When the president's wife sponsors the circumcision of 1,500 young girls to win votes for her husband, you know you've got a problem persuading ordinary people and the government that female genital mutilation (FGM) is a bad idea.
And when the woman who is now Minister of Social Welfare, Gender and Women's Affairs, threatens to "sew up the mouths" of those who preach against FGM, you realise that you are facing a really big uphill struggle.
But that has not dissuaded Olayinka Koso-Thomas, a gynaecologist in Sierra Leone, from campaigning against the practice for 30 years, ignoring death threats and angry protestors storming her clinic.
A crudely performed operation to remove the clitoris from adolescent girls forms a key part of the initiation ceremonies held by powerful, women-only secret societies that prepare young girls for adult life, marriage and motherhood in the West African country.
Koso-Thomas, who came to Sierra Leone from Nigeria, sees nothing wrong with such 'bundu' societies and their initiation ceremonies but, on medical grounds, she and a handful of other women's rights campaigners want the circumcision ritual replaced by something less brutal and hazardous.
"Continue with this training, but do not cut"
"People got me wrong at first. When I was going to the communities and sensitising them, they thought I was against their society," Koso-Thomas told IRIN. "But it is as a doctor that I started campaigning and sensitising people about the health hazards, because I saw all the complications."
"The real meaning of the bundu society is very good," she said. "It is where they train young girls to become women: they teach them how to sing, dance and cook ... girls who don't go to school learn how to use herbs and treat illnesses; they are taught to respect others."
"All that I am saying is, 'Continue with this training, but do not cut.' This is my message," said the gynaecologist who has written a book about the practice of FGM in Sierra Leone.
Koso-Thomas joined forces with a group of Sierra Leonean women, who she had met while they were refugees in Guinea during Sierra Leone's 1991-2001 civil war, to discuss the medical complications they had all suffered following circumcision.
Some of these activists banded together to form a small non-governmental organisation (NGO) called the Amazonian Initiative Movement (AIM), and started having a modest impact.
AIM says it has dissuaded some traditional midwives and other women who perform genital cutting to give up the practice by promising them alternative employment.
"We want to see people dropping their knives," said AIM's coordinator, Rugiatu Turay. "We want to see parents and girls becoming more open about the practice; we want to see victims of the practice talking about it and ready to say 'no', so that the government will know women are ready for a change."
FGM wins votes
It is difficult to stop FGM when it remains popular with most women in Sierra Leone and is seen by the government as a vote winner. Noting that Patricia Kabbah, the late wife of President Ahmad Tejan Kabbah, had sponsored the circumcision of 1,500 young girls in the presidential election, and other politicians had organised smaller initiation campaigns to gain popularity in virtually every district of the country, Koso-Thomas asked, "How can they pass a law against this when they are paying for it?"
Turay agreed. "Politicians in Sierra Leone do not think issues such as FGM need to be talked about, because they use FGM as a way of getting the votes of women." Indeed, Zainab Bangura, the only female presidential candidate to challenge Kabbah's successful bid for a second term in 2002, blames her poor showing in the election on a malicious rumour that she opposed female circumcision. She got less than one percent of the vote.
Bangura, who now runs an anti-corruption watchdog organisation called the National Accountability Group, admits that she almost bled to death while undergoing circumcision as a teenager, but refuses to condemn the practice or the secret societies that enforce it.
Secret societies remain powerful
It would be impossible for any uncircumcised woman to be elected in Sierra Leone, because she would be unable to win votes in the interior, Bangura told IRIN. "A woman from Freetown and the Western Area would get no chance to be a successful politician if she were not part of a secret society," Bangura explained. "Those of us who joined the society are expected to support it - we cannot stand out and criticise it, otherwise you will be sidelined by the family," she added.
The United Nations Children's Fund (UNICEF) estimates that 90 percent of all women in Sierra Leone have undergone circumcision, which is practiced by all ethnic groups in the interior. Only the Krio people, the detribalised descendents of freed slaves who settled in and around Freetown, shun the ritual.
Elsewhere, women who have not undergone the ordeal are still considered children - not proper adults - who are unworthy of marriage or any position of leadership in society.
Although Sierra Leone signed the Convention for the Elimination of Discrimination against Women (CEDAW) in 1988, no laws outlawing female circumcision have been passed by the government.
In fact, Shirley Yeama Gbujama, the Minister for Social Welfare, Gender and Child Protection, has made it clear that the passage of such legislation was not a priority. "We will do something if the women themselves ask for it," she told IRIN.
Nine years ago, when Gbujama was foreign minister, she spoke out publicly in support of female circumcision after two local newspapers published a series of articles condemning the practice.
David Tambayoh, one of the journalists behind the 1996 press campaign against FGM, recalled that hundreds of women circumcisers staged protest demonstrations at the time, and presented a petition supporting FGM to President Kabbah.
He noted that Gbujama had threatened to "sew up the mouths of those preaching against bundu", while Kabbah had expressed support for the secret societies, saying he was "from a traditional background."
Donors reluctant to take the initiative
If the government is reluctant to take on the secret societies that regard female circumcision as a cornerstone of their rituals, foreign donors are equally hesitant to put pressure on ministers to ban the practice.
"We only work in partnership with the government on proposals and ideas put forward by them," the Freetown representative of one major western donor told IRIN. "No proposal has ever been submitted to us on this topic."
However, there are indications that the fundamental role secret societies once played - training girls for womanhood and providing a lifelong sisterhood for them once they became adults - has been eroded in recent years.
Koso-Thomas and many other women interviewed by IRIN noted that the apprenticeship in womanhood, once provided by the secret societies in a secluded building known as the 'bundu bush', had been reduced from a year or more to just a few days, while female circumcision, rather than being a symbol of the rites of passage, had simply become an end in itself.
"The very essence of initiation has disappeared, as it used to last one or two years previously, and has been reduced to one or two weeks nowadays," said Laurel Bangura, an activist from the Centre for Safe Motherhood, another small NGO fighting FGM in Sierra Leone.
Circumcision may be increasing
Although these customs are being downgraded, Zainab Bangura, the politician turned anti-corruption campaigner, said traditional values, symbolised by female circumcision, still maintained a powerful hold over a population whose lives and expectations had been decimated by the recent civil war.
"Sierra Leone is a traditional society running at a par with modern society," she pointed out. "The level of illiteracy is high, and it is a collapsed state. People respond to this by resorting to traditional values."
Some suspect that the number of circumcisions may actually be increasing as the country gradually returns to normality after a decade of conflict that has left it last of 177 countries listed in the United Nations Development Programme (UNDP) Human Development Index.
"The war tended to disrupt initiation, so it is a sign of normality returning, after a year or two of people settling and producing good harvests, that they revive the tradition," commented Paul Richards, head of the technology and agrarian development group at Wageningen University in the Netherlands, who has conducted social research for the Sierra Leonean government.
"The initiation of young people requires resources - during the war, people were scattered and did not get the money to initiate." He suggested that many communities were "catching up with the backlog of people who had not been initiated during the war".
Although Turay said AIM had so far persuaded 400 circumcisers in 111 villages to "drop their knives", this was a drop in the ocean, and village elders have a powerful economic incentive to keep the tradition going.
"For every initiation we practice, we need to pay 70,000 leones (US $25) to the village chief, Nandewa Bangura, a circumciser from Rothana village near Port Loko in western Sierra Leone, told IRIN.
The custom also provides an income to the women performing circumcisions. AIM's Turay believes that change will only come to the country as a whole once the government decides that FGM is undesirable and takes action.
"Support has to come from government," she said. "When it is willing, change will take place."
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