar year 2014. 

While 12 missions reported having programs with FGM/C components in 

2014, we only presented information on the 5 projects that we were able 

to independently confirm as having FGM/C-related components through 

searches on websites of USAID’s missions or implementing partners. At 

the time of our request, Indonesia had not been identified as a country 

where FGM/C was prevalent, and therefore, the USAID mission there 

was not included among those contacted.11 

We conducted this performance audit from June 2015 to April 2016 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

 11USAID has no mission in some of the countries where FGM/C is known to be prevalent. 

These countries currently are Cameroon, Central African Republic, Chad, Eritrea, the 

Gambia, Guinea-Bissau, Mauritania, Sierra Leone, Somalia, Togo, and Yemen. USAID 

officials noted that USAID does have programs in many of these countries.
Appendix II: Percentage Distribution of Girls 

Who Have Undergone Female Genital 

Mutilation/Cutting by Type of Procedure

Page 35 GAO-16-485 Female Genital Mutilation/Cutting

The type of female genital mutilation/cutting (FGM/C) commonly practiced 

varies by country, according to data presented by the United Nations 

Children’s Fund, based on surveys of mothers about FGM/C performed 

on their daughters (see table 2). For example, more than 20 percent of 

girls who underwent FGM/C in Somalia, Eritrea, Niger, Djibouti, and 

Senegal experienced infibulation (Type III)—the most radical form of 

FGM/C. In other countries, infibulation was uncommon. For example, in 

Egypt, mothers reported that infibulation represented 2 percent of cases. 

Table 2: Percentage Distribution of Girls Who Have Undergone Female Genital Mutilation/Cutting (FGM/C) by Type of 

Procedure

Type of FGM/C and percentage

Country Cut, some flesh removed

(Types I and II)

Sewn closed

(Type III)

Cut, no flesh removed/ 

nicked (Type IV)

Type not determined/ not 

sure/ don’t know

Benin 95 2 2 1

Burkina Faso N/A 1 N/A N/A

Central African Republic 61 6 24 9

Chad 81 8 9 2

Côte d’Ivoire 82 6 7 5

Djibouti 53 30 15 3

Egypt N/A 2 N/A 1

Eritrea 6 38 52 4

Ethiopia N/A 4 N/A N/A

The Gambia 86 12 0 1

Ghana 68 17 8 7

Guinea 85 10 2 2

Guinea-Bissau 88 10 0 2

Kenya 79 17 3 1

Mali 71 3 16 11

Mauritania 80 N/A 6 14

Niger 63 35 0 2

Nigeria 69 6 16 9

Senegal N/A 21 N/A N/A

Sierra Leone 70 12 1 17

Somalia 25 63 5 7

United Republic of Tanzania 98 2 1 N/A

Legend: N/A = Not applicable

Source: United Nations Children’s Fund, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change (New York, N.Y.: July 2013). | GAO-16-485

Notes: The United Nations Children’s Fund (UNICEF) reported these figures based on questions in 

household surveys of mothers about FGM/C performed on their daughters. These surveys were 

Appendix II: Percentage Distribution of Girls 

Who Have Undergone Female Genital 

Mutilation/Cutting by Type of Procedure
Appendix II: Percentage Distribution of Girls 

Who Have Undergone Female Genital 

Mutilation/Cutting by Type of Procedure

Page 36 GAO-16-485 Female Genital Mutilation/Cutting

conducted between 1995 and 2011. Data for Senegal refer to all daughters aged 0 to 9 who have 

undergone FGM/C. Data for Burkina Faso, Central African Republic, the Gambia, Ghana, Mauritania, 

Nigeria, and Sierra Leone refer to all daughters aged 0 to 14 who have undergone FGM/C. For all

other countries, data refer to the most recently cut daughter among mothers aged 15 to 49 with at 

least one living daughter who has undergone FGM/C.

The surveys were worded to be understood by respondents. The questions classified the types of 

FGM/C into four main categories: (1) cut, no flesh removed; (2) cut, some flesh removed; (3) sewn 

closed; and (4) type not determined/not sure/don’t know. These categories do not fully match the 

typology used by the World Health Organization. In reporting these data, UNICEF states that cut, no 

flesh removed describes a practice known as nicking or pricking, which currently is categorized as 

Type IV. Cut, some flesh removed corresponds to Type I (clitoridectomy) and Type II (excision) 

combined. Sewn closed corresponds to Type III, infibulation. In surveys in Burkina Faso, Egypt,

Ethiopia, and Senegal, questions only differentiated infibulation from non-infibulating forms of FGM/C.

Numbers in this table may not add up to 100 percent because of rounding.
Appendix III: List of Countries Where Female 

Genital Mutilation/Cutting Is Concentrated with 

Decrees or Legislation Related to the Practice, 

According to the United Nations Children’s 

Fund

Page 37 GAO-16-485 Female Genital Mutilation/Cutting

The United Nations Children’s Fund (UNICEF) reported in 2013 that 24 

countries where Female Genital Mutilation/Cutting (FGM/C) is prevalent 

have enacted legislation related to FGM/C.1 These laws reportedly vary in 

their scope. UNICEF reports that some ban the practice only in medical 

facilities; others ban the practice anywhere.

Table 3: The United Nations Children’s Fund’s (UNICEF) List of Countries Where 

Female Genital Mutilation/Cutting (FGM/C) Is Concentrated with Decrees or 

Legislation Related to This Practice

Country

Year of enactment 

of decree or legislation 

Benin 2003

Burkina Faso 1996

Central African Republic 1966, 1996

Chad 2003

Côte d’Ivoire 1998

Djibouti 1995, 2009

Egypt 2008

Eritrea 2007

Ethiopia 2004

Ghana 1994, 2007

Guinea 1965, 2000

Guinea-Bissau 2011

Iraq (Kurdistan region) 2011

Kenya 2001, 2011

Mauritania 2005

Niger 2003

Nigeria (some states) 1999, 2006

Senegal 1999

Somalia 2012

Sudan (some states) 2008, 2009

Togo 1998

Uganda 2010

United Republic of Tanzania 1998

 1

UNICEF, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the 

Dynamics of Change (New York, N.Y.: July 2013).

Appendix III: List of Countries Where Female 

Genital Mutilation/Cutting Is Concentrated with 

Decrees or Legislation Related to the Practice, 

According to the United Nations Children’s Fund
Appendix III: List of Countries Where Female 

Genital Mutilation/Cutting Is Concentrated with 

Decrees or Legislation Related to the Practice, 

According to the United Nations Children’s 

Fund

Page 38 GAO-16-485 Female Genital Mutilation/Cutting

Country

Year of enactment 

of decree or legislation 

Yemen 2001

Source: United Nations Children’s Fund, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of 

Change (New York, N.Y.: July 2013). | GAO-16-485

Note: This list of countries was reported by the United Nations Children’s Fund (UNICEF) in 2013.

Bans outlawing FGM/C were passed in some African countries, including Kenya and Sudan, during

colonial rule, according to UNICEF. This table includes only legislation that was adopted by 

independent African nations and does not reflect earlier rulings during colonial rule. Later dates reflect 

amendments to the original law or new laws. GAO did not independently verify the status of these 

laws reported by UNICEF.
Appendix IV: GAO Contacts and Staff 

Acknowledgments

Page 39 GAO-16-485 Female Genital Mutilation/Cutting

David B. Gootnick, (202) 512-3149 or gootnickd@gao.gov

In addition to the contact named above, Leslie Holen (Assistant Director), 

Ashley Alley, Lynn Cothern, Howard Cott, Jill Lacey, and Nancy Santucci 

made significant contributions to this report.

Appendix IV: GAO Contacts and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(100113)
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