Child marriages not a religious or cultural issue

After struggling for three days in labour, Fawziya Abdullah Youssef, 12, bled to death. Her baby didn't survive either. It was later revealed that the Yemeni child bride had suffered even before that. Fawziya's mother said her daughter's 23-year-old husband had beaten and even tied her down to have sex with her.

We do not have extreme cases like this being reported about Malaysians but we have read stories about girls being married at a very young age. In 2010, for example, there was a report about an 11-year-old girl who was married off to a 41-year-old man by her father in Kelantan. It wasn't the fact that she was married at 11 that made the news but that she was found starving and barely conscious in a mosque two weeks after their wedding.

Malaysia's adoption of a United Nations resolution to end child, early and forced marriage at the Human Rights Council last week could not be more timely. Calls for banning child marriages have been ringing loud in the last few years, but not much has been done about it as many see it as a religious and cultural issue.

Girls Not Brides global coordinator Lakshmi Sundaram highlights that child marriage is not officially endorsed by any religion.

"People often used religion and tradition to justify certain practices but it's not really a religious obligation by any means in any religion in the world. It must also be noted that child marriages happen in all religions in the world. It is a problem across the world," she says.

Sundaram believes it is more linked to man-made traditions, which can be changed when they are no longer applicable in society.

While people who want to perpetuate child marriage hide behind this religious veil to block discussion and dialogue, others are scared to talk about it because they are scared of being accused of religious insensitivity, she notes.

"That's the biggest problem - when there is no opportunity to talk about it and explore the alternatives."

She highlights that the importance of dialogue has been seen in countries (such as Turkey and Pakistan) where members of the Girls Not Brides coalition are working with religious leaders. Many of these respected religious authorities have come out to make a stand against child marriages.

What we need to stress is that child marriage is a human rights violation that has a major health impact, she says.

"It's not easy to talk about girls being child wives and all that marriage entails for them, but we can't shy away from an issue when it has such an impact on the health of so many girls and women."

According to Sundaram, there is growing evidence that child marriage and maternal health are inextricably linked.

Studies show that girls who give birth before the age of 15 are five times more likely to die in childbirth than girls in their 20s. Where girls survive childbirth, they are at increased risk of pregnancy-related complications and injuries such as obstetric fistula, a medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina. Sixty-five per cent of all cases of fistula occur in girls under the age of 18.

Teen childbirths are increasing in Malaysia; the Health Ministry recorded 18,652 births by girls below the age of 19 in 2011, compared with 5,962 in the second half of 2010.

When asked about the Malaysian notion that early marriage did not do much harm on our own mothers and grandmothers, Sundaram says we only need to look at our maternal mortality rate from that era.

"How many women died in childbirth in the past? How many babies did not survive?"

True, statistics from Malaysia's Statistics Department show that in 1933, the maternal mortality ratio (per 100,000 live births) was 1,080 compared to 26.1 in 2010 when women are marrying and having babies later.

To improve maternal and child health worldwide, we must address child marriage, she stresses, citing a recent study from the University of California, San Diego.

Conducted by Professor Anita Raj and Ulrike Boehmer (Associate Professor at the Boston University School of Public Health), the study shows that reducing child marriage will accelerate efforts to reduce maternal mortality.

"There are strong correlations between maternal mortality rates and child marriage prevalence rates. The study shows that a 10 per cent reduction in girl child marriage could be linked to a 70 per cent decline in a country's mortality rate."

While concurring that premature pregnancy has long been a risk to young mothers, Unicef chief of health Dr Mickey Chopra, however, concedes that there are parents who are unaware of the harmful consequen­ces of such early marriage.

"They may feel that their actions are in the best interest of their daughters but the fact is child marriage leads to early sexual initiation. Married girls who have reached puberty, regardless of how young, are often forced into early childbearing."

As he highlights, premature pregnancy often leaves girls with many physical and emotional scars.

"It presents a high risk for complications, including prolonged and obstructed labour, haemorrhaging, infection and obstetric fistula. Young mothers often require more Caesarean sections than women over 18 because their bodies are not yet sufficiently developed for childbirth. At worse, these child pregnancies can lead to infant death and even maternal death."

Health risks

Dr Chopra adds that child brides are also more vulnerable to the risk of HIV infections and other sexually-transmitted diseases since their husbands are usually older men who, in all likelihood, may have previously had unprotected sex with multiple partners.

"Powerless and without the skills to negotiate for safer sex, these young girls' lives are jeopardised through their early marriage," he notes.

Still, raising public awareness of this harmful practice alone will make little impact on the lives of vulnerable girls, stresses Dr Chopra.

"We have learnt that child marriage cannot be solved in isolation as it results from a complexity of social, cultural and economic dimensions and widespread gender discrimination.

"Because child marriage is made worse by poverty, addressing the financial motivations behind the practice could help reduce prevalence among impoverished and indebted families."

Ultimately, says Dr Chopra, governments must outlaw the practice of child marriage by increasing the legal age of marriage for both girls and boys to 18, regardless of religion.

"While child marriage is culturally packaged as a social necessity, in many cases it amounts to socially licensed sexual abuse and exploitation of a child. The fact that the arrangement is socially accepted does not diminish the reality that a girl is deliberately exposed to sexual abuse and exploitation," Dr Chopra reiterates.

Training law enforcement officials on the dangers and health risks and consequences of child marriage and their duty to enforce laws is another important first step towards reducing the prevalence of child marriage.

Law enforcement officials and judiciary bodies need to collaborate to ensure a severe legal response to those abetting the practice of child marriage as stringent punitive action will act as a deterrent.

"Only then can you have a comprehensive public education and mass media campaign on the harms of child marriage and the laws regulating the practice, especially in areas and amongst communities that have this harmful practice. The campaign should serve to remind citizens of the legal age of marriage and the consequences an individual will face if they marry a child, or arrange for their underage children to be married," he says, adding that a better-equipped police and a better-informed population will be able to monitor and enforce the law.

Given the influence of religion, approaching the issue through the enforcement of Syariah law is also necessary, Dr Chopra notes.

"While many religious leaders have claimed they disapprove of marrying underage girls, in practice, there are some who oversee these unions. Because religious leaders officiate over the ceremonies of many weddings, it important they receive training on the adverse effects of child marriage since they know how to communicate effectively with parents and their opinions are held in high regard. By changing the beliefs of religious leaders around child marriage, it will be easier to change the behaviour of the people."