EDITORIAL: Prevention of Child Marriage and Teenage Pregnancy in Africa: Need for more Research and Innovation

Abstract

Child marriage (defined as marriage before age 18 years) is currently one of the most challenging issues affecting child and adolescent development in substantial parts of Africa. Aggregated data from the UNFPA1 using DHS, MICS and other household surveys suggests that over 30% of girls in the developing world are married before age 18, and 14% before age 15 years. South East Asia and sub-Saharan Africa have the highest concentration of child marriage in the world, with estimates exceeding the global average in both regions. Rates of child marriage in sub-Saharan Africa vary from as low as 2% in Algeria to as high as 75% in Niger. Within Africa, the practice is most common in West and Central region where up to 41% of girls enter into marital union before the age of 18 years. By contrast, rates of child marriage in East/Southern Africa and the Mediterranean regions are lower at 34% and 15% respectively.
Evidence is increasingly accumulating to suggest that child marriage is not just a religious or cultural practice but is driven largely by poverty, ignorance and illiteracy, gender and social discrimination against the girl child, a misconception of the need to “protect” the girl’s sexuality, sexual impunity bothering on sex trafficking, and inadequate implementation of laws and policies that protect the rights and social development of children and adolescents.
The health and social consequences of child marriage are manifold. Girls married as children are known to experience educational, social, and personal disadvantages as compared to those that marry later. They are locked into social impoverishment right from their early days, and are unable to return to mainstream development in adult life. Child marriage prevents girls from reaching their full educational achievements, enjoying optimal work and health opportunities, bonding with their peers, maturing with full range of competencies and having the ability to choose their desired life partners.
The reproductive health consequences are even more pervading. Child marriage is now known to account for the high adolescent fertility rate approximating 108/1000 in sub-Saharan Africa2, and for the very high overall fertility rates in many parts of the region. This is attested to by evidence showing that countries such as Niger and Mali that have high rates of child marriage also have the highest rates of adolescent fertility (of 192 and 172/1000 respectively) in the world.
Child marriage carries additional health risks including sexually transmitted infections (and possibly HIV/AIDS), cervical cancer, malaria, maternal mortality and obstetrics fistula3. Indeed, for a country such as Nigeria, maternal mortality rates are three to four times higher in the Northwest and Northeast regions of the country where child marriage is highly prevalent as compared to the Southwest and Southeast regions, with lower prevalence of child marriage. In those northern Nigeria regions, Kelsey Harrison4 has shown through his elegant research that most maternal deaths occur in young teenagers, whose birth canals have not matured enough to allow for easy passage of the term baby. This results in obstructed labour, a major cause of maternal mortality in the region. Among those who survive the ordeal, many end up with obstetric fistulae, with continuous lifetime leakage of urine through the vagina. Often such girls are abandoned by their spouses and relatives and left to face the problem alone. Available evidence indicate that of the nearly 2 million girls with obstetric fistulae, mostly in developing countries, up to 800,000 (40%) are resident in Nigeria alone.
Clearly, child marriage is one of the most intolerable and serious human rights and social justice issue of our time. The paper by Mainthia and colleagues in this issue of the journal5 which reports that the mean age of a cohort of single mothers in a coastal city in Kenya was 20.2 years, with mean age of pregnancy being 15.9 years is a sober reminder of the social consequences of early pregnancy among immature adolescents in the region. Many of the single mothers in Kenya experienced marital abuse and were chased away by their partners, with many having nowhere to go since they come from impoverished backgrounds. under such a scenario, the prospects for long term development of these girls appear bleak while the resulting infants, if they survive also face a perilous future.
Despite the traumatic effects of child marriage in sub-Saharan Africa, there have been little concerted efforts by researchers, social advocates, policymakers and public health practitioners in the region to deal with the problem. A recent review of policies and programs across 16 West African States6 showed that nearly 111 interventions to end child marriage were implemented in the region between 2000 and 2011. However, only 10 of these interventions addressed child marriage prevention as the stated objective, while the majority shied away from dealing with the problem directly. Furthermore, many of these interventions were engineered by international development partners, with local NGOs playing secondary or partial roles. While several governments in the region have enunciated laws and policies that seek to prevent child marriage, with many having child protection acts or statutes, only a few carry out specific programs to implement the policies. A recent attempt by the Nigerian Senate to reverse the age-long constitutional provision that limited the age of marriage to 18 years and above, eloquently testifies to the lack of political commitment to address the problems posed by child marriage in the region.
We conclude this analysis by stating that child marriage prevention is a critically unmet need for research and programming for the protection and promotion of adolescent reproductive health and social development in Africa. Formative research is required that illuminate the social, cultural and economic determinants of the problem in various parts of the continent, needed to plan culturally relevant and appropriate solutions. Intervention and implementation research are also needed to identify what works and what might not work for child marriage prevention, and how the identified best practices might be translated into effective policies and programs for the eradication of the practice. Most importantly, concentrated efforts need to be devoted to leveraging political commitment at both the national and international levels for ending the practice. The role of the Girl Not Bride (GNB) initiative, whereby prominent international personalities are coalescing efforts to end the practice is already gaining momentum at the international level, but this must be backed up by in-country commitments and national level drive and ownership. Going forward, the extent to which countries address social justice issues such as the prevention of child marriage must be used as a benchmark for measuring the quality of governance in the African region in the coming years.