Human rights campaigners in West Africa say legal victories and education are helping them reduce the practice of female genital mutilation. But they say more work is needed, because the practice remains widespread throughout West Africa, especially among poor people.
Female genital mutilation is believed to have started in Africa 5,000 years ago, as a rite of passage into womanhood.
The practice, also known as female circumcision, removes some parts of the woman's genital area. It is designed in part to eliminate the pleasure of sexual intercourse, in order to promote abstinence before marriage, and reduce the motivation for adultery after marriage.
Many people see the practice as connected to Islam, but it has spread to non-Muslim areas, too. Many Islamic leaders now reject it, and say it is not rooted in Islam. Indeed, they say the tradition pre-dates the founding of Islam.
The mutilation is usually done to adolescent girls, and often by minimally trained people, and without anesthetic. In some societies, it is widespread. In Mali, for instance, about 90 percent of adolescent girls are mutilated in this way.
Medical experts say the health consequences of the mutilation include fevers, severe pain, chronic urinary tract infection, psychological trauma and sometimes bleeding to death.
A Senegal-based aid worker, Molly Melching, organizes human rights workshops in villages in West Africa, during which she describes the practice as a health hazard. Her group is called Tostan, which means breakthrough, in the Wolof language.
"Tostan never tells people, 'Oh, you should end this practice, this is something that you have to do' at all," she explained. "It's something that the people bring up themselves, as a way to contribute to better health."
Ms. Melching says it is important for entire villages to agree to abandon the practice at the same time.
"As it is now, it's like driving on the left side of the street," she said. "You may decide that it's safer to drive on the right side, but you can't just stand up and say, 'Okay, I'm going to drive on the right side of the street,' because everyone else is driving on the left side of the street."
But the experts say this age-old practice appears to be changing somewhat. In some areas, villagers have come to understand the hazards, and to see the mutilation as a human rights violation. In those villages, chiefs and even religious leaders have decided to replace the tradition with new rituals that do not involve cutting.
What happens often is that villagers then hold a public ceremony to declare the abandonment of the practice. Ms. Melching says more than 1,000 villages in Senegal have already done so, and her group's method is now being taught in other West African countries.
Ms. Melching says, in Africa, villages are usually the source of cultural traditions. So, she says, changes in attitude in the villages can have a wide impact.
"When people in the cities see that people in the village are deciding to abandon FGC, then they realize, 'Well they're abandoning, so, of course, we will not have the pressure to circumcise our girls anymore, because people in the village will not accuse us of being traitors to our tradition,'" said Ms. Melching.
Another approach to try to end the practice has been to punish those performing mutilations.
In Ghana, two women farmers in northern regions were recently jailed for five years for circumcising girls as young as three-weeks-old. In neighboring Burkina Faso, in January, a woman received a jail sentence of one-year for mutilating eight girls.
Other countries in the region, such as Benin, recently passed new laws banning mutilations, and establishing jail sentences and fines for circumcisers. There is also an effort to broaden laws to cover anyone who promotes the practice, including parents who send their daughters across borders to be circumcised.
But a human rights official in northern Ghana, Dajiah Idrissu, says he believes a more regional effort is needed.
"If we actually want to stamp it out completely, then it means that there should be some amount of networking among the various neighboring countries, and then to see to it that it is effective in all the other countries.
"Other organizations, such as the World Bank, promote what they call 'dropping the knife' ceremonies to rehabilitate circumcisers, instead of having them prosecuted," continued Mr. Idrissu. "These women are given training to become seamstresses, hairdressers, gardeners and midwives."
Human rights campaigners are pleased to be making some progress on the legal front, and in the villages. But they concede they are only just beginning to have an impact and that the tradition of mutilating young girls remains strong in West Africa, especially in remote regions.