Female genital mutilation (FGM) is most common in Africa and the Middle East - 125 million girls and women aged between 15 and 49 years old have been cut in these regions. Worldwide an estimated 140 million females are affected by FGM.
FGM happens in countries including Jordan, Oman and Saudi Arabia, but also in other parts of the world, like in Indonesia and Malaysia in Asia and Colombia in South America. FGM is also prevalent in pockets of Europe - in England and Wales 103,000 women and girls are affected by FGM (or 0.38 percent of female population), according to estimates #link:http://www.equalitynow.org/sites/default/files/FGM%20EN%20City%20Estimates.pdf:by Equality Now#.
If there's no reduction in the practice, the number of mutilated girls worldwide will grow from 3.6 million in 2013 to 6.6 million in 2050 - simply due to population growth.
Prevalence of FGM varies in correlation with ethnic groups living within countries. In Kenya and Nigeria for example, only 27 percent of women and girls are affected by FGM on average, but within certain communities, this average rises significantly to more than 80 percent.
The opposite is found to be the case in Ethiopia: here, the country average is more than 70 percent, although there are also groups with no FGM cases.
The reasons for FGM vary: some say it prevents girls from becoming promiscuous, others name cleanliness and hygiene as benefits; also social acceptance, better marriage prospects and preservation of virginity are among the reasons given.
Although FGM has no basis in the Koran, some people falsely believe it is a religious requirement. For others it is a long-inherited tradition that is not questioned: "People have very deep-seeded beliefs that talking about it was taboo and really bad things happen to you when you bring it up. And people have always been told 'you never ever discuss this with anyone'. So this is what made it difficult in the beginning to even talk about it for educational groups coming in and people who wanted to work on this issue," says Molly Melching, founder of Tostan, an NGO working to empower African communities to create social change based on human rights.
The world health organisation differentiates between four different types of FGM. The type that is performed is often linked to ethnicity.
80 percent of women are cut in a type 1 or type 2 way. Type 1, also called sunna circumcision, equals cutting away parts of or the clitoris. In type 2 cases, the clitoris and the inner labia (parts or the whole) are cut away.
Type 3 is performed in 15 percent of FGM cases. In this type of mutilation, also referred to as pharaonic circumcision or infibulation, the whole (or parts of the) outer genitals are cut away. The stumps of the labia are then sewn together with only a small hole left for urination and menstruation. Before sexual intercourse and birth, the vagina is opened again. In some severe cases it is sewn closed again afterwards.
Type 4, which does not appear in the diagram, refers to 5 percent of FGM cases and is any other procedure where the female genitals are cut or injured - this could be pricking, notching, stretching the clitoris or labia, burning or scraping the vagina, or burning the inside with chemicals or herbs to narrow the vagina. Any form of FGM is condemned as a violation of human rights of girls and women.
In half of those countries where there is available data on FGM, mothers told researchers that the majority of girls are cut before they are five years old. In most cases traditional practitioners carry out the procedure on children using a blade or a razor - an exception to this is in Egypt, where most are performed by doctors (72 percent).
This happens despite the fact that FGM is illegal in 22 of the 29 countries where the practice is most prevalent. Fear of social segregation for not following the tradition is often bigger than the fear of legal punishment.
"In communities, where 85 percent are practicing, how many people do you want to put in prison? A robber [should go to prison], yes. But someone who is following a practice that is believed to be important in their culture? We have seen over and over again that [legal punishment] has not worked," says Melching.
A majority of people - both, men and women - in the 29 countries think FGM should stop. However, a closer look reveals some exceptions: in Egypt, Gambia, Somalia, Sierra Leone, Guinea and Mali, most women aged between 15 and 49 say FGM should continue.
"The men I have met often tell me about the experience of bringing pain to their wives on their wedding night. One said, 'My wife was in such horrible pain. Never would we do that to our daughters.'," Melching recalls. "Once men start understanding what harm [FGM] brings to women, that's when they stand up and really speak out for the first time and say we don't want that to happen to our daughters."
Apart from that, researchers revealed a correlation with the educational background: the more educated girls, women and men were, the more likely they are to speak up to #endFGM.
For some countries like Ghana, Cameroon, Benin and Tanzania, for example, eliminating FGM could be within reach by 2030.
But for others, where prevalence is particularly high, like in Somalia, Mali and Gambia, there is still a long way to go. In these countries, they are only steadily managing to decrease FGM.
Despite there being different attitudes towards FGM in Kenya and Burkina Faso, both countries have made exceptional progress over the last three decades in reducing mutilation cases.
"Countries which implement the law against FGM have shown to be most successful - countries like Kenya and Burkina Faso have have shown strong government accountability to take action to protect girls at risk and support survivors," says Mary Wandia, FGM programme manager at campaign group Equality Now. "Without a law against FGM, it would have been very difficult to ensure justice. The law is not everything, but it is an essential starting point and its effective implementation sends a strong message that FGM is not acceptable and it will not be tolerated."
Today, in most of the 29 countries, FGM is less common among adolescent girls than middle-aged women - underlining an overall decreasing trend and hope to #endFGM.