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