Child Marriage and Infant Mortality

Save the Children is launching a new report this week on ending newborn deaths, and lots of organizations are writing articles and thoughts and tagging them on Twitter with #FirstDay. The hashtag refers to the (terrible) statistic that over a million newborns die on their first day of life. The report offers some useful suggestions, like more births attended by trained health workers, birth kits, kangaroo care, and other medical approaches. Yet looking through the executive summary of the report and some of the articles written based on it, I see a glaring omission: child marriage.

The language in the video and in the report is troubling–it is “women” who give birth, making the common (meaningful) semantic error that once a person becomes a mother, she is an adult. While motherhood is certainly an adult-level responsibility, pregnancy does not a woman make. In fact, estimates show that over 10 million girls are married before age 18 each year, with most giving birth soon after. Having better medical care will certainly help these girls (who are girls, not women), but what they really need is to avoid early marriage in the first place and delay childbearing. There are programs out there doing just that, and I’ve worked on a few of them. But they are a harder sell to the public than things that sound like easy (often medical or technological) fixes. Buried in two paragraphs on page 14, we get the idea that “young mothers” are one cause of infant mortality, but most of the report is on medical shortcomings and related solutions. We as public health professionals need to not shy away from the difficult social change work that will make a difference in the lives of people we want to help.

In related child marriage news, there was another article that sparked my interest today. With the provocative title, “Child marriage in Nepal: What do you do when it’s by choice?” I was looking forward to a discussion of the limited choices young people in Nepal actually have (I wrote my masters thesis on adolescent sexual health and early marriage in Nepal). This is mentioned in passing, but most of the article laments that while many parents are now on board with delaying marriage, adolescents themselves are more exposed to entertainment that makes them want to be in “love marriages.” The author suggests educating young people about the health and social implications of child marriage as a solution. Maybe that will work, but it seems obvious that what these young people want is not marriage at all, but just to be in a relationship. Since marriage is the only socially-acceptable option they go for that. Now that parents agree child marriage is a bad idea, perhaps efforts would be better spent nudging them toward a world in which young people can date. My bet is most of these early “love marriages” would disappear completely.

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