; (5) any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in subsection (a); (6) the conduct described in subsection (a) occurred within the special maritime and territorial jurisdiction of the United States, or any territory or possession of the United States; or (7) the conduct described in subsection (a) otherwise occurred in or affected interstate or foreign commerce. (e) For purposes of this section, the term female genital mutilation means any procedure performed for non-medical reasons that involves partial or total removal of, or other injury to, the external female genitalia, and includes— (1) a clitoridectomy or the partial or total removal of the clitoris or the prepuce or clitoral hood; (2) excision or the partial or total removal (with or without excision of the clitoris) of the labia minora or the labia majora, or both; (3) infibulation or the narrowing of the vaginal opening (with or without excision of the clitoris); or (4) other procedures that are harmful to the external female genitalia, including pricking, incising, scraping, or cauterizing the genital area. . 4. Report Not later than one year after the date of the enactment of this Act, and annually thereafter, the Attorney General, in consultation with the Secretary of Homeland Security, the Secretary of State, the Secretary of Health and Human Services, and the Secretary of Education, shall submit to Congress a report that includes— (1) an estimate of the number of women and girls in the United States at risk of or who have been subjected to female genital mutilation; (2) the protections available and actions taken, if any, by Federal, State, and local agencies to protect such women and girls