Child Marriage, Mental Health, and Sexual and Reproductive Health Needs of Syrian and Jordanian Adolescents: An Interview with Jewel Gausman

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By: Sherine Andreine Powerful, MPH, Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health and Research Assistant at the Maternal Health Task Force

Jewel Gausman, Areej Othman, Iqbal Lutfi Hamad, Maysoon Dabobe, Insaf Daas, Abeer Shaheen, and Ana Langer are currently conducting qualitative research studies on how conflict affects community norms that impact adolescents’ sexual and reproductive health needs and challenges in Syria and Jordan. You can find the study protocols here and here

Sherine: Can you tell us more about your research on child marriage in Jordan?

Jewel: Our research team’s interest in child marriage has really grown out of a larger project focused on adolescent sexual and reproductive health. We, including Areej Othman from the University of Jordan and a local NGO called the Jordanian Hashemite Fund for Human Development (JOHUD), have been funded by the Dutch government to conduct a large qualitative study focused on adolescent sexual and reproductive health. Our interest in child marriage really stemmed from that study. 

Sherine: Were there any challenges or surprises that you encountered while doing the study?

Jewel: Dealing with sexual and reproductive health, and in particular child marriage in this part of the world, is extremely sensitive. Often times, in working with adolescent sexual and reproductive health, the populations are not married. In this region, there’s very little sanctioned sexual activity outside of marriage, so the needs and concerns are different from other places in the world. Recently there’s been a lot of attention on child marriage in this region, especially with the Syrian refugee crisis. In Jordan, there have been huge numbers of Syrians living there since the beginning of the Syrian conflict. And while child marriage is somewhat common in Jordan, it was more common in Syria. At the beginning of the conflict, and during the ten years that a lot of people have been in displacement, child marriage has been increasing. Statistics are difficult to pin down because a lot of marriages happen outside of formal legal entities, so they’re not registered. However, data indicate that child marriage has been increasing among Syrians in Jordan, and that, especially in Jordanian cities and communities where there are a lot of Syrian refugees, child marriage also increasing among Jordanians. This is somewhat surprising.

Sherine: In the commentary you wrote, you mention that the “Jordanian Parliament rejected a measure to eliminate the exceptions under which girls younger than 18 years can be legally married, citing a lack of evidence of the health consequences of child marriage”. What were the exceptions that stuck out to your team? 

Jewel: I don’t want to say too many specifics about the Jordanian law [and child marriage], because it’s complicated to interpret, and I’m not an expert in Jordanian law. But many of the exceptions have to do with parental approval for the marriage, and whether or not (and again I don’t know if this is officially part of the law or not) the girl would be considered better off if she were married. There are also exceptions related to marriages that are sanctioned through religious institutions rather than government institutions. There are several loopholes that exist right now.

Sherine: Do you think there was a lack of evidence of health consequences?

Jewel: Globally there is evidence, [for example, Dr. Yvette Efevbera’s mixed methods study on child marriage and health in Sub-Saharan Africa, embargoed until November] and one of the concerns in the refusal to overturn these exceptions is that there has not been a lot of research done in the Jordanian population on the health consequences, so this is an issue of there not being a large amount of local evidence. From what I understand, it’s deeply embedded as a cultural issue, and there is some reluctance to overturn it because of that. 

Sherine: In what ways would you say your research is contributing to the evidence?

Jewel: One of the issues that has emerged from our research is the overlap between sexual and reproductive health, mental health, and child marriage. Our findings really highlight this overlap. In particular, girls associate child marriage with depression, gender-based violence, with other sexual and reproductive health issues like sexually transmitted diseases. Some of the girls even mentioned associations with suicide. It was very heartbreaking listening to them describe how they view the connections between these particular issues. And there is not a lot of research in the Middle East, particularly in Jordan and among Syrian refugees, on depression and other common mental health issues among the population, especially among married adolescents.

Sherine: With adolescent study participants, were you able to get into any specifics around how the war compounded or exacerbated issues at the intersection of sexual and reproductive health and mental health?

Jewel: Some of the issues are of trauma from displacement, post-traumatic stress disorder, girls having to move into a new culture, especially those in refugee camps. Our study focused outside of camps, as most Syrian refugees in Jordan live in communities into which they are integrated, but a lot of girls do live in camps. I think that this population is particularly vulnerable to these issues. One point that has been documented elsewhere is that because of displacement, many refugee girls feel they are being pushed into child marriage because of the economic and social benefits. It offers stability, financial incentives to their families, and in some cases, opportunities to get out of the refugee camp. I think that the fact that the girls are being pushed into a situation that is not ideal is also very damaging. 

Sherine: Given your experience, for researchers aiming to investigate the sexual and reproductive health and rights of adolescents displaced by war, what are some considerations they must make?

Jewel: In terms of our study, the fact that we used participatory and interactive methods allowed the participants to tell their story, rather than superimposing outside ideas. We tried very much to let the participants direct where we go with the research and data we collect, which was important in order to understand some of the nuances affecting this population.

Sherine: For the participants who you were able to interact with who identified as both adolescents and mothers, were there any themes that came up for them that were different than for other adolescents?

Jewel: In our study, we had very few girls who were actually married, because the girls who get married become somewhat hidden and unseen. They are very restricted in terms of even being able to leave the house and are very hard to reach. Our local partner tries to do work from an intervention standpoint in trying to reach married adolescents, and it’s quite difficult. 

Sherine: And given the sociocultural context, only the married adolescents would be parents?

Jewel: There is a very small, unknown, percentage of girls that become pregnant outside of wedlock, but it’s uncommon,and there are also no data on that. So it’s really unknown. Of course there are also issues around sexual violence and rape, too, that could result in pregnancy outside of marriage, and that’s thought to be more common than it had been previously, given the issue of displacement, the transience of the camps and refugee communities, the difficulties that people face there, and the lack of security. So it does happen. There’s just so little data. 

Sherine: What’s next in your research on this area?

Jewel: We’re hoping to continue to design research that focuses on child marriage, sexual and reproductive health, and mental health. Our ongoing research focuses on sexual and reproductive issues more broadly among youth. Our current project focuses on youth, their parents, and service providers to better understand how to reach the needs of the population. We also have research focused on sexual and gender-based violence among disadvantaged urban youth in Jordan that would also have a large population of refugees. We don’t have any concrete plans specifically related to child marriage, but child marriage is an issue related to sexual and gender-based violence, so there may be an opportunity within that study to include child marriage.