NAIROBI, Kenya — Trying to stop a bloody ritual undergone by millions of Muslim women in sub-Saharan Africa and the Arab world, health activists are trying a new appeal — they're citing the Quran.

"The guiding factor is always Islam," says 34-year-old Maryam Sheikh Abdi, who grew up in a region of northeast Kenya where 98 percent of girls are believed to undergo the procedure, a genital mutilation sometimes called female circumcision. Women believe "the pain, the problems, the bleeding — they are all God's will."

Health activists, finding that focusing on women's rights isn't working to persuade Muslims to stop performing the ritual, are increasingly using theology to make the case that "the cut" has nothing to do with religion. Abdi, who speaks about female genital mutilation on behalf of the U.S.-based Population Council, said invoking Islam penetrates years of cultural indoctrination.

"Women don't have to torture themselves. Islam does not require them to do it," said Abdi, who underwent the procedure when she was 6 and was a college student by the time she realized it was not necessary from a religious viewpoint.

With age-old cultural roots, female genital mutilation is practiced today in parts of sub-Saharan Africa and Egypt and other parts of the Arab world such as Yemen and Oman. In the rest of the Islamic world — the Middle East, North Africa, southeast Asia — it's nearly nonexistent.

In the most extreme form, the clitoris and parts of the labia are removed and the labia that remain are stitched together. Those who practice it believe it tames a girl's sexual desires and increases her marriageability.

Knives, razors or even sharp stones are used during ceremonies usually performed by elder women in the bush with no medical supervision. The tools are frequently not sterilized, and often, many girls are cut at the same ceremony, creating the chance for serious infections.

Late last year, the top cleric in Egypt — where the practice is pervasive and many believe it is required by Islam — spoke out against it, saying circumcision was not mentioned in the Quran, the Muslim holy book, or in the Sunna, the sayings and deeds of Muhammad — the two main sources of Islamic practice.

"In Islam, circumcision is for men only," Mohammed Sayed Tantawi said. "From a religious point of view, I don't find anything that says that circumcision is a must" for women.

Laws against female genital mutilation exist in many of the regions where it is practiced, but poor enforcement and lack of publicity can hinder the laws, human rights groups and women activists say. They say laws aren't effective unless those who practice and require the tradition are first made aware of its physical and mental damage.

U.S. Ambassador Michael Ranneberger has taken on the cause in Kenya.

"Stated in its starkest terms, there are mothers, wives, sisters and daughters who are dead today and who will die tomorrow specifically because of the practice of female genital mutilation," Ranneberger said in a recent speech.

Ibrahim Lethome, legal adviser of Supreme Council of Kenya Muslims, said he recently started focusing on Islam as a way to stop female genital mutilation after meeting with Muslim university students who were shocked that the practice had no religious basis.

"I have even met a medical doctor who allows" the procedure, he said. "Even educated people believe Islam demands it."

UNICEF says an estimated 3 million women and girls undergo female genital mutilation each year and that the age at which it is carried out is getting lower in some countries.

Abdi was just 6 when two women led her into the bush near her home and held her down, ordering her not to scream. One of the last images she recalls before the razor sliced into her was one of the women giving her a conspiratorial wink.

"I think she was trying to tell me to get ready for the pain," said Abdi, who believed the ensuing years of frequent infection and psychological distress were simply part of being a Muslim woman.

It wasn't until 1995 when she learned, from another Muslim woman at university, that female genital mutilation wasn't part of her religion.

"I knew that I was a Muslim and she was a Muslim," Abdi said. "I just remember thinking, 'Why was I brought up this way?' "