(Reuters)

Minnesota state Rep. Mary Franson received a note from a friend last year urging her to draft stricter legislation against female genital mutilation. The state had banned the practice in 1994, so the Republican worried that a new law would seem ­“Islamophobic,” given its target audience.

One case changed her mind.

Federal prosecutors last month charged a Michigan doctor and his wife in connection with performing the procedure on two Minnesota girls. The parents of one girl — believed to have been involved in arranging the procedure — lost custody “for a whopping 72 hours,” Franson told lawmakers on the floor of the Minnesota statehouse last week.

Another Michigan doctor, ­Jumana Nagarwala of Detroit, has been charged in a separate case.

Now Franson wants Minnesota to pass a bill that would send perpetrators to prison for up to 20 years, targeting parents as well as doctors.

FBI agents leave the office of Dr. Fakhruddin Attar at the Burhani Clinic in Livonia, Mich., on April 21, after completing a search. The investigation is connected to the case of Dr. Jumana Nagarwala, of Northville, charged with performing genital mutilation on two young girls from Minnesota. (Clarence Tabb Jr./Detroit News via AP)

“We’re saying that if you harm your child in this way, you’re going to be held responsible,” she said.

Female genital mutilation has been a federal crime in the United States for more than two decades, carrying a maximum sentence of five years in prison. But the three doctors are the first to be charged under the law. The case has set off a flurry of new bills across the country, with a growing number of states moving to extend penalties to the parents and hit them with lengthy prison terms.

The issue has been a lightning rod in right-wing political circles for years, with anti-Muslim and anti-immigration activists linking it explicitly to Islam. In fact, there is no mention of female genital mutilation in the Koran, and the procedure is rare in most Muslim countries. But attorneys for the doctors, all three of whom are Muslim, say their trial defense next month is likely to invoke religious freedom, a move that is sure to lend the case even more political ammunition.

Republican-authored bills are pending in Michigan, Minnesota, Texas and Maine, and activists say Massachusetts is also weighing legislative action.

In Minnesota, which is among the 25 states that ban female genital mutilation, state representatives on May 15 voted 124 to 4 in favor of expanding the penalties. The bill will go to the state Senate for consideration, but it will probably be signed into law before the fall.

Female genital mutilation (FGM), sometimes called female genital cutting or circumcision, refers to the ancient, ritual practice of cutting off parts of a girl’s genitalia, and sometimes sewing shut the vaginal opening. It has no health benefits and can result in serious complications, including hemorrhaging and death, the lifelong loss of sexual pleasure, painful intercourse, and chronic infections.

The World Health Organization says more than 200 million women and girls living in 30 countries have experienced FGM. Most of those countries are in Africa.

Toddler Salsa Djafar cries as a traditional healer conducts a circumcision in Indonesia, where female circumcision is often considered a rite of passage. (Bay Ismoyo/AFP/Getty Images)

The practice spans an array of ethnic and religious groups despite nearly universal national bans. Although the rationale for the practice varies, experts say it is often driven by social pressures to control women’s sexuality and ensure girls’ virginity before marriage. Some practitioners also believe that it serves a religious mandate, although the practice has no root in religious doctrine.

Some Muslim clerics have endorsed the practice, but a number of major Muslim leaders have condemned it. The three doctors in Michigan and the girls whom investigators say they cut are from the tiny Dawoodi Bohra sect of Shiite Islam, in which the practice is common and clerics are said to endorse it. The doctors’ trial is set for next month.

There’s no reliable data on how common the practice is in the United States, according to the authors of a 2016 Government Accountability Office report. But the Centers for Disease Control and Prevention estimates that about 513,000 women and girls in the United States either had the procedure or are at risk of experiencing it in the future, based on immigrant populations from countries where the practice is prevalent, including Somalia, Ethi­o­pia and Sudan.

The Maine law would make parents who consent to FGM liable for up to 10 years behind bars. This month, the Texas state Senate unanimously approved a similar bill that would allow the state to prosecute people “who transport or permit the transport of a person for the purpose of FGM,” said the bill’s author, state Sen. Jane Nelson (R).

In Michigan, where the state Senate unanimously approved a package of bills on female genital mutilation May 17, perpetrators and accomplices would face up to 15 years in prison.

“We want to send the message that Michigan is not the place to bring your daughter for this evil, horrific, demonic practice,” state Sen. Rick Jones (R) told his colleagues during a recent hearing on the measure.

The Department of Homeland Security, which is responsible for criminal investigations under the federal ban, is set to launch a pilot program next month that aims primarily to reduce FGM abroad by warning travelers of its illegality. The practice of taking girls abroad to be cut, sometimes called “vacation cutting,” was banned in 2013.

The program, Operation Limelight USA, will be limited to John F. Kennedy International Airport in New York, although officials said they are still drafting specifics on how it will work.

The fresh wave of attention has been bittersweet for the U.S.-based activists who have spent years campaigning to end a practice that they say is poorly understood and generally ignored by the public, law enforcement and U.S. officials.

“When things like this happen, people just want to focus on getting all states to penalize it. But there’s a bigger picture out here that we’re not focusing on,” said Jaha Dukureh, the founder of the Atlanta-based Safe Hands for Girls, a leading advocacy group against FGM.

Dukureh, who underwent the procedure as an infant in Gambia, said she would rather see education and outreach aimed at preventing the practice than punishment alone.

For instance, many activists, doctors and lawmakers have said they want better training for medical professionals so they can address the issue with pregnant women who have experienced FGM before they give birth to girls. And they want to see efforts to spread awareness of the procedure’s dangers in vulnerable schools and communities, enlisting the support of neighborhood and religious leaders in condemning it.

Somali American activists have been pushing legislators for funds to prevent the practice through education and outreach, said Minnesota state Rep. Susan Allen of the Democratic-Farmer-Labor Party.

“They have not gotten resources,” she said.

The United States banned female genital mutilation in 1997, and in 2003 banned the transport of a minor abroad to have the procedure. But there have been only two other FBI investigations into the practice over the past two decades. In both cases, the FBI was unable to find victims, and only one of the cases, in California, led to charges, according to the GAO report.

Experts say a culture of shame and secrecy — or even ignorance of having undergone a procedure that they might have been too young to remember — keeps many from talking about FGM in the United States.

Deborah Thorp, who is an ­obstetrician-gynecologist in Minneapolis, said she sees at least one patient a day who has undergone FGM. Many are older refugees from Somalia, where the prevalence rate is 98 percent.

But she said she doubts that the practice is common for Somali American children who are born in the United States.

“I’m seeing a lot of moms who are so angry that it got done to them that I have a hard time thinking that they would ever have anything to do with it,” she said.

Some activists and Democratic lawmakers have argued — in lieu of hard data about the prevalence of FGM — that racism, Islamophobia and anti-immigrant sentiments have played a role in fueling enthusiasm for the new policies.

Far-right blogs and news websites have long perpetuated the myth that FGM is a common Islamic practice by immigrants who are fundamentally at odds with American society.

FGM and honor killings “would not exist in the U.S. without mass immigration bringing its practitioners into U.S. communities,” Breitbart reporter ­Katie McHugh wrote in March. Stephen Miller, a top aide to President Trump, has voiced the same sentiment.

In Minnesota last week, some dissenting lawmakers worried that meting out “draconian” punishment for a poorly understood crime might make it worse. The Minnesota law would make it easier and more likely for the state to take custody of a child whose parent is suspected of involvement in FGM. For suspects who are not yet U.S. citizens, the crime would probably mean deportation.

“When you start removing children from their families, increasing penalties for families,” Allen, the state lawmaker, said, “it’s likely that it may deter them from reporting the violence. They may not cooperate with police.”

Alice Crites contributed to this report.