New research published by the British Medical Journal reveals that almost one in five women and girls in Saudi Arabia has undergone female genital mutilation (FGM).
"That's a high rate," says MENA consultant for the London based women's rights organisation Equality Now, Suad Abu-Dayyeh. "We knew FGM is being practiced in Saudi Arabia but not to this extent."
The practice is associated with early and forced marriage as girls are usually cut between 10 and 13 years of age in preparation for a husband, Abu-Dayyeh told MEMO. "It is seen as increasing a girl's desirability and preventing her from engaging in sexual activity or becoming pregnant outside of wedlock."
Though UN statistics put the number of girls and women impacted by FGM worldwide at some 200 million, activists claim the figure is much higher.
Statistics remain unclear because women feel uncomfortable discussing it, practitioners in countries where it is illegal don't document it and young girls without education may not fully understand what has happened to them, says Abu-Dayyeh.
Still, for the countries that are associated with the practice including Egypt, Yemen and Iraq, there are at least established civil society organisations which campaign to end cutting women. As there is no recognition that it takes place in the kingdom, there are no NGOs or institutions women can turn to for help.
Civil society within Saudi Arabia is almost non-existent and those who speak out about women's rights are persecuted and imprisoned by the government. This has created a climate of fear which makes campaigning on issues like FGM virtually impossible.
Recently the kingdom has come under fire for arresting and torturing 11 female human rights activists weeks before a ban on women driving cars was lifted. They have been denied access to lawyers and independent monitors banned from the courtroom.
Under the male guardianship system women in Saudi are legally classified as minors and must seek permission from a male relative to travel, play sports and make choices regarding health care.
"Under such a repressive system, it is incredibly hard for any women or girl to take a stand against a harmful practice like FGM."
"Although women's rights are an issue across the Middle East," says Abu-Dayyeh "the situation in Saudi Arabia is particularly dire with women enduring very extreme oppression that is legally sanctioned by the state."