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Kate Grant is CEO of The Fistula Foundation, a nonprofit that works to end the suffering caused by the childbirth injury of obstetric fistula. Follow the organization online on Twitter and on Facebook.

Gul lives in Afghanistan. At the age of 13, she became the second wife of a much older man. One year later, Gul was pregnant. When the time came for her to deliver her baby, Gul endured three excruciating days of prolonged obstructed labor. With no doctors or clinics near her home, the only “treatment” she received during labor was a sacrificial sheepskin laid over her belly. The baby did not survive.

Afterward, Gul found that she could not control her urine. What Gul thought was an illness was actually the childbirth injury of obstetric fistula, an injury caused by prolonged obstructed labor. Fistula is preventable when a woman has access to emergency medical intervention, such as a C-section, and curable only through a fistula repair surgery that costs as little as $450.

Gul suffered 12 years of incontinence and shame before learning of CURE International Hospital in Kabul. She and her husband rode a bus for four days to get to the hospital, but it was worth the trip: Gul’s surgery was successful and she was no longer incontinent.

My organization, The Fistula Foundation, works with pioneering organizations like CURE International Hospital to fund treatment for women who are suffering the misery and shame that accompanies obstetric fistula. Too often, these women are actually girls like Gul, who give birth too early in life, before their bodies have fully matured.

Most of us want to do something to help girls like Gul, but it can be hard to figure out how to help when Gul and other women suffering from obstetric fistula live so far away, in cultures we don’t always understand. But what if you could do something right now to help heal girls and women with fistula in the developing world? And what if helping was as simple as playing a game?

Today, it is. Half the Sky Movement: The Game launches today on Facebook. It’s the next phase in the Half the Sky Movement, a call to action to end the oppression of women and girls worldwide, centered around the book and documentary film of the same name by Pulitzer Prize winning journalists Nicholas Kristof and Sheryl WuDunn. In the game, players progress through a series of quests and stories related to challenges that real-world women and girls face, through examples provided by The Fistula Foundation and the six other NGO partners featured in the game: GEMS, Heifer International, United Nations Foundation, ONE, Room to Read and World Vision.

The game gives all of us an opportunity to learn more about problems affecting women in the developing world, such as obstetric fistula. It also empowers us with a chance to act online for real-world change offline, thanks to our long-term partner, Johnson & Johnson, which has committed $250,000 to support surgeries for women in the developing world through this game.

So, for perhaps the first time in history, you can help a woman with fistula, like Gul, get the surgery she desperately needs – simply by playing a game.

Just a few hours ago today, Congress voted to renew the Violence Against Women Act. This important bill is a reauthorization of legislation first enacted in 1994; this version includes provisions to combat child marriage.

Early marriage is an egregious violation of human rights with severe consequences for girls’ sexual and reproductive health. Every day more than 37,000 girls get married, and if present trends continue, an estimated 15 million girls will become child brides every year beginning in 2021. Girls who are married are forced to take on roles for which they are not emotionally and physically prepared. For many girls, marriage marks the beginning of their sexual life. Married adolescents have sex more often than their unmarried peers; are less able to refuse sex or negotiate safe sex; and often have older, more sexually experienced partners — all factors that increase their risk of HIV infection. Young women are often expected to demonstrate their fertility by becoming pregnant. Many give birth within the first year of marriage when their bodies are not fully matured. Childbirth- and pregnancy-related complications are the number one cause of death among girls ages 15-19; of the 16 million adolescent girls who give birth each year, 90% are married.

The early marriage provisions included in this bill mandate that the administration create a multisectoral strategy to end child marriage. The bill states that the “Secretary of State shall establish and implement a multi-year, multi-sectoral strategy—

  1. to prevent child marriage,
  2. to promote the empowerment of girls at risk of child marriage in developing countries
  3. that should address the unique needs and vulnerabilities and potential of girls younger than 18 years of age in developing countries
  4. that targets areas in developing countries with high prevalence of child marriage and
  5. that includes diplomatic and programmatic initiatives.”

In response to this act, U.S. Senator Durbin stated,

 “Today is a victory for women and girls not only living here at home but abroad; The new mandate for a multisectoral strategy to end child marriage is an important step forward and now we must focus our efforts on ensuring it is developed without delay and its implementation is fully funded.”

This is an important step in the fight against early marriage. President Obama is expected to soon sign the bill in law saying

 “Renewing this bill is an important step towards making sure no one in America is forced to live in fear, and I look forward to signing it into law as soon as it hits my desk.”

Tomorrow, February 14th 2013, marks the fifteenth anniversary of the V-day campaign to end violence against women and girls. Through their One Billion Rising campaign, V-day organizers are inviting activists around the world to rise, dance and “join in solidarity, purpose and energy and shake the world into a new consciousness.” One Billion Rising was developed in response to the staggering statistic that one in three women on the planet will be beaten or raped during her lifetime. With the world population at 7 billion, this adds up to more than 1 billion women and girls.
Violence against women and girls is most often perpetrated by someone the woman knows. Intimate partner violence, rape, “honor” killings, female genital cutting, and human trafficking are all examples of violent acts committed against women and girls. In all parts of the world, adolescent girls experience violence at astronomical levels.

 
Harrowing numbers:

  • Approximately 50% of all sexual assaults occur against girls age 15 or younger.
  •  In 2002, 150 million girls under the age of 18 experienced sexual violence, and many times, adolescents’ first sexual experience is forced or coerced.
  • One in five females will be a victim of rape in her lifetime.
  • Between 15% and 76% of women experience physical and/or sexual violence perpetrated by an intimate partner over the course of their life.
  • Between 2 to 4 million people are trafficked in and across borders each year and females account for 98% of all trafficking victims.
  • Approximately 10 million adolescent girls become child brides each year.
  • Each year, approximately 5,000 women and girls die because of dowry-related murders.
  • An estimated 5,000 adolescent girls and women are killed by family members in the name of honor every year.
  • Over 130 girls have undergone female genital cutting and an estimated 30 million are at still risk.

These numbers are unacceptable. Violence against adolescent girls curtails their education and opportunities; it can lead to poor health and psychological outcomes. Repercussions include unwanted pregnancies, HIV and other sexually transmitted infections, and death. Violence against women and adolescent girls hinders their ability to thrive and is a blatant violation of their human rights. We can all take a stand and join the movement to end violence against women. Learn how you can take part here: One Billion Rising.

 

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our series on early marriage. The original post, located on “Impatient Optimists,” is available here.

Every day more than 37,000 girls get married, and if present trends continue, an estimated 15 million girls will become child brides every year beginning in 2021. Early marriage has devastating social and health impacts on adolescent girls. Girls who are married are forced to take on roles for which they are not emotionally and physically prepared. When girls marry at a young age, they often leave their homes, stop attending school, and lose contact with family and friends. Many married adolescents experience domestic and sexual violence. 

For many girls, marriage marks the beginning of their sexual life.  Married adolescents have sex more often than their unmarried peers; are less able to refuse sex or negotiate safe sex; and often have older, more sexually experienced partners — all factors that increase their risk of HIV infection.  Young women are often expected to demonstrate their fertility by becoming pregnant. Many give birth within the first year of marriage when their bodies are not fully matured.  Childbirth- and pregnancy-related complications are the number one cause of death among girls ages 15-19; of the 16 million adolescent girls who give birth each year, 90% are married.  Furthermore, because adolescents’ bodies are not yet fully developed, they are at a greater risk pregnancy complications including obstructed labor, which can cause obstetric fistula. The consequences of obstetric fistula are devastating: the baby usually dies, and the woman can suffer from constant leakage of urine or feces or both. The condition can result in stigma, isolation, and abuse.

Early marriage is an egregious violation of human rights with severe consequences for girls’ sexual and reproductive health. All girls deserve to enjoy their adolescence, and the cycle of early marriage can be broken. Programs that can help include those that provide better economic opportunities for girls, that help girls stay in school, and that work to change traditional attitudes and policies about early marriage, as well as those that offer sexual and reproductive health services to married adolescents.

In the next two blog posts, two youth authors, one from Zimbabwe and one from the Philippines, will share the direct impact of early marriage on their communities.

© 2006 Khumar Taghieva, Courtesy of PhotoshareThis post, written by Rebecca Shore, originally appeared on the k4Health blog and can be accessed here.

The world is a scary place, especially for women. Many live their lives in fear and are constantly treated like second-class citizens. Photographer Stephanie Sinclair of National Geographic took a close look at child marriage and created a 10-minute film Too Young to Wed: The Secret World of Child Brides. She captured the true consequences of the practice of child marriage. This practice, though illegal nearly everywhere worldwide, is still practiced by many cultures, in many countries. This video focuses on India, Yemen, Afghanistan, Nepal, and Ethiopia and the acts of child marriage. Throughout the video, several girls are interviewed about the lives they live as young brides. It is dramatic and at times hard to watch, but it gives a glimpse into the pain and fear that runs these young girls lives.

Though child marriage is on the decline, it has been a slow decline. Because child brides are used for their family’s financial gain and because of myths—like the myth that virginity cures HIV— child marriage continues throughout much of the developing world. According to the International Center for Research on Women (ICRW), if present trends continue, 100 million girls will marry over the next decade. In countries like Niger, Chad, and Mali, the rate of girls married before 18 is over 70%.

The negative results of child marriage are astounding. Child brides are often victims of abuse, rape, and even murder, and they have little to almost no input into their own decisions. Once a girl gets married she is usually forced to leave school, which perpetuates the cycle of poverty. However, the more educated girls are, the less likely they are to become child brides. Maternal mortality and obstructed labor leading to fistula are also common among child brides both because young girls’ bodies are still immature and because of a  lack of knowledge about maternal health, lack of control over medical decisions, and lack of access to timely and adequate health care.

Child marriage is a devastating practice that is still all too common in the poorest countries in the world and continues to perpetuate poverty. Organizations and campaigns to end child marriage are helping to change the landscape for girls everywhere. The more people who are aware of this practice, the more we can hope to change and end this behavior. Everywhere in the world, women are not just fighting for equality, they’re often fighting for their lives.

For more information or to get involved, take a look at these organizations that are committed to the cause:

For more information on Stephanie Sinclair, visit her web site.

To learn more about early marriage and youth sexual and reproductive health, read the IYWG YouthLens, “Addressing Early Marriage of Young and Adolescent Girls.”

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the third in our three-part series on adolescent pregnancy. The original post, located on “Impatient Optimists,” is available here.

Gaj Bahadur Gurung works as the program coordinator for the National Federation of Women Living with HIV and AIDS in Nepal.

For a young girl in Nepal or South Asia, pregnancy can be disastrous. If it occurs outside the context of marriage, it will bring her disgrace and might lead to expulsion from her family and school. The young woman may be perceived as deviant in the community and will be considered a curse for her family.

Young women have little choice or control over contraceptives. For unmarried young girls in South Asia, male condoms are their only contraceptive option. Yet, patriarchal gender roles and norms make it difficult or impossible for girls to negotiate condom use with a male partner and often inhibit girls from even buying condoms or other types of contraception.

A lack of appropriate information also contributes to adolescent pregnancy. Parents rarely discuss sexual and reproductive health with their children, and the school curriculum has outdated and inadequate information. In spite of the attempts by nongovernmental organizations to disseminate information, some people are difficult to reach, especially low-income girls in mobile populations.

Early marriage is another major contributor to pregnancy among adolescents. Early marriage is quite normal in this culture, and once married, a young woman is expected to give birth to prove her family’s honor. Once a young married woman becomes pregnant, she receives tons of affection, but often she drops out of school, becomes more economically dependent on her family, and has less social interaction.

Policies and programs must both help prevent early and unintended pregnancy (for married and unmarried women) and mitigate the negative consequences for girls who do become pregnant. Programs should provide young women access to, control over, and informed choice about sexual and maternal health services. Youth-friendly maternity services with easy access for young girls would minimize health risks to mother and baby during pregnancy, delivery, and the post-delivery period.

Laura Dickinson is communications officer for Girls Not Brides: The Global Partnership to End Child Marriage. You can follow Girls Not Brides on Twitter @GirlsNotBrides or join them on Facebook: www.Facebook.com/GirlsNotBrides

Photo Credit: Cibele Vieira, Clinton Global Initiative

“Nobody seems to talk about child brides,” says Archbishop Desmond Tutu, Nobel Peace Prize winner and Chair of The Elders. “But I cannot stay silent.”

 The plight of child brides has long been ignored by the international community, despite the sheer scale of the problem: in the next year alone, 10 million girls around the world will marry before they are 18. That’s 100 million girls within the next decade who will marry as children.

Child brides are among the world’s most voiceless and vulnerable people. Rarely do they have any choice in when or whom they marry, nor do they have a voice in their relationship with their often much older husbands. They usually drop out of school, too, which only serves to reinforce their isolation.

Hard to reach and invisible, child brides rarely benefit from aid and development programs designed to curb maternal deaths, infant mortality or the spread of HIV and AIDS – despite the fact that they are among those who could most benefit from such support. Pressured to prove their fertility, young brides often become pregnant before their bodies are physically ready for childbearing. The results can be devastating: girls under 15 are five times more likely to die in childbirth than women in their 20s.

Photo Credit: Ashenafi Tibebe,The Elders

Child brides rarely receive support and guidance on issues such as family planning and safe sexual health. They are less likely to space out their children and, unable to negotiate safe sexual practices with their husbands, they are more likely than their unmarried peers to contract HIV and other sexually transmitted infections.

The repercussions of early marriage are serious, even dangerous – so why has it received so little attention from leaders and policy makers?

Desmond Tutu is right: very few people talk about child brides. Not only are they invisible, talking about their plight is deemed taboo – a topic too closely related to sensitive issues of tradition and culture for leaders to address.

That’s why he and his fellow Elders, an independent group of global leaders working for peace and human rights, brought together Girls Not Brides, a partnership of  nongovernmental organizations from around the world that work to tackle child marriage at the grassroots, national and global levels.

The aim of the Partnership is to give girls a voice, to connect those who work closely with girls vulnerable to early marriage to the leaders and policy makers who have a real opportunity to implement policies that protect and empower young girls and help them avoid early marriage.

Addressing sensitive issues such as child marriage can be lonely work, and organizations have long had to act in isolation. By coming together in partnership, Girls Not Brides members find strength in unity, sharing experiences and learning from each other about the successful programs that have helped to reduce child marriage. It also enables them to raise their collective voice, increasing awareness of the solutions that help to end child marriage and calling on leaders to take action.

Girls Not Brides and its members are determined to show that there’s a growing, global movement to end child marriage and enable millions of girls to fulfill their potential. We won’t be staying silent.

Find out more about Girls Not Brides at www.GirlsNotBrides.org, follow us on Twitter @GirlsNotBrides or join us on Facebook. Watch our video, featuring Graça Machel, Mary Robinson and Desmond Tutu of The Elders: Traditions can change: ending child marriage

In early August, the international news agency, Reuters, reported that families in Kenyawere selling their daughters into marriage, sometimes for as little as $168.00 dollars, in an attempt to ease the economic burden caused by drought. The story about the “child drought brides” gathered international attention. Sadly, the situation inKenya is not unique. Climate change, and its detrimental effects on the environment, disproportionately affects adolescent girls and is increasing girls’ risk for school dropout, early marriage, sexual violence, and other negative outcomes.

 

“Climate change and local environmental change may destroy all of my dreams and aspirations,” 15 year-old girl from the Philippines

Drought and natural disasters often increase the economic burden felt by vulnerable households.  In the aftermath of natural disasters, families may experience job loss, home damage, and loss of crops and livestock. Girls are often the first pulled out of school to help supplement the household income.

Girls may also be forced to leave school in order to shoulder some of the burden of increased household responsibilities. Girls may be expected to care for sick or injured relatives or to provide childcare for younger siblings when parents are traveling to collect aid or food.  Furthermore, drought, deforestation, and natural disasters often cause adolescent girls to spend more than half of their days looking for wood and clean water; this results in less regular school attendance.  When a girl is forced to leave school, not only is her education jeopardized, but she faces increased risk of early and unintended pregnancies, and HIV and other STIs.

The economic burden of climate change also increases a girl’s risk of early marriage. Many families arrange marriages for the “bride price” and to ease the burden of having to feed and care for girls. Early marriage often results in girls leaving school and increases the risk of early pregnancy.

In disaster situations, women and girls are more likely to experience all types of violence including sexual violence. Girls are at risk of sexual violence while staying in relief shelters, on the way to the shelters, and when collecting water or firewood while staying in a shelter.  Sexual violence leads to poor health consequences for its victims including unintended pregnancies, HIV and other sexually transmitted infections, and death. Also, because families perceive shelters as unsafe, girls may be left at home, making them unable to benefit from the reproductive health services offered there.

Programs and policies need to place a greater focus on the potentially catastrophic effects of climate change on the reproductive health of adolescent girls. In a recent report called “Weathering the Storm: Adolescent Girls and Climate Change,” Plan International makes the following programmatic and policy suggestions.

Programs should ensure that girls have: 

  1. Greater access to quality education
  2. Greater protection from gender-based violence  
  3. Greater participation in activities related adapting to climate change and reducing risk

Policies should:

  1. Prescribe gender-sensitive strategies for adapting to climate change
  2. Address gender inequality as a root cause of vulnerability to climate change

 

Kate Stence is the communications manager of Knowledge for Health. As a writer and endurance athlete, her writing and running support females worldwide in achieving gender equity.

In late July, Secretary of State Hillary Clinton took the stage to speak at “Saving Lives at Birth: A Grand Challenge for Development.” A joint effort of USAID, the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, and the World Bank, the event called on the brightest researchers around the world to identify and scale up transformative prevention and treatment approaches for pregnant women and newborns in rural, low-resource settings around the time of birth.

Clinton relayed how great the opportunity was to internationalize efforts and bring change through innovation. “We want to do development more effectively. That is our goal. We want to change systems. We want to deliver highest possible impact for every tax payer dollar we spend,” she said.

According to Clinton, few challenges are as persistent or heartbreaking as the poor health of many women and children around the world. She cited WHO’s calculation that 2.6 million children are stillborn each year and that a woman living in Sub-Saharan Africa is 136 times more likely to die during childbirth than women elsewhere in the world.

Like so many development issues, saving lives at birth has strong ties to the health and safety of the mother. For example, Trustlaw.org is currently featuring child marriage with a focus on how greatly it influences maternal and child health, both directly and indirectly. “Children of child brides are also at risk. Babies born to mothers younger than 18 are more likely to be underweight or stillborn. Girls forced into early marriage are also at an increased risk of contracting sexually transmitted diseases [infections] and HIV/AIDS because they are unlikely to be able to negotiate safe sex with their husbands.”

According to PBS, child brides can be as young as 5 or 6 when they enter marriages, often with much older men. In April 2011, Who Speaks for Me? Ending Child Marriage was released by the Population Reference Bureau, further clarifying how vast this problem is on a global scale.

In the last decade, 58 million young women in developing countries — one in three — have been married before the age of 18, many against their will and in violation of international laws and conventions on women’s rights. Even more disturbing, according to new figures, one in nine girls, or 15 million, has been forced into marriage between the ages of 10 and 14. With limited education and economic opportunities, child brides are often condemned to a life of poverty, social isolation, and powerlessness, infringing on their human rights, health, and well-being.

 In the coming years, the number of child brides will increase drastically. As such, the Elders, a group of global leaders ranging from Nelson Mandela to Mary Robinson, introduced an initiative to bring more awareness. They state, “Every single day, it is estimated that more than 25,000 girls under the age of 18 are married. At this rate, 100 million more girls — around 10 million each year — will become child brides over the next decade.”

In June, National Geographic documented why whole cultures continue to abide by child marriage as cultural tradition. The article opened in India on the night of a wedding for three girls.

They squatted side by side on the dirt, a crowd of village women holding sari cloth around them as a makeshift curtain, and poured soapy water from a metal pan over their heads. Two of the brides, the sisters Radha and Gora, were 15 and 13, old enough to understand what was happening. The third, their niece Rajani, was 5. She wore a pink T-shirt with a butterfly design on the shoulder. A grown-up helped her pull it off to bathe.

In the story’s outcome, journalist Cynthia Gorney spent her own money to educate an 8-year-old child bride from Northern India so she could access education post-high school. Months after Shobha Choudhary began school, Cynthia received a video of the young girl thriving while living in a safe house for girls and continuing her education. “She looked straight into the camera at one point, and in English, an enormous smile on her face, she said, ‘Nothing is impossible, Cynthia Mam. Everything is possible.’”

Shobha’s story is one of hope but hers is also rare. Yet, the report Paying the Price: The Economic Cost of Failing to Educate Girls highlights why education will lead countries toward economic vitality. “Based on World Bank research and economic data and UNESCO education statistics, it estimates the economic cost to 65 low and middle income and transitional countries of failing to educate girls to the same standard as boys as a staggering US$92 billion each year. This is just less than the US$103 billion annual overseas development aid budget of the developed world.”

You can learn more about gender equality through the IGWG Gender and Health Toolkit and on the Interagency Gender Working Group web site.

 

Recently, a compelling story about the perils of early marriage caught our attention. In a book called I Am Nujood, Age 10 and Divorced, Yemini Nujood Muhammed Nasser tells her own courageous story about her fight to end her forced marriage to a 30-year-old man.

Named 2008 woman of the year by Glamour magazine, Nujood recounts her family’s move from a rural village to a large metropolitan area, where her parents were unable to afford the high cost of living or care for her and her 16 siblings. Nujood and her siblings had begun begging in the streets when her father received a proposition: a man from his home village asked to marry one of his daughters. He accepted.  In February 2008, Nujood, the oldest single daughter, was married in exchange for the equivalent of US$750.

As is common for child brides, Nujood was immediately taken out of school, and she became isolated from friends and family when she moved to her husband’s village several hours away. Nujood was treated poorly by her new mother-in-law and was repeatedly raped by her husband. Unfortunately, most of Nujood’s family did not sympathize with her plight. They said it was her duty as a wife to obey her new husband and that divorce would dishonor her family. However, encouraged by her father’s second wife, Nujood decided she would go through the court system to demand a divorce. Alone and afraid, she made her way to the courthouse, approached the judge, and requested permission to divorce her husband. Over time, with help from a few sympathetic judges and a women’s rights activist lawyer, Nujood’s divorce was granted. Her story of bravery and determination has become an international sensation and serves as a symbol of hope for all victims of child marriage. 

Read the most recent YouthLens brief, Addressing Early Marriage of Young and Adolescent Girls, to learn about some successful approaches for delaying marriage.

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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