The practice is prevalent in 28 African countries and parts of the Middle East and Asia, notably Yemen, Iraqi Kurdistan and Indonesia. There are several types including partial or total removal of the genitalia and narrowing of the vaginal opening.

It is usually arranged by other women in the family for girls between infancy and 15, and performed by traditional cutters who use anything from razor blades to scissors or tin can lids.

The United Nations passed a resolution in December urging countries to ban the practice that an estimated 100 to 140 million girls worldwide have been subjected to, putting them at risk of serious physical and psychological problems.

But participants at an international meeting in Rome said new laws needed to be accompanied by education and discussion in traditional communities to help dispel misleading myths.

"Religious leaders have to be involved, primarily Muslims and those from traditional religions. Opinion leaders have to be on board in this fight," Benin's Family and Social Affairs Minister Fatouma Amadou Djibril said.

"We can uphold traditions but we have to find ways to replace this kind of practice with different rituals," she said.

People often believe the practice is required by religion, but it is not mentioned in the Koran or any other religious text.

Speakers at the Rome meeting said it was crucial to inform and educate the women who were perpetuating the practice, often because they worry they will be punished by ancestors in the afterlife for not performing it on relatives.

"We need to explain to the women, because they don't understand how it can be prevented - it has such important societal implications," Ivory Coast Health Minister Raymonde Coffie Goudou said.

"The traditional practitioner who uses the knife has value, she has a reputation, she is a woman with a role in the village - we have to understand her to deal with this," she said.

The practice can cause severe bleeding, pain, shock, recurrent urinary tract infections, cysts and infertility. It increases the risk of labor complications and newborn deaths. The procedure itself can prove fatal.

Speakers said cross-border cooperation and enforcement was also crucial for eradicating the practice, because cutters often move to countries where legislation is less strict so they can carry on working unhindered.

Female genital mutilation has been banned by 20 of the 28 countries that practice it in Africa as well as many industrialized countries. But enforcement is usually weak and prosecutions are rare.