It was a routine procedure undertaken by thousands of Egyptian girls every year, but something went wrong and Budour Ahmed Shaker died while having her genitals cut in a rite known locally as "purification".

The death of the 11-year-old schoolgirl at a private clinic in the Egyptian village Mughagha in June prompted the government to outlaw the custom of female genital mutilation, which is so widespread in Egypt that 95 per cent of the country's women are estimated to have undergone the procedure.

But the ban may be hard to enforce and activists fear the practise may go underground as the vast majority of Egyptian families still view circumcision as necessary to protect girls' chastity. Most girls are cut by the time they reach puberty.

Even in Mughagha, a village of low rise houses hemming the Nile, many women and girls say they want the procedure to be allowed but under more stringent medical supervision.

"If a girl is not purified, she will just go hook up with men. This protects women's honour. Otherwise it will become just like America here and girls will go with guys," said Asma Said, a 16-year-old secondary school student.

"Those who say it doesn't happen are lying 100 per cent. There is not one person here not circumcised, and it will continue."

She, like many of the schoolgirls in Maghagha, said they supported the practice, even if they were frightened of having it done.

The only girl who spoke against the practice was shouted down by her classmates until she conceded that genital cutting was a necessity.

"No one can get married without it," said the girl. Another classmate, 15-year-old Nesma Radi, chimed in:

"Egypt lives in peace and security because there is circumcision."

Egypt imposed a complete ban on female genital cutting - also known as female genital mutilation or circumcision - in June after Ms Shaker died of an excessive dose of anaesthesia while being cut at a private clinic in Maghagha.

Egypt's state-appointed Grand Mufti, the government's official arbiter of Islamic law, decreed in June that female genital cutting was forbidden by Islam, in his strongest statement yet against the practice.

In Egypt, the cutting is done on both Muslim and Christian girls and typically involves excising the clitoris and sometimes other female genitalia, often by a doctor. Side effects include haemorrhage, shock and sexual dysfunction.

Outside of Egypt and Sudan to the south, the practice is extremely rare elsewhere in most of the Arab world but, is common in Eritrea, Ethiopia and Somalia.

More than 95 per cent of Egyptian women had been circumcised, with the highest levels in poor families living in rural areas of the Nile valley in southern Egypt, according to an Egyptian Demographic and Health Survey conducted in 2005.

The highly publicised death of Ms Shaker at the start of what activists call Egypt's "circumcision season", spanning the hot summer months when school is out of session, prompted Cairo to close a legal loophole that had allowed doctors to perform the rite for documented "health reasons".

Like Ms Shaker, nearly three quarters of girls who are circumcised in Egypt are cut by medical personnel, including doctors and nurses who receive fees of between $8.85 to $88.50, activists say.

They say that a handful of girls die each season - either because they receive an improper dose of anaesthesia or from haemorrhage or other complications.

"Some doctors, so that they feel better about themselves and more ethical in a way, say: 'I'll prick her' so she bleeds and her parents are happy... I've heard a lot of doctors saying if I don't do it they will go to my fellow doctor who will do it," said Yasmine Wahba, child protection officer at Unicef.

"I think it's cuckoo," she added, referring to the logic. She said she feared the practice may now be driven underground.

Even after the government imposed its full ban on the practice, the procedures continue to happen, although an Egyptian anti circumcision activist in southern Egypt said doctors were now demanding higher prices to compensate for increased risk.

In the southern town of Edfu, a seven-year-old girl was brought to hospital last month after she haemorrhaged while being cut in a village clinic, the health ministry said.

Health authorities are investigating reports that a nurse in a town south of Cairo had cut the genitals of three girls in a single day in procedures done in their homes.

The ministry said the woman, who confessed, could face up to two years in jail.

"At least the doctors will be scared," Ms Wahba said. "They will be scared because there is a lot of talk now of enforcing the law."

Factbox

• What is female genital circumcision? FGM, often referred to as "female circumcision", comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs. The practice involves cutting off all or part of the clitoris and other female genitalia, sometimes by a doctor but also often by a relative or midwives.

• Side effects: The immediate and long-term health consequences of the process varies according to the type and severity of the procedure performed. Immediate complications include severe pain, shock, haemorrhage, urine retention, ulceration of the genital region and injury to adjacent tissue. Haemorrhage and infection can cause death. There is also increased susceptibility to HIV/AIDS. It may leave a lasting mark on the life and mind of the woman who has undergone it. In the longer term, women may suffer feelings of incompleteness, anxiety and depression.

• Why is the procedure carried out? In order to attenuate sexual desire in the female, maintain chastity and virginity before marriage and fidelity during marriage, and increase male sexual pleasure. To conform with the social norm - those who don't conform are likely to be stigmatised. To initiate girls into womanhood, social integration and the maintenance of social cohesion. Some African Muslims believe that cutting is required by Islam and fulfils a religious obligation, however the practice predates both Islam and Christianity.

• Who performs FGM? Genital mutilation predominantly occurs in around 28 African countries, but it also takes place in some Middle Eastern nations, like Saudi Arabia, among immigrant communities in Europe and North America, and parts of Asia, including Indonesia. A 2005 Unicef report said that 97 percent of Egyptian women between the ages of 15 and 49 had been circumcised.

Unicef said Eritrea ranks amongst the worst in the world for FGM and a survey by its government in 2002 found less than one per cent of circumcisions were performed by trained health professionals. Eritrea banned FGM last April. In Kenya, the government has estimated about a third of women suffered the procedure.

FGM is practised throughout West Africa. In Guinea, Sierra Leone and Mali, at least 90 per cent of women are cut.

The number of girls and women who have been undergone female genital mutilation is estimated at between 100 and 140 million. It is estimated that each year, a further two million girls are at risk of undergoing circumcision.