India, March 21 -- The 22-year-old Lamkelo Mtyho had no known health issues when he joined his peers, wrapped in blankets and smeared in clay, for the most important ritual of his young life: the highly secretive process of traditional circumcision. His family in South Africa expected him to return triumphant, full of cultural knowledge and officially a man.

Three weeks later, they learned that he was dead. He was one of at least 48 boys and young men who died during the latest round of initiation ceremonies in South Africa. It is rare to hear the story of an initiate who died. Because of participants' silence around the ritual, families and authorities have struggled to understand and police a deeply traditional but often abused practic...