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Health Consequences of Child Marriage in Africa

Despite global agreements and national legal guidelines, marriage of girls <18 years of age is commonplace global and affects millions. Child marriage is a human rights violation that stops women from obtaining an schooling, playing ideal fitness, bonding with others their very own age, maturing, and in the long run selecting their very own lifestyles partners. Child marriage is pushed by means of poverty and has many effects on women’ fitness: improved hazard for sexually transmitted diseases, cervical cancer, malaria, dying at some point of childbirth, and obstetric speed dating fistulas. Girls’ offspring are at increased chance for premature beginning and dying as neonates, babies, or kids. To forestall baby marriage, guidelines and packages should teach communities, increase awareness, engage nearby and spiritual leaders, involve mother and father, and empower women thru training and employment.

Keywords: Child marriage, early marriage, maternal mortality, HIV/AIDS, fistula, perspective
Awareness of reproductive health problems in growing international locations is growing. Critical problems are the high incidence of HIV/AIDS among younger humans; childbearing by young women, that can cause obstetric fistulas and dying of the mother; and baby marriage.

Child marriage, defined as marriage of a baby <18 years of age, is an historic, global custom. Other phrases carried out to baby marriage encompass “early marriage” and “toddler brides.” Early marriage is indistinct and does now not always check with kids. Moreover, what is early for one man or woman can be past due for any other. Child bride seems to glorify the technique, implying a party and a bride who is glad to begin a loving union along with her partner. But for the most part, lady brides do now not know—and might have in no way met—their groom.

In 2002, ≈fifty two million women <18 years of age had been married. With ≈25,000 women <18 years being married each day, an estimated one hundred million may be married by means of 2012 (1). Child marriages occur maximum frequently in South Asia, in which 48% of women elderly 15–24 were married earlier than the age of 18; these figures are forty two% for Africa and 29% for Latin America and the Caribbean (2).

Although the definition of baby marriage includes boys, maximum kids married at <18 years of age are ladies. For instance, in Mali the female:boy ratio of marriage earlier than age 18 is seventy two:1; in Kenya, 21:1; and even in the United States, eight:1 (three–five). We therefore cognizance at the social and fitness results of infant marriage for ladies. And despite the fact that we focus on African countries, comparable arguments over what drives infant marriages, how they have an effect on women, and the way to stop them can be applied to other continents.

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United Nations Efforts and National Laws
Since 1948, the United Nations and different global corporations have attempted to forestall baby marriage. Article sixteen of the Universal Declaration of Human Rights states that persons ought to be at “complete age” while married and that marriage have to be entered into “freely” and with “complete consent.” In different words, any united states of america that lets in child marriage is committing a violation of human rights (6). Articles 1, 2, and 3 of the 1962 Convention of Consent to Marriage, Minimum Age for Marriage, and Registration of Marriages require that international locations establish a minimal age for marriage and that every one marriages be registered (7). Article 16 of the 1979 Convention at the Elimination of All Forms of Discrimination towards Women requires minimal a while for marriage to be targeted and says that child marriages are unlawful (eight). However, now not until 1989, at the Convention at the Rights of the Child, did international regulation outline children as individuals <18 years of age (Article 1) (9). In 1994, the International Conference on Population and Development stated that the minimum age of marriage should be raised and enforced, all forms of coercion and discrimination should be eliminated, marriage should be entered into with free consent and as equal partners, and the education and employment of girls should be encouraged (Principle 9, Action 4.18, Action 5.5) (10).

In many countries, the legal age for marriage is 18, yet some governments enforce these laws loosely. For example, the percentage of girls married before age 18 in Niger is 77%, in Chad 71%, in Mali 63%, in Cameroon 61%, and in Mozambique 57% (1). In parts of Ethiopia, 50% of girls are married before the age of 15, and in Mali, 39%. Some marriages even occur at birth; in such instances, the girl is sent to her husband’s home at the age of 7 (11).

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Incentives for Perpetuating Child Marriages
Poverty plays a central role in perpetuating child marriage. Parents want to ensure their daughters’ financial security; however, daughters are considered an economic burden. Feeding, clothing, and educating girls is costly, and girls will eventually leave the household. A family’s only way to recover its investment in a daughter may be to have her married in exchange for a dowry. In some countries, the dowry decreases as the girl gets older, which may tempt parents to have their daughters married at younger ages. These are not necessarily heartless parents but, rather, parents who are surviving under heartless conditions. Additionally, child marriages form new alliances between tribes, clans, and villages; reinforce social ties; and stabilize vital social status.

Parents worry about ensuring their daughters’ virginity and chastity. Child marriage is also seen as a protective mechanism against premarital sexual activity, unintended pregnancies, and sexually transmitted diseases (STDs). The latter concern is even greater in this era of HIV/AIDS.

Girls who marry young tend to be from poor families and to have low levels of education. If they marry men outside their village, they must move away. Coping with the unfamiliar inside and outside the home creates an intensely lonely and isolated life. As these girls assume their new roles as wives and mothers, they also inherit the primary job of domestic worker. Because the husband has paid a hefty dowry, the girl also has immediate pressure to prove her fertility. Girls often embrace their fate and bear children quickly to secure their identity, status, and respect as an adult. As a result, these young girls have high total fertility rates but have missed the opportunities to be children: to play, develop friendships, bond, become educated, and build social skills.

Characteristics of the men who marry young girls are also fairly homogenous. Because men have to pay large dowries for girls, many must work for years to generate enough income. As a result, they are older when they marry, which means that they have little in common to discuss with their young wives except household responsibilities and child rearing. Men also are expected to have had multiple sex partners and to be sexually experienced. Because men are aware of the HIV/AIDS danger, they seek even younger, virginal brides, who are presumably not infected.

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Risk for HIV and Other Sexually Transmitted Diseases
A common belief is that child marriage protects girls from promiscuity and, therefore, disease; the reality is quite different. Married girls are more likely than unmarried girls to become infected with STDs, in particular HIV and human papilloma virus (HPV). In sub-Saharan Africa, girls ages 15–19 years are 2–8 times more likely than boys of the same age to become infected with HIV (12). The risk of acquiring HIV from a single act of unprotected vaginal intercourse is 2–3 times greater for women than men (13). Globally, the prevalence of HIV infections among women is highest from ages 15 to 24; the risk for men peaks 5–10 years later (12).

Marriage by age 20 has become a risk factor for HIV infection for young and adolescent girls (13), as has been shown by several studies of African populations (14–16). A study in Kenya demonstrated that married girls had a 50% higher likelihood than unmarried girls of becoming infected with HIV. This risk was even higher (59%) in Zambia. In Uganda, the HIV prevalence rate for girls 15–19 years of age was higher for married (89%) than single girls (66%); for those 15–29 years of age, HIV prevalence was 28% for married and 15% for single girls. This study noted that the age difference between the men and their wives was a significant HIV risk factor for the wives (16). All of these studies showed that girls were being infected by their husbands. A hypothesis relevant to this finding is that a young girl may be physiologically more prone to HIV infection because her vagina is not yet well lined with protective cells and her cervix may be more easily eroded. Risk for HIV transmission is also heightened because hymenal, vaginal, or cervical lacerations increase the transmission rate, and many of these young girls lose their virginity to HIV-infected husbands. Also, STDs such as herpes simplex virus type 2 infection, gonorrhea, or chlamydia enhance girls’ vulnerability to HIV (17–19).

Another study explored why married girls in Kenya and Zambia had a higher risk for HIV infection. This study concluded that because married girls are under intense pressure to prove their fertility, they have more unprotected intercourse. The study also found that husbands were substantially older (5–14 years) than their wives and were 30% more likely than boyfriends of single girls to be HIV infected. Because of their age alone, the husbands had already had numerous sex partners. Additionally, in these areas of Africa, polygamy is common (20).

One fundamental difficulty with child marriage is that girls are financially dependent on their husbands and therefore lack the power to make demands upon them. They cannot ask their husbands to get an HIV test; they cannot abstain from intercourse or demand condom use (20); they cannot insist that their husbands be monogamous; and ultimately, they cannot leave because they cannot repay their high dowry (21). In addition, returning to their parents’ home may not be an option because divorce is considered unacceptable and leaving their husbands may have serious implications on the social or tribal ties that were developed during the marriage.

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Cervical Cancer
Child marriage and polygamy play an important role in another deadly disease, cervical cancer. HPV infection has become endemic to sub-Saharan Africa (22–24). Although many African nations do not have the capacity to adequately or effectively screen for cervical cancer or HPV, the incidence of cervical cancer in Africa is estimated to be extremely high. Common risks for cervical cancer are child marriage, low socioeconomic status, poor access to health care, and husbands who had multiple sex partners. For example, in Mali, cervical cancer is the most common cancer in women, has an age-standardized incidence rate of 24.4 per 100,000, and is the second most common cause of death from cancer (25). In a case-control study of 200 participants with and without cervical cancer, among whom the mean age at marriage was 15 years, HPV was detected in 97% of the cases and 40% of the controls. The risk factors identified were child marriage, high parity (>10 kids), polygamous husbands (>2 other halves), and negative genital hygiene (no tap water available and reuse of sanitary napkins). Another study in Morocco had similar findings (26), with cervical cancer threat factors diagnosed as child marriage, excessive parity, long-term use of oral contraceptives, and poor genital hygiene (control members bathed extra frequently, and case-contributors used selfmade sanitary napkins greater often). Other studies have also implicated hygiene as a likely component (22,27).