On International Day for the Elimination of Violence Against Women 2004, Andrew Natsios, administrator of the U.S. Agency for International Development (USAID), stated that, "Not only does such violence impede women's ability to live full and productive lives, but it restricts their contributions to family, society, and economic development." In Darfur, Sudan, Natsios noted that women still suffer from an "appalling number of rapes and other sexual violence, branding, maiming, and displacement ... leading to the disintegration of families, ostracism of the victims, and ultimately mental, medical, and economic consequences of untold proportions." He cited the $113 million that USAID had sent to the Darfur region to help with shelter, food, medical care, and other relief, which includes specific funding for Physicians for Human Rights to address sexual violence.

Gender-based violence is of particular concern when dealing with refugees and displaced persons, since the majority are women and children. They are exposed to violence at every stage of their flight, and they are at risk even after they become refugees. They face horrific dangers: sexual violence in the form of rape and exploitation, as well as after-effects — HIV/AIDS, post-traumatic stress disorder, and other afflictions — that may not appear for months or even years.

Improving protection for women in conflict situations and for refugee women and girls and ensuring that humanitarian programs focus on their needs and concerns are U.S. government goals. In Fiscal Year 2003, the U.S. Department of State provided over $4 million of its contributions to the U.N. High Commissioner for Refugees (UNHCR) for women and children's special programming. In addition, it gave more than $2 million to UNHCR and nongovernmental organizations (NGOs) for gender-based violence-prevention programs. The article on "Building Peace in War-Torn Countries" points out that since 2002, the United States has provided some $10 million to NGOs for programs that focus on prevention and response to rape, sexual exploitation, domestic violence, and more. In over 15 conflict areas where women are at risk — including East Timor, Eritrea, Kosovo, Liberia, Pakistan, Sierra Leone, and Uganda — NGO grantees on the ground provide counseling, health care, and legal aid to victims of violence; they teach girls how to resist sexual exploitation; and they educate entire communities about preventing domestic abuse.

Trafficking in Persons: A Human Rights Concern

Human trafficking is first and foremost a grave violation of human rights. It inflicts unspeakable physical and psychological damage on its victims, primarily women and children, and it feeds growing global health problems, such as sexually transmitted diseases and HIV/AIDS. It also fuels organized crime, undermining the safety and security of communities worldwide.

Emphasizing the U.S. commitment to ending this plague, President Bush brought international attention to trafficking in persons during his 2003 U.N. General Assembly address. He announced the launch of a $50-million U.S. anti-trafficking initiative. "We must show new energy in fighting back an old evil," he said. "Nearly two centuries after the abolition of the transatlantic slave trade, and more than a century after slavery was officially ended in its last strongholds, the trade in human beings for any purpose must not be allowed to thrive in our time." In June 2004, the Department of State announced that the recipients for the president's new anti-trafficking initiative would be Brazil, Cambodia, India, Indonesia, Mexico, Moldova, Sierra Leone, and Tanzania.

The Bush administration has provided more than $295 million to support anti-trafficking programs in more than 120 countries. This funding helps countries to develop laws, create special law enforcement units to investigate cases, rescue victims, build emergency shelters, conduct voluntary repatriation for displaced victims, run information and awareness campaigns, and create long-term rehabilitation and vocational training programs.

As the president mentioned in his U.N. address, state-sanctioned ownership of human beings ended early in the 20th century. However, each year an estimated 600,000 to 800,000 people are illegally trafficked as slaves across international borders. Millions more are trafficked within the borders of their own countries. Estimates of the total number of victims of trafficking reach the millions.

According to Ambassador John R. Miller, senior advisor to the U.S. Secretary of State and director of the State Department's Office to Monitor and Combat Trafficking in Persons, U.S. data find that 80 percent of the trafficked persons are female and up to 50 percent are children. "Sex slavery ... is the dominant form," he noted, "then domestic servitude, both of which are largely women or girls. What was once a race issue has become primarily a gender issue."

Ambassador Miller feels "a corner has been turned" in increasing global attention to this problem. He called the 8,000 or so prosecutions and 2,800 convictions worldwide in 2003 an "enormous" increase. And he pointed to a number of U.N. protocols and other international covenants calling for the abolition of trafficking in persons.

Trafficking: The International Effort

The United States is confronting nations that profit from or tolerate human trafficking. Those countries face possible sanctions that include the loss of U.S. military and economic assistance and U.S. support at the World Bank and the International Monetary Fund. This approach and the State Department's annual listing of countries in its Trafficking in Persons Report have helped heighten international awareness of human trafficking.

The U.S. report is a diplomatic tool, encouraging governments around the world to cooperate in the global effort to end trafficking in persons. The 2004 report looks at 140 countries that have significant numbers of victims of severe forms of trafficking. Countries are rated according to their efforts to eliminate trafficking in persons.

Tier 1 countries are those that comply with the TVPA's minimum standards for the elimination of trafficking. Tier 2 countries do not yet fully comply with these standards, but they have been making significant efforts to do so. Tier 2 Watch List countries require special scrutiny because they have a high number of victims or have failed to provide sufficient evidence of their efforts to combat trafficking. Tier 3 countries do not satisfy the minimum standards of the TVPA or show any effort to do so.

A Tier 3 assessment can result in the withholding of U.S. nonhumanitarian, nontrade-related assistance to those countries. Countries listed on Tier 3 can avoid sanctions by taking swift action within three months of the report's release.

Bangladesh was one of the countries that did just that. Within 90 days of the release of the 2004 report, its government substantially increased anti-trafficking activities. It opened an office on trafficking in persons. It completed 17 trafficking-related cases, resulting in 30 convictions. It launched a number of law enforcement operations against suspected traffickers, leading to the arrest of 47 persons and the rescue of 102 victims. As a result of its efforts, Bangladesh was moved from Tier 3 onto the Tier 2 Watch List.

Through the Department of State, U.S. assistance goes to NGOs also combating trafficking. The Angel Coalition, one of the groups funded by the department, assists NGOs in Russia and is building an international hotline to improve investigation of trafficking rings that will lead to more convictions in court. Grants from the U.S. Agency for International Development (USAID) go to NGOs such as the International Justice Mission, a faith-based organization fighting trafficking in Cambodia.

The United States works through international organizations, too, to fight trafficking in persons. This includes promoting and supporting resolutions in various U.N. forums, and providing voluntary contributions to U.N. bodies that assist victims of trafficking and countries that suppress trafficking. For example, U.S. contributions enable the U.N. to translate and distribute public service anti-trafficking announcements in Chinese, French, German, Hausa, Portuguese, Russian, Spanish, and Swahili. U.S. funds also were used to help establish a center in Indonesia where victims receive medical, legal, and psychological care before returning home.

To bring greater international attention to the problem of a growing demand for child prostitutes, and to stimulate foreign government action, the United States cohosted a luncheon panel discussion in New York with World Vision and pop singer Ricky Martin in 2004. At the event, Martin spoke eloquently about the work of his foundation and the urgent need for the United Nations to help governments and NGOs end the tragedy of child sex tourism. The United States also has signed the Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children, part of the U.N. Convention on Transnational Organized Crime. The next step is for the U.S. Senate to approve it.

U.S. Domestic Efforts Multiply

As the United States fights the trade in human beings abroad, it also has launched an unprecedented domestic effort to deal with it at home. Last August, for example, a Federal District Court sentenced two women to prison for the maximum time allowable — more than 17 years — for bringing four Mexican girls into the United States and forcing them into prostitution.

Rising levels of U.S. assistance to victims of trafficking clearly demonstrate the importance that the U.S. government places on protecting vulnerable women and children. Victims can receive, for example, cash, medical care, legal aid, and the opportunity to apply for permanent residence in the United States. Dozens of NGOs throughout the United States have received more than $35 million to aid these victims. In 2003, the TVPA was amended to include a provision that allows victims to sue their traffickers in federal district court.

The United States has seen quick results at home after passage of TVPA in 2000. Within the first two years, federal prosecutors initiated prosecutions against 79 traffickers — three times as many as in the two previous years. Nearly 400 victims in the United States received assistance through the Departments of Health and Human Services (HHS), Justice, State, and Labor, among others. Such focused efforts are increasing.

In Fiscal Year 2003, HHS issued nearly $3.5 million to 15 organizations to meet the needs of victims of trafficking, including temporary housing, training in independent living skills, cultural orientation, and transportation needs, as well as access to appropriate educational programs and legal assistance and referrals. HHS may also provide victims with intensive case-management programs to help them obtain housing, find employment, receive mental health counseling, and obtain specialized foster care programs for their children.

The U.S. Department of Defense has issued a zero-tolerance policy for any service member found participating in human trafficking, and it has instituted a universal mandatory training program about sex slavery. Legislation is currently under review by the U.S. Congress to make brothel patronage a crime under the Uniform Code of Military Justice. The United States is also working with the United Nations to ensure that its peacekeepers do not visit brothels and thereby attract or subsidize human trafficking for sexual purposes.

Female Genital Cutting

Like trafficking in persons, female genital cutting (FGC), also known as female genital mutilation or female circumcision, has only recently gained attention as a practice that harms victims, with serious and potentially grave health consequences.

Some of the immediate health consequences of this practice include hemorrhage or shock, which can result in death, severe pain, injury to the urethra, acute urine retention, infections, and failure to heal. Long-term complications include recurrent urinary tract infections, pelvic infection, infertility, scarring, and obstructed childbirth.

There are many reasons the world has found it difficult to eradicate this violent practice. For one thing, many practicing communities fail to understand the relationship between FGC and its serious health and psychological consequences. In addition, some practicing societies see it as a way to ensure fidelity or make a girl more marriageable, and thereby attract a better dowry. Many say it is an act of love for their daughters, who typically undergo FGC between the ages of two and 11. Some believe it is mandated by their religion or that it will promote good health. In some societies, uncircumcised women may not hold elective office.

Since the 1980s, USAID has provided assistance to eliminate female genital cutting. Yet, the practice has proved tenacious. In Egypt, for example, prevalence remained at 97 percent from 1994 to 2003; in Mali, it declined a mere 2 percent, from 94 percent to 92 percent, over that period. Sadly, the age of mutilation is going down — in Egypt from age 10 to age three, and in Mali from age three to one. Minority groups in some Asian countries, including India and Indonesia, still practice it.

The practice has spread through immigration to Europe and North America. It is now an issue in major U.S. cities like Los Angeles, San Diego, Houston, New York, and Boston. Consequently, the U.S. government has accelerated its domestic efforts. In 1996, Congress passed a law making performance of female genital cutting on a girl under the age of 18 a federal crime. On February 6, 2004 — Zero Tolerance Day for FGC — a symposium was held at the National Press Club in Washington, D.C., to focus on the challenges and best practices in getting local communities to abandon female genital cutting. Speakers ranged from a village worker in Senegal to a Boston physician who dealt with the problem.

The U.S. government funds educational and information programs about the harmful effects of FGC in numerous countries, increasing funding from zero to $500,000 in 2002, and again in 2004 to $2.2 million. In Burkina Faso, Chad, Djibouti, Egypt, Eritrea, Ethiopia, The Gambia, Ghana, Guinea, Kenya, Mali, Senegal, Somalia, Togo, and Yemen, U.S. funds have helped train health care providers about FGC's long-term consequences, supported research on the prevalence of the practice, and helped countries develop and test strategies to end it.

Substantial results are evident already. In Senegal, where studies estimate that 20 percent of women have undergone FGC, USAID funding allowed Tostan — an NGO based in that country — to develop a village empowerment project to address women's health issues such as FGC in a holistic manner. The project strives to educate men as well as women about the consequences. After just two years, women participants demonstrated the most knowledge about the practice and experienced the greatest shift in attitudes. Surprisingly, 105 villages in the region (with some 80,000 inhabitants) held a public ceremony at which they issued a declaration ending the practice.

It is too soon to judge the long-term success of these efforts. But Dr. Abdelhadi Eltahir, USAID's senior technical advisor on female genital cutting, points to surveys that show a decline in the practice. He is encouraged by an increase in public declarations against the practice in villages where it used to be acceptable. Bougouni, Mali, is such a village. According to Eltahir, its chief has declared a 10-year moratorium on girls' circumcision. The village chief believes setting a specific time frame for ending it is easier to impose than a decision to stop the practice immediately. And he believes that 10 years will be sufficient time for the community to abandon the practice permanently.

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