Determinants of Child (Early) Marriages among Young Girls- A Public Health Issue

“The Sindh government has recently proposed amending the old child marriage laws to include stricter penalty and punishments”. The practice of early marriage has increasingly been recognized as human rights violation affecting girls more than boys with severe consequences. Though the numbers of cases have reduced worldwide, it still remains pervasive in South Asia, predominantly in Pakistan. Despite national laws and international agreements, this public health issue presents a threat to the lives and health of children, especially young girls. This paper highlights the major determinants of child marriages, the magnitude of the problem and its implications along with some of the public health measures to reduce the impact. *Corresponding author: Sahreen Malik Bhanji, Aga Khan University School of Nursing and Midwifery, School of Nursing and Midwifery, Pakistan, Tel: 9223322042134; E-mail: sahreen0707@gmail.com Received March 12, 2014; Accepted April 25, 2014; Published April 30, 2014 Citation: Bhanji SM, Punjani NS (2014) Determinants of Child (Early) Marriages among Young GirlsA Public Health Issue. J Women’s Health Care 3: 161. doi:10.4172/2167-0420.1000161 Copyright: © 2014 Bhanji SM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
According to the Article 1 of the Convention on the Rights of the Child and UNICEF, the terms child or early marriage are used interchangeably to describe a legal or accustomed union between two people, of whom one or both spouses is below the age of 18 years [1][2][3][4]. Currently, one third of the women in Pakistan get married before the age of 18, while about 12 to 13 percent get married before their 15th birthday (Nadia, 2013). Child marriages are considered by many to be a way to protect young girls; rather early marriages leave them physically and socially vulnerable to gender inequality, illness, poverty, and violence [5]. Apart from these consequences, young married girls are exposed to early frequent unplanned pregnancies and termination of pregnancy which results from depriving the women of the contraceptive methods increasing the likelihood of maternal and infant morbidity and mortality [3,6,7]. Most importantly, in its recent guidelines on preventing early pregnancy, The World Health Organization has included the prevention of child marriages as one of the six primary goals [8].

Magnitude of the Problem
According to Machel, Pires, and Carlsson 34% of girls globally, are married by the age of 18 years and 11% marry before the age of 15 years. Child marriage is a global challenge with a severe impact. The severity is such that it causes psychological trauma and increased risk for sexually-transmitted diseases among young married girls with complications like fistula during childbirth and even death of the young mother or her baby [3,9]. Child marriage does not only deprive girls of their childhood and educational opportunities, but also makes them vulnerable to the brutal cycle of domestic violence, sexual abuse and poverty [2,6]. According to Nour [10] young women (girls) who are forced into marriage are additionally exposed to greater risk of HIV and other sexually transmitted infection as they are forced into sexual activities by their much older husbands.

Family coercion and values
Child marriage is referred to as early or forced marriage since the children are not given a chance for a prior informed consent for their marriage partners. The girls are often forced into marriages who willingly accept marriage as their allotted fate [9]. Moreover, in Islam, the elders in the family are highly respected; therefore they may advocate marriage of young children especially girls in their families with a belief such that this union will keep their daughters safe. Subramanian undertook a study to examine the factors that are associated with the female age at marriage in rural areas of India [11]. Among the respondents, Twenty-three percent of them got married at a younger age (i.e., younger than 17 years) due to either parental compulsion, traditional family practices, or compulsion by the relatives. Therefore, families may also put their children under social or emotional pressure and urge them to marry as part of their family values and tradition.

Patriarchal structure of the society
In Pakistan like other South Asian countries, men have more control and power and thus are considered as the decision makers of the family [2]. In contrast, females are considered as secondary or as a guest in her parents' house and that the final destiny or permanent place is her husband's house. According to Subramanian "Early marriage is a part of the wider practice of female seclusion through their subordination to men and deprivation of equal access to social and material resources" [11]. Parents consider their daughters as someone else's 'property' (i.e., husbands) that they have to look after and nurture only until she is married off (Nadia, 2013;Subramanian, 2008). Schuler, Bates, Islam, and Islam (2006) in their study found that the belief that wives should be several years younger than their husbands seemed to be a strong contributing factor for early marriage of young girls [12]. Therefore, the parents prefer to fulfill this responsibility of handing over their daughters in a marriage relationship as soon as possible.

Integrated System of Kinship
Marriages within the "biradari" or within close family (cousin marriages) are very common in rural areas of Pakistan; the reason being that, people prefer to preserve strong familial ties to ensure their security and personal interests [1]. At some instances, marriages are decided and arranged even before the girl is born, and once the marriage is fixed, parents are bound to marry their daughters before she reaches the perfect age for marriage. Cousin marriages provide them an opportunity to conserve their economic and social ties in order to safeguard their personal benefits [1]. Moreover, cousin marriages keep families from incurring huge expenses on their child's marriage. Besides, these have very low chances of divorce. Taking these reasons into account, the age factor is often overlooked while preferring a good match for their child within the family.

Poverty and Economic Transactions
Poverty is also one of the critical factors which contribute to child marriages. In countries like Bangladesh, poverty is considered as the most powerful driver of child marriage [7]. A young girl in a poor family is often regarded as an economic burden while marrying her to an older man is believed to bring social as well as financial benefits to the poor family. The girl is regarded as a commodity to be traded to settle the disputes or debts [1]. At times poverty is such a critical factor that in order to attain economic safety in conditions of war or poor harvest, poor families try to attain stability by marrying their young daughters to much older men.

Notions of Morality and Honor
The notions of morality and honor are considered to be an important force that drives families to child (forced) marriages. In Islamic countries like Pakistan, a high value is placed on a girl's virginity and is considered as a shame on a family if a girl is not a virgin when she marries [1,2]. Consequently, in order to uphold the honor of the family and morality of the adolescent girl, she may be married earlier without taking into consideration her age or sense of maturity. A qualitative study by Schuler et al. [12] revealed that the participants felt that marrying their girls in an early age kept them from worrying about the gossips regarding sexual relationships if any about their daughters which might decrease their marriage prospects later. Moreover, early marriage allows the family to ensure that the girl's virtue remains intact, with the perception that a husband who is much older to the girl will act as a guardian against any immoral or inappropriate behavior that the girl may deem to.

Educational Status of Women
Kamal and Hassan [7] ascertain that women's education is also one of the significant determinants of child marriage. This is also supported by Sabbe et al. [2] who affirm the attainment of education as one of the important determining factor of marriage and adolescent child bearing [7]. It is vital to understand that child marriages hold back young girls from continuing their education even basic primary education and are bound to forced marriages thereby impeding the achievement of millennium development goals of universal access to education and women empowerment [7]. A cross-sectional study to examine the prevalence of child marriage and its effect on reproductive outcomes among women in Bangladesh by Kamal and Hassan revealed women's level of education as the most single significant determinant that negatively influenced child marriage, i.e., the higher the level of education, the lower the likelihood of child marriage. Pakistan Demographic and Health Survey report 2012-2013 clearly indicate that the care provided by mothers and the methods of contraception used by women is directly related to the years of education achieved by the mother [7,13].

Prevailing Legislative Framework
Sabbe et al. [2] believes that a proper legislative framework and policy have the greatest potential to halt child marriages. Though the Sindh government has recently proposed amendments in the old child marriage laws to embrace stricter punishment for this act [1]. Yet, it remains to be a growing concern among the low and middleincome countries such as India, Bangladesh and Pakistan. In Pakistan, 30 percent of all marriages fall into the category of child marriages; highest prevalence being reported from Sindh where child marriages are still practiced despite the implementation of Child Marriage Act 1929 which awards three months imprisonment and penalty of Rs1, 000 [7]. However, Poor implementation of the law and relatively mild nature of the punishment, have found to the reasons for its failure.

Public Health Strategies to Reduce the Impact
The magnitude of the problem i.e. child marriages is already described above such that its consequences can be intimidating for the entire nation and can even hinder its socio-economic growth. The efforts should bring in public attention to this issue to develop and implement policy proposals to stop child marriages and ensure legal protection to girls. One such step towards improving social protection for child brides as proposed by Machel et al. [6] is to strengthen birth and marriage registration systems to enforce legislation to assist the public health workers reach child brides with targeted programs and services.
It is appreciable that the United Nations have dexterously prioritized and included maternal health, infant mortality and women's empowerment in the Millennium Development Goals which determines that the issue has a global significance. However it is the prime responsibility of the states to emphasize on the proper enforcement of existing policies to stop child marriages. An example of this could be the recent amendment in the old child marriage laws proposed by the Sindh government to include stricter penalty and punishments for this crime. Similarly, Dhakku proposed that being an Islamic state, Shariah laws need to be addressed to curtail child marriage in Pakistan. Nonetheless, before the implementation of any policy or law to stop child marriage, it is essential to educate the community about the hazards and impact of child marriages. Apart from the laws, several other strategies could be designed to halt this practice and prevent its precarious outcomes.
The existing child-marriage programs which primarily focus on prevention of child marriages and target unmarried girls should broaden to include education to the parents on the legal age at marriage and interventions for women married as children and men who might pursue young girls for marriage. Another effort could be Social change programs to provide education and job opportunities for girls in rural areas, along with the acceptability of girls' participation in such initiatives, accepting the fact that child marriage is not the only economically feasible and socially acceptable choice for the underprivileged families [3]. It is an established fact that education does not only adjourn early marriage but can also empower women to face the evil realities of life [1,2]. Several studies have reported the more education a girl receives, the lesser chances are her to be married as a child [3,6,7]. An example of a modest investment made to give adolescent girls a chance towards more productive and fulfilling future is a program called "Berhane Hewan" (light for Eve) in Ethopia [8]. This program promised families of a goat to girls and their families who kept their girls unmarried and in school, provided school supplies to the girls to encourage their school attendance and held discussion among community members to change their attitudes towards child marriages. The success of this program as evaluated by Erulkar and Muthengi [14] was such that after the implementation of this program, the girls were only one tenth times more likely to be married and three times more likely to be in school compared with girls in the control group.
The role of mass media and community based NGO's to stop child marriages is another approach. Radio and television programs should aim to educate people about the risks and disadvantages of child (early) marriages [2,12]. Media may collaborate with public health workers in producing stage shows or telefilms that portray the destructive features of child marriages. It is a great achievement that HANDS, one of the well known NGO's in Pakistan has already stepped forward to stop child marriages by organizing a Two-Day Conference with media personnel on "Enhancing role of Media in eradicating Child marriages in Sindh" (Husain, 2013). The main objective of the conference was to seek support from media to ensure legislation from the Sindh Assembly against child marriages [7]. Moreover, recently The Action Aid Pakistan, Plan International and Ideas for Life Trust jointly organized a campaign with the message of "Safeguard My Childhood: Stop Girl Child Marriage" at The National College [9]. The event focused on explaining youth about the issue through live painting, poetry, writing and musical activities. Such efforts by the NGO's to access the high risk population and focus on preventive approaches like awareness would help to reduce the incidence of child marriages. On the contrary, Sabbe et al. [2] explains that due to the lack of funding opportunities and resources, most NGO's are only able to offer their assistance to those who seek their help. Therefore the potential victims of child marriage are often overlooked. Thus, the stakeholders and funding agencies should certainly asses the progress of NGO's, emphasizing more towards preventive actions rather than curative measures.
Having discussed all the determinants that come into play for child marriages, it is essential to understand that all these determinants create an impact in combination rather than in isolation. The cumulative impact of all these determinants builds the magnitude of the problem for the community at large and especially the young girls who are actually deprived of their childhood and basic educational needs. According to Raj et al. [3] the consequences of early marriages can be devastating for young girls; stunting their educational and vocational opportunities, couples, the maternal and child health, and above all it can be dangerous for the entire nation itself.

Conclusion
The practice of child marriage has decreased worldwide during the past 20 years and is increasingly being recognized as a human-rights violation. However, it is still prevalent in most parts of South Asia [3]. The elimination of child marriage is vital as it is intricately linked to the issues that are linked with children and young people. It requires partnership and collaboration across sectors such as, education, health, and justice, and must include young girls and boys, their families, communities, religious and traditional leaders, governments, and other stakeholders to move towards eradication of this menace [6].