Soraya Miré was 13 years old and living in Somalia with her family when the moment that would forever change her life happened: Miré was taken to a local doctor to have her clitoris and labia surgically removed—a form of female genital mutilation that’s a rite of passage predominantly practiced on young girls in certain parts of Africa, Asia and the Middle East.“My mother said, ‘I’m going to give you a gift,’ ” recalls the now 52-year-old activist and author of “The Girl With Three Legs.” “I thought I was getting a dress, and she took me to a doctor.”When Miré realized what was about to happen to her, she felt like she wanted to die. “It was so shocking because you were not expecting it,” she says. “The pain is so unbearable. You leave your body. But what was more painful was having your mother watch as you suffer, and she’s saying this is okay.”After the procedure, Miré was sewn up using the remaining tissue from her outer labia, leaving only a tiny opening to allow urine and menstrual blood to pass through. Once sewn up, women remain that way until their wedding day.The inhumane practice of female genital mutilation, also known as female circumcision, usually occurs between birth and 8 years of age. It’s considered a coming-of-age ritual that ushers girls from childhood to womanhood, notes Miré, who chronicled what had happened to her in her 1994 documentary, “Fire Eyes.” The procedure is meant to ensure virginity and reduce libido. “It’s to make sure you’re property to a man who will be marrying you,” she says.In some cases, the practice is the execution of the belief that girls are born with something wrong with them and that FGM is actually fixing an error in the girl’s anatomy. “You feel like a woman’s private part is ugly,” says Miré. “It’s seen almost as an accident, a mistake that women were given a clitoris.”Adds Marianne Sarkis, assistant professor of international development and social change at Clark University and a medical anthropologist: “[The clitoris] is seen as the girl [being] born with a penis so it’s up to the community to ensure that foreign element is removed. The thought is if you don’t remove it, it will continue to grow.” After the procedure, girls are viewed as “clean” and “beautiful.”The Types of Surgery and Its ConsequencesThe World Health Organization classifies FGM into four categories: Type 1, which is the most commonly practiced, according to Sarkis, is a clitoridectomy in which part or all of the clitoris is removed. Type 2 is called excision, which involves partial or total removal of the clitoris and the labia minora (inner lips), with or without removing the labia majora (outer lips). Type 3, infibulation, is the most severe and may involve removing the clitoris, labia minora and labia majora and creating a small hole for the vaginal opening. Type 4 is made up of all other harmful procedures to the female genitalia for non-medical reasons, including pricking, piercing, scraping and cauterization.Less than 20 percent of FGM procedures are performed by health care providers, as in Miré’s case. The rest are carried out by traditional circumcisers, who use a razor blade or in some cases broken glass as a cutting instrument in the procedure. With the latter, “none of this happens with anesthesia,” notes Sarkis. “The girl is usually held down by her mother or aunt. While struggling, the [person performing the procedure] can be very precise or may end up removing a lot more. They’re sewn closed with things like thorns or cat gut, very rarely with thread.”Not surprisingly, there can be serious and immediate health consequences, including hemorrhaging, wound infections, sepsis (bacterial infection) and shock, as well as chronic problems including urinary tract infections, incontinence, infertility, menstruation problems and pain, including painful intercourse.After coping with myriad health issues, on her wedding night, the woman is then reopened either by being cut open with a sharp object such as a knife or by the husband trying to force himself into that tiny opening, which is excruciating and could take weeks to months for it to be completely open, according to Sarkis. “I’ve heard women say when the nighttime comes it’s the darkest time because the pain is so great,” she says.Female Genital Mutilation in the U.S.The barbaric practice doesn’t sound like something that would ever happen to anyone living in America, but using 1990 census data, the Centers for Disease Control and Prevention estimated that 168,000 women and girls have experienced or are at risk for FGM in the U.S. It was enough of a concern that a federal law banning FGM in minors was passed in 1996. Despite the law, that number appears to have risen by 35 percent; according to 2000 census data, an estimated 228,000 women and girls have experienced or are at risk for FGM in the U.S., notes the African Women’s Health Center at Brigham and Women’s Hospital, which is the first and only African health practice in the states that focuses on issues regarding FGM.And yet, there have been no prosecutions of female genital mutilation under federal or state law in the U.S.One of the reasons is that enforcing the law is difficult. Immigrants from East Africa and other countries who reside in the U.S. and seek to continue the practice mainly live in tight-knit communities, making it difficult to find out who is performing the procedure on young girls in the states, according to Miré. In some cases, families even take their young children to their country of origin for the purpose of performing FGM over school holidays or the summer, despite the fact that in January 2013 it became illegal to transport minors living in the U.S. to have the procedure overseas.Part of the problem is that moving to the U.S. doesn’t erase the cultural pressure to continue the tradition. “If a girl is not circumcised, she’s not considered to be a woman, she gets ostracized, her mother gets known as mother of the prostitute,” says Sarkis. “You bring shame to your immediate family and your whole community. It’s a lot of pressure.”The Uphill BattleAlthough stopping the practice in the U.S. and abroad is an uphill battle, Sarkis sees that outreach and education within local immigrant communities, along with political pressure both here and overseas, are making a difference. “What we’re seeing in Somalian communities [in the U.S.] is now the second generations are not getting infibulated,” she notes. “It’s because the girls are getting educated and their value is rising. The parents are very proud of them and their prospects for marriage are very high unlike in Somalia. Here, you have lots more opportunities.”For Miré, she continues to dedicate herself to raising awareness, educating people about female genital mutilation and counseling victims. After going through the procedure herself, as well as multiple infections and hospital visits for years, Miré vowed: “I could use this pain for the better. I’m going to let everyone know what is happening to our vaginas. It’s the ultimate child abuse.”Want to take action to help end female genital mutilation across the globe? Find out how at Equality Now.