In Egypt, 91 percent of women between the ages of 15 and 49 have undergone female genital mutilation, the partial or total removal of their external genitalia. In Somalia, the figure is 98 percent. More than 125 million women and girls living in Africa and the Middle East have endured the procedure, with 30 million girls at risk over the next decade.

But the practice of female genital mutilation is gradually declining, according to a report issued this week by the United Nation's Children's Fund (UNICEF). Younger women are less likely to have undergone the procedure than women in previous generations, and they are less likely to support it for their daughters.

To find out more about female genital mutilation, National Geographic spoke with Efua Dorkenoo, advocacy director for Equality Now and a recipient of the Order of the British Empire for her campaign to stop the practice.

You have been working on the issue of female genital mutilation since the 1980s. Why did you first get involved?

I was working as a midwife in the U.K. [and delivered] a woman who had the most radical form. There were various complications.

When you say the most radical form, you mean that her clitoris had been removed and the outer lips of her labia had been sewn shut?

Yes.

Did she survive?

Yes, but it introduced me to the subject in terms of trying to understand as an African what the practice is about.

Does female genital mutilation cause immediate health problems?

Most of FGM is done by traditional practitioners with crude instruments and no anesthetic. Girls go through traumatic pain, they may develop infections, they may lose blood, and sometimes it leads to death. We don't actually have figures for the number of girls who die from the operation—it is often done in rural areas where deaths are not recorded—but when you speak with families, they always tell you about one family member who died from it.

If the girls survive, later on they have long-term complications like pain during intercourse, loss of sensation during intercourse, and childbirth problems. They develop cysts, keloids, and psychological complications, a risk that's quite neglected but is coming up quite a lot.

How long has this tradition been in existence?

We don't know exactly when it started, but in some communities they would trace it back 3,000 years. It's been in communities for a very long time.

What are the reasons that people give for subjecting their daughters to female genital mutilation?

One of the most common reasons given for FGM is that it enforces virginity, chastity, and fidelity in women. Muslim groups that practice it say that it's a religious obligation, although it is not in the Koran and most Muslims in the world do not practice it. (It's also practiced among Christian or indigenous religions.)

Others might say that it's at the core of initiation rituals, that it's part of what makes you a woman. That is quite common in West African countries—for example, in Sierra Leone and Liberia.

In some places like Egypt, they also link it to aesthetics: The external genitals are dirty, they don't look nice, it looks so ugly that it needs to be taken out. In some areas, they say that if you don't take the clitoris off it will elongate and become like the penis of a man.

In the areas where they do the most radical forms—where almost everything is taken off and the place is closed up, like in Sudan, Somalia, Djibouti, parts of Ethiopia, parts of Mali—the main reason is to make sure that nobody touches the girl until she is married. Then that place has to be widened for sexual intercourse.

The UNICEF report found that there's been major reductions in female genital mutilation in a few countries like Kenya, Burkina Faso, and Tanzania. How are those countries halting the practice?

In Burkina Faso, for example, there is leadership from the government, which openly acknowledges that it is a women's rights and a children's rights issue. They are trying to address it from different angles, one that incorporates education, protection measures, and also prosecution. They have put quite a few people in prison for it.

In the areas where FGM is going down, it has been addressed in a violence against women framework. It's a gender power control issue, and it is not something you can just educate people out of. It requires people to think that if they do it, there are ramifications. We cannot just rely on people's good will.

The practice doesn't seem to have declined in Senegal, the site of a much-touted program. Why is that?

You would expect that after heavy, heavy investment by United Nations agencies, we should have seen some significant drop, but we haven't. It just shows that community mobilization and education are not enough to stop FGM.

You've been working on this issue for the last three decades. How optimistic are you?

When I started, we couldn't even discuss this issue. Now there's a growing voice, particularly among younger people, which is very, very satisfying.

This interview has been edited and condensed.