Women who do not submit to the procedure are often considered unclean and not permitted in worship areas. They usually become outcasts of society and have no hope of marrying. In Africa and the Middle East, a midwife usually performs the ritual assisted by several women, often the girl's mother and other relatives. It is done without anesthetic or sterilization. It can result in HIV or other blood-borne disease.
Victims have difficulty passing urine and have many urinary tract and reproductive tract infections.
Increased infertility and high infant mortality abound in this part of the world. Some 25 percent of infertility can be traced to female genital mutilation. Although religion is cited as the justification, the real reason seems to be rooted in culture, tradition, and sexual control of women. It is overlooked because it is imposed upon children and not adults. The 1993 UN World Conference on Human Rights declared female genital mutilation a human rights violation, and many international groups have united to oppose and eliminate the practice.