The health of young brides

March 22, 2020

Early marriages of women are associated with an increased maternal and infant mortality rate and burden our social, educational, health and economic systems

The caged bird sings/with a fearful trill/of things unknown/but longed for still/and (her) tune is heard /on the distant hill/for the caged bird sings of freedom.

‘Caged Bird’ by Maya Angelou

A young woman, all of 13 years old, told me a story which made me very sad. She told me about her best friend whose older sister had tried to commit suicide because her parents had married her off against her wishes at the age of 17. She had been in love with someone else but her parents, who had earlier married off two older daughters, decided that the young man she liked was not a good match for her and found a more ‘suitable’ match for her. Now, according to my young friend, she was ‘moping around her parents’ house and had recently drank a household chemical in a futile attempt at assuaging her misery. This story is likely repeated countless times in innumerable homes in Pakistan daily.

Before we go any further, let us look at some facts: child marriage is any marriage where at least one of the parties is under 18 years of age. According to the amendments made in Child Marriage Restraint Act of 1929 passed by the Senate of Pakistan in 2019 (XIX of 1929), a “child” is anyone under the age of eighteen. The legal age for marriage amongst females which was previously 16 years is now 18. According to UNICEF, 21percent of girls in Pakistan are married under the age of 18 and 3percent are married under the age of 15. The highest number of girl child marriages was recorded in the former FATA where 99 percent of the girls are married off before the age of 18, followed by Sindh where 72 percent of girls and 25percent boys are married off early. There are multiple reasons behind early marriage including traditional customs/gender norms, family practices, religious beliefs, level of education (lower levels of family education are usually linked to increased incidence of child marriage), place of residence (rural greater than urban areas) and socio-economic status.

Medically speaking, early marriage of women is associated with an increased maternal and infant mortality rate especially among women married between 15 and 18 years of age. In addition, girls married off under the age of 18 tend to have children earlier and have more children leading to adverse consequences on their own health as well the health of their children. More children also means an increase in our already huge population further stressing our social, educational and economic systems. Pakistan has committed itself to eliminating child, early and forced marriages by 2030 in line with target 5.3 of the Sustainable Development Goals of the UN although, like previous commitments, how much of this will be achieved remains to be seen.

Which brings us back to my young friend and her story. The silver lining in these clouds is, of course, the huge number of young women like her currently enrolled in our school and higher education institutions. In the medical institution where I teach (one of the highest ranking ones in the country), our student population consists of around 65 to 70percent women and while the men in our faculty (especially the older ones) often bemoan the fact that most of these young women will become ‘doctor brides’ and not work outside the home, their sheer numbers tend to argue the opposite. In the next decade, the percentage of women in the workplace will continue to rise including in the highest ranks of academia, industry and all walks of life. This, of course, will pose a problem opposite to early marriage for many of these women.

Traditionally, in urban settings, girls are considered at a ‘marriageable’ age when they graduate college (or somewhat earlier). This usually equates to 21 or 22 years of age.

When should they marry? And who?

Traditionally, in urban settings, girls are considered at a ‘marriageable’ age when they graduate college (or somewhat earlier). This usually equates to 21 or 22 years of age. In rural areas, where education is scarce, puberty is generally considered the benchmark which for most Pakistani girls falls somewhere around their 11th or 12th birthday (plus/minus 1-2 years). From a strictly legal standpoint then, the enforcement of Pakistan’s current laws is much more problematic in semi-urban and rural areas. Our experience at our large public hospital over the last 10 years has shown us the same: in the poorly educated, poverty-stricken people that we serve, young girls and women are disproportionate sufferers. For instance, it is not uncommon for us to see women in their early twenties suffering their 3rd or 4th bout of severe mental illness secondary to pregnancy and childbirth and still being forced to have more children. I still remember the 20 something woman I treated for severe depression after her 4th child who, upon recovery, pleaded with me to let her have another child because she only had one son and her husband and mother in law were insisting that she needed at least one more. It is not uncommon for these young women to tell me point blank that permission for any contraception needs to be granted by their mother-in-law. This is after I have pleaded with them to stop having children or at least space out their pregnancies.

So, what is the solution? As is usually the case, educated, financially empowered women have to lead the way to demand a change. And the hundreds of thousands of young women currently enrolled in our colleges and universities will be the vanguard of that change in a few years when they begin to outnumber men in offices, factories, hospitals and universities. As women rise up in the workforce ranks, their entirely justified demand that they should be allowed autonomy over their own bodies including the right to marry when and who they choose as well as the right to decide when and how many children they have will resonate much more widely. Men may find a society dominated by women frightening but if history is any guide, it will be a much more tolerant and just society.

Maya Angelou’s poem begins with this stanza:

A free bird leaps/ on the back of the wind/and floats downstream/till the current ends/and dips (her) wing/in the orange sun rays/and dares to claim the sky.

The time when the women of Pakistan will claim the sky as their own is not far off.

The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh

Early marriages of women increase maternal, infant mortality rate and burden social, educational, health, economic systems