The Linkage Between Child Marriage and Maternal Health

How can we improve maternal and newborn health for girls, women and children around the world?

Tackle child, early and forced marriage.

Last month, world leaders came together and agreed on 17 Sustainable Development Goals that will shape our world until 2030. The third of these, to “Ensure healthy lives and promote well-being for all at all ages”, includes the following targets:

  • By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
  • By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

In a world where each day, 800 women die from complications before, during or after pregnancy, and the annual infant mortality rate remains at 4.5 million, these targets have the potential to change the fate of millions of girls, women and children.

Maternal and newborn health remain inextricably linked to the practice of child, early and forced marriage (CEFM), and progress cannot be made without a widespread understanding of the connection. According to Plan International’s ‘A girl’s right to say no to marriage’, most adolescent pregnancies take place within marriage. Child, early and forced marriage is therefore not only a serious violation of girls’ and women’s rights, but a global health issue to be tackled at community, national and global level as part of the implementation and monitoring of the SDGs.

For adolescent girls, the risk of complication during pregnancy and childbirth is dangerously high – miscarriage, obstructed labour and obstetric fistula are a few examples from a list of many. Babies born to young mothers have a higher chance of being stillborn or premature, and girls who give birth before the age of 15 are five times more likely to die in childbirth than women in their 20s.

The social pressure on girls who have been married early, or who have been forced into marriage, intensifies the risks to health and wellbeing. In many communities, the expectation that a new bride will have frequent pregnancies from the beginning of her marriage puts immeasurable strain on both her body and her mind, and removes any choice she might otherwise have over her own reproduction.

If maternal and newborn health is to see sustainable improvement by 2030, focused efforts must be made to end CEFM. We already have a reason to celebrate, as the practice is mentioned specifically within Goal 5 (“Achieve gender equality and empower all women and girls”):

  • Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.

Next week global leaders, advocates and policy-makers are convening at the Global Maternal Newborn Health Conference in Mexico City, where they will come together and discuss how to protect the health of mothers and children around the world. Child, early and forced marriage is one lens of many through which maternal and newborn health can be looked at, but if we consider that a 10% reduction in child marriage could be associated with a 70%, it certainly seems like an important view.

 

Girls’ Globe will be attending the Global Maternal Newborn Health Conference and provide live coverage through blog posts, Twitter, Instagram, Periscope and more. Follow along using #GlobalMNH.

Featured image: DFID, UNFPA and Plan International are working in Zambia to end child marriage through education, advocacy and policy work. Photo: Jessica Lea/DFIF. 

SDG 3: Healthy women and girls are the foundation for healthier societies

Goal 3 of the newly adopted 17 Sustainable Development Goals is “Ensure healthy lives and promote well-being for all at all ages”. There are 13 targets under this Goal, including reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, ending preventable deaths of newborns and children under 5 by 2030, and ensuring universal access to sexual and reproductive health services, including family planning, by 2030.

One big issue that underpins most, if not all of the targets for Goal 3, is the need for universal health care coverage including access to comprehensive maternal healthcare services and benefits – such as maternity and paternity leave, post-partum support and breastfeeding support. Particularly for women’s health and well-being, the issue of sexual, reproductive and maternal health care – which should start even before a woman becomes pregnant in the form of family planning and continue well into the post-partum period – is absolutely necessary for the success of Goal 3, and for the empowerment of women and girls. The empowerment of women and girls, and realization of gender equality, is a prerequisite for the success of all the Goals, and perhaps especially Goal 3. Why? Keep reading.

We know that investing in women has far reaching positive effects on not only the women themselves, but their families and communities. This also holds true with regards to investing in women’s and girls’ health. Investing in women’s health has proven positive effects on economic growth and production – according to The Partnership for Maternal, Newborn and Child Health, every dollar spent on interventions for reproductive, maternal, newborn and child health can generate benefits worth $20.  Investing in the health of women and girls doesn’t only lead into healthier women and girls – it leads to healthier families, healthier societies and healthier nations.

The issue of healthcare is a gendered issue. While many illnesses and diseases do not discriminate based on gender, women and girls continue to be disproportionately affected by poor availability of and access to basic healthcare services. The lack of sexual and reproductive health care services impacts women and girls disproportionately, as does the lack of contraceptives. Unsafe pregnancies impact the health and well-being of women and girls, not as directly men and boys – and it is women and girls who continue to suffer the consequences of both unsafe labor and unsafe abortion, often costing them their lives or leaving them with permanent injuries. Women and girls also continue to suffer from conditions directly stemming from the impacts of discrimination and gender inequality, such as fistula, female genital mutilation

While more or less all countries and all actors agree that protecting and improving the health of newborns and children should be a priority, and access to things like antibiotics, vaccines and other childhood healthcare services is rarely politicized, women’s health is a whole other matter. Sexual and reproductive health is a hugely political and contested issue, as is sexual education, access to contraceptives – and access to abortion. But here’s the thing: We cannot improve the health of newborns and children, if we do not improve the health of women – and improving the health of women is impossible without ensuring the availability of sexual and reproductive health services. As long as women cannot take control over their bodies and their reproductive choices, Goal 3 cannot be reached – not for women, men, boys nor girls.

Women’s health and well-being has even broader impact, because of the fact that women continue to be the primary care-giver of both children and the elderly everywhere in the world, as well as de facto managers of their homes, households and families. When women are healthy and can access family planning services and contraceptives, they are able to start their families when they are ready. Women who have planned their pregnancies and have access to maternal health care services can enjoy safe pregnancies and deliver healthy babies in a safe environment with trained staff assisting them to bring their babies into this world. Postpartum support and services allow women to recover and rest after delivery, and breastfeeding support is absolutely crucial for more mothers to be able to initiate breastfeeding right at the start, and continue it for as long as feasible.

President of a community nutrition group in the Democratic Republic of Congo teaches community members how to make nutritious milk from peanuts to tackle malnourishment.
President of a community nutrition group in the Democratic Republic of Congo teaches community members how to make nutritious milk from peanuts to tackle malnourishment. Image by Russel Watkins/DFID

In the end, the 17 Goals are obviously all dependent on each other’s success. As long as people stay poor or malnourished – topics of Goal 1 and Goal 2– they will also suffer from bad health and be susceptible to illnesses and diseases. Goal 3 will in turn impact the success of Goal 4 on education because weak, poor, malnourished and sick children won’t learn, no matter how many schools, teachers, books and pens we provide them with. The success or failure of Goal 3 has particularly broad and far reaching consequences, because the health and well-being of people is, in the end, a prerequisite for everything else – and the foundation of healthy families and societies are healthy, thriving and empowered women and girls.

Illustrations for the SDG campaign have been made for Girls’ Globe by artist Elina Tuomi.

Youth: The Leaders of Change Today

The city of New York is flooded with celebrities and high-level politicians this week as the United Nations gathers to adopt the next set of global goals for sustainable development – but there is another group of individuals that just cannot be silenced any longer.

There has never before been such a large population of young people in the world – approximately 1.8 billion between the ages of 10 and 24. Youth and children make up the vast majority of the population in 48 of the world’s least developed countries. This means potential for a tremendous amount of progress, since young people are already leaders of change in their communities. With the knowledge and tools to bring about change, they need the support of the gate-keepers and key-holders – the one’s who often hog the microphones and take over the stages at high-level events like the United Nations General Assembly.

Illustration by Elina Tuomi
Illustration by Elina Tuomi

Young people, and especially young women, face several barriers in the decision-making process due to a lack of inclusiveness and invisible hierarchies. Yet – it is important for all heads of state, ministers, religious leaders and other international development professionals to acknowledge that youth are not only instrumental, but essential to ensuring that the Sustainable Development Goals (SDGs) will be met.

At Girls’ Globe we are amplifying the voices of youth this week – young women and men who are drivers of change for equality and social progress in their communities. Don’t miss our conversations with young leaders LIVE from New York City on Periscope, and listen to their lightning talks on Instagram. Their inspirational stories and strong energy will light the way forward and will lead the way for others to follow.

My message to global leaders at the United Nations Sustainable Development Summit that starts today is this:

“Give space and time to truly listen to young people – without them, you will never succeed!”

 

Follow @GirlsGlobe on Twitter, Instagram, Facebook and Periscope, and #GlobalGoalsLive for coverage related to the United Nations General Assembly Week – and the health and rights of women and girls in particular.

The Integration Hypothesis

​Empowering women and girls has taken me from East Africa to South and East Asia. The scope of my work has cut across sectors including health, trafficking prevention, gender based violence, water and sanitation and women’s empowerment. Several years ago, while working in rural Uganda, I learned you can not approach issues for women and girls without recognizing the interconnectivity that exists. Speaking with communities in rural Uganda about gender-based violence brought to light the lack of adequate access to healthcare services for women and girls. In rural India, an immense need existed to involve a variety of stakeholders including community leaders, health workers, men, faith communities, governments, organizations, the private sector and donors in a locally-led process to empower women and girls through water and sanitation (WASH) programs. While working among women and girls who had been trafficked throughout South and East Asia, I realized the power and importance of working with local women. Their ideas and solutions for their own development continually inspired me. Change for women and girls requires a variety of entities working together towards an integrated approach to development.

FHI360 is an organization that strives to improve the lives of women, girls and communities by advancing integrated, locally driven solutions for human development. They challenge the development community to think proactively and provocatively about holistic development for women and girls. Yesterday, FHI360, in partnership with Johnson and Johnson and Women Thrive Worldwide, hosted an event in New York City to discuss what’s being called the ‘Integration Hypothesis’ – which poses the question:

Can breaking development silos make a difference for women and girls?

 

Abbigal Muleya, Monitoring and Evaluation Officer for Zubo Trust in Zimbabwe is a young woman who is breaking all barriers to improve the lives of women and girls. During the event, she delivered a powerful ‘lightning talk’ about community driven solutions which empower girls and women through fish farming programs. Zubo Trust provides networking, capacity development and rights awareness workshops to expand economic opportunities for women. In conjunction with Zubo Trust, Abbigal has worked tirelessly on locally led solutions to ensure women and girls have the same rights as men to become fish farmers and own their businesses. She has cut across sector, social and cultural lines to make this dream a reality. Abbigal set the stage for an engaging conversation around integrated development. She challenged participants to critically think about ways to approach community-led integrated development initiatives.

Leith Greenslade, Panel Moderator and Vice Chair of the MDG Health Alliance, shared with us her thoughts on integrated development priorities for women and girls on Instagram.

Using #IntegratedDev on Twitter, audience members helped spread awareness of the positive examples of integrated development as well as the challenges related to working in silos:

An integrated approach for women and girls requires the development community to address issues from a variety of angles and perspectives. We cannot work in isolation but rather, we must work together to find creative solutions. Central to this is listening to the voices of women and girls. I sat down with Ann Starrs, CEO of the Guttmacher Institute and a champion for women’s and girls’ health. Ann believes truly listening to women and girls is an essential ingredient for successful integrated development programs. I whole-heartedly agree with her and other panelists who passionately spoke about their work and creative solutions.

After the panel ended, we asked event participants their thoughts and ideas on improving the lives of women and girls through integrated development approaches. Find out what Judith Moore, Principal Associate/Strategic Lead for MNCH at Abt Associates, and Mary Kate Costello, Policy Analyst at The Hunger Project had to say on our Instagram.

Want to join the continued conversation on integrated development? Stayed tuned for more engaging interviews and blog posts!

Follow #IntegratedDev, @GirlsGlobe & @FHI360

Event panelists included (left to right as shown above):

The Story of My Daughter’s Birth

Originally published on Huffington Post

It felt like I was in a movie — one of those scenes where the woman in labor screams in pain and squirms as each contraction kicks in. Never had I imagined that giving birth would feel like a thin line between life and death — both for me and my baby.

My pregnancy was a good one. Besides the first trimester’s spells of nausea, I had a great summer, with the possibility to both work, travel and enjoy life to the fullest. As my due date came and went, I tried to stay active, sleep a lot and prepare for the storm ahead. Twelve days passed, and I didn’t have the slightest notion that my baby wanted to enter the “real” world — yet that evening around dinnertime, I felt the first sign of labor. My contractions came quickly. In the comfort of my home, I tackled the first hour without a problem — but after those 60 minutes, I already had one-minute-long contractions every five minutes. I contacted the hospital, located only a few blocks from our apartment, and they were informed that my husband, Markus, and I would be arriving that night. We tackled the next two hours together at home — Markus timed the contractions with an app on his smartphone and helped me through the worst back pain. As he called the taxi to take us to the hospital, I threw up. My contractions were now only two minutes apart and stronger than I could ever have anticipated.

When preparing for labor, I had written a birth plan hoping that my baby’s birth would be completely natural. I was open to the fact that labor might not go as I had planned, but I had almost ruled out the option of medical interventions — unless it was absolutely necessary for my baby’s survival.

Upon arriving at the hospital, our midwife greeted us and took us to our room, monitored my contractions and my baby’s heart rate. She also checked how much I was dilated — and to my disappointment, the previous intense hours had not been to much effect. After a hot bath, I almost fainted, threw up again and felt utterly exhausted and hopeless. At this point my contractions came in a steady flow with hardly any break in between. I couldn’t bare it any more. My midwife offered me a shot of morphine, which I accepted.

In this daze, my mind drifted to the women who at the same time were in labor, yet did not have the same access to care and necessary interventions as I did. How could they cope?

The next four hours of sleep and battling pain were effective. At 5 a.m. my water broke, I was ten centimeters dilated and ready to start pushing. What a relief!

As I started to push, the midwife and assisting nurse noticed that my baby’s heart rate was recovering slowly from each contraction — a little bit too slowly. They called the obstetrician, who determined they needed to assist my delivery with a vacuum. They wanted the baby to come out quickly. They called another midwife to help me through the pushing, and as my daughter was delivered there were six medical professionals in the room, and it all went really quickly. My daughter had been incredibly active in the womb and had managed to get caught in the umbilical cord, which she had twisted twice around her neck and once around her arm. The pediatrician attended to her immediately and helped stabilize her, with my husband and I watching from a meter or two away. After ten minutes, my daughter was perfectly fine. She was brought to my chest and as I looked into her wide-open eyes for the first time I felt so incredibly grateful.

In the world today 290,000 women die during pregnancy and childbirth and 2.6 million babies die in the last 3 months of pregnancy or during childbirth every year. Another 2.9 million newborns die in their first days of life. The majority of these deaths are preventable with access to essential maternal and newborn health care.

This is the final year to reach the Millennium Development Goals, and this year the world moves into a new development agenda post-2015. As we do so, we need to ensure that women and children are at the core of this agenda. We know what is needed to reduce maternal, neonatal and newborn mortality, and we must act to guarantee that necessary investments are made and measures taken.

Without the professional medical assistance of midwives, nurses and doctors, I am not sure what would have happened to me and my daughter. My only wish is that expecting mothers everywhere have the same chances I had. Together we can make sure that every mother and every baby survives and thrives.

War and Women

In military conflicts, there are never winners. Without fail, war brings a devastating loss of life, property and irreparable psychological damage to civilians. Though it is not often brought into the spotlight, the suffering of women can be particularly acute. Major General Patrick Cammaert, a former member of the UN Peacekeepers, was reported as commenting, “It is now more dangerous to be a woman than a soldier in modern conflict.”

Image c/o UK Foreign and Commonwealth Office
Image c/o UK Foreign and Commonwealth Office

Women Under Siege has done extensive reporting on the effect of conflict on women, not only where rape is used as a tool of war but in sexual coercion, child marriage and gender-based violence. In the last few years alone, dispatches from the most headline-grabbing conflicts (such as in Syria, the Democratic Republic of the Congo and Gaza) have included accounts of violence against women, and not solely perpetrated by soldiers, but by men abusing their wives and daughters, families forcing their daughters into early marriages and girls forced into sexual slavery because of economic conditions.

The most recent conflicts have begun to recognize the far-reaching impacts of war on women’s welfare. In the case of Gaza, the UN Development Fund for Women (UNIFEM) reported an increase in cases of domestic violence. Syria’s women have been victim to multiple abuses, with child marriages on the rise, sexual violence used by both sides in the conflict and domestic violence at home. Buzzfeed’s Miriam Berger gathered stories from both men and women in Syria who attributed a spike in violence against women to the indirect causes of war, quoting one Jordanian man as saying about his own family: “I’m depressed; I’m short-tempered — I never was before. But here… I beat my daughters — this one I beat every two to three days; this other all the time. I don’t want to; I just — I’m angry all the time.”

In response to the numerous reports of atrocities against women, the phrase ‘do something’ has been thrown around with abandon, though defining that ‘something’ has proven elusive. Providing security for women in conflict is not an easy task, nor is it one that can be accomplished without a continued holistic approach to development.

Addressing inequality and poverty to raise the status of women, ensuring maternal health and education to improve family planning and allow girls’ and women greater autonomy over their own lives, tightening on human rights to prevent crimes such as FGM or child marriage – these will all contribute to a greater potential outcome for women in conflict as well as in peacetime, by elevating the overall status of girls and women worldwide. The suffering of women in war is inextricably tied to the suffering of women as a whole.

More specific interventions could also be integrated, such as more stringent protections for crimes against women. Though recognized as a war crime, the prosecution of rape is not always enforced. The global resignation to sexualized violence as an inevitable fact of war is unacceptable, for both victims and those at-risk in conflict regions.

The UN’s MDGs were wide enough in scope to integrate progress for women under the umbrella of other goals. Increased education for all ensured girls too benefited from greater resources allocated to learning. Decreasing poverty allowed ventures which empowered women to begin small business and generate income. Goals specifically targeting gender inequality and maternal health aided women in both social empowerment and in providing resources for childbearing women.

Now, looking forward, the post-2015 agenda can place a greater emphasis on the issues relevant to the turbulent world we live in. The ugly reality of war is not one that is comfortable to discuss or face, but the escalating crises that surround us make further inaction inexcusable.With Ban Ki-moon recently stating that the world has entered an era of “unprecedented conflict”, now more than ever it is important to focus on ensuring security for civilians, and particularly for women and children, in warfare.

September 21st-26th Girls’ Globe will be in New York for the 2014 UN General Assembly. We are partnering with FHI360, Johnson & Johnson, and Women Deliver in support of Every Woman Every Child to amplify the global conversation on the Millennium Development Goals and the post-2015 agenda. Follow#MDG456Live, raise your voice and join the conversation to advance women’s and children’s health. Sign up for the Daily Delivery to receive live crowd-sourced coverage of these issues directly to your inbox.

Cover image c/o the Advocacy Project Flickr Creative Commons