She also challenges some common misconceptions around FGC, like the belief that it is forced on women by men. In fact, elderly women often do the most to perpetuate the custom. I thought African girls were held down and butchered against their will, but some of them voluntarily and joyfully partake in the ritual. I thought communities would surely abandon the practice once they learned of its negative health consequences. And yet, in Shell-Duncan's experience, most people who practice FGC recognize its costs—they just think the benefits outweigh them.

Shell-Duncan recently joined a five-year research project, led by the Population Council, whose goal is reducing female genital cutting by at least 30 percent across 10 countries over five years. I spoke with her about how activists, policymakers, and everyday people can better understand FGC so that they can avoid alienating the communities they aim to help.

An edited and condensed transcript of our conversation follows.

Olga Khazan: How did you get into this topic?

Bettina Shell-Duncan: In 1996 I went to Kenya—northern Kenya among an ethnic group called the Rendille. I was doing research on anemia, iron deficiency. I started asking questions about what people in the community perceived were the major health problems. I talked to men and women throughout the community, and they listed a whole host of things: malaria, men talked a lot about diseases in their animals.

People started saying, “We don’t have enough antibiotics for our weddings.”

I was so confused, like, what does that mean? I couldn’t understand what they were talking about. And they pulled me aside and said, “You know, we’re talking about circumcision.”

I said, “I know what circumcision is. I’ve had my son circumcised.”

And they said, “No, we mean for our girls.”

I was completely confused. And they realized that not only had I gotten married without being circumcised, but that I had obviously delivered children without being circumcised, which in their culture was unthinkable.

These women were my very good friends, and they were covering up their faces to not show how repulsed they were by the idea of somebody being uncircumcised and delivering a baby. They were, you know, revolted.

Khazan: Well, wait, what did you say? Because I could imagine—and this is probably why I’m not an anthropologist—but I could imagine myself saying something untoward in that moment, like, “What do you mean? What I’m doing is fine! ... What are you doing?”

Shell-Duncan: On the other hand, these are women who live in a drought-prone region of Africa. Living in circumstances that are so dire. And they’re smart. They know how to cope in those circumstances. And honestly, I have a Ph.D. Would I know how to raise a kid under those kinds of conditions?

Khazan: So when they say that they don’t have enough antibiotics for the wedding, is it because they would do the cutting at the wedding?