Female genital mutilation (FGM) is often thought of as a distinctly foreign issue. The practice is primarily performed in the Middle East and Africa, but unfortunately, it has cropped up on other continents — the U.S. is no exception. New York in particular sees too much of it, as it has the second-highest number of women and girls at risk for FGM in the country.

Following only California, New York is home to about 48,000 women and girls deemed to be at risk for FGM, a figure based on ties to countries with a high prevalence of FGM. This is almost 10 percent of all at-risk females in the U.S. (about 500,000), and 13 percent of these live in the New York City metropolitan area. New legislation hopes to reduce these numbers.

Illegal under federal law, FGM is not widely understood throughout the country. New York Governor Andrew Cuomo signed legislation in November that will add information about the “physical, sexual, and psychological consequences of undergoing female genital mutilation” to the state’s “health care and wellness education and outreach.”

In the most common types of FGM, the clitoris is partially or completely removed. In a rarer form called infibulation, all external female genetalia is removed and the vulva is sowed shut, requiring another procedure to open it for childbirth. The World Health Organization calls FGM a “violation of the human rights of girls and women” that “reflects deep rooted inequality between the sexes.”

It’s an accurate description: the practice has exactly zero health benefits, inhibits sexual function, and can cause several physical complications including infection, pain, and even infertility.

Lawmakers say that without publicizing the existence of the practice and its risks, there isn’t much hope for effective enforcement of the laws we have in place to prevent FGM. One example was that of New York City social worker Mariama Diallo, who told PBS this summer that she personally knew of four cases of "vacation cutting," the practice of sending a girl out of the country to be cut (also illegal). In one of the cases, the girl apparently tried to get help from her school guidance counselor after learning that her family was planning to send her to Africa for FGM.

“She spoke with the guidance counselor, who did not know what she was talking about,” Diallo said. “And the guidance counselor sent her back home. And I think if it was another case where the child went to see a guidance counselor, told them something as simple as, ‘I don’t feel safe. I’m not going back home,’ they would call the Children’s Services. But with FGM, they see it as a cultural problem. So, they don’t want to get involved.”

New York’s campaign to raise awareness is taking shape, according to Shelby Quast, the Americas director for Equality Now, an international human-rights organization that has taken a leadership role in advocating for FGM awareness. “Just because there’s a law on the books doesn’t mean people are aware of it,” she told The Daily Beast. “It doesn’t mean that hospitals, physicians, teachers, or individual communities are aware of it. So there has to be a lot of public awareness raising.”