Despite decades of activists trying to curb the practice and dozens of laws banning it, the horrific procedure of cutting or removing babies' and girls' external genitalia continues.
According to an exhaustive new report from the United Nations Children's Fund (UNICEF), more than 125 million girls and women in 29 countries have undergone female genital mutilation.
The reasons are varied. It will stop girls from being promiscuous and preserve their virginity, proponents say. It's socially expected; it's tradition; it's religious.
But it's also incredibly dangerous and painful, and most of the girls and women who experience it want it to stop.
The practice occurs mostly in African and Middle Eastern countries. Women, and men too, say they subject their daughters to it because they will be socially ostracized if they don't.
It would be easy to blame parents, but that would be ignoring the complexities of the issue. The practice is tied to everything from tradition to patriarchy, and that's part of the reason attempts to stop it have been only marginally successful.
The report points out that the practice is becoming less common in about half of the countries where it is most prevalent. But it is still deeply entrenched in others, and there is still work to do.
The report lays out possible solutions, but organizations working on the ground to end genital mutilation say there are some very real challenges that stand in the way of fully implementing them:
1. Tougher laws
There are laws against female genital mutilation in most African nations, but the practice continues, because the laws don't address the social and cultural reasons for committing the act in the first place.
"If individuals continue to see others cutting their daughters and continue to believe that others expect them to cut their own daughters, the law may not serve as a strong enough deterrent to stop the practice," the report states. "Conversely, among groups that have abandoned [female genital mutilation and cutting], legislation can serve as a tool to strengthen the legitimacy of their actions and as an argument for convincing others to do the same."
Liesl Gerntholtz, director of the Women's Rights Division of Human Rights Watch, said good laws -- not just blunt laws -- are critical.
They should put obligations on the health and justice sectors of a country, she said, and provide training to police and community midwives, who often perform the cutting, instead of simply banning the practice.
They're not a "magic bullet," she said, but "without them, it's hard to change customs without a legal policy framework that really says what the government approach is."
Places like Kenya and the Kurdistan region of Iraq have solid laws in place and have seen improvements, she said. But the harsh reality is that countries like Somalia, where there is no strong central government to enforce the laws, are unlikely to see significant improvement anytime soon.
2. Ending social ostracism
Many of the countries where cutting occurs are predominantly Muslim, but it would be wrong to say the religion is somehow at fault. There are Muslims around the world who abhor the practice, and it is often linked to other ethnic and social traditions unique to different regions. According to the UN, organizations that have encouraged people to abandon the practice "not as a criticism of local culture but as a better way to attain the core positive values that underlie tradition and religion, including 'doing no harm to others'" have had some luck in limiting the procedure.
"We have found that, addressed in this way, efforts to end [female genital mutilation] contribute to the larger issues of ending violence against children and women and confronting gender inequalities," reads the report.
Gerntholtz says that ending social ostracism is where civic organizations can come in.
Organizations need to let women know about specific imams, for example, who have disavowed the practice, so they don't see it as something absolutely required by their religion.
They also need to talk about the health consequences, Gerntholtz said, including to mental health.
But "women feel very strongly that they have to cut, that it is a religious obligation," she said, adding that convincing women to abandon a practice they see as so intrinsic to womanhood in cultures that value girls as wives and mothers above all else is complicated.
Women in these countries are not given the same political or educational opportunities as men. They hold very little power, and even when they want to end the cycle of mutilation, they face the prospect of being cast out if they resist. Some women fear that if they do not have their girls cut, they will be "unsuitable" for marriage, which would doom them to a life of ostracism and poverty in many places. Without education or means to support themselves, women are stuck in a vicious cycle of poverty and oppression.
To end female genital mutilation, Gerntholtz said, governments and nonprofits and other entities have to work together to broadly increase the status of women in these countries, and that's a complex, deep problem.
Education could draw women into the labor market, which could weaken traditional family structures. The report notes that women might be seen as desirable partners for their ability to contribute to household income, which might reduce what some see as the need for cutting. School can also expose girls to people from different cultures and to mentors who might oppose the practice. While many girls have been cut by the time they reach school, they may be more likely to not continue the cycle with their own daughters.
Educating men and boys about the dangers of cutting is important, too. And the report found that many men, like women, want the practice to end but feel they have to subject their daughters to it for social reasons.
Ultimately, as many as 30 million girls face genital mutilation in the next decade, but there is some hope.
"If, in the next decade, we work together to apply the wealth of evidence at our disposal, we will see major progress," Geeta Rao Gupta, deputy executive director of UNICEF, wrote in the report's foreword. "That means a better life and more hopeful prospects for millions of girls and women, their families and entire communities."