“There’s no question this is a global-health issue. In the U.S., adult women are capable of giving consent for surgical procedures. But what would it take to get a woman in an African country to the same position of being able to give consent? Social pressures are so strong that no woman could ever opt out. Everybody would come down on her. That’s the problem. . . .
“This is not an individual behavior. . . . If I decide I don’t want to circumcise my daughter, that’s not an individual behavior. I would have to answer to my husband, to my mother-in-law, my mother-in-law would have to answer to her friends throughout the community, my father-in-law would have to answer to people in the community, so there’s societal pressure. So understanding what is a collective decision versus individual is really important. You can go and tell an individual mother what the health risks are and she can believe you, but it doesn’t mean, first of all, that she has the power to make that decision, or even that she has the authority to impart that information to her mother-in-law and other senior people in the society who are the decision-makers. . . .
“We need to be targeting people who are in the extended family, and we know that we need to figure out who are the figures of authority in these families, and who are the influences on them in the community. We need to do male elders, but also female elders.”