For years, intactivist and genital autonomy groups have wondered why anti-FGM organizations have not joined them in opposing all genital cutting, rather than just harm done to one gender.

Both movements oppose cutting the genitals of those who cannot consent. Both movements support the principle of gender equality. Given those principles, it follows that opposing one form of forced genital cutting requires opposing the other. Yet anti-FGM groups have drawn a clear distinction between male and female genital cutting. Why?

After researching and following the money, I believe I have an answer.

Summary: Anti-FGM organizations made a strategic decision to exclude male genital cutting from their mission. That decision allowed them to receive funding from governments and medical foundations that support male circumcision. Now, they are captured by those interests and effectively controlled opposition. The strategy intended to allow them to protect girls at the expense of boys made it so they cannot protect either.

Intactivists Have Opposed FGM/C

Intactivists and genital autonomy organizations oppose medically unnecessary genital cutting of all children, including FGM/C:

• The National Organization of Circumcision Information Resource Centers adopted a declaration at its first international symposium in 1989 that asserted a right to an intact body and expressly named the foreskin, clitoris, and labia.

• NOCIRC’s Fall 1993 newsletter was devoted to FGM. It promoted Soraya Miré’s documentary Fire Eyes, advertised educational material treating female and male genital cutting together, and directed readers to anti-FGM organizations including FORWARD and the Washington Metro Alliance Against Female Genital Mutilation.

• NOCIRC’s Third International Symposium in 1994 screened Fire Eyes with Miré participating in discussion and included a dedicated FGM track covering medical ethics, eradication strategies, U.S. policy, and prosecution.

• The International Coalition for Genital Integrity, founded in 1999, was an umbrella for approximately eighteen organizations addressing genital cutting of children regardless of sex.

• Intact America gave Soraya Miré, the Somali filmmaker and FGM survivor, its Award for Personal Courage in 2009. In 2010 it opposed the American Academy of Pediatrics’ proposal to permit a ritual nick on girls.

• Attorneys for the Rights of the Child applies a child-rights framework to genital cutting of girls, boys, and intersex children.

• The Worldwide Day of Genital Autonomy, held annually since 2013, calls for protection of every child from non-therapeutic genital alteration. Its platform names FGM alongside male circumcision and intersex surgery.

• Genital Autonomy submitted written evidence to the UK Parliament’s 2014 inquiry into FGM, supporting protection for girls while arguing it should extend to all children.

Despite Intactivist and genital autonomy organizations opposing female genital cutting, anti-FGM organizations have not reciprocated their support.

Anti-FGM Organizations Have NOT Opposed MGM/C

None of the anti-FGM organizations I contacted has opposed male genital cutting or infant circumcision the way they oppose female genital cutting:

• AHA Foundation calls the analogy with male circumcision “blatantly off-base.”

• A senior Equality Now representative told ABC News the practices were not the same at all. Equality Now has presented the comparison as an argument used by defenders of FGM.

• The FGM/C Research Initiative, hosted by Orchid Project, rejects the terminology “female circumcision” because the implied parallel is said to obscure FGM’s seriousness.

• End FGM European Network has stated explicitly that it has no position on male circumcision.

• Sahiyo’s FAQ recognizes consent-related overlap and published a universal-consent guest essay in January 2026, but attached a disclaimer that the essay did not necessarily represent the organization.

• No public position on male circumcision was found for Safe Hands for Girls, U.S. End FGM/C Network, or Tahirih Justice Center.

However, it wasn’t always this way.

Anti-FGM Founders Once Stood With Intactivists

The founders of the anti-FGM movement once shared the stage with intactivists:

• Fran Hosken, author of The Hosken Report, presented “Female Genital Mutilation: Strategies for Eradication” at the first intactivist symposium in March 1989.

• Hanny Lightfoot-Klein, author of Prisoners of Ritual, presented on FGM at NOCIRC’s 1994 and 1996 symposia. Her 1989 book on FGM included a chapter on protecting boys from circumcision, as ARC’s Oregon brief notes.

• Nahid Toubia, who founded the anti-FGM organization RAINBO in 1994, gave the keynote address at NOCIRC’s 1998 symposium at Oxford. Her paper was titled “Evolutionary Cultural Ethics and Circumcision of Children.”

• Soraya Miré, asked on The Oprah Winfrey Show in 1995 whether the sex of the child should matter, is quoted as saying: “Cut is cut.” She also appeared in my documentary American Circumcision opposing male genital cutting.

• Comfort Momoh, a leading British FGM specialist, presented at NOCIRC’s 2008 Keele symposium, became joint patron of Genital Autonomy at its launch that year, and was listed as a speaker again in 2016.

• Efua Dorkenoo, who founded FORWARD in 1983 and is remembered as the mother of the movement to end FGM, sat on a panel with Steven Svoboda of Attorneys for the Rights of the Child at the Royal Society of Medicine on July 4, 2008.

It is worth noting that these individuals, not organizations.

Why if the founders of the anti-FGM movement understood the parallels between male and female genital cutting, did anti-FGM organizations not oppose male circumcision?

Dorkenoo explained why.

Anti-FGM Organizations Strategic Decision

On July 4, 2008, the Royal Society of Medicine in London hosted a conference called “Genital Cutting in a Globalized Age” that included people working against FGM, male circumcision, intersex surgery, and cosmetic genital surgery.

Steven Svoboda, founder of the intactivist organization Attorneys for the Rights of the Child, gave a talk on the harm, law, and ethics of male circumcision.

Efua Dorkenoo spoke after him. She had founded FORWARD, Britain’s leading anti-FGM organization, and would go on to run Equality Now’s anti-FGM program.

According to ARC’s report on the conference, Dorkenoo told the audience she wholeheartedly supported intactivism. The anti-FGM movement, ARC wrote, had simply made “a strategic decision not to work to protect males,” because protecting them would make its work harder.

That is ARC’s account of her remarks, not a transcript. Dorkenoo died in 2014. But it comes from someone who was on the panel with her, and nothing the anti-FGM movement has done since contradicts it.

In other words: the anti-FGM movement made a strategic choice to ignore male genital cutting.

What The Strategy Bought

By ignoring male circumcision, the anti-FGM movement achieved money and power. Here is a timeline of what followed Dorkenoo’s speech:

• 2008: UNFPA and UNICEF launched the Joint Programme on FGM, which they describe as the largest global programme on the issue.

• 2009: Amnesty International launched the END FGM European Campaign. Human Dignity Foundation was its sole funder.

• March 2013: The UK government announced £35 million to end FGM in a generation. The UK’s aid watchdog called it the largest single donor investment ever targeted at FGM.

• February 2014: The UK government appointed a consortium to run the campaign. Equality Now and FORWARD were members. It was led by Efua Dorkenoo of Equality Now.

• 2014: The End FGM European Network was founded out of the Amnesty campaign. It now receives approximately 96% of its revenue from the European Commission.

• 2020: Congress passed the STOP FGM Act. The Department of Justice made its first FGM-specific grants, including over $1 million to a technical-assistance provider partnered with the U.S. End FGM/C Network.

Six years after Dorkenoo told intactivists that leaving boys out was strategic, she was running the largest government-funded FGM campaign in history.

From one perspective, the strategy worked. The anti-FGM movement achieved money and power by ignoring the suffering of men and male children.

However, if we follow the money, there is another narrative: pro-circumcision medical and government organizations bought the anti-FGM movement.

Pro-Circumcision Groups Bought The Anti-FGM Movement

The funders of anti-FGM organizations are pro-circumcision.

• Government: The same U.S. government that funds these organizations through Department of Justice grants has supported 35.1 million circumcisions through PEPFAR since WHO and UNAIDS recommended male circumcision in 2007, putting nearly $2 billion into it over the next decade. Medicaid covers routine newborn circumcision in 33 states. The State Department ran a coordinated campaign against circumcision bans in European countries. Congress wrote prohibitions on male circumcision bans into the Wolf Act as religious-freedom violations the State Department must monitor.

• Bill & Melinda Gates Foundation gave Equality Now $8,297,470 across multiple grants, including a $1 million grant in September 2024. The same foundation has committed approximately $252 million across 44 grants to male circumcision programs. Those grants funded Population Services International to circumcise nearly 650,000 men in two countries, the Johns Hopkins randomized trial in Uganda, Weill Cornell Medical College to test a circumcision device on infants, and the University of Manitoba to introduce early-infant circumcision in Kenya.

• Human Dignity Foundation financed the creation of the End FGM European Network through an approximately €2.2 million grant to Amnesty International. HDF was founded by Dr. John Climax, co-founder of ICON, a major clinical-research company.

• Morris and Alma Schapiro Fund gave $250,000 to Safe Hands for Girls and separately funds Memorial Sloan Kettering Cancer Center ($550,000) and the Prostate Cancer Foundation ($400,000).

• Oak Foundation funds the broader anti-FGM movement’s infrastructure through the Five Foundation and separately funded a Botswana HIV trial that included expanded access to circumcision services.

• Novo Nordisk Foundation gave $650,000 to the UNFPA-UNICEF Joint Programme on FGM. Novo Nordisk Foundation is an enterprise foundation centered on medical science and biotechnology.

• Children’s Investment Fund Foundation participates in the HER Africa Funder Alliance, a funder collaborative created by the Five Foundation to finance African anti-FGM organizations. CIFF’s portfolio includes global health programs across the same institutional networks.

I have documented these conflicts organization by organization in these articles:

• Do Anti-FGM Organizations Have a Financial Conflict of Interest?

• Is the Anti-FGM Movement a Government Sock-Puppet?

While the strategic decision to take money from pro-circumcision groups might have increased the wealth of the anti-FGM movement, what did this cost them?

What The Strategy Cost

Taking pro-circumcision money from government and medical interests made it so anti-FGM organizations cannot oppose female genital cutting when doing so means opposing the state and those financial interests and must support male genital cutting when the state and their financial interests demand it.

Two ways that is currently manifesting:

• Anti-FGM organizations will not say FGM doctors should lose their licenses. Dr. Jumana Nagarwala and Dr. Fakhruddin Attar, the physicians charged in America’s first federal FGM prosecution, hold active medical licenses in Michigan today. On July 25, I emailed Equality Now, the U.S. End FGM/C Network, and Sahiyo asking whether physicians who perform FGM on children should hold medical licenses. None of them answered. A medical licensing board is a government agency. Criticizing its decision means criticizing the government while depending on the government for operating revenue.

• Those same anti-FGM organizations will go to court to keep boys out of a genital cutting law. On July 23, two days before ignoring those emails, the same three organizations asked an Oregon court to reject a lawsuit brought by three men challenging the state’s FGM statutes as sex discrimination. Their brief argues that including male circumcision would “needlessly and negatively impact” the work to end FGM. Extending the law takes nothing from girls. But it would challenge the medical system their donors finance.

Read about these two issues here:

• Are Anti-FGM Organizations Fine With Licensing FGM Doctors?

• Anti-FGM Groups Protect Male Circumcision While Ignoring FGM Licensing

Dorkenoo's strategy was presented as a sort of triage: Protect girls first, because that fight can be won. Come back and save the boys later.

However, that strategy is only defensible if:

1. Girls are actually protected.

2. The movement eventually returns to the issue of male genital cutting with their newfound resources and support.

Instead, the strategy sacrificed both their core mission of ending female genital cutting and the issue of male genital cutting.

Anti-FGM organizations are now ignoring the licensing medical doctors who performed female genital cutting while filing legal briefs against male circumcision lawsuits. As a strategy to end female genital cutting, it failed. As a strategy to make money, it succeeded.

In other words, the movement sold out.

The Pro-Circumcision Strategy

Consider this from the perspective of pro-circumcision organizations. There is a growing movement against all genital cutting. What is your best strategy to stop them?

You could fight the genital autonomy movement directly, but that draws attention to them and the comparison between male and female genital cutting. A better strategy would be to divide them and fund a controlled opposition movement — one that appears to be against “genital cutting” but never actually threatens your money, power, and institutional connections.

Whether or not it was a conscious strategy, this is what pro-circumcision organizations did to the tune of millions of dollars. They funded organizations that opposed female genital cutting with a narrative that excluded male genital cutting, and gave them access to law firms, government contracts, UN partnerships, and media attention.

From this perspective, the $8.3 million the Gates Foundation gave Equality Now is not a grant to end FGM. It is the cost of ensuring that the world’s most prominent anti-genital-cutting organizations will never threaten the $252 million circumcision portfolio. The DOJ grants to Sahiyo are not the cost of ending FGM in the Dawoodi Bohra community. They are the cost of making sure the organization founded by that community’s survivors will not say that a doctor who cut their girls should lose her license.

What pro-circumcision organizations are buying is a credible voice against genital cutting that draws the line exactly where they need it drawn to protect their interests. Now anyone who argues that cutting a boy is the same as cutting a girl is not arguing against pro-circumcision organizations, but anti-FGM organizations. The movement that should be their biggest threat is on their payroll and doing their work for them.

How Anti-FGM Narrative Supports Male Genital Cutting

Anti-FGM organizations have framed the issue of genital cutting as exclusively as violence against women and girls, creating a narrative that prevents acknowledging the ways male children are harmed and makes cooperation with genital autonomy organizations impossible:

• The joint amicus brief filed by Equality Now, Sahiyo, Safe Hands for Girls, and WeSpeakOut in the Nagarwala case presents FGM as a violation of girls’ and women’s rights, not children’s rights. The framework itself excludes boys.

• AHA Foundation’s terminology article argues the comparison with male circumcision is used to diminish FGM’s seriousness. An AHA-hosted advocate profile describes raising male circumcision in FGM-law discussions as “a distraction.”

• Equality Now’s coverage of the 2026 Indian Supreme Court hearing presents the comparison with male circumcision as an argument made by defenders of the practice. Comparing FGM to circumcision is cast as defending FGM, not as defending children.

• The World Health Organization said in 1996 that FGM could not be likened to male circumcision. UNFPA says the term “mutilation” helps establish a clear distinction from male circumcision. The U.S. Office on Women’s Health states directly that FGM is not the same as male circumcision. These institutional positions provide the authoritative language anti-FGM organizations invoke when resisting a universal genital-autonomy frame.

• Political scientist Charli Carpenter analyzed how advocacy networks treat male circumcision as a “lost cause.” She found that linking the issue to FGM triggered gatekeeping concerns: competition for attention, confusion of the anti-FGM message, conflict with the women’s-rights framing, and fear of weakening a successful campaign.

• When GAMS Belgium organized a 2019 expert meeting examining FGM in relation to male genital cutting, the invitation generated negative reactions from partners within the anti-FGM network itself. Some feared that opening the comparison meant weakening opposition to FGM.

• In July 2026, Equality Now, the U.S. End FGM/C Network, and Sahiyo went to court in Oregon to oppose a lawsuit challenging the state's FGM statutes as sex discrimination. Their brief claims that FGM is rooted in gender-based violence and the control of women’s sexuality, has no medical benefits, and causes severe lifelong harm, while male circumcision does not.

The pro-circumcision strategy worked. There is now a large movement against “genital cutting” that ignored the most prolific form of genital cutting and excludes real opposition to their interests.

Are Anti-FGM Organizations Controlled Opposition?

Political scientists have a term for what happens when funders redirect a social movement’s agenda: movement capture. Megan Ming Francis coined it to describe how the Garland Fund used its money to shift the NAACP from fighting lynching to fighting school segregation. The funder didn’t oppose the NAACP. It supported it, on the condition that it pursue the funder’s priority rather than its own.

A 2025 paper on controlled opposition in democracies takes this further. It argues that in liberal democracies, controlled opposition no longer requires spies or informants. It runs on NGO funding dependencies and what the author calls “performative dissent”: organizations that look like opposition, hold the credentials of opposition, and never threaten the interests of the people paying them.

The anti-FGM movement fits this definition. Its organizations receive funding from governments and foundations that support male circumcision. They have adopted a narrative that treats any comparison between male and female genital cutting as an attack on their mission. They show up in court to defend FGM laws from being extended to boys but will not answer an email about whether FGM doctors should keep their licenses. They produce laws, conferences, reports, and amicus briefs. They do not produce prosecutions, license revocations, or any outcome that would require confronting the government agencies and medical institutions that fund them.

Whether this is controlled opposition depends on how you define the term. If it requires a conscious conspiracy, some secret meeting in a room where a nefarious cabal decided to buy a movement, I’m not sure there is one. Each groups appears to be acting on their interests. Pro-circumcision medical and government groups want to fund organizations that won’t oppose circumcision. Anti-FGM groups want mainstream support and funding. Everyone wins — except for the children. This appears to be the result of systems, not conspiracy. However, the result is the same as if there was conspiracy.

The anti-FGM movement occupies the space where a real genital autonomy movement should stand. It holds media contacts, UN partnerships, and legal budgets, but uses those to oppose efforts against genital cutting and ignore the licensing of FGM doctors. Whether or not anyone consciously asked them to this, this is exactly what anti-FGM organizations would do if they were controlled opposition.

For years, intactivists have wondered why anti-FGM groups will not work with them. The answer is that they were built to never do that.

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Anti-FGM organizations receive money from the government. They also receive private funding from foundations with ties to the medical system. The licensing of two FGM doctors sits at the intersection of both funding streams. Pursuing it means criticizing both a government medical board and the professional infrastructure their own donors finance. This is a financial conflict of interest.

Context

Dr. Jumana Nagarwala and Dr. Fakhruddin Attar were charged in the first federal FGM prosecution in U.S. history. Both hold active, unrestricted Michigan medical licenses. Michigan’s Bureau of Professional Licensing closed investigations into both licenses before the federal prosecution ended. Memos explaining why their cases were closed have been withheld from the public.

I asked eight anti-FGM organizations whether the physicians should continue to hold active medical licenses. Six did not respond. One responded without answering the questions. One had to be told to read the reporting before it revised its position.

Full story on anti-FGM organizations response:

The Government Conflict

As I reported in “Is the Anti-FGM Movement a Government Sock-Puppet?,” anti-FGM organizations receive government money.

Government funding creates one conflict of interest: pursuing the licensing issue means criticizing a state government agency, and these organizations depend on government agencies for grants and contracts.

You can read that full article here:

However, government funding is only half the problem. The rest of the funding of anti-FGM organizations has ties to the medical system.

The Medical Conflict

I researched the fourteen largest private foundations funding the anti-FGM movement. Seven have ties to medicine, hospitals, biomedical research, pharmaceuticals, or public health as a central program area, a material grant category, or the source of the founding fortune.

Three are biomedical or global-health funders:

• Bill & Melinda Gates Foundation gave Equality Now $8,297,470 across multiple grants, including a $1 million grant in September 2024. Gates is one of the world’s largest global-health and vaccination funders. It committed $1.9 billion to Global Health in 2024 and pledged $1.6 billion to Gavi in 2020 alone. It works through WHO, UNICEF, universities, pharmaceutical firms, and national public-health systems.

• Children’s Investment Fund Foundation participates in the HER Africa Funder Alliance, a funder collaborative created by the Five Foundation to finance African anti-FGM organizations. CIFF’s health and nutrition portfolio includes HIV medication, reproductive health, maternal health, government health systems, and pharmaceutical-access programs.

• Novo Nordisk Foundation gave $650,000 to the UNFPA-UNICEF Joint Programme on FGM. It is an enterprise foundation centered on medical science, biotechnology, and life-science research, and committed DKK 1.8 billion to its vaccine and immunity initiative.

Three make medical grants:

• Oak Foundation gave $466,667 over three years to the Five Foundation, a coordinating body for anti-FGM funders. Its Special Interest Programme expressly includes medical research and healthcare projects.

• Conrad N. Hilton Foundation participates in the HER Africa Funder Alliance. Its longstanding programs include multiple sclerosis, avoidable blindness, substance-use prevention, and children affected by HIV/AIDS.

• Morris and Alma Schapiro Fund gave $250,000 to Safe Hands for Girls and separately funds Memorial Sloan Kettering Cancer Center ($550,000) and the Prostate Cancer Foundation ($400,000).

One was built on a medical-industry fortune:

• Human Dignity Foundation financed the creation of the End FGM European Network through an approximately €2.2 million grant to Amnesty International. HDF was founded by Dr. John Climax, co-founder of ICON, a major clinical-research company that runs trials for pharmaceutical firms. Climax remains founder and chair, and the foundation’s board and staff draw partly from the pharmaceutical sector.

The largest private donors to anti-FGM organizations are embedded in the medical system. How has the medical system responded to licensing FGM doctors?

Medical Complicity

The medical system has not condemned licensing FGM doctors.

As I previously reported, the Federation of State Medical Boards did not say that physicians charged in a federal FGM prosecution should lose their medical licenses. The American Medical Association would not condemn licensing FGM doctors, and deferred to the Federation of State Medical Boards. No insurer would say that FGM doctors should be removed from their network.

No medical organization would say that FGM doctors should lose their licenses, including the American College of Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and American College of Emergency Physicians.

The anti-FGM organizations’ private donors are embedded in this medical infrastructure. Pushing a medical board to revoke a physician’s license means pushing against the professional system their funders finance and participate in. Anti-FGM organizations’ response mirrors the response of medical organizations.

Intersectional Conflict

The licensing issue sits at the intersection of both medical and government conflicts. Pursuing it would require anti-FGM organizations to act against the interests of both.

Every organization has at least one conflict:

• Equality Now reported $500,054 in government grants in 2021 and received $8,297,470 from the Gates Foundation, one of the world’s largest global-health funders. Both conflicts.

• End FGM European Network receives approximately 96% of its revenue from the European Commission and was created with an approximately €2.2 million grant from Human Dignity Foundation, whose founder co-founded ICON, a clinical-research company. Both conflicts.

• Sahiyo reported 60.3% of its operating budget as government grants, including DOJ and HHS funding. Government conflict.

• Tahirih Justice Center reported $5,552,673 in government grants in 2024, approximately 46.6% of revenue. Government conflict.

• AHA Foundation reported $38,000 in government grants in 2024 and holds a $500,000 DOJ award. More than $2 million of its identified private funding came through donor-advised funds that do not disclose the underlying donors. Government conflict; private donors untraceable.

• U.S. End FGM/C Network is a DOJ Office for Victims of Crime technical-assistance provider and participates in a $300,000 DOJ cooperative agreement. It is fiscally sponsored by Reading Room Cleveland and does not disclose its budget or donors. Government conflict; private donors undisclosed.

• Orchid Project is a funded participant in a UK FCDO program on ending FGM; its share is not disclosed. Government conflict.

• Safe Hands for Girls has no verified government funding. Its largest identified donor, the Schapiro Fund, gave $250,000 and separately funds Memorial Sloan Kettering and the Prostate Cancer Foundation. Medical conflict.

The licensing of FGM doctors requires opposing both at once. None did.

The Conflict

Anti-FGM organizations have a financial conflict of interest when it comes to opposing the licensing of FGM doctors.

The organizations with the budgets, the legal teams, the policy staff, and the stated mission to end female genital mutilation have not pursued the licensing of two physicians charged in the first federal FGM prosecution.

The licensing issue requires them to challenge a government medical board. Their government funders pay them to serve government agencies, not to criticize them. Their private donors are embedded in the medical system they would need to challenge.

While these organizations might care about FGM, does their funding allow them to act on it, when acting means challenging the institutions that fund them?

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P.S. I do not have government funding or large private donors.

I have a GoFundMe. You can support it here.

Anti-FGM organizations receive government funding. They act when activism means supporting government prosecution. They are silent when it means criticizing the government. Is the anti-FGM movement a government sock-puppet?

Context

Dr. Jumana Nagarwala and Dr. Fakhruddin Attar were charged in the first federal FGM prosecution in U.S. history. The district court dismissed the FGM counts and held the federal statute unconstitutional in November 2018. Despite the FGM being undisputed, neither physician was convicted.

My original reporting revealed that Michigan's Bureau of Professional Licensing closed investigations into both licenses before the federal prosecution ended. Despite their involvement in FGM, both hold active Michigan medical licenses with no disciplinary action on their public records. Michigan's Bureau of Professional Licensing lied to the press about its investigation, dismissed physician complaints, and renewed Nagarwala's medical license during my investigation. It has refused to tell the public why the doctors are still licensed. Memos explaining why their case was closed have been withheld from the public.

How did anti-FGM organizations respond to the continued licensing of FGM doctors?

They did nothing.

Anti-FGM Intaction

As I previously reported:

I asked eight organizations that work to end female genital mutilation whether two physicians charged in America’s first federal FGM prosecution should continue to hold active medical licenses. Six did not respond. One responded, but did not answer the questions. One initially took a position that meant that FGM doctors should keep their licenses, and had to be told to read the reporting they were responding to before they gave a new comment.

None showed they were aware the FGM doctors were still licensed. Why?

Case Involvement

Anti-FGM organizations were actively involved in the Nagarwala case:

• AHA Foundation claims it connected the original whistleblower to federal law enforcement. It filed its own amicus brief through White & Case on September 24, 2018. Amanda Parker testified before the Michigan House Committee on Law and Justice in May 2017 and helped develop Michigan’s state FGM legislation. AHA says it worked with members of both parties on the revised federal ban signed in January 2021.

• Equality Now was the lead organization on a joint amicus brief filed September 24, 2018 with Sahiyo, Safe Hands for Girls, and WeSpeakOut. Shelby Quast gave media commentary after Nagarwala’s arrest and wrote two case-centered essays for Ms. magazine.

• Sahiyo was a named party on the joint amicus brief. Sahiyo organized a roundtable with the Michigan Department of Health and Human Services on October 9, 2017 and later produced a podcast episode on the prosecution’s effect on Bohra survivors.

• Safe Hands for Girls was a named party on the joint amicus brief. Founder Jaha Dukureh gave media commentary throughout the prosecution.

• U.S. End FGM/C Network claims it joined the amicus brief, but the filed document does not list the Network in its caption or signature block. The Network sent a letter to Speaker Pelosi on September 10, 2020 urging passage of the STOP FGM Act and issued a statement after the final dismissal in 2021.

• Tahirih Justice Center participated in an October 2017 Michigan DHHS roundtable on the case with Sahiyo and Equality Now.

• Orchid Project published a response to the constitutional ruling on November 21, 2018.

• End FGM European Network issued a press release the day after the ruling.

Given that these organizations were aware of the case, why were they not tracking the medical licensing? Did they just lack the resources?

No. The anti-FGM movement is a multimillion dollar operation.

Significant Resources

Anti-FGM organizations have significant resources:

• Equality Now reported $12,083,779 in revenue and $27,682,465 in net assets in its 2024 Form 990. It also operates a U.K. entity that reported £2.91 million in income.

• Tahirih Justice Center reported $11,920,808 in revenue in its 2024 Form 990 and $10,151,038 in net assets. Its 2025 audit shows an additional $29,241,898 in donated professional services.

• AHA Foundation reported $1,187,403 in revenue in 2024. It spent $593,000 on FGM legislative advocacy and support, roughly 45.5% of all expenses.

• Orchid Project reported £957,920 in income for the year ending March 2025.

• Safe Hands for Girls reported $877,303 in revenue in 2024.

• End FGM European Network reported €684,048 in revenue in 2024.

• Sahiyo reported a $576,444 operating budget for 2023-24.

• U.S. End FGM/C Network does not file its own Form 990. It operates through fiscal sponsorship by Reading Room Cleveland, Inc. and does not publicly disclose its budget.

Lack of awareness or involvement in the medical licensing case can’t be explained by lack of resources. These organizations had the budget.

But where does that money come from?

The government.

Government Funding

Most anti-FGM organizations are government funded.

• End FGM European Network receives approximately 96% of its revenue from the European Commission or EU-cofunded projects, roughly €656,686 in 2024.

• Sahiyo reported 60.3% of its operating budget as government grants, approximately $347,596. Its government funders include the DOJ Office on Violence Against Women, HHS Administration for Children and Families, and Washington State Department of Health.

• Tahirih Justice Center reported $5,552,673 in government grants in its 2024 Form 990, approximately 46.6% of revenue. Its 2025 federal expenditure schedule lists $2,638,741 from the Departments of Justice, HHS, Labor, and Treasury.

• AHA Foundation reported $38,000 in government grants in 2024, approximately 3.2% of revenue. It also holds a separate $500,000 DOJ Office on Violence Against Women award for a 36-month FGM prevention project.

• Orchid Project is a funded participant in a U.K. Foreign, Commonwealth and Development Office program on ending FGM. Its individual share is not publicly disclosed.

• U.S. End FGM/C Network is a DOJ Office for Victims of Crime technical-assistance provider and participates in a $300,000 DOJ cooperative agreement and a Washington State contract. Its individual shares and total budget are not disclosed.

• Equality Now reported $500,000 in government grants in 2021 and appears in EU grant records.

What do these organizations do with all that money they get from the government?

They send it back to the government in the form of lobbying and services.

Government Lobbying and Services

The primary activism of many anti-FGM organizations is lobbying the government and fulfilling government contracts.

• AHA Foundation spent $593,000 on “FGM legislative advocacy and support” in 2024, approximately 45.5% of all expenses that year. Its Form 990 states AHA worked closely with legislators in Washington, D.C.

• Tahirih Justice Center reported $33,129 in statutory lobbying in 2024, up from $14,870 in 2021. Its broader advocacy spending was $1,873,463 in 2024. Tahirih’s auditors state the organization holds cost-reimbursable grants and contracts with U.S. government and state agencies.

• Equality Now reported $67,602 in statutory lobbying in 2023 and $0 in 2024. Its program descriptions include training law-enforcement officials, prosecutors, and judges. Through the SOAWR coalition, Equality Now trains government officials and submitted 78 legal submissions to governmental bodies in 2024.

• End FGM European Network declared “no lobbying costs” on its EU transparency register while spending approximately €394,524 on “core activities” that include advocacy, communications, and governance. In 2024, the Network secured signatures from 144 European election candidates, 20 of whom became MEPs, and sent policy requests to incoming Commissioners.

• Sahiyo holds government contracts to implement Washington State’s FGM law and participates in a $300,000 DOJ cooperative agreement to provide training and technical assistance. Its program spending includes work with government officials to build systems of care.

• U.S. End FGM/C Network is a DOJ Office for Victims of Crime technical-assistance provider, participates in the same $300,000 DOJ cooperative agreement as Sahiyo, and holds a Washington State Department of Health contract with Sahiyo and Mother Africa. The Network describes its work as advocating for state FGM laws, strengthening the federal FGM law, and seeking increased government funding.

• Safe Hands for Girls trained Gambian prosecutors and Child Welfare Officers on investigating and prosecuting FGM. Its Form 990 describes sponsoring lawmakers’ visits to Egypt and engagement with governments and UN bodies to shape policy.

• Orchid Project holds responsibility for global advocacy within a U.K. FCDO-funded consortium and submits evidence to U.K. parliamentary inquiries on government policy toward FGM.

If we follow the money, these are not independent “grassroots” organizations. They receive money from the government, and in turn, serve the government and lobby for its preferred policies.

There is a name for this arrangement: sock puppets.

Sock Puppets

The 2012 paper Sock Puppets: How the Government Lobbies Itself and Why by Christopher Snowdon at the Institute of Economic Affairs defines sock-puppet organizations as state-funded pressure groups that “masquerade as civil society while promoting the ideology of the political elite.”

These organizations create “the illusion of grassroots support for new legislation” by appearing to be independent, instead of “government lobbying government.” If these organizations were funded by an industry, “we would call them front groups.”

The anti-FGM movement in the United States fits this model. Government money flows to these organizations, which they then use to lobby for the laws that support government prosecutions, to train the government officials to enforce those laws, and to seek more government funding. The money flows in a circle.

Snowdon is careful to note that this does not mean activists involved in sock-puppet organizations are not sincere or that their cause does not have merit. However, sock-puppet organizations create several issues, one of which is that those organizations lose any independent voice they once had, and “speak loudly when it agrees with its funders, but fall silent when it does not.”

Anti-FGM organizations’ actions align to government incentives:

• Anti-FGM organizations were loud when it meant supporting the government. Eight organizations filed amicus briefs, testified before state legislatures, gave media commentary, organized government roundtables, and lobbied Congress. All aligned with the Department of Justice's prosecution.

• Anti-FGM organizations went silent when it meant criticizing the government. When I asked all eight whether FGM doctors should continue to hold active medical licenses, six did not respond, one responded without answering the questions, and one had to be told to read the reporting before it revised its position. None knew the doctors were still licensed.

Even though there is no direct link between government funding and anti-FGM organization inaction, Snowdon’s model doesn’t require one. Incentives alone are enough to explain their behavior.

Supporting a federal prosecution aligned with the government. Criticizing a state licensing board's decision did not. So they did one, but not the other.

Grassroots Activism

One of the costs of sock-puppets is that they crowd out genuine independent voices by forcing them to compete against millions in public money with only their own resources.

The anti-FGM movement has tens of millions of dollars in annual revenue. The organizations in this article receive government grants, hold government contracts, and spend money lobbying the government. They did nothing to investigate the medical licensing of FGM doctors.

I am an independent journalist spending my own money. I did all of the research in this investigation in my spare time. I do not have government grants. I have a GoFundMe. I broke the story that they were still licensed. This is what actual grassroots look like. This is what a genuine anti-FGM movement would support.

When I reached out to the eight anti-FGM organizations mentioned, they did not pursue action that would put them in conflict with a government agency, instead of profiting from one. Their response is consistent with the behavior of sock-puppet organizations.

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Does America have a mandatory reporting crisis for female genital cutting?

Before I discovered that two physicians federally prosecuted for FGM still hold active, unrestricted Michigan medical licenses, I was researching mandatory reporting around female genital cutting.

Given that certain populations have majority female genital cutting rate and those populations are growing in the United States, then it follows that there should also be high mandatory reporting rates from doctors who see those populations.

I assumed that the first federal prosecution of FGM in the United States would have some information on this and went to look up how the medical license was taken in that case… only to discover it wasn’t. That lead to the six month investigation you can read in detail here:

However, the original mandatory reporting question remains unanswered.

Summary

Based on the available numbers, here is what the math shows:

• 390,000 women/girls in the U.S. estimated living with FGM

• 31,000 girls under 18 at risk.

• 39,000 OB/GYNs have likely seen it clinically.

• 30,000 doctors in a position to have filed a mandatory report on a minor.

• Failure to report suspected child abuse is a crime in 46 states, typically a misdemeanor punishable by up to a year in jail and fines up to $5,000.

• There are essentially zero at the national level.

That means approximately 30,000 doctors might have failed to fulfill a legal obligation to report suspected abuse of a minor, which carries criminal penalties in nearly every state.

How I arrived at those numbers:

Here is the math behind that.

Skip if you’re just here for the commentary, but read in detail if you want to check my numbers.

Survivors

The 2023 AHA Foundation/Orchid Project analysis, Female Genital Mutilation/Cutting in the United States, identified 1,325,989 U.S. women and girls with ancestry or birthplace links to countries or communities where FGM is practiced. Using American Community Survey data, country-of-origin prevalence rates, age-at-cutting data, and migration and acculturation adjustments, the study estimated that 384,714 of them are living with FGM. A separate estimate of approximately 5,500 Dawoodi Bohra women and girls, calculated from congregation and community size rather than the ACS method, brings the central estimate to about 390,000.

That is roughly 0.23% of all women and girls in the United States.

384,714 + 5,500 = 390,214
390,214 ÷ 172,601,353 U.S. women/girls = 0.23%

Minors at risk

The same study estimated 30,956 girls under 18 are still at risk of FGM. These are the cases most directly relevant to mandatory reporting — a minor who has undergone FGM, is suspected to have undergone it, or faces credible risk.

30,956 ÷ 73,483,744 U.S. minors = 0.04% of all minors
30,956 ÷ 35,800,000 U.S. girls under 18 = 0.09% of girls under 18

This figure likely undercounts. Girls cut in infancy — common in some Nigerian and Indonesian communities — are modeled as already living with FGM rather than “at risk,” so they don’t appear in the 30,956.

Doctors who have seen it

A national survey of OB/GYN physicians published in 2021 found that 66% of clinically active respondents had cared for a patient who had undergone female genital cutting. The AAMC counts 58,739 professionally active OB/GYNs in the United States.

58,739 × 0.66 = 38,768

Roughly 39,000 OB/GYNs have likely treated at least one FGM survivor in a clinical setting where the cutting would be visible — pelvic exams, pregnancy care, delivery, cervical screening.

A broader estimate using CDC physician visit rates (320.7 office visits per 100 people per year) and the survivor population suggests the total number of physicians who have encountered at least one FGM patient could range from 100,000 to 250,000. I use the OB/GYN figure because it is the cleanest — it comes from an actual survey rather than modeling.

390,214 survivors × 3.207 visits/year = 1,251,416 physician visits/year
1,251,416 ÷ 12 visits per physician = ~104,000 physicians (low end)
1,251,416 ÷ 5 visits per physician = ~250,000 physicians (high end)

Doctors in a position to report

Not every physician who sees an adult survivor has a mandatory reporting obligation. Mandatory reporting is most clearly triggered when a minor is involved. Modeling from the at-risk minor population, the number of direct-patient-care physicians, and the likelihood of clinical contact produces a central estimate of about 30,000 doctors who have been in a position where a mandatory report involving a minor and FGM could reasonably have been expected.

30,000 ÷ 1,032,365 active U.S. physicians = 2.9%
30,000 ÷ 866,460 direct-patient-care physicians = 3.5%

Population denominators

U.S. total population: 341,784,857
Female share: 50.5% → 172,601,353
Minors (under 18): 21.5% → 73,483,744
Girls under 18: 73,483,744 × 0.487 ≈ 35,800,000
Active U.S. physicians: 1,032,365
Direct-patient-care physicians: 866,460

Sources

AHA Foundation/Orchid Project, Female Genital Mutilation/Cutting in the United States (2023); CDC/Public Health Reports, updated estimates (2016); U.S. Census Bureau QuickFacts; AAMC 2025 Key Findings: Physician Specialty Data Report; PubMed, national OB/GYN survey on female genital cutting care experience (2021); CDC/NCHS FastStats, physician office visits; Child Welfare Information Gateway, Mandatory Reporting of Child Abuse and Neglect.

Caveats

The United States does not directly count FGM survivors. Every number above is an estimate derived from indirect methods — ancestry data, country-of-origin prevalence rates, survey responses, modeled visit rates. The survivor count applies source-country prevalence to diaspora populations, which may not reflect actual prevalence among immigrants and their U.S.-born children. The physician estimate relies on a single specialty survey extrapolated to the broader physician population. No national database tracks mandatory reports filed specifically for FGM. I am presenting these numbers because the scale of the gap between estimated physician exposure and known reporting demands the question, not because the numbers are precise.

Where is the mandatory reporting?

If the above math is correct, then even on the low-end, there should be thousands of mandatory reports from physicians around FGM. Where are they?

I don’t have data to answer that. There is no national database tracking mandatory reports filed specifically for FGM. State child protective services agencies track reports by category, but FGM is not consistently broken out as a separate category in most states. The reporting infrastructure is not designed to track this.

But the absence of data is itself informative. Federal prosecutors in United States v. Nagarwala alleged that as many as 100 girls were cut at a single clinic over twelve years. The case was discovered not because a physician filed a mandatory report but because of a tip to law enforcement. No medical organization I contacted would say that physicians who perform FGM on children should lose their medical licenses. The American Medical Association condemned FGM in the abstract but declined to say whether the specific physicians charged should be disciplined. The Federation of State Medical Boards refused to condemn genital cutting on children. Eight other organizations did not respond at all.

If the estimates are even roughly correct, the scale of the gap is difficult to explain as anything other than systemic. Thirty-one thousand minors at risk. Thirty thousand physicians in positions to report. A practice that is a federal crime under the STOP FGM Act of 2020 and illegal in most states. Yet a near-total absence of reporting.

The Michigan case I’ve documented provides one answer for how this happens. A licensing board authorized an investigation and then never assigned an investigator. An attorney general’s office recommended closure while the evidence was still being gathered. A complaint calling the practice “torture” was dismissed through a citation to a file that had no investigative authority. Board members were not even notified of the outcome. Two physicians whose case generated the first federal FGM prosecution in American history now practice together at a clinic in Detroit, accepting patients, their licenses renewed without review.

That is one state. One case. Two physicians. And it took more than a hundred FOIA requests, multiple appeals, and a six-month investigation to document what happened. If the system failed that completely for a case that made national headlines, the question is: What is happening with the thousands of cases that didn’t?

Is there a systemic failure to report female genital cutting by those in the medical system? No one has investigated that question yet.

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