Editor’s note: This article contains references to gender-based violence. If you or someone you know needs support, contact the Student Health Center at (202)994-5300 and ask to speak to a counselor or reach the National Domestic Violence Hotline at 1−800−799−SAFE(7233).

The Milken Institute School of Public Health announced earlier this month that it received a $300,000 grant to support prevention and response efforts to female genital mutilation/cutting, or FGM/C.

Researchers at Milken are working to reduce FGM/C in the U.S. and worldwide by confronting a lack of awareness of gender-based violence and underreported FGM/C rates. The Department of Justice’s Office on Violence Against Women will divide the grant equally among four organizations, and the money will go toward advocacy programs for the enforcement of laws prohibiting FGM/C and awareness projects like the FGM/C toolkit, support groups for survivors and the annual Walk To End FGM on the National Mall.

FGM/C is known to be practiced in at least 92 countries around the world — including the United States — for religious reasons and to control female sexuality. The practice is known to cause lifelong physical and mental harm, like serious infections and fertility issues. About 200 million women are survivors of FGM/C, and an additional 4 million girls are projected to have an FGM/C procedure each year around the world.

Milken is collaborating with U.S. End FGM/C Network, the Global Woman P.E.A.C.E. Foundation and Sahiyo U.S. to carry out prevention and support strategies.

Karen McDonnell, an associate professor of public health and the principal investigator on the project, said researchers aim to spread awareness of FGM/C as a form of gender-based violence. She said many people in the U.S. do not know or believe that FGM/C is happening.

“The challenges that we face are that: A) in the U.S. people don’t believe it’s happening, and B) that it’s shrouded in what we call the three S’s: secrecy, shame and stigma,” McDonnell said. “It’s very difficult to get people to talk about what they’ve experienced, they’ve been told that they should not talk about it because bad things will happen if they do.”

She said there are two parts to their plan: FGM/C prevention, by ensuring that laws banning the practice are fully enforced, and raising awareness that FGM/C is a form of violence instead of a social norm. She said they will also work to support survivors, which can take many forms, from support groups to funding for restorative surgery.

The collaboration also aims to more accurately count the victims of FGM/C in the U.S. and around the world, she said. McDonnell said estimates of FGM/C rates in the U.S. are vastly underreported because FGM/C is not well documented.

“We have something called the uncounted, where those are persons in the U.S. who were born in the U.S. who have experienced FGM but may not have been counted, because we don’t ask about it here in the U.S., but we know that it is happening,” McDonnell said.

McDonnell said several groups in this team worked on reforming a law banning FGM/C to tighten up loopholes — like the defendant’s ability to use religion or culture as a legal defense — in 2020 as a result of a federal court case involving charges against a doctor that was performing FGM/C procedures in Michigan.

“We tightened up the law so that you can’t hide behind religion and culture. And there’s also a provision that I’m really excited about, and that is sort of public health approach,” said McDonnell. “And that was to make sure that there are reporting requirements by federal offices, about the effort that they are convening in to prevent and document FGM.”

Mariya Taher, a co-founder and director of Sahiyo U.S., an organization aiming to end FGM/C, said researchers must break through the normalization of FGM/C among communities where it is practiced in order to prevent it.

“Generally, in communities where it’s practiced, there are justifications and it’s a social norm, so it’s considered something that’s needed to happen,” Taher said. “So we’re trying to change that perception, it really helps highlight that this is a form of gender-based violence. And it is something that’s often happening to children, so to girls that are under 18.”

In U.S. communities where this is a common practice, survivors are often afraid of speaking out against FGM/C and telling their stories, she said. Taher said there is a history of backlash toward survivors and advocacy groups that support them, including people boycotting their businesses. She added that there is a history of FGM/C in the U.S., including among religious groups and immigrant communities with people from countries where it is more common.

“We’ve had stories from survivors that come from white fundamentalist Christian communities, that it’s occurring,“ Taher said. ”We also know that there is actually a history of clitoridectomy happening in the U.S. up until the 1960s, in some cases, 1970s. Which was done to treat women for what they said was hysteria, mental illness or lesbianism.”

Angela Peabody, the executive director of the Global Woman P.E.A.C.E. Foundation, said survivors are threatened into staying silent about their experiences with FGM/C, which makes them afraid to share their stories and seek out help.

“When they cut the girls, they tell them this is a secret, they swear them to secrecy. You don’t tell anyone, if you tell somebody, you will die,” Peabody said. ”If you tell a 7-year-old or a 6-year-old that she will die if she discloses what just happened to her, of course, she won’t.”

She said FGM/C procedures are often shrouded in secrecy for the girls involved, who typically do not know what is about to happen to them. In many cases, parents will tell their daughters that they are going to visit family or go to a party.

Peabody said people must understand that FGM/C is gender-based violence capable of happening anywhere in the world.

“It doesn’t only happen in Africa, Southeast Asia and parts of the Middle East. It happens right here in the U.S.,” Peabody said. “It happens right here in Virginia, in Pennsylvania, everywhere, in every state in the U.S. it’s possible that FGM is happening.”