Maternal Health Task Force

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From the Archives | Recognizing Child Marriage as a Maternal and Women’s Health Issue

By: Yvette Efevbera, Doctoral Candidate, Harvard T.H. Chan School of Public Health

Fatimatah* was forced into marriage by her family at the age of 16. She described not wanting to marry: “I told him, ‘No, I do not love you, and I do not want that this is my husband. For now, I am going to pursue my studies, and even if I am going to marry, it is not with you. I do not love you.’”

But she was already three years older than the age at which her sister was married, and her family said she had no choice. Fatimatah ran away from home, hid at neighbors’ houses and tried to finish her schooling, but was eventually forced to return home, where her family had already celebrated the traditional marriage.

Married life for Fatimatah was physically and emotionally painful. Her husband was poor, and she was forced to find ways to earn money for her own livelihood; she still has scars on her head from carrying buckets of water and candies to sell over four miles a day. Her husband regularly beat her and threw objects at her, causing chronic back pain, headaches and sinus infections. Fatimatah suffered from three miscarriages that went untreated and is now told she cannot have children. She described her ailing physical health and overall wellbeing as consequences of her marriage.

Unfortunately, Fatimatah’s story is not hers alone. Globally, one in nine girls marries before age 15, and about one in three marries before age 18. The majority of these child marriages occur in South Asia and sub-Saharan Africa. In Guinea, a West African country recently devastated by the Ebola epidemic, more than 50% of girls marry early, despite that the legal minimum age of consent for marriage in Guinea is 18 years old.

As Fatimatah’s case illustrates, early marriage puts young girls at risk of developing numerous negative maternal and reproductive health outcomes including early pregnancy, reduced contraceptive use and poor birth spacing. Studies have also found poorer maternal health-seeking behaviors among child brides, such as fewer antenatal visits and lower odds of deliveries with skilled birth attendants.

Women who marry early may also have lower decision-making power and autonomy in the household, another pathway through which early marriage affects health. Like Fatimatah, young brides may be at increased risk of experiencing domestic violence. One study found that women who married before the age of 18 in India were almost twice as likely to have reported ever experiencing intimate partner violence in their married lives than those who married as adults. In addition to physical consequences, these interactions directly led to stress and depression, as described by Fatimatah, ultimately affecting socioemotional wellbeing.

Risk factors for early marriage, as well as poorer maternal health outcomes, may be linked to education and poverty. In the African context, early marriage has accounted for up to 28% of school dropouts in some countries. Girls with primary education or no education are more likely to marry early compared to girls with secondary education, and secondary school attainment has been documented to be disrupted by the marriage, as illustrated by Fatimatah’s case. When girls are not able to complete higher levels of education, their opportunities to find employment and earn income are reduced. Lower income and education may affect maternal knowledge, behavior and accessibility to resources. Moreover, a mother’s education not only affects her own health, but also that of her children. Recent evidence from across sub-Saharan Africa illustrates that through reduced wealth and education, early marriage negatively affects early childhood development, creating an intergenerational cycle.

When asked to share any positive experiences from her marriage, Fatimatah responded, “Yes, there were positive things: suffering. The suffering that I suffered there. It is that which gave me the courage to become what I would be tomorrow, or what I am today.”

In some ways, her story might be considered a success. Her parents, fearing for her life, removed her from her marital home after five years. Her knack for entrepreneurship and her perseverance to study enabled her to make enough money to complete secondary school, national exams and eventually university. She was also able to start her own small organization and is now in a role that allows her to guide and council other young women.

So what we can learn from Fatimatah’s experience? Child marriage cannot be viewed or treated exclusively as a human rights issue. The public health community must also address it from the perspective of maternal and women’s health.

*Name changed to protect the identity of the participant.

**Fatimatah’s interview is part of a larger qualitative study on child marriage, health and wellbeing in Guinea led by Yvette Efevbera. Most sincere thank you to Fatimatah for sharing her experiences, to numerous Guinean friends and colleagues who supported and encouraged this research and to Dr. Paul Farmer, Prof. Jacqueline Bhabha and Dr. Günther Fink for academic advising.

Access resources related to global adolescent sexual and reproductive health.

Learn more about child marriage from UNFPA, UNICEF and the World Health Organization.

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