By Heather B. Hamilton, Deputy Executive Director, Girls Not Brides: The Global Partnership to End Child Marriage

The world has made great strides in maternal and child health in the past quarter-century, with rates of maternal and child mortality nearly halved since 1990. But as the Global Strategy for Women’s, Children’s, and Adolescents’ Health is updated, it’s important to keep in mind that future progress could be undermined by the continued persistence of child marriage. We have to prioritize interventions to address child, early and forced marriage to ensure that past gains continue.

Child marriage is a massive, global issue that affects one out of three girls in the developing world. Fifty-one countries have rates of child marriage above 25%. According to UNICEF, 700 million women alive today were married before the age of 18, and up to 280 million girls are currently at risk of becoming child brides. But if we act to prevent child marriage now, we could dramatically improve the maternal and child health outcomes for millions of girls and women.

Consider the effects of child marriage on the health of girls and their children:

• 90% of adolescent pregnancies in the developing world are to girls who are already married.
• 11% of all births worldwide, an estimated 16 million, are to girls aged 15-19.
• Complications in pregnancy and childbirth are the second leading cause of death in girls aged 15-19 in low- and middle-income countries; girls under 15 are five times more likely to die in childbirth than women aged 20-24.
• When a mother is under 20, her child is 50% more likely to die within its first weeks of life than a baby born to a mother in her 20s.
• Early pregnancy leaves girls vulnerable to obstetric fistula, a preventable yet debilitating injury resulting from obstructed labour or prolonged childbirth; 65% of all cases of obstetric fistula occur in girls under the age of 18.

The effects of child marriage, however, last far beyond a girl’s adolescent years.

It is well known that well-educated mothers have healthier babies. But when girls are married early, they tend to drop out of school – in fact, child marriage is a key driver of lack of educational attainment for girls. In most cases, child marriage means an end to a girl’s formal education, which has a devastating impact both for her and for the health of her future children.

It is extremely difficult for child brides to assert their wishes and needs to their usually older husbands, particularly when it comes to negotiating safe sexual practices and the use of family planning methods. Child brides often face intense social pressure to prove their fertility, and experience early and frequent pregnancies.

In spite of this, few health services are tailored to the particular needs and circumstances of child brides, who are hard to reach and are often unaware that services are in place to support them.

What can be done?

• Focus on the social determinants of early pregnancy for both married and unmarred girls, which also underpin child marriage, in programming for maternal health. Many girls who find themselves pregnant due to a lack of knowledge about sex and/ or have limited access to sexual reproductive health services, may find themselves at a higher risk of child marriage or may choose marriage as they can’t see any other options for themselves.
• Tailor maternal health programmes to the unique needs of adolescent girls: programmes must cater to the needs of child brides as well as girls who are pregnant outside of marriage. Adolescent girls have a right to access quality health information and services that are adolescent-friendly and provide them with the knowledge and support they need to manage their sexual reproductive health needs now and in the future.
• Use health services as an entry point to other services: Once child brides have been reached, it is also important that they are given opportunities to engage in formal and informal education, skills building activities and income-generating opportunities.
• Create safe spaces for girls: Effective programmes include the creation of ‘safe spaces’ where married girls and those vulnerable to early marriage can seek support from each other and learn about maternal health services. Programmes that include such safe spaces have resulted in an increase in the proportion of girls who demonstrate knowledge about contraception; increases in the proportion of girls who speak to a peer about contraception; and increases in the self-reported use of contraception by sexually active girls.
• Establish a minimum age of 18 for marriage, with no exceptions for parental consent or customary law, and ensure implementation of the law.
• Make birth and marriage registration mandatory.

The Global Strategy Progress Report, Saving Lives, Protecting Futures: Progress Report on the Global Strategy for Women’s and Children’s Health, noted that ‘Complementing the critical focus on health, greater attention will be required with respect to social and structural factors that affect the vulnerability of women and children. Urgent attention is needed to tackle such issues as human rights violations, gender inequality, gender-based violence, early marriage and limited educational and economic opportunities that prevent women and girls from benefiting from sexual and reproductive health and rights.’

As stakeholders gather in Johannesburg from May 6-7 to review the progress report and identify next steps, we can’t miss this opportunity to ensure that we heed the lessons learned and make sure that child marriage is clearly and comprehensively addressed in the new global strategy.

Girls Not Brides: The Global Partnership to End Child Marriage consists of than 450 civil society organisations from over 70 countries united by a commitment to work in partnership to end child marriage and enable girls to fulfil their potential.