A Child Abuse: Marriage at Childhood Age.

Child marriage, which is seen as both a global public health and social problem, is defined as marriage before the age of 18 years. Gender inequality, migration and wars, economic problems, lack of education, and non-deterrent laws are the main causes of child marriage. Child marriage in our country, and other places where child marriage is still commonplace, is a breach of the widely recognized human rights of the child. Prevention of this breach requires effective and target-oriented counter-measures. At the same time, to achieve sustainable change, problems should be analyzed and solutions should be provided with programmed and multi-layered components. It should not be forgotten that "the child is not a bride, the place for the child is in school and the playground."

Introduction

Child marriage, which is a public health problem in Turkey and other countries of the world, includes marriage before the age of 18 years. Although it is seen in both sexes, it tends to affect women more, depending on prevalent gender inequalities. Forced marriage is defined as the lack of full and free consent of one or both parties. Being under the legal age for marriage can be considered to constitute a lack of consent. Consent of an adolescent who is not fully developed psychosocially may not be a reliable criterion. Many countries, including Turkey, do not consider marriages of persons under the age of 18 years as legally appropriate. However, in Turkey, with the approval of families and judicial authorities, legal permission can be given to marriages of persons aged 16 years over, in extraordinary situations. According to the legal regulations in our country, children over the age of 17 years, with the consent of their parents, and those who have completed their 16th year but have not yet completed the age of 17 can legally marry with a court decision. However, since the concept of an “extraordinary situation” or an “emergency” is not fully defined, this process can be used against children. Child marriage is a human rights violation, and human rights violations can also lead to child marriage. Unfortunately, the morbidity and mortality associated with these marriages are higher than in other age periods. An important role of preventative and adolescent-friendly health services is to protect the child, prevent child marriages, and thus prevent pregnancies.[1-3] It follows, therefore, that health policies should be guided by studies to be carried out during adolescent health practice. The aim of this review was to discuss what should be done in terms of preventing early marriage of girls, who constitute an obviously disadvantaged group in terms of gender inequality, in order to protect and improve child health and to raise awareness of this issue.

Epidemiology

Although child marriage has tended to decrease worldwide, unfortunately, this decrease is far from the necessary levels. While the rate of marriages involving a child bride a decade ago was 25%, a decade later, this rate has only dropped to 20%. Every year, 15 million girls get married before the age of 18 in the world.[4] The United Nations Sustainable Development Goals called for global action to end this human rights violation by 2030, and if efforts are not effective, more than 120 million girls will be married before the age of 18 by 2030. Child marriages are often the result of established gender inequality, and girls are disproportionately affected. Globally, the prevalence of child marriage among boys is only one-sixth of girls.[5] Although child marriages can be seen in almost every society in the world, it is seen at higher rates in less developed and socioculturally disadvantaged countries. It is seen at a rate of 71% in Bangladesh, 62% in Nepal, 59% in India, and 50% in Pakistan.[6] Low socioeconomic status and rural lifestyle tend to increase the likelihood of child bride marriage.[7]

Unfortunately, there are very few studies providing data from Turkey. According to marriage statistics data from the Turkey Statistical Institute, while the proportion of all official marriages involving girls in the 16-17 age group was 8.1% in 2009, this rate decreased to 3.1% in 2019. When the 2019 data were analyzed by province, Ağrı ranked at the top with 13.2%, followed by Muş with 13.0%, and Kars with 10.6%. The provinces with the lowest rates of female child marriage among total marriages were Tunceli with 0.2%, Bayburt and Rize with 0.7%, and Trabzon with 0.8%.[8] Unfortunately, the highest rate of child marriage in Europe is seen in Turkey.[9] In addition, if religious marriages that are not officially registered or undeclared child marriages are taken into account, it is very likely that the rates of child marriage in Turkey are higher than reported in the studies.

Reasons for Child Marriage

The term “sex” corresponds to the biological nature of being male or female. The gender specified in the identity cards of individuals is appropriate for this meaning.[10] Gender, on the other hand, refers to the meanings and expectations that society and culture attribute to being a woman or a man. Gender may vary according to culture, occasion, and society.[11] According to the sociologist Ann Oakley, who added the concept of gender to sociology, “sex refers to the biological distinction between men and women, while gender refers to the socially unequal division between masculinity and femininity in parallel with the biological distinction.”[12] Gender encompasses the social expectations regarding behavior that are considered appropriate for each gender member. Gender refers not to the physical qualities that cause men and women to be different from each other but to the characteristics of men and women attributed by the society they inhabit.[13] Girls whose education is interrupted due to inequalities created by the concept of gender in the society they inhabit and who do not have job opportunities may be seen as a burden in the family, leading to social and familial pressure to get married earlier.

The study of the International Center for Research on Women (ICRW), in the sub-Saharan African countries of Kenya, Senegal, Uganda, and Zambia, provided guidance and useful information in terms of defining the problem in practice. The ICRW’s research in these 4 countries confirmed the existing data that child marriage originates from unequal gender norms that prioritize women’s roles as wives, mothers, and housekeepers, resulting in an insufficient investment of families in girls’ education. Since there are no employment opportunities due to these discriminatory norms, child marriage can be seen as an alternative. In Senegal, where there were increased educational attainment and workforce opportunities for young women, these societal changes have contributed to a decrease in the rate of child marriage for girls. It shows that improving gender equality norms and providing girls with more equitable opportunities, particularly in terms of education and employment, is likely to improve prospects for the child.[4]

It is known that migration- and relocation-related factors may also cause an increased risk of child marriage. Many reported situations among refugees, such as security concerns, worsening economic conditions, displacement, and disruption to adolescent girls’ education, have emerged as driving forces in child marriage.[14,15]

Risks Posed by Child Marriage

The risks posed by child marriage are not small. It has been observed that maternal and infant mortality rates are higher in countries where child marriage rates are high, and also maternal and child health is more at risk.[16,17]

Unfortunately, research into the marriage of adolescent girls does not yield optimistic results. Household and cleaning work is undertaken by these women, so they must leave their schools, and thus lose their right to education. As they are then not qualified and because of the heavy burden of housework, they lose job opportunities. These children are almost imprisoned in the marriage institution, and rates of violence against them are increasing. This can result in these children feeling that even their own bodies are not theirs. They may become mothers before the end of their childhood. They carry more health risks than other age groups.[2,5,17-20]

Another risk posed by adolescent marriage is anxiety, depression, and suicide attempts, which are more common in children at this age. In a study, a significant negative relationship was found between very early marriage rates and general psychological well-being in both Nigeria and Ethiopia. Except for self-control, all sub-domains of psychological well-being, including depression, anxiety, positive well-being, vitality, and general health, were negatively associated with very early marriage. In addition, in qualitative analysis, it was reported that Ethiopian child brides experienced anxiety and depression problems caused by the burden of fulfilling their marital responsibilities at an early age.[18]

Child marriage puts girls at higher risk of early pregnancy and sexually transmitted infections because married girls typically have limited ability to influence decisions regarding condom or contraceptive use. They are predisposed to a wide range of infections and sometimes this can have severe or even fatal consequences.[21]

Child Marriage Prevention Strategies

Child marriage has received increasing attention, both politically and socially. Some development programs have advanced in the last 10 years, and progress has been made to counter child marriage. The ultimate goal is to eliminate child marriages by 2030, but achieving this goal will require coordinated action and additional investment. Despite some improvements, we are still far from the targets set by the World Health Organization on a global scale. For this reason, there have been attempts to create road maps including the prevalence of the problem, the causes, the results, and the efforts to prevent the problem. In addition, research has been undertaken into how best to support adolescent girls at risk of child marriage. If the target of eliminating child marriage by 2030 is to be achieved, then progress in the next 9 years will need to be 17 times faster than progress made in the past decade. With the global program and educational support initiated by the efforts of Unicef, 7.9 million adolescent girls have been provided with new life skills. Close to 40 million people, including major community leaders, have participated in dialog and communication campaigns to support adolescent girls or other efforts to end child marriage.[17,22]

Simply being a refugee is one of the reasons for child marriage. Intervention proposals to mitigate the drivers and negative consequences of child marriage should build on a clear understanding of the local refugee context and the driving forces for child marriage in refugee settings. Interventions should involve multiple stakeholders and should be adjusted to target each specific context, age group, and marital status. For these interventions to be effective, they must be addressed simultaneously and presented in a culturally sensitive and practical manner.[14]

In a review of 83 articles on child marriage prevention interventions, it was reported that addressing child protection issues, including child marriage, in low-income settings, and engaging in successful interventions required a combination of approaches. Common education and microfinance programs and life skills programs appear to have the greatest impact on child protection outcomes. Both awareness-raising programs for adults and education/life skills programs for adolescents have resulted in notable changes in child protection outcomes.[23]

Although the sustainable development program has a target of ending child marriage by 2030, it seems unlikely that this target will be achieved due to the relatively low annual decline rate. The annual reduction rate should be increased from 1.9% to 23%. Many countries develop policies and programs at a national level to achieve these goals. At the national level, countries should establish coordination mechanisms, develop the awareness and capacity of child marriage prevention staff, use sub-national evidence to contextualize and adapt interventions, develop coordinated budgets and cost-sharing mechanisms, and integrate monitoring and evaluation systems. The most common challenge identified, based on analysis from some studies, was the lack of clear roles and responsibilities for relevant stakeholders, including government departments/ministries, civil society, the private sector, and economic supporters. It is important to identify how the different roles and responsibilities and their complementary contributions will be combined for stakeholders in the initial phase. The findings of this analysis have important implications for ending child marriage. Given that the end of child marriage requires the implementation of coordinated multi-component interventions in health, education, child protection, and many other sectors, this analysis shows that there is much to learn and adapt to from the implementation of other multisectoral policies/programs. For example, key stakeholders should identify a common conceptual framework around drivers and solutions to end child marriage and use evidence to understand the needs of different adolescent groups in different contexts to tailor interventions accordingly.[4,24-27]

In a study consisting of 651 cases who got married in childhood in our country, it was found that those with roman ethnicity, primary school graduates, those with low education, and/or low-income parents were most likely to be married in childhood. Considering the reasons for early marriages, it was recommended that women who are at risk of early marriage and who seek support should be educated about the negative aspects of early marriages.[15]

Addressing child marriage requires recognition of the factors that make this possible. Although the roots of the practice differ across countries and cultures, poverty, lack of educational opportunities, and limited access to health services increase child marriage. Some families marry their daughters to reduce their economic burden or earn income. Others can do this because they believe it will secure or protect their daughter’s future.

Unfortunately, there is still a long way to go to reduce child marriage as a component of the sustainable development program and to promote children’s rights. When the causes of child marriages are examined, it is evident that gender inequalities, lack of education, poverty, wars, migration, and traditional structures that support discrimination are the main causes. Therefore, it is possible to list some practical suggestions for change from this review as follows:

Gender inequalities should be eliminated. It should be taught to every individual of society that being a man biologically is not a distinct sign of superiority. This should be taught in schools and universities as a course.

All children should have compulsory education for at least 11 years. Deterrent sanctions, rather than symbolic punishment sanctions, should be applied. With family and community-oriented training, persuasion methods should also come into play for education. Training programs should be organized by using training modules with researchers working in the field on this subject. Sexually transmitted disease, the loss of educational opportunity, and the problems caused by this, and the expectation of the servant in the house after marriage should be explained gradually, as a training module using an example profile of an early married girl.

Economic inequalities should be eliminated. Disadvantaged groups should be identified and supported. For this, a separate fund should be created and a share from the national income of the country should be allocated for it.

To prevent child marriage caused by war and emigration, world peace should be advanced across the globe. It will not be possible to sustainably achieve the 2030 goal without preventing war and migration.

Child marriage is abuse, and a child cannot be a bride. These concepts should be supported with more severe punishment sanctions. Since children mature psychosocially late, the 18-year-old age limit, as a definition of the child, should be supported by laws. The psychosocial maturation limits of adolescents are given as 10-21 years old, and it has been suggested by some that this should be extended to 25 years old. In Turkey, permission to marry between the ages of 16-18 years can be given by a court and the families’ consent. Therefore, new and deterrent laws are needed to combat the negativities of this intermediate age.

Children who conceive due to inadequate sex education and, therefore, cannot be protected and who have to marry due to the pressure this creates should be protected. Protection methods must be taught to adolescents. This goal can be achieved by developing adolescent-friendly health services across the country.

Achieving these goals requires the participation and co-operation of all stakeholders concerned with this issue in our country and the world. Local guidelines specific to each country should be created.

The target audience in education should include everyone—adolescents of both sexes, mother, father, grandfather, grandmother, and so on. A “butterfly effect” should be created in society in this regard. This will be difficult but not impossible.

The distribution of duties of official and non-governmental organizations and local and judicial authorities on this issue should be clearly defined. An example of this would be the clear legal definition of what constitutes child abuse under the age of 18. This should be exactly known. The use of vague ranges in these definitions, such as the age range of 16-18, may exacerbate the problem.

Conclusion

Appropriate programs should be put in place to prevent child marriage, both in our country and across the world. These programs, if they are to be successful, require a societal change, hence the target audience should not only be the children but also all family members, together with all strata of society, which might make this profound change possible. In order to accelerate the rate of change, sharing of labor should be mandatory and the distribution of duties of the relevant legal units should be determined precisely and clearly.