[House Report 116-506]
[From the U.S. Government Publishing Office]


116th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                      {      116-506

======================================================================



 
 STRENGTHENING THE OPPOSITION TO FEMALE GENITAL MUTILATION ACT OF 2020

                                _______
                                

 September 16, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Nadler, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6100]

    The Committee on the Judiciary, to whom was referred the 
bill (H.R. 6100) to amend title 18, United States Code, to 
clarify the criminalization of female genital mutilation, and 
for other purposes, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for the Legislation..........................     2
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
New Budget Authority and Tax Expenditures and Congressional 
  Budget Office Cost Estimate....................................     5
Duplication of Federal Programs..................................     5
Performance Goals and Objectives.................................     6
Advisory on Earmarks.............................................     6
Section-by-Section Analysis......................................     6
Changes in Existing Law Made by the Bill, as Reported............     8

                          Purpose and Summary

    H.R. 6100, the ``Strengthening the Opposition to Female 
Genital Mutilation Act of 2020,'' or ``STOP FGM Act of 2020,'' 
would amend Section 116 of Title 18 to clarify the manner in 
which female genital mutilation (FGM)\1\ is prohibited in the 
U.S. Code. Specifically, the bill explicitly defines what types 
of procedures constitute female genital mutilation. In doing 
so, H.R. 6100 would fortify the prohibition against FGM.
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    \1\Female Genital Mutilation, or FGM, is sometimes referred to as 
Female Genital Mutilation/Cutting (FGM/C).
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    The STOP FGM Act of 2020 makes it a federal criminal act to 
knowingly (1) perform, attempt to perform, or conspire to 
perform female genital mutilation on a minor; (2) facilitate or 
consent to the female genital mutilation of a minor, while 
being a parent, guardian, or caretaker of the minor; or (3) 
transport a minor for the purpose of the performance of female 
genital mutilation on the minor.
    H.R. 6100 would increase the statutory maximum term of 
imprisonment for a violation of the federal statute pertaining 
to FGM--18 U.S.C. Sec. 116--from 5 years to 10 years. It would 
prohibit a defendant charged under section 116 from using as a 
defense the argument that they were compelled to commit the 
offense because of religion, custom, tradition, ritual, or 
standard practice.
    The STOP FGM Act of 2020 would also require the Attorney 
General, in consultation with other federal agencies, to submit 
an annual report to Congress to include: (1) an estimate of the 
number of women and girls in the United States who are at risk 
of FGM or who have been subjected to it; (2) a description of 
the protections available and actions taken by federal, state, 
and local agencies to protect such women and girls; and (3) a 
description of the actions taken by federal agencies to educate 
and assist communities and key stakeholders about FGM.

                Background and Need for the Legislation

    Female genital mutilation involves the partial or total 
removal of external female genitalia or other injury to the 
female genital organs for non-medical reasons.\2\ FGM can cause 
severe bleeding and problems urinating, and later cysts, 
infections, as well as complications in childbirth and an 
increased risk of newborn deaths.\3\ More than 200 million 
girls and women alive today have been cut in 30 countries in 
Africa, the Middle East, and Asia, where the practice of FGM is 
concentrated.\4\
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    \2\Female Genital Mutilation, World Health Organization) Feb. 3, 
2020), https://www.who.int/news-room/fact-sheets/detail/female-genital-
mutilation.
    \3\Id.
    \4\Id.
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    According to the World Health Organization, FGM is 
recognized internationally as a violation of the human rights 
of girls and women, reflecting deeply-rooted inequality between 
the sexes, and constituting an extreme form of discrimination 
against women.\5\ It is nearly always carried out on minors.\6\
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    \5\Id.
    \6\Id.
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i. United States v. Nagarwala

    H.R. 6100 was drafted to address the holding in United 
States v. Nagarwala,\7\ which dismissed the first federal 
prosecution under 18 U.S.C. Sec. 116(a) since the statute's 
enactment in 1996. Dr. Jumana Nagarwala (Nagarwala), a Detroit-
based emergency room physician, and other defendants were 
charged with performing FGM on minor girls out of a medical 
clinic in Livonia, Michigan.\8\ The United States presented 
evidence that some of the victims were residents of other 
states and, therefore, that they had traveled interstate to 
have the procedure performed in Michigan.\9\ Following 
Nagarwala's arrest, a representative from DOJ commented that 
Nagarwala ``is alleged to have performed horrifying acts of 
brutality on the most vulnerable victims,'' and that the DOJ 
``is committed to stopping female genital mutilation in this 
country and will use the full power of the law to ensure that 
no girls suffer such physical and emotional abuse.''\10\
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    \7\350 F. Supp.3d 613 (E.D. Mich. 2018), appeal dismissed by United 
States v. Nagarwala, 2019 WL 7425389, Case No. 19-1051 (6th Cir. Sep. 
13, 2019). The United States declined to defend the constitutionality 
of section 116(a) and voluntarily moved to dismiss its own appeal of 
the District Court's ruling. See Motion to Dismiss Voluntarily Pursuant 
FRAP 42(B) [Dkt. #40], United States v. Nagarwala, Case No. 19-1051 
(6th Cir. May 31, 2019).
    \8\Nagarwala, 350 F.Supp.3d at 615.
    \9\See id. at 616,
    \10\Detroit Emergency Room Doctor Arrested and Charged with 
Performing Female Genital Mutilation, U.S. Attorney's Office, E.D. 
Mich. (Apr. 13, 2017), https://www.justice.gov/usao-edmi/pr/detroit-
emergency-room-doctor-arrested-and-charged-performing-female-genital-
mutilation.
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    Before trial, the defendants moved to dismiss the third 
superseding indictment, arguing that Congress lacked the 
authority to enact section 116(a).\11\ The district court 
agreed and held that section 116(a) is ``unconstitutional''\12\ 
because ``Congress overstepped its bounds by legislating to 
prohibit FGM.''\13\ The court ruled that the statute did not 
satisfy (1) the Necessary and Proper Clause as a means of 
implementing the federal government's treatymaking authority in 
relation to the International Covenant of Civil and Political 
Rights (ICCPR),\14\ or (2) the Commerce Clause as, in the 
court's view, ``[t]here is nothing commercial or economic about 
FGM'' nor does ``FGM itself ha[ve] any effect on interstate 
commerce'' because no market exists for FGM beyond the mothers 
of the victims alleged in the indictment.\15\ On September 13, 
2019, the United States Court of Appeals for the Sixth Circuit 
granted the government's motion to voluntarily dismiss the 
appeal the government had previously filed and denied the U.S. 
House of Representatives' motion to intervene and for oral 
argument on the motion.\16\ The United States' withdrawal from 
the case left the district court's holding in place.
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    \11\Nagarwala, 350 F.Supp.3d at 616.
    \12\Id. at 630.
    \13\Id. at 620.
    \14\The ICCPR, a multilateral treaty, was ratified by the U.S. 
Senate in 1992. See https://www.ohchr.org/en/professional interest/
pages/ccpr.aspx; https://www.congress.gov/treaty-document/95th-
congress/20/resolution-text. The International Covenant on Economic 
Social and Cultural Rights, the Universal Declaration of Human Rights, 
and the ICCPR and its two Optional Protocols, are collectively known as 
the International Bill of Rights. The court found that ``there is no 
rational relationship'' between the FGM statute and the Articles in the 
ICCPR. See Nagarwala, 350 F. Supp. 3d at 618.
    \15\350 F. Supp. 3d at 630.
    \16\ Order Granting Dismissal and Denying as Moot Motions to 
Intervene and for Oral Argument [Dkt. # 49], United States v. 
Nagarwala, Case No. 19-1051, (6th Cir. Sep. 13, 2019).
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ii. Congress's Constitutional Authority

    Despite the district court's holding in Nagarwala, Congress 
maintains two bases upon which to enact a prohibition on FGM. 
Under Article I, Section 8 of the Constitution, Congress has 
the power ``[t]o make all laws which shall be necessary and 
proper for carrying into Execution'' treaties entered into by 
the United States.\17\ At the district court level, DOJ argued 
in Nagarwala that the FGM ban was an appropriate means of 
implementing Article 24 of the ICCPR.\18\ Article 24 states 
that, ``Every child shall have, without any discrimination as 
to race, colour, sex, language, religion, national or social 
origin, property or birth, the right to such measures of 
protection as are required by his status as a minor, on the 
part of his family, society and the State.''\19\ Despite 
precedent to the contrary, the district court observed that 
``the relationship between the FGM statute and Article 24 is 
tenuous.''\20\ It further found that even assuming the treaty 
and the FGM statute are rationally related, federalism concerns 
deprive Congress of the power to enact this statute.\21\
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    \17\U.S. Const., Art. I, Sec. 8, cl. 18 & Art. II, Sec. 2, cl. 2.
    \18\ See 350 F. Supp. 3d at 618.
    \19\ See https://www.ohchr.org/en/professionalinterest/pages/
ccpr.aspx.
    \20\Nagarwala, 350 F. Supp.3d at 618.
    \21\ Id.
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    The district court's holding is untethered from Supreme 
Court precedent. In Missouri v. Holland,\22\ the Supreme Court 
rejected an argument that a treaty-implementing statute usurped 
a power reserved to the states. The Holland Court reasoned that 
because the underlying ``treaty was valid, there can be no 
dispute about the validity of the statute under Article I, 
Sec. 8, as a necessary and proper means to execute the powers 
of the Government.''\23\
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    \22\ 252 U.S. 416 (1920).
    \23\Holland, 252 U.S. at 432.
---------------------------------------------------------------------------
    Congress also has the power under the Commerce Clause to 
prohibit FGM. Article I, Section 8, Clause 3 of the 
Constitution grants Congress the power ``to regulate Commerce 
with foreign Nations, and among the several States, and with 
the Indian Tribes.''\24\ To pass Constitutional muster, the 
government must show, under a rational-basis test, that FGM is 
either commercial or economic in nature and that it 
substantially affects interstate commerce directly or as part 
of an interstate market that has such an effect.\25\ The 
district court held that FGM is a ``purely local crime,'' and 
is not commercial or economic in nature.\26\ This 
interpretation ignores the interstate implications of the 
performance of an FGM procedure. Moreover, the Supreme Court 
has held in Wickard v. Filburn, that Congress has the power to 
regulate purely local activities that are part of an economic 
``class of activities'' which have a substantial effect on 
interstate commerce.\27\
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    \24\U.S. Const., Art. I, Sec. 8, cl. 3.
    \25\350 F. Supp. at 621.
    \26\Id. at 630.
    \27\317 U.S. 111, 124-25(1942).
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    The Commerce Clause also empowers Congress to regulate 
foreign commerce. In the United States, approximately 513,000 
women and girls were at risk for FGM/C or its consequences.\28\ 
And more than 3 million girls are estimated to be at risk for 
FGM annually, worldwide.\29\ The international implications of 
FGM are profound. Indeed, even the U.S. government has 
acknowledged as much. For instance, in 2018, the U.S. 
Immigration and Customs Enforcement (ICE) initiated Operation 
Limelight USA. Operation Limelight is an outreach program 
designed by ICE's Homeland Security Investigation's Human 
Rights Violators and War Crimes Unit to educate travelers on 
the dangers and consequences of FGM.\30\ In addition, both the 
Human Rights and Special Prosecutions Section of the DOJ 
Criminal Division and the FBI work domestically to prosecute 
and investigate cases involving FGM.\31\
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    \28\See Centers for Disease Control and Prevention, Women and Girls 
at Risk of Female Genital Mutilation/Cutting in the United States, Jan. 
2016, www.prb.org/us-fgmc.
    \29\See World Health Organization, Female genital mutilation, Jan. 
31, 2018, https://www.who.int/news-room/fact-sheets/detail/female-
genital-mutilation.
    \30\See U.S. Immigration and Customs Enforcement, ICE leads effort 
to prevent female genital mutilation at Newark Airport, June 25, 2018, 
https://www.ice.gov/news/releases/ice-leads-effort-prevent-female-
genital-mutilation-newark-airport.
    \31\See U.S. Dep't of Justice, Human Rights and Special 
Prosecutions Section, https://www.justice.gov/criminal-hrsp; see also 
ICE, FBI Recognize International Day of Zero Tolerance for Female 
Genital Mutilation/Cutting, FBI National Press Office, Feb. 6, 2018 
(noting that the Nagarwala case was a joint investigation conducted by 
the FBI and HSI).
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                                Hearings

    On July 16, 2019, the Subcommittee on Crime, Terrorism, and 
Homeland Security held a hearing titled, ``Women and Girls in 
the Criminal Justice System,'' which helped develop the 
substance of the STOP FGM Act of 2020.

                        Committee Consideration

    On March 11, 2020, the Committee met in open session and 
ordered the bill, H.R. 6100, favorably reported, by voice vote, 
a quorum being present.

                            Committee Votes

    No record votes occurred during the Committee's 
consideration of H.R. 6100.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

  New Budget Authority and Tax Expenditures and Congressional Budget 
                          Office Cost Estimate

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has requested 
but not received a cost estimate for this bill from the 
Director of Congressional Budget Office (CBO). The Committee 
has requested but not received from the Director of the CBO a 
statement as to whether this bill contains any new budget 
authority, spending authority, credit authority, or an increase 
or decrease in revenues or tax expenditures.

                    Duplication of Federal Programs

    No provision of H.R. 6100 establishes or reauthorizes a 
program of the Federal government known to be duplicative of 
another federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
6100 would strengthen and clarify the definition of FGM to 
ensure more effective prosecution by the federal government of 
those who engage in this heinous practice. Additionally, the 
bill would require a report to Congress regarding the 
prevalence and practice of FGM and the protections available 
and actions taken by Federal, State, and local agencies to 
protect women and girls from FGM.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 6100 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                      Section-by-Section Analysis

    The following discussion describes the bill as reported by 
the Committee.
    Section 1. Short title. The title of this Act is the 
``Strengthening The Opposition to Female Genital Mutilation Act 
of 2020'' or the ``STOP FGM Act of 2020.''
    Sec. 2. Congressional findings and purpose. Section 2 sets 
forth several Congressional findings pertaining to female 
genital mutilation, which go to assert the propriety of 
Congressional action prohibiting this practice. To begin, the 
findings underscore that FGM is recognized internationally as a 
human rights violation and a form of child abuse, gender 
discrimination, and violence against women and girls; that its 
eradication requires international cooperation and enforcement 
at the national level; and that the United States should 
demonstrate its commitment to the rights of women and girls by 
banning it. The findings further state that Congress has 
previously prohibited the practice in relation to minors as it 
is a practice that inflicts excruciating pain on its victims 
and causes grave physical and psychological harm. In addition, 
Congress has the power to prohibit female genital mutilation 
under the Necessary and Proper clause of the U.S. Constitution, 
to make all laws that are necessary and proper for carrying 
into execution treaties entered into by the United States, and 
under the Commerce Clause of the U.S. Constitution because an 
international market for the practice exists, persons who 
perform FGM in other countries typically earn a living from 
doing so, and those who perform this conduct often rely on a 
connection to interstate or foreign commerce. Finally, the bill 
finds that amending the statute to specify a link to interstate 
or foreign commerce would confirm that Congress has the 
affirmative power to prohibit the conduct involved in female 
genital mutilation.
    Sec. 3. Amendments to current law on female genital 
mutilation. Section 3 would amend title 18, section 116 of the 
U.S. Code by setting forth three groups of persons who can be 
prosecuted under the statute: (1) anyone who knowingly 
performs, attempts to perform, or conspires to perform, female 
genital mutilation on a minor (i.e., someone who has not 
attained the age of 18 years); (2) a parent, guardian, or 
caretaker of a minor who knowingly facilitates or consents to 
the female genital mutilation of the minor; and (3) anyone who 
knowingly transports a minor for the purpose of performance of 
female genital mutilation on the minor. Section 3 would also 
increase the statutory maximum for a violation of the statute, 
from 5 years to 10 years.
    Section 3 would prohibit a defendant charged with this 
offense from using as a defense the argument that they were 
compelled to commit the offense because of religion, custom, 
tradition, ritual, or standard practice.
    Section 3 would also explicitly set forth a series of 
circumstances under which the offense of female genital 
mutilation would be committed, including (among others) that 
the conduct occurred in the special maritime and territorial 
jurisdiction of the United States, or any territory or 
possession of the United States; the defendant or victim 
traveled in interstate or foreign commerce; the defendant used 
a means of interstate or foreign commerce in furtherance or in 
connection with the conduct; payment of any kind was made using 
any means, channel, facility, or instrumentality of interstate 
or foreign commerce; the defendant used a means of 
communication affecting interstate or foreign commerce; any 
instrument, item, substance, or other object that traveled in 
interstate or foreign commerce was used; and the conduct 
otherwise occurred in or affected interstate or foreign 
commerce .
    Section 3 would also amend the existing statute to 
explicitly define what specific types of procedures constitute 
female genital mutilation. FGM is defined as any procedure 
performed for non-medical reasons that involves partial or 
total removal of, or other injury to, the external female 
genitalia, and includes: (1) a clitoridectomy or the partial or 
total removal of the clitoris or the prepuce or clitoral hood; 
(2) excision or the partial or total removal (with or without 
excision of the clitoris) of the labia minora or the labia 
majora, or both; (3) infibulation or the narrowing of the 
vaginal opening (with or without excision of the clitoris); or 
(4) other procedures that are harmful to the external female 
genitalia, including pricking, incising, scraping, or 
cauterizing the genital area.
    Sec. 4. Report. Section 4 imposes an obligation upon the 
Attorney General, in consultation with the Secretary of 
Homeland Security, the Secretary of State, the Secretary of 
Health and Human Services, and the Secretary of Education, to 
submit an annual report to Congress including: (1) an estimate 
of the number of women and girls in the United States at risk 
of female genital mutilation or who have been subjected to it; 
(2) the protections available and actions, if any, taken by 
Federal, State, and local agencies to protect such women and 
girls; and (3) the actions taken by Federal agencies to educate 
and assist communities and key stakeholders about female 
genital mutilation.
    Sec. 5. Sense of the Congress. Section 5 would express the 
sense of the Congress that, in United States v. Nagarwala, 350 
F. Supp. 3d 613 (E.D. Mich. 2018), the U.S. District Court for 
the Eastern District of Michigan erred in invalidating the 
version of section 116 that this bill seeks to amend. Section 5 
would express the sense of Congress that the commercial nature 
of female genital mutilation is ``self-evident,'' meaning that 
the absence of particularized findings in the predecessor 
statute did not call into question Congress's authority to 
legislate. The bill would further express that, in amending the 
statute, Congress would nevertheless not be ratifying the 
district court's erroneous interpretation in Nagarwala.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 18, UNITED STATES CODE

PART I--CRIMES

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CHAPTER 7--ASSAULT

           *       *       *       *       *       *       *


Sec. 116. Female genital mutilation

  [(a) Except as provided in subsection (b), whoever knowingly 
circumcises, excises, or infibulates the whole or any part of 
the labia majora or labia minora or clitoris of another person 
who has not attained the age of 18 years shall be fined under 
this title or imprisoned not more than 5 years, or both.]
  (a) Except as provided in subsection (b), whoever, in any 
circumstance described in subsection (d), knowingly--
          (1) performs, attempts to perform, or conspires to 
        perform female genital mutilation on another person who 
        has not attained the age of 18 years;
          (2) being the parent, guardian, or caretaker of a 
        person who has not attained the age of 18 years 
        facilitates or consents to the female genital 
        mutilation of such person; or
          (3) transports a person who has not attained the age 
        of 18 years for the purpose of the performance of 
        female genital mutilation on such person,
shall be fined under this title, imprisoned not more than 10 
years, or both.
  (b) A surgical operation is not a violation of this section 
if the operation is--
          (1) necessary to the health of the person on whom it 
        is performed, and is performed by a person licensed in 
        the place of its performance as a medical practitioner; 
        or
          (2) performed on a person in labor or who has just 
        given birth and is performed for medical purposes 
        connected with that labor or birth by a person licensed 
        in the place it is performed as a medical practitioner, 
        midwife, or person in training to become such a 
        practitioner or midwife.
  [(c) In applying subsection (b)(1), no account shall be taken 
of the effect on the person on whom the operation is to be 
performed of any belief on the part of that person, or any 
other person, that the operation is required as a matter of 
custom or ritual.
  [(d) Whoever knowingly transports from the United States and 
its territories a person in foreign commerce for the purpose of 
conduct with regard to that person that would be a violation of 
subsection (a) if the conduct occurred within the United 
States, or attempts to do so, shall be fined under this title 
or imprisoned not more than 5 years, or both.]
  (c) It shall not be a defense to a prosecution under this 
section that female genital mutilation is required as a matter 
of religion, custom, tradition, ritual, or standard practice.
  (d) For the purposes of subsection (a), the circumstances 
described in this subsection are that--
          (1) the defendant or victim traveled in interstate or 
        foreign commerce, or traveled using a means, channel, 
        facility, or instrumentality of interstate or foreign 
        commerce, in furtherance of or in connection with the 
        conduct described in subsection (a);
          (2) the defendant used a means, channel, facility, or 
        instrumentality of interstate or foreign commerce in 
        furtherance of or in connection with the conduct 
        described in subsection (a);
          (3) any payment of any kind was made, directly or 
        indirectly, in furtherance of or in connection with the 
        conduct described in subsection (a) using any means, 
        channel, facility, or instrumentality of interstate or 
        foreign commerce or in or affecting interstate or 
        foreign commerce;
          (4) the defendant transmitted in interstate or 
        foreign commerce any communication relating to or in 
        furtherance of the conduct described in subsection (a) 
        using any means, channel, facility, or instrumentality 
        of interstate or foreign commerce or in or affecting 
        interstate or foreign commerce by any means or in 
        manner, including by computer, mail, wire, or 
        electromagnetic transmission;
          (5) any instrument, item, substance, or other object 
        that has traveled in interstate or foreign commerce was 
        used to perform the conduct described in subsection 
        (a);
          (6) the conduct described in subsection (a) occurred 
        within the special maritime and territorial 
        jurisdiction of the United States, or any territory or 
        possession of the United States; or
          (7) the conduct described in subsection (a) otherwise 
        occurred in or affected interstate or foreign commerce.
  (e) For purposes of this section, the term ``female genital 
mutilation'' means any procedure performed for non-medical 
reasons that involves partial or total removal of, or other 
injury to, the external female genitalia, and includes--
          (1) a clitoridectomy or the partial or total removal 
        of the clitoris or the prepuce or clitoral hood;
          (2) excision or the partial or total removal (with or 
        without excision of the clitoris) of the labia minora 
        or the labia majora, or both;
          (3) infibulation or the narrowing of the vaginal 
        opening (with or without excision of the clitoris); or
          (4) other procedures that are harmful to the external 
        female genitalia, including pricking, incising, 
        scraping, or cauterizing the genital area.

           *       *       *       *       *       *       *


                                  [all]