For thousands of years, girls in the area that is now the tiny African country of Djibouti, have been subjected to pharaonic circumcision.
It is a practice that involves cutting away a girl’s inner labia and clitoris, and sewing the wound together, leaving a tiny hole for passing urine and menstrual blood.
Siti Robitu, 21, describes a recent argument she had with her family over the circumcision of her four-year old daughter. "My father, my mother - they all cried," she said. "They wanted my daughter to be circumcised. I was against it."
Siti, a nursing aid in a local clinic, belongs to a small number of mothers in Djibouti who are trying to protect their daughters from the circumciser’s knife.
Despite medical evidence that genital mutilation puts women at risk of infection, pain and complications during childbirth, social pressure is such that most mothers opt to circumcise their daughters.
"At first, I asked the doctor to do it, but he refused," Siti said. "My mother was furious. When you are not circumcised, the whole neighbourhood talks behind your back. They say she [my daughter] is like a white woman."
Djibouti’s health ministry estimates that 98 percent of all Djiboutian women are circumcised - the highest rate of any country in the world.
"Mothers have their daughters infibulated to make sure that they get a husband and a secure future. Otherwise they get loose and become prostitutes, people believe here," Fatuma Abdi, from the Djibouti National Women’s Union (UNDF) explained.
"It is the women not the men who insist on circumcision," she added. "The weird thing is that my mother believes she has benefited from it. How, she can't tell me."
Siti is encouraged by activists like Fatuma Abdi not to follow age-old tradition.
Door to door campaigns, programmes on government radio and roundtable television shows bring the new message into every home.
Teachers are obliged to talk about the issue for at least five minutes a day, so girls do not perpetuate in adulthood what may have already been done to them.
It has been a long, hard struggle for Djiboutian women activists to get this far.
QUARTER CENTURY OF STRUGGLE
Twenty-six years ago, members of the women's union started the fight against female genital mutilation (FGM). The breakthrough came only early this year after a decade-long series of conferences and meetings with religious leaders.
Safia Elmi, technical advisor to the Ministry of Health, recalls the outcry of more than 200 women in a conference hall on 2 February, when Muslim Imams conceded that female circumcision was not required by the Koran.
Nonetheless, they demanded that women still have at least their clitoris cut.
"That was the best thing that happened to us," Safia says. "We all stood up and shouted - 'don’t touch our girls'."
The Minister of Health was forced to call another closed session with clergymen. They finally declared female circumcision a thing of the past.
This, however, was just on paper.
FGM was made a criminal offence in Djibouti as far back as 1994, incurring a penalty of one million Djbouti francs (US $5,500), or up to two years imprisonment.
"But until now, nobody was jailed or fined because it is difficult to fine someone for a cultural practice that is very widespread," said Ayanne Hassan Omar, spokeswoman for Djibouti’s president, Omar Guelleh.
FIGHT ACROSS BORDERS
Safia Elmi is establishing an organisation of midwives who oppose FGM. She wants to track down those who carry out female circumcisions and have them prosecuted.
Increased public censure in Djibouti, she says, means more Djiboutian mothers are taking their daughters to Ethiopia or Somaliland to be circumcised. To prevent this, she wants to create a regional anti-FGM committee.
The UNDF’s Fatuma Abdi says circumcision is primarily cultural, not religious: "It is not just the Muslims who are practicing infibulation. It is the Catholics as well."
In December 2003, Djibouti signed the Maputo Protocol of the African Charter of Rights, which stipulates that FGM must be forbidden and condemned.
This did not stop the average mother from subjecting her daughter to it.
"The real reason why nobody was punished, is that nobody complained," Safia Elmi said. "In Djibouti, everybody is a cousin of someone."
PAIN AND SUFFERING
Madina Mohammed, a mother of five, lives in a very poor Djibouti neighbourhood. She proudly describes how her daughter was circumcised shortly after birth. The girl is now three years old.
"It needs three women to do the procedure. One closes the eyes of the girl. One spreads the legs and one does the cutting. Then we tie the legs together for seven days. I spent DF50 (30 US Cents) for Afar medicine to help the healing."
The women of the Afar ethnic group circumcise girls in the first week after birth. The Somali Issa girls are circumcised between five and nine years of age.
An expert circumcision costs to DF5,000 ($30). People often save for years to get the money together for the practitioner.
Many circumcisions are badly carried out.
Fatma Hatchi, one of just two local gynaecologists in Djibouti, is confronted daily with women who suffer complications stemming from infibulation. Girls bleeding profusely are regularly admitted to the hospital where she works.
There are other complications too. "Sometimes girls take half an hour to urinate," she says. The urethra is closed-up during infibulation, forcing urine inside the vagina, before it finds it way out through the tiny hole left after circumcision.
"Today, we had a patient who could not pee anymore. When we opened her up, we found lots of blood. The woman must have had menstruation for a year, but it could not get out. She had pharaonic circumcision," Hatchi explained.
"During my time, it was important that five women from the family inspected whether the hole was small enough," Hatchi said. "If it was too big, even if the woman had had no contact with a man, she was sent home and could never get married."
Siti, the health worker who refuses to circumcise her daughter, remembers her wedding night was not what she had dreamt of. "We tried for a whole week, but my husband could not penetrate," she says. "It was very painful. Then he sent me to the hospital, to open the hole."
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions