Female genital mutilation has decreased in Egypt since the procedure was outlawed in 2007, but women’s groups say more work is needed to change society’s thinking toward the practice.

The procedure, also known as female circumcision, involves removing the clitoral hood, clitoris and labia. The area is then stitched together leaving a small hole for urination. Complications include problems menstruating, scarring, infections, painful intercourse, infertility and problems during childbirth.

The surgery is supposed to abolish promiscuity.

Shereen El Feki, a journalist and author, cited research in her book Sex and the Citadel showing nearly 100 percent of women in Egypt older than 45 had been circumcised. But the trends are shifting. Fewer women (80 percent) between 15 and 17 have been circumcised, and it is believed that in the next 12 years the national average among 18-year-olds will fall to 50 percent.

"Until we have the latest DHS figures. . . it's hard to tell national trends,” El Feki told Women's eNews. “But certainly evidence up to 2011 showed that FGM was decreasing substantially in certain populations."

But El Feki said Egypt’s cultural paradigm would have to change in order to end the procedure.

“The forces that drive FGM are deeply rooted in society, which is why it takes so long to make a dent in the practice. I would argue that FGM is one of the few subjects related to women's sexuality that is not taboo in Egypt," El Feki said. "For many women in Egypt, circumcision is a point of pride, not a shame to conceal.”

After 13-year-old Suhair Al-Bata'a died during the procedure in June 2013, national women's groups started a new campaign against FGM.

Twenty groups began the Kamla campaign – which means “complete” in Arabic – to raise awareness of the procedure’s continued prevalence and its dangers.

Egypt’s health ministry bars doctors and nursing staff from performing the operation, but journalist Jessica Gray, who focuses on the Middle East, reported medical professionals still provide the service.

“Before, many sought out village midwives, known as 'dayas', but nowadays Egyptians are turning to modern medicine,” Gray said. “Experts say families believe their daughters will be safer under the care of doctors, and medical professionals are all too willing to provide their services for a fee.”

And while an article of the Egyptian penal code punishes those who conduct the procedure, few have been prosecuted, Gray said.

The Kamla campaign has spread its message to government workers, other organizations and religious leaders. It’s Facebook page has more than 4,000 likes with more than 169,000 people viewing the page or campaign videos.

In July, UNICEF released a groundbreaking report showing the practice was declining in 29 countries in Africa and the Middle East. The report showed incidents dropping by almost 50 percent in Benin, the Central African Republic, Iraq, Liberia and Nigeria.

“In most of the countries surveyed, [the] majority of girls and women who have undergone the practice do not see benefits to it and think that the practice should stop,” UNICEF specialist Claudia Cappa said. “More mothers are aware that [it] can lead to their daughter’s – or a girl’s – death. So, there is a better understanding of the consequences, which, in itself, is very important progress.”

In Egypt specifically, the number of women between 15 and 49 who have heard of the procedure and believe it should continue declined to 62 percent in 2008, down from 82 percent in 1995. Meanwhile, 35 percent of girls and women now believe the practice should end.