A/HRC/29/20 59. Legislation in most countries provides for large fines and prison sentences for those who engage in the practice. However, effective enforcement is often inadequate, particularly in States with plural legal systems and even more so where customary, traditional or religious norms may appear to support female genital mutilation. Furthermore, prosecutions remain rare. This is partly due to the nature of the practice, which poses particular investigation challenges to law enforcement officials. The ceremony is often deeply taboo, usually performed in the privacy of the family or community and shrouded in secrecy. It is also not immediately obvious that a woman or a girl has been subjected to female genital mutilation, and law enforcement officials often lack accessibility to rural areas where it is carried out. In a number of places, the enforcement of laws against female genital mutilation and the punitive legal approach has driven the practice underground. 60. There is also a gap in the protection afforded by existing legal frameworks. Most States have criminalized female genital mutilation when it takes place on national territory or when a girl is taken abroad for mutilation if she is a citizen or permanent resident of the State. This fails to recognize the obligation of States to protect all children within their jurisdiction and does not take into consideration the mobile, transnational character of practicing communities. A further challenge is insufficient collaboration among Governments across borders. Girls living near border areas are most vulnerable, particularly if they are living next to countries with weaker legislation against the practice than their own. 61. There is evidence that the medicalization of female genital mutilation has risen. However, reliable data on medicalization is difficult to obtain. Allowing medical professionals to perform the practice is often the logical response of parents who are under social pressure to have their daughter undergo female genital mutilation, but who want to minimize harm. Medicalization can also act as an additional source of income for healthcare workers and can undermine efforts to eliminate the practice.22 62. United Nations and regional human rights mechanisms have raised concerns with regard to genital surgeries on intersex infants and children for non-medical reasons.23 The Committee on the Rights of the Child has called upon States to ensure that no one is subjected to unnecessary medical or surgical treatment during infancy or childhood, to guarantee bodily integrity, autonomy and self-determination to children concerned and to provide families with intersex children with adequate counselling and support. 24 63. The collection of reliable data on female genital mutilation in countries where minority communities perform the practice remains a major challenge, as do the lack of capacity of relevant officials and the absence of standard guidelines. Many front-line professionals, such as teachers, medical professionals and child protection officers, are not trained in or may not understand the law, or may be unfamiliar with the issue and fail to record cases. Similarly, while there is empirical evidence showing that female genital mutilation can result in deaths, many Governments do not collect or maintain official data on deaths associated with the practice, and hospitals do not have policies of recording female genital mutilation-related deaths. 22 23 24 Plan International, “Tradition and rights: female genital cutting in West Africa”, 2005. Available from www.plan-uk.org/resources/documents/27624/. See, inter alia, CRC/C/CHE/CO/2-4, CAT/C/DEU/CO/5, A/HRC/22/53 and A/64/272. See also the statement by the Council of Europe Commissioner for Human Rights, available from http://oiiusa.org/1720/council-of-europes-statement-on-intersex-peoples-need-for-equal-rights. See CRC/C/OPSC/CHE/CO/1. 15