Early Marriage (Child Marriage) in Women Attending Consultancy Clinic at Elwiya Maternity Teaching Hospital

Samar D. Sarsam^*, Ahmed H. Al-Tameemi, Batool D. Muhsin,
Zahraa M. Essa

Department of Obstetrics and Gynecology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Abstract

Early Marriage is one of the major issues of today’s society especially the Middle Eastern Society as a result of a variety of causes that primarily relate to tribal rules, religious and cultural beliefs and poverty. It is considered a violation of human rights as well as it is believed to cause serious issues concerning maternal and offspring health. Our goal is to provide estimated data on the incidence of Early Marriage in females attending a consultancy clinic at Elwiya Maternity Teaching Hospital. 109 patients were interviewed in a cross-sectional study pattern and found that over quarter of young girls under 18 years of age are currently married. Early Married victims are mostly young girls from rural areas, religious families and those who follow their tribal and cultural rules strictly. The majority of those young girls did not pursue their education (forced by parents or spouse).

Keywords

Child Marriage, Education, Domestic Violation, Court Marriage

Received: June 13, 2016
Accepted: June 21, 2016
Published online: July 21, 2016

@ 2016 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY license. http://creativecommons.org/licenses/by/4.0/

1. Introduction

Child marriage, also known as early marriage, is defined as "Any marriage carried out below the age of 18 years, before the girl is physically, physiologically, and psychologically ready to shoulder the responsibilities of marriage and childbearing." Marriage is a formalized binding partnership between consenting adults, which sanctions sexual relations and gives legitimacy to any offspring. It is still a respected and valued social institution throughout the world, and may take different forms in different cultures, [1].

While boys can be subjected to child marriage, the practice affects girls in greater numbers and with graver consequences. Child marriage is often referred to as "early" and/or "forced" marriage since children, given their age, are not able to give free, prior and informed consent to their marriage partners or to the timing of their marriage. Many girls, for example, may have little understanding of or exposure to other life options. They may "willingly" accept marriage as their allotted fate. An element of coercion may also be involved if families apply social or emotional pressure or urge marriage for economic reasons, or further advocate marriage in the (misguided) belief that such a union will keep their daughters safe, [2]. Child marriage is a violation of human rights, compromising the development of girls often resulting in early pregnancy and social isolation, and the concomitant decline in their education level, which leads to less profitable occupations that reflect the gendered nature of poverty. It is known that women who are married at early ages are more likely to drop out of school, give birth to more children and are more exposed to domestic violence and the risk of maternal mortality, [3].

Child marriage is often associated with multiple health risks. This is because young brides have limited access to, and use of contraception and reproductive health services and information. The majority are exposed to early and frequent sexual relations and to repeated pregnancies and childbirth before they are physically mature and psychologically ready. Obstetric fistula is one of the most devastating consequences, with over two million girls and young women affected by this treatable and indeed preventable reproductive health complication. Pregnancy-related deaths are also the leading cause of mortality in 15–19-year-old girls, and those aged under 15 years are five times more likely to die than those aged over 20. Infant deaths are also twice as high in babies of very young mothers, [4]. Despite national laws and international agreements, child marriage remains a real and present threat to the human rights, lives and health of children, especially girls. In Iraq, one in five young women between 15-19 years of age (21%) is currently married, [5].

Adolescent pregnancy can prevent girls from practicing their rights, including the right of education and the social support they need for healthy development and a safe and successful transition to adulthood. The consequences of adolescent pregnancy reverberate throughout the girl’s life and for generations after. There are only two ways for girls to prevent adolescent pregnancy, abstain from sex or use effective contraception. Where abstinence is not possible, for example because of child marriage, then consistent use of effective contraception is essential, [6]. Globally, 23% of adolescent girls are married or in union, and 3% are unmarried but sexually active. A substantial majority, 74%, are not sexually active. Only about 15% of adolescent girls who are married or in union are using modern contraception, [7]. Women who married younger are more likely to be beaten or threatened, and more likely to believe that a husband might sometimes be justified in beating his wife, [8].

Gender-based discrimination in education is both a cause and an outcome of poverty and results in a breakdown of social and economic development. Gender-based violence in Iraq is one of the factors preventing women’s full political, social, and economic participation. Domestic violence, honor killings, and human trafficking remain a threat to many Iraqi women and girls due to a complex mix of misconceptions in cultural beliefs and traditions. Most of the violence against women occurs at home. Iraqi women aged 15-49 describe common culture, influence of the family, and incorrect interpretations of religion, as well as the laws of the country, as the main causes of violence against women, [9]. Violence against women at home is a major problem that prevents women’s full participation in society. One in five women (21%) in Iraq aged 15-49 has suffered physical violence at the hands of the husband.14% of women who suffered physical violence were pregnant at the time.33% have suffered emotional violence, and 83% have been subjected to controlling behavior by the husbands. Emotional violence includes insults, threats and public humiliation, and many men seek to control the wife’s social life and access to medical care. Early marriage still occurs, but is decreasing. 4% of young women aged between 15 and 19 were married before they turned 15, compared to 11% among those aged 15-49. Marriage before the age of 15 is illegal in Iraq, and marriage between the ages of 15 and 18 requires special authorization from a judge, [10]. The objectives of this study are to find an estimated incidence of Early Marriage in females attending a consultancy clinic at Elwiya Maternity Teaching Hospital, detect the effect of early marriage on the health and psychology of young females, investigate the possible causes of Early Marriage and estimate the effect of early marriage on the level of education.

2. Material and Method

2.1. Descriptive Study

Cross-Sectional Study held at Elwiya Maternity Teaching Hospital (Consultancy Clinic) from the 1^st of March, 2016 to the 20^th of May, 2016. Married women under the age of 30 years who are victims of Early Marriage attending the consultancy clinic of Elwiya Maternity Teaching Hospital were included in the study. 109 young females experiencing Early Marriage attending the consultancy clinic of Elwiya Maternity Teaching Hospital, were chosen randomly.

2.2. Study Instruments

The study instruments consists of preparation of a questioner to collect information from subjects, an Online Survey implemented to give an idea about the number of cases, and a simple survey held in girls’ high schools to give an idea about the number of cases in schools. Subjects were interviewed by the researchers to estimate an average number of Early Marriage cases and what are the common causes, conditions and consequences.

The questions asked include the following: Age, Residency, Age of Spouse, Year of Marriage, Number of Siblings, Number of Children, Age at First Pregnancy, Associated Gynecological Conditions, Possible causes of Early Marriage, Did you get married at court or out of it?, Have you given birth at a hospital or by a midwife?, Have you ever had a C-Section?, If you have a newborn, do you preform breastfeeding or not?, Have you ever been exposed to any form of violence?, Do you live with your husband’s family or at an independent house?

3. Results and Discussion

Total Number of women visiting the consultancy clinic during period of interview was 566, out of these 374 females were less than 30 years old. The number of Early Marriage cases in females younger than 30 years of age was 109, the incidence among those was 29.14%. An online survey was published by the researchers at the same time during the held study to give a supporting idea about Early Marriage percentages. The Survey is available at the link below:

https://docs.google.com/forms/d/1bqWHmS9TiKxMVCWr4zTU4Vv6jqVkB08RlmvTmfQFRrg/viewform?usp=send_form

807 females filled the survey 242 of them only were married women under 30. So, according to the responses we have got 46 women married under 18, the percentage was 19.1%.

A school survey was done, four schools were visited by the researchers and the results were listed in Table 1.

Table 1. School survey.

3.1. Field Study, Case No.1

Age: 26

Residency: Baghdad Jadida

Year of Marriage: 2004 (13 years old)

Husband’s Age: 32

Education: Primary School

She has 4 children and currently is pregnant. She had 2 abortions (3 months, 6 months) and complains of repeated bleeding. She was obviously insecure and devastated as she was crying while telling us her story. She was a daughter of divorced parents each one of them has remarried and they abandoned her and her sister. Then, they were sheltered by their uncle’s house whom soon had forced them both marry his two sons in a young age which is 13 years old. She mentioned that she is often subjected to physical domestic violence.

3.2. Field Study, Case No.2

Age: 17

Residency: Al-Ameen

Year of Marriage: 2013 (14 years old)

Husband’s Age: 24

Education: 5th Secondary

She has two children and currently is pregnant. Her first delivery was at age 14 She was forced to get married by her family as they were telling her that a mature decent man would make her live with dignity without a need for money She showed us some of the bruises on her body as her husband often beaten her even when she is now pregnant. Her husband has a mistress whom he fell in love with and she told her parents and his and they did not do a thing and kept justifying his act. She came to the hospital to check if the baby is okay after she was beaten by her husband she is willing to sue him and she is preparing evidence and papers to prove his brutal acts inflicted on her.

3.3. Field Study, Case No.3

Age: 15

Year of Marriage: 2012 (11 years old)

Residency: Al-Nahrawan

Husband’s Age: 52

Education: Primary School

She is in her first pregnancy and her husband forced her to marry him by threatening her and her family by a weapon. She seemed lacking hope and devastated and eventually she cried as we were speaking with her.

3.4. Field Study, Case No.4

Age: 13

Year of Marriage: 2016

Residency: Al-Karrada

Husband’s Age: 18

Education: Primary School

She came with her mother in law seeking medical advice because she got pregnant now. Her mother and father died in a terrorist attack so she got married to her cousin, her mother in law was anxious about this pregnancy and was aware of the possible complications that may occur. Tables (2, 3, 4 and 5) show the age group percentages of the tested sample and the age group of the husbands and the relativity of the husbands. As demonstrated in table 5, forty five percent of the females in the studied group were married to their cousins.

Table 2. Number and percentages of the current age groups whom are victims of Early Marriage.

Table 3. Number and percentages of the ages at which the girls were subjected to Early Marriage.

Table 4. Number and percentages of the ages of husbands (at time of marriage of girls) subjected to Early Marriage.

Table 5. Number and percentages of subjects’ relativity to their husbands.

One in every 5 women, that is, 21% of young women (aged 15-19) are currently married that was what the United Nations-Iraq Women Factsheet –March, 2013 [9]stated. On the other hand, UNICEF, State of the World’s Children, 2015 [11] suggests that 5% of females get married by the age of 15 while 24% of them get married by the age of 18. In the current study as shown in Table 6 and Fig. 1, the percentage of current victims of Early Marriage in women below the age of 30 is around 8% higher than it was in 2013 according to the UN Factsheet and around 5% higher than that of the UNICEF in 2015 [11]. A possible cause of this rise of percentage might be due to the increasing number of people forced to leave their houses that had its peak in mid-2015. That was clearly shown by the increase of new Early Marriage cases in 2016 which was recorded by its own a percentage of (22.9%) of incidence among those who are 17 years old and less.

Table 6. Number and percentages of the year of marriage of subjects.

Another study done by Baghdad Women Association - February, 2016 [12] Showed that the highest current percentage of victims of Early Marriage was (60.5%) recorded by the age group 14-24 years of age while the study we preformed states it to be (84. 4%). By that, it is verified that over half of Iraqi young women aged 14-24 years are victims of Early Marriage.

Fig. 1. Number and percentages of the year of marriage of subjects.

Fortunately, Iraq was not included in the Top 20 countries list issued by International Center for Research on Women (ICRW): Child Marriage around the World [13] as listed in plate 1, which stated the following:

Plate 1. International Center for Research on Women (ICRW): Child Marriage around the World[13].

However, Iraq still has higher Early Marriage percentage than the following neighboring countries:

1.  Egypt: 17% of girls in Egypt are married before their 18th birthday [12].

2.  Turkey: Turkey has one of the highest rates of child marriage in Europe with an estimated 14% of girls married before the age of 18 [12].

3.  Iran: UNICEF estimates that approximately 17% of girls there are married before the age of 18 [12].

4.  Jordan: Approximately 8% of girls in Jordan are married before the age of 18 [12].

According to the IAU (inter-Agency Information and Analysis Unit) –Iraq, Iraqi Women: Facts and Figures [14]concerning education, men get double the opportunity for pursuing their education and that certifies the extent of gender inequality in Iraq. It states that the percentage of illiteracy in female’s aged (15-29) particularly in rural areas is 15% while assuming a percentage of 33% of females who have entered a primary school. 26% was noticed as a percentage of females who have entered a secondary school and intermediate school. Our study showed in Table -7 and Fig. 2 that 6.4% of Early Marriage victims under 30 are illiterate with 40.4% of our subjects have been into a primary school. Close to it, we recorded a 39.4% percentage of those who have been into intermediate school. Secondary school takes the third place with a percentage of 11%. Furthermore, 1% and 1.8% were the percentages of those who are pursuing their education and those who got higher education, respectively. Most of our studied group are still married.

Table 7. Number and percentages of the educational level of subjects.

Fig. 2. Educational level of subjects.

Table 8 shows that 89.9% of the married women lives with the husband’s family. Table 9 present the residence of our sample as we can see most of the women are from crowded and low income areas in Baghdad.

Table 8. Number and percentages of subjects’ places of living.

Table 9. Number and percentages of subjects’ residency.

Table 10 present women having children and Table 11 shows that about 80% of women had their first delivery before the age of 18. Percentages of the factors that have caused Early Marriage are listed in Table 12. In Tables 13 and 14 it can be observed that the complications the studied sample had, abortion was a common problem.

Table 10. Number and percentages of subjects having children.

Table 11. Number and percentages of the ages of subjects at their first delivery.

Table 12. Percentages of the factors that have caused Early Marriage, most Subjects have chosen multiple factors but family pressure was the main factor.

Table 13. Number and percentages of subjects who had complications.

Table 14. Number and percentages of subjects who had complications indicating the type of complication.

Back to the study done by Baghdad Women Association - February [12] which clearly states that there was a percentage of 46.1% Early Marriage victims who had a C-Section while ours prove that it is a quite smaller number maintaining a percentage of 9.2% as seen in Table 15. A Possible cause of such low percentage is that even though the number of those giving birth by a midwife has significantly declined than it was in the past but it is still a leading cause that makes a significant number of full-term pregnant patients give birth by midwives outside hospital. Table 16 illustrate that 38.5% of our cases delivered outside hospital, even though it might be less than half either way but it could greatly contribute to some complications as a result of poor hygiene and primitive sometimes dangerous methods of giving birth that might possibly in some occasions predispose to infection. while 53.2% delivered at hospital as recorded in table 16 which matches the percentage found by the study of Baghdad Women Association - February [12] which was 53.3%.

Table 15. Number and percentages of subjects who had C-Sections.

Table 16. The numbers and percentages of subjects’ places of delivery.

Another important percentage of an extremely inhumane act which is Gender-Based Violence (GBV) is shown to be 21% as the IAU (inter-Agency Information and Analysis Unit) -Iraq Iraqi Women: Facts and Figures[14] literally states that One in five married Iraqi women has been a victim of physical domestic violence, while one in three has been subjected to emotional violence. Of the women victims of physical domestic violence, 14% were subjected to violence during pregnancy. As seen in Table 17 the percentage of Early marriage victims exposed to the brutal act of physical domestic violence is about 3.7% while most cases were apparently subjected to a great deal of emotional violence making young girls unconfident, vulnerable and insecure.

Table 17. Number and percentages of subjects who have been exposed to physical domestic violence.

A striking fact worth focusing on is that 56.5% of Early Marriage victims were satisfied of them being "victims" as shown in Table 18 and Fig. 3, some are even considering applying the same experience to their future young daughters. On the other hand, 43.1% were totally against the whole idea of marrying under 18.

Table 18. Number and percentages of subjects’ opinions on Early Marriage.

Fig. 3. Subjects’ opinions on Early Marriage.

Although the Iraqi Personal Status Laws of 1959 [15] states clearly that it is not possible for individuals who are less than 18 to get married with the exception of urgencies and necessities with an evidence of legal puberty and physical ability, a percentage of 20.2% seen in Table -19 indicating an estimation of those who got married outside the courts. That brings focus to a greater problem which is that a 79.8% of girls under 18 get married at court and that may force us to ask a question: " Are all of those 79.8% urgencies or necessities?" and the answer is still to be discovered.

Table 19. Shows the numbers and percentages of subjects who got married in court and outside court.

4. Conclusion and Recommendation

Early Marriage incidence percentage was found to be 29.14% is mainly caused by familial and financial pressure which became worse after the year 2015 and it usually makes young girls predispose to complications as abortion. It is also the main reason why young girls drop off school. The study recommends the following:

1)  Raise awareness about the negative effects of Early Marriage especially in rural areas.

2)  Advocate law amendments to make it strict that a marriage should be exclusively at court with both partners being over 18 and with their full consent.

3)  Develop a Human Rights’ curriculum to educate future generations about the devastating effects of Early Marriage.

4)  Raise awareness and advocate for gender equality in Iraq to guarantee equal rights and opportunities for both males and females.

References

1. International Planned Parenthood Federation and the Forum on Marriage and the Rights of Women and Girls, 2006 "Ending child marriage: A guide for global policy action" - September (Page. 7).
2. UNFPA, 2012 "Marrying Too Young: End Child Marriage" (Page. 11).
3. UNICEF, 2011 "Preliminary Findings Report: Fourth Round of the Multiple Indicator Cluster Survey (MICS-4): IRAQ" (Page.28).
4. International Planned Parenthood Federation and the Forum on Marriage and the Rights of Women and Girls, 2006 "Ending child marriage: A guide for global policy action" - September (Page. 11).
5. United Nations – Iraq, 2013 "Women in Iraq Factsheet" –March.
6. UNFPA, 2015 "Girlhood Not Motherhood: Preventing Adolescent Pregnancy" (Page.5, 8, 9).
7. UNFPA, 2016 "Facing the Facts: Adolescent Girls and Contraception" - February (Page.4, 5, 8).
8. Youth Coalition, 2015 "Including Youth in the Post-2015 Development Agenda: Youth Sexual and Reproductive Rights and Child, Early & Forced Marriage".
9. United Nations – Iraq, 2013"Women in Iraq Factsheet" –March.
10. IAU (Inter-Agency Information and Analysis) -Iraq, 2010 "Violence against Women in Iraq Factsheet" –November.
11. UNICEF, 2015 "State of the World’s Children", (Page.86).
12. Baghdad Women Association, 2016 "Field Study in Baghdad: Forced and Early Marriage" – February.
13. International Center for Research on Women (ICRW): Child Marriage around the World.
14. IAU (inter-Agency Information and Analysis Unit) -Iraq 2010 "Iraqi Women: Facts and Figures".
15. The Iraqi Personal Status Law, 1958. Available at: https://apps.americanbar.org/rol/publications/iraq_personal_status_law_1959_english_translation.pdf