A Must read: My Thoughts on Child Marriage

Senate proceeding was about renunciation and not child marriage

Firstly, it is important to correct an outrageous error that spread as fast as bad news is know to, all over the Nigerian media and blogosphere. The senate proceedings on child marriage were actually not about child marriage. Section 29 is in respect to the right of a married lady no matter how young, to be empowered "of age," to take important decisions like renunciation of her citizenship, if she so desires-to seek foreign asylum for instance. Being "of age" after a legal marriage is global legislative setting which proffers on the individual various rights and abilities to make decisions and choices to be respected by all parties and the state, as well as entitlements. Marriage must first have occurred legally and the topic of marriage age and requirements is not covered under section 29 in view. See: http://newsrescue.com/how-nigerias-gutter-media-misconstrued-the-yerima-underage-marriage-senate-proceeding/

Age of marriage in America

The United States is by no means a standard for Nigeria's legal decisions or considerations, however for a robust conversation, I will like to point out the ages of marriage in various states in America. In all states, to marry without parental and/or court consent, the minimal age is 18. But, with parental and in some cases, additional family court consent, the ages of marriage are rather interesting and will be a cause of grief for Nigerian senators and the media, no doubt: New York has the minimum being 14 years. North Carolina allows marriage at 14 years too. South Carolina sets it at 14 for females and 16 for males. And New Hampshire sets their minimum age of marriage at 13 years.

But it gets more interesting. In several states, there is actually no legal minimum age of marriage. Nigerians will say, 'so you can marry at one year old?' Yes, so it appears in the United States-with court approval, theoretically you can. Washington state, Tennessee, Pennsylvania and Rhode Island states set no minimum age of marriage for Americans. Once you can get court approval, you can marry in these states, regardless of your biological age. This information is freely available online. This website carries it: http://www.usmarriagelaws.com/search/united_states/teen_marriage_laws/


Who is a child?

This is the next relevant question in this essay. The phrase, 'child marriage,' is notably unpleasant. So we will summarily discuss who a child is. There are two markers for the defining of who a child is.

Western/UN: According to the United Nations (UN), a child is "a human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier". Thus, the UN defines child based on the 'age of majority,' which is set by the state. Age of majority, as opposed to 'minority,' or being a minor, is an age limit set by countries usually '18,' by which time minors have assumed the legal rights of adults.

Biological/Cultural: According to medical science and biology, as well as from a traditional and cultural perspective, an adult is anyone who has attained puberty. Puberty is defined as physical and social maturity, based on hormonal changes and their related effects on the individual. This is called 'Biological adulthood.'

The day I hit puberty, I stopped being a child

As can be expected, Western/UN adulthood hardly ever correspond with biological/traditional adulthood. One, the former is strictly based on years and does not consider the physical attributes of the individual, whereas the later, Biological adulthood, considers the attributes and development of the individual on a case basis. From an economic stand point, the former, Western/UN adulthood based on set age of majority, is more easy to regulate, as it will limit assessments needed to check individual by individual, the physiological and social maturity as the later demands. With this understanding, we get an insight into the rules of marriage in the United States. The approval for minors (children) is granted by a court which evaluates biological maturity, as these states in America do not subject themselves to the adult age regulations of the Western/UN maturity 'age of majority.'

It is also important to mention at this stage, that the UN strictly in a big-brotherly manner, watches and criticizes developing nations who utilize similar methods as the United States does, not relying devotedly on the global UN recommended age of majority set point, simply because we, Africans for instance are not mature, and our health care system can not cope with nutrition related complications of biological maturity marriageability determination. This leads us to the next aspect:

VVF (Vesico-Vaqinal Fistulae)
Does early marriage predispose to VVF? The surprising answer is no, not anymore than living in Russia causes rickets. Early marriage and pregnancy does not cause fistulas unless you are malnourished and in a third world country with poor health care. The United States is developed world leader in teen pregnancies. With up to 500,000 teen pregnancies per year and over 4000 pregnancies at age 12, the United States should have some of the highest VVF rates in the world, but not so. VVF is not a problem in America, this is because of nutrition and good health care. Consequently, the UN does not breath down their necks. See: http://www.nationmaster.com/graph/hea_tee_pre-health-teenage-pregnancy

VVF arises as a result of obstructed labor due to multiple causes, either due to Cephalo Pelvic Disproportion CPD ("the baby is too big and/or the pelvis too narrow" or Malposition ("the baby comes the wrong way" - ex. transverse or oblique) :

A study from Nigeria found that more than 30% of the fistula patients were younger than 16 years of age. These women usually have had just 1 pregnancy. In Ethiopia, more than 60% of the fistulas seen are a result of a woman's first delivery.As mentioned previously, these women are usually isolated and have limited support. Another study from Nigeria found that 80% of fistula patients had been abandoned and 60% were divorced or separated. An overwhelming number of these women are uneducated. One report from Nigeria found that 99.4% of the fistula patients were illiterate. In another report of 1443 patients who underwent surgery for vesico-womanly fistulas, only 3 had received any conventional education. As a result, these women maintain a subordinate position in society. They are often excluded from decision making, even decision making about their own health. As noted by Zacharin, "in an unequal world, these women are the most unequal among the unequal."

Another factor is the lack of skilled obstetric providers in the developing world. It has been said that the incidence of obstetric fistulas is a direct indicator of quality obstetric care in an area. It is easy to understand that Ethiopia has one of the highest rates of obstetrical fistulas, considering the fact that there are more Ethiopian doctors in New York City than in Ethiopia. Source: http://www.medscape.com/viewarticle/455965_4

A very important study of Fistulas at the Aira fistula Hospital, in Ethiopia had this to say: Even if all marriages and first time pregnancies could be delayed until whatever age, even if malnutrition could be prevented and female circumcision eradicated, there would still be a lot of new fistula patients.

One has to focus on the fact that the one and only cause for a fistula is lack of competent nearby obstetrical service. Everything else is of no or minor importance. If only every woman in labor had access to obstetrical service, so that a caesarean section could be performed within four hours after the delivery gets complicated, there would be no fistulas occurring.

Ref CNN http://www.cnn.com/2009/HEALTH/09/14...ath/index.html
Yemeni girl, 12, dies in painful childbirth "Although the cause of her death was lack of medical care, the real case was the lack of education in Yemen and the fact that child marriages keep happening," said Seyaj President Ahmed al-Qureshi.

contd....

Remember that some hundred years ago fistulas were as common in the west world as it is in Ethiopia today. Only when trained midwifes and hospitals with surgical service became generally available in the west world, the incidence of fistulas decreased, and is now unheard of.

Teen-age pregnancies are not very uncommon in the developed world, certainly not in the USA (where you even have religious sects practicing polygamy, child marriage and child pregnancies) but VVF/RVF are extremely rare due to the fact that good obstetrical service is at hand, and no obstructed labor goes unattended for a longer period.

Another important fact to keep in mind is that more than 50% of the fistula patients in Ethiopia are multipara (have already delivered one or more children), so it is certainly not exclusively young first time pregnants who are victims of VVF/RVF.

Any midwife who has seen a large third degree tear (a tear involving the rectum) in an otherwise normal delivery will understand that the soft tissues can never cause any major obstruction to delivery. The expelling forces are simply too powerful. That is why female circumcision, even in its most extreme form, is not related to fistula. Some years ago a Swedish gynecologist published her result of comparing the second stage (the time from start of pushing to the delivery of the child) in circumcised and uncircumcised women. Very surprisingly she found that the second stage was shorter in circumcised women!

Only when good obstetrical service is generally available, are fistulas prevented.

So we easily appreciate the problem in Africa. Poor health care, and postponing pregnancy is a quick and cheap fix to this serious problem. In rural areas, the prevalence rate is said to be higher due to inadequacy of facilities for pre and post-natal care. In such areas, long distances combined with high cost of care; ignorance and poor nutrition make women more vulnerable to VVF.

Causes of VVF could be direct or indirect:

Direct causes of VVF - The main and direct cause of VVF is 'unrelieved' obstructed labour. This means that in an ideal situation, where there are health facilities to prevent obstructed labour, and where pregnancy has been monitored during the course of at least 6 months before the onset of labour, the likelihood of obstructed labour is minimised. Other factors that influence the incidence of VVF include accidental surgical injury related to pregnancy, and crude attempts at induced abortion.

Surgical procedures that cause VVF are of two types. The first, orthodox medical accidental injury, which refers to injury caused to the bladder during surgical obstetric procedures performed within a formal/modern health care system, such as a hospital. Such procedures include Caesarean sections and difficult forceps deliveries.

The second are traditional procedures commonly employed during pregnancy and labour, and sometimes result not only to VVF, but also haemorrhage and sepsis. Examples include female Core mutilation (FGM), 'Gishiri' and 'Angurya' cuts.

In conclusion, fistula's are related to young pregnancy due to social constraints, including poor nutrition, poor perinatal -cum- obstetric care and social abandonment, and not due to the 'age factor,' itself. If these confounders are resolved, there will be minimal to nil incidence of fistulas in the young. Due to the irresponsibility of our men, however, setting age limits and possibly even banning marriage altogether for some men is understandable.

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