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INDONESIA - Thrashing wildly, five-year-old Reta wails as she is hoisted onto a bed during a circumcision ceremony in a school-hall-turned-clinic on Indonesia's island of Java.
"No, no, no," she cries, punching and kicking as her mother cups her tear-soaked face to soothe her.
Doctors clap and cheer encouragingly.
One of them gently swipes her genital area with antiseptic and then swiftly pricks the hood of her clitoris with a fresh sewing needle, drawing no blood.
The ordeal is over in seconds as other girls and babies waiting for their turn shriek in fear.
Doctors say the procedure will have no effect on the girl, her sexual pleasure in later life or ability to bear a child.
"I'm happy. My daughter is now clean," said Ms Yuli, 27, a seamstress, at a mass circumcision of 120 girls and babies at the Assalaam Foundation's Islamic school, in the western Javanese city of Bandung.
She believes the ritual will nevertheless have an effect.
"Many girls are getting pregnant out of wedlock these days. Circumcision hopefully will prevent my daughter from becoming oversexed and will make her less amorous when she grows up," she added.
Indonesia, home to the world's largest Muslim population, argues that this form of circumcision is largely symbolic, not harmful and should not be seen as mutilation.
Banned
The United Nations thinks otherwise.
In December, it passed a resolution banning female genital mutilation, which includes the circumcision practised in Indonesia.
Procedures such as pricking, piercing, incising, scraping, cauterisation, or burning that are carried out for non-medical purposes are classed by the World Health Organisation (WHO) as mutilation along with practices that alter or remove any part of the genitals.
The more extreme practices can lead to severe bleeding, urination problems and complications during childbirth, according to the WHO.
A ritual dating back thousands of years and typically seen in parts of Africa, Asia and the Middle East, its most brutal forms require stitching together the inner and outer labia, or cutting off all or part of the clitoris.
Indonesia says that genital cutting does not take place and that it has worked to eradicate other more severe circumcisions as it seeks compromise between conforming to international standards and placating cultural and religious traditions.
It banned female circumcision in 2006 but backtracked in 2010, arguing that many parents were still having their daughters circumcised but often by unskilled traditional doctors who may botch the procedure.
"It's impossible to ban a longtime tradition," Health Ministry official Budi Sampurno said.
In response to the ban, the Indonesian Ulema Council, the country's top Islamic clerical body, issued a fatwa in 2008 allowing the practice but did not make it compulsory.
While no official data is available to measure the extent of the practice in Indonesia, it is common in the country of 240 million people, according to aid agencies.
A 2003 study by the Population Council found that 22 per cent of 1,307 female circumcision cases were excisions, meaning part of the clitoris or labia was removed.
Of the rest, 49 per cent involved incisions while 28 per cent were "symbolic".
Researchers say the situation has improved in the past 10 years.
A 2009 study led by Jurnalis Uddin, a doctor and lecturer from Jakarta-based Yarsi University showed that 18 per cent of health institutions still performed female circumcisions but that these did not extend to cutting the genital area.
"If there is excision, the number must be significantly lower (than in 2003)."
Jakarta issued a 2010 regulation allowing "scraping the clitoral hood, without injuring the clitoris", while criminalising more severe procedures - a regulation that is nevertheless defined by the WHO as mutilation.
Despite the UN resolution, the custom has deep meaning for Indonesian Muslims and will likely remain, officials say.
Housewife Tita Lishaini Jamilah, 28, who also took her baby to the clinic for a circumcision ceremony, said Indonesia should not bow to the UN's ban on the practice, insisting that the ritual was safe.
"Why would any parent hurt her child? If any doctor were to mutilate my daughter, I'd be the first to protest," she said.