February 6 is the International Day of Zero Tolerance for Female Genital Mutilation. The practice, also known as female circumcision or cutting, poses serious health risks but remains common in many countries, particularly in West Africa.
More than 200 million women and girls who are alive today have been cut, according to the World Health Organization, putting them in danger of excessive bleeding, infection and death.
As circumcised girls enter adulthood, they are at risk of chronic problems such as mental health disorders and pain during urination or sex. FGM also may cause life-threatening complications during childbirth.
Despite these risks, the practice has continued largely in the name of culture and tradition. Some communities believe FGM helps prevent premarital sex and helps ensure a wife's fidelity by reducing her libido.
FGM is practiced in 30 countries throughout Africa, the Middle East and Asia, as well as among migrants from those regions.
Within West Africa, the prevalence of FGM ranges from 2 percent in Niger to 97 percent in Guinea, according to data from UNICEF. Gambia, Burkina Faso, Mali and Sierra Leone also have rates at above 75 percent.
"The prevalence is still quite high in a number of countries," said Christina Pallitto, a research scientist with the WHO. "There's a lot of variation between countries, even within countries. We do see positive trends, trends of decreased rates of FGM in a number of countries."
Twenty-six countries in Africa and the Middle East have laws that prohibit FGM, but legislation can be difficult to enforce and may unintentionally push the practice underground.
"For the last 20 years, we have a law against the practice in this country," said Amadou Moreau, founder of Global Research and Advocacy Group, a Senegal-based nonprofit working to end FGM. "It's the most controversial law in this country. Because, when you're dealing with people's faith and beliefs and culture and tradition, executive order has no place to guide people on how they should behave, how they should act."
Moreau and Pallitto said the most effective solutions combine both grass-roots efforts and policy change.
But it's especially important to engage local communities and address the beliefs that are driving the practice, says the WHO's Pallitto.
"We do find that people, once they realize that it is harmful, once they realize that by stopping the practice it can improve health, it can improve the well-being of girls in the community," she said.
When people know others who have stopped the practice, she added, it can "be a very powerful way to bring about change."