Contraception and child brides
Contraception and child brides
By April Houston, Senior Program Officer, Sexual Reproductive Health and Rights, CARE USA
There’s been a lot of talk lately about ending child marriage – and for good reason. Girls who are married before age 18 are more at risk for HIV and other sexually transmitted diseases, cervical cancer, intimate partner violence, and complications during pregnancy and childbirth than their unmarried peers. They may quit going to school to take care of their husbands and manage their own households, which ultimately reduces their ability to work outside of the home. Dr. Babatunde Osotimehin, the late director of the United Nations Population Fund (UNFPA) described early marriage as “an appalling violation of human rights.”
Still, early marriage persists around the world, and over 140 million girls will be married by 2020 if current trends continue. The problem is worse in some countries than others. In Bangladesh, an estimated 65% of girls under age 18 are married. In Niger, that figure is 76%.
Let that sink in for a second. Over three-quarters of the young female population of Niger is already married. So, while it is critical to work on preventing child marriage – what do we do about the millions and millions of girls that already have husbands? Is it too late to help them? What do they need? Fortunately, CARE has some insight into answering these questions based on our work with married and divorced adolescent girls (age 10-19) in Ethiopia.
In the Amhara region of Ethiopia, about 45% of girls are married before age 18. It is uncommon for parents to talk with their children about sex and reproductive health issues, so many married girls are unaware of how their bodies work. They are expected to start having children almost immediately; even though there’s a high possibility that childbirth might kill them (Ethiopia has one of the highest maternal mortality rates in the world).
“Adults think having a child strengthens the marital bond between wife and husband and the relationship between all family members,” explains Yordanos Zelalem of CARE Ethiopia. In other words, a married girl usually has no say in family planning decisions.
Addisalem Berhane, also of CARE Ethiopia, agrees. “Culturally, women are expected to bear children and take care of household chores. If the idea of using contraceptives comes into the picture, it is associated with them not performing their role properly.” She continues: “because of their age, the girls are exposed to many problems – social problems, endless health problems, and very hard economic problems – because of their dependency, and they are often alienated.”
After many discussions with community members, leaders, and married adolescents, CARE staff recognized the need for sexual and reproductive health dialogues and access to family planning information and services, but realized that simply providing these things would not be enough to turn things around for the teenage brides of Amhara. Gender and cultural norms and community expectations also needed to change. TESFA (Towards Improved Economic and Sexual/Reproductive Health Outcomes for Adolescent Girls) was designed to address these issues simultaneously.
First, adolescent girls formed peer solidarity groups, which provide training on sexual and reproductive health, communication and negotiation skills, economic empowerment and financial literacy. They also serve as a safe space for girls to discuss problems and seek social and emotional support.
At the same time, influencers at the community level – village elders, religious leaders, mothers-in-law, husbands, and community health workers also participate in discussion groups, where they are supported to reflect on and reexamine their own beliefs and attitudes and practices related to early marriage and family planning, and to consider the impact that they have on the health of girls and the community at large.
After one year, all of the girls who participated in the TESFA groups had access to reproductive health information and services. Most expressed confidence in their ability to negotiate with their husbands about household chores and family planning. Some even decided to go back to school. Husbands became more supportive and willing to include their wives in household decision-making. Many couples started using contraception for the first time, allowing them to have children when they were ready, and not before.
The common practice of foot-washing became a symbol of equality for those who participated in TESFA. Before the program, wives were expected to wash their husbands’ feet when they returned from the field. However, after discussions on gender roles and the division of labor, many husbands began to help with household chores and child rearing, while wives gladly began helping with farming. Husbands and wives now wash their own feet because both pairs get equally dirty in the fields.
“TESFA is unique and important because it addresses a vulnerable group whose problems were not being considered by the government or other NGOs. It uncovered overlooked issues and helped to influence decision-makers so institutions started to serve the unserved group,” explained Yordanos.
On World Contraception Day (September 26), let’s remember the millions of married adolescents in Ethiopia, Niger, and around the world, who need access to sexual and reproductive health information and family planning services. They have been overlooked long enough.
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