Module 12: Child Marriage and Health

What is Child Marriage?

Child marriage, defined as marriage of a child less than 18 years of age, is a widespread practice in the developing world.  In particular, the marriage of young girls is common in sub-Saharan Africa and Southeast Asia; at the national level, 62% of Ethiopian women aged 20-49 get married before the age of 18.2 (1)  The practice of child marriage can deny educational opportunities, lead to poverty, and can have a negative impact on the health of young girls.(2)  

What are the Factors behind Child Marriage? (3)

Three main drivers of child marriage include: 1) economic impoverishment, 2) tradition and the need to reinforce and establish social ties, and 3) the belief that it offers protection and security.  Most often, parents promote child marriage to ensure their daughter’s financial security and to reduce the economic burden placed on the family.(4)   An additional motivation is the belief that once married, girls will be safe from rape, premarital sexual activity, and sexually transmitted infections.(5) 

According to interviews conducted in Ethiopia, the strongest reason for early marriage is the desire to maintain the family’s good name and social standing.  Often, the social success of children is a measurable status, and a daughter’s success lies in a good marriage to another family. In this study, only one-fifth of the respondents reported pregnancy out of wedlock as a reason for early marriage.(6) While parents and family members may have good intentions for encouraging an arranged child marriage, the outcomes of such marriages are rarely positive.  This module explores several health risks posed by childhood marriage, such as risk of STIs, risk of maternal mortality, and risk to infants.

Risk of Sexually Transmitted Diseases

As mentioned, parents may believe that marriage will protect their daughter from sexually transmitted disease, while in reality they are putting their child more at risk.  More often than not, husbands are considerably older and have more sexual experience, sometimes already infected with STIs or HIV.   In fact, research has shown that marriage by the age of 20 years is a risk factor for HIV infection in girls.(7)   In Kenya, married girls are 50% more likely than unmarried girls to become infected with HIV.  In Zambia, the risk is even higher (59%), and in Uganda, the HIV prevalence rate of married girls and single girls between the ages of 15 and 19 years is 89% and 66%, respectively.(8)  Furthermore, research demonstrates that child marriage also increases the risk of HPV transmission and cervical cancer.(9)

Risks to Mothers and Infants

Child marriage not only puts girls at risk of STIs. It also leads to an increased risk of maternal death because girls between the ages of 15 and 19 are more likely to experience complications during pregnancy and childbirth.(10) 

“45% of girls in Mali, 42% in Uganda, and 25% in Ethiopia have given birth by the age of 18. In Western nations, the rates are 1% in Germany, 2% in France, and 10% in the United States. Girls between the ages of 10 and 14 years are 5 to 7 times more likely to die in childbirth; girls between the ages of 15 and 19 years are twice as likely.(11) High death rates are secondary to eclampsia, postpartum hemorrhage, sepsis, HIV infection, malaria, and obstructed labor. Girls aged 10 to 15 years have small pelvises and are not ready for childbearing. Their risk for obstetric fistula is 88%.(12)(13)”

Because early motherhood is linked to poor maternal health outcomes, these risks increase the likelihood of poor infant and child health outcomes.(14) Young girls are more likely to have children with low birth weight, inadequate nutrition and anemia.  Child marriage is significantly associated with increased likelihood of neonatal death and stillbirth as well as child and infant morbidity and mortality.(15)(16) 

Social Implications

Ultimately, the adverse affects of child marriage extend beyond the immediate health risks of increased STI rates, maternal mortality, and poor child health outcomes.  For example, when young girls enter into marriage, they are usually forced to drop out of school and end their education.  This has repercussions throughout their life and can lead to increased social and financial dependence and lack of individual empowerment.  In addition, their young age often poses a challenge to the demands required in the planning and management of a family.  The unstable family environments can have health consequences for the next generation.

Footnotes

(1) Alemu, B. Early marriage in Ethiopia: Causes and health consequences. Exchange on HIV/AIDS, sexuality and gender, No. 1, p.4-6.

(2) EGLDAM, UNIFEM and UNFPA, Early Marriage in Ethiopia: Law and Social Reality, 2005.

(3) Adapted from:  Nour, N. M. (2009). Child marriage: a silent health and human rights issue. Reviews in obstetrics and gynecology, 2(1), 51.

(4) Ibid.

(5) Nour, N. M. (2006). Health consequences of child marriages in Africa. Emerg Infect Dis. 12:1644–1649.

(6) Alemu, B. Early marriage in Ethiopia: Causes and health consequences. Exchange on HIV/AIDS, sexuality and gender, No. 1, p.4-6.

(7) Joint United Nations Programme on HIV and AIDS, authors. World AIDS Campaign 2004: Women, Girls, HIV and AIDS. Strategic Overview and Background Note. http://catalogue.safaids.net/publications/world-aids-campaign-2004-women-girls-hiv-and-aids-strategic-overview-and-background-not. Accessed 9 April 2020.

(8) Nour, N. M. (2009). Child marriage: a silent health and human rights issue. Reviews in obstetrics and gynecology, 2(1), 51.

(9) Zhang ZF, Parkin DM, Yu SZ, et al. (1989). Risk factors for cancer of the cervix in a rural Chinese population. Int J Cancer. 43:762–767.

(10) Nour, N. M. (2009). Child marriage: a silent health and human rights issue. Reviews in obstetrics and gynecology, 2(1), 51.

(11) United Nations. We the Children: End-Decade Review of the Follow-Up to the World Summit for Children. Report of the Secretary-General (A/S-27/3). New York: United Nations; 2001. https://digitallibrary.un.org/record/441465?ln=en.

(12) United Nations Children’s Fund, authors. Fistula in Niamey, Niger. New York: United Nations Children’s Fund; 1998.

(13) Nour, N. Child Marriage: A Silent Health and Human Rights Issue Rev Obstet Gynecol. 2009 Winter; 2(1): 51–56.

(14) World Health Organization (WHO). Reduction of maternal mortality. A joint WHO/UNFPA/UNICEF/World Bank statement. 1999. https://apps.who.int/iris/bitstream/handle/10665/42191/9241561955_eng.pdf;jsessionid=9BF3C26209912237543E61C8AEA74C10?sequence=1.

(15) International Council for Research on Women. New insights on preventing child marriage: a global analysis of factors and programs. 2007. https://www.icrw.org/publications/new-insights-on-preventing-child-marriage/. .

(16) UNICEF. Early marriage: child spouses. Innocenti Digest No 7, March 2001. https://www.unicef-irc.org/article/514-innocenti-digest-no-7-early-marriage-child-spouses.html.