The practice of cutting girls' genitals has undergone a dramatic, sometimes spectacular, fall in frequency over the last 30 years in Africa, a new study has found. However, an apparent rise in Western Asia has led the authors to warn against complacency.

Female genital cutting (FGC, also widely known as female genital mutilation or FGM) was widespread across much of Africa and Western Asia until recently. The practice can involve removal of the clitoris and narrowing of the vaginal canal. In some regions it is typically less drastic, but still comes with a danger of infection. In addition to the horrendous pain, FGC can greatly increase the risk of childbirth, in addition to the devastating effects on female sexual pleasure.

Many nations have outlawed FGC, but enforcement is patchy. Activist organizations have been working to change cultural norms, but data has been lacking on how well this is working on a continental scale. A paper in BMJ Global Health analyzes trends by region over the period 1990-2017 using data sets from 29 countries of more than 200,000 children aged under 14.

East Africa, has seen the most dramatic turnaround, with the proportion of girls cut falling from 71.4 percent in 1995 to 8 percent in 2016. The trends in Northern Africa (57.7 to 14.1 percent) and Western Africa (73.6 to 25.4 percent) are slower, but still heading strongly in the right direction.

The findings demonstrate that currently practiced interventions can be highly effective, but 3 million children are thought to remain at risk annually.

Inevitably, efforts to both prevent FGC and to measure its frequency have focused on the places where it is thought to be most common. Consequently, the authors express the fear FGC may be occurring under the radar elsewhere. This includes both among immigrants coming from places where the practice was widespread when they left, but also much of Asia where there have been reports of FGC occurring without detailed studies of its frequency.

The paper's authors, led by Professor Ngianga-Bakwin Kandala of Northumbria University did not collect their own data, instead combining surveys conducted by national governments within small clusters and extrapolated to the national level. Clusters were sparse outside West Africa, limiting the reliability of the data in some places.

FGC is thought to be common in Iraq and Yemen among other West Asian nations, but with just three surveys conducted outside Africa, much uncertainty remains about its frequency and which way trends are running. The authors also acknowledge there are risks in relying on self-reporting, as occurred here, potentially exaggerating the trend as FGC becomes less socially acceptable.

Moreover, the apparent rise in FGC in Western Asia, and flat trend in Central Africa, demonstrates this is far from a solved problem.

"If the goal of public policy is to ensure that the practice is eliminated, further efforts and interventions are urgently needed," the study concludes. And to do this means partnering with religious, community and government leaders to encourage education, legislation, and public support.