A federal judge in Detroit has dropped nearly all charges against a doctor accused of performing female genital mutilation procedures on underage girls, in the first federal case targeting the controversial procedure.

Dr. Jumana Nagarwala, the lead defendant, was charged with committing female genital mutilation in violation of federal law at a clinic in Livonia, Michigan, plus conspiring to commit female genital mutilation, as well as aiding and abetting others. He was charged alongside Dr. Fakhruddin Attar, his wife, and five parents who subjected at least nine girls to the procedure, all of whom are residents of Michigan or Minnesota.

The term “female genital mutilation,” or FGM, refers to the non-medical practice where external genitalia, including the clitoris, is removed partially or entirely. Often carried out on underage girls, it’s common in many West African countries and parts of the Middle East and Asia, and it's done for a number of religious and cultural reasons. The United States is one of at least 44 countries that currently bans the practice.