Female genital mutilation is illegal under federal law, but hundreds of thousands of girls in the United States remain at risk. Lawmakers in New York, a hotbed for the practice, hope to change that by raising public awareness of a relatively unknown crisis.

In November, Gov. Andrew Cuomo signed legislation authored by Assemblywoman Amy Paulin (D-88) and passed in June 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 program.”

The program will also warn New Yorkers about vacation cutting, which, as the new law notes, is the practice “whereby girls are sent out of state or the country to undergo female genital mutilation, typically during school vacations.”

FGM is a ritualistic practice primarily performed in Africa and the Middle East in which some or all of the female external genitalia is removed. In the two most common types of FGM, the clitoris is either partially or completely removed. In a rarer type known as infibulation, all of the external genitalia is removed and the vulva is sutured shut, requiring a second procedure to reopen 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 has no health benefits, inhibits sexual function, and can cause several complications including pain, infection, and infertility.

The association of FGM with Africa is fairly common knowledge but too few realize that it is a problem in the United States as well, albeit on a smaller scale. Risk for FGM is especially high in New York and other areas with substantial ties to countries where FGM is legal and/or frequently practiced.

The Population Reference Bureau estimates that behind California, New York has the highest number of women and girls at risk of undergoing FGM, whether at home or abroad. Of the estimated 506,795 at-risk women and girls in the U.S.—a figure based on ties to countries with a high prevalence of FGM—nearly 10 percent (48,000) live in New York State and 13 percent live in the New York City metropolitan area.

There are already laws banning FGM and vacation cutting, but advocates and lawmakers say that, without public awareness of the practice, there’s little hope of widespread enforcement.

New York, for example, is one of 24 states that expressly criminalizes FGM. On a federal level, FGM has been illegal since 1996 and vacation cutting was criminalized by the 2013 passage of the Transport for Female Genital Mutilation Act. But as The Daily Beast reported in August after an anonymous Redditor voiced fears that she was going to be taken abroad for FGM, there have been only three convictions for FGM in the United States, one at the federal level in 2005 and two at the state level. No cases of vacation cutting have been prosecuted, and the practice continues largely unseen.

This summer, for instance, New York City social worker Mariama Diallo told PBS that she personally knew of four cases of vacation cutting. In one case, a girl reportedly tried and failed to get help from her school after learning that her family was planning to send her to Africa for FGM.“[S]he 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.”

Assemblywoman Paulin told The Daily Beast that the gap between the criminalization of FGM and enforcement needs to be filled in with knowledge.

“This law is of critical importance because it will educate the public about this horrible practice,” she said in a statement. “Many New Yorkers don’t even know what FGM is or that it happens to our young girls. By undertaking a public awareness campaign we can inform the public about what it is, how girls are put at risk, and the physical, sexual and psychological consequences of undergoing FGM. The more aware we all are of the issue, the more vigilant we can be and help prevent girls from being subjected to this deleterious and illegal procedure.”

According to Shelby Quast, the Americas Director for Equality Now, an international human-rights organization that has spearheaded worldwide advocacy around FGM, New York’s awareness campaign is still taking shape, but it will be an important step toward bringing the public up to speed on the issue.

“Just because there’s a law on the books doesn’t mean people are aware of it,” Quast 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.”

On a legislative level, too, the U.S. has been lagging behind, Equality Now contends. Twenty-six states do not have laws banning FGM. In England and Wales, by contrast, FGM is not only illegal, it is also mandatory as of Oct. 31 for health-care workers, social workers, and teachers to report any known instances to police—a requirement that Quast believes could be carefully integrated with the United States’ mandatory reporting laws around child maltreatment.

Given President Obama’s recent remarks on the topic along with other signs of change on a federal level, Quast is optimistic that the U.S. is going to start taking FGM more seriously soon. In a July speech in Kenya, Obama publicly condemned the practice as a “bad tradition” along with sexual assault and the forced marriage of children, saying, “These traditions may go back centuries; they have no place in the 21st century.”

“The U.S. having a very clear policy that this is a form of violence? That’s been a really big shift,” said Quast.

This February, too, another New York legislator, Congressman Joseph Crowley (D), and Texas Congresswoman Sheila Jackson Lee (D), introduced the Zero Tolerance for FGM Act, which calls for a “multi-agency strategy” to prevent FGM and vacation cutting. That law has not yet been passed but Quast tells The Daily Beast that several federal agencies are meeting “about every six weeks” to address FGM.

In the meantime, one of the most important things the public can do to address FGM is to simply talk about it, Quast says. “For some reason, this particular issue has been really hidden and I think it’s because of genitalia, quite candidly,” she said. “People don’t want to talk about genitalia. They don’t want to talk about what it means to be cutting off the clitoris or the inner labia or the outer labia and so, therefore, it’s remained a hidden practice.”

In August, The Daily Beast reached out to several federal agencies about the enforcement of federal FGM law and learned that women and girls at risk of FGM, or those who have knowledge of someone at risk, can contact the Department of Justice at hrsptips@usdoj.gov or 1-800-813-5863, and notify the FBI at tips.fbi.gov.