SOURCE: TrustLaw
From horrific childbirth injuries to death in the delivery room, millions of teen brides worldwide face a “silent health emergency” as their young bodies struggle to cope with pregnancy, rights groups say.

Poverty, poor healthcare and a higher risk of contracting sexually transmitted diseases compound the threats for about 10 million girls under 18 who get married each year, mostly in Africa and South Asia.

"Child marriage is a silent health emergency in the sense that it's often overlooked as a root cause of maternal mortality and morbidity (illness)," said Jeffrey Edmeades, a social demographer with the International Center for Research on Women (ICRW), a Washington-based think tank.

A girl under the age of 18 is married every three seconds, often without her consent and sometimes to a much older man, according to children's charity Plan UK.

Though illegal in many countries, the practice is fuelled by endemic poverty and is often seen as a way of securing a girl's future, both financially and socially.

Girls under 15, their bodies still developing and their pelvises narrow, are five times more likely to die during pregnancy or childbirth than women over 20, the United States Agency for International Development estimates.

The vast majority of those deaths are in the developing world, where a lack of pre- and post-natal care and advanced procedures such as Caesarean sections makes pregnancy and childbirth far more risky than in rich countries.

In Africa, for example, 60 percent of women and girls give birth without a skilled medical professional present, according to the U.N. World Population Fund.

Worldwide, 70,000 girls aged 15-19 die each year during pregnancy or childbirth, UNICEF says. The U.N. World Population Fund considers pregnancy the leading cause of death in that age group, citing complications of childbirth and unsafe abortions as major factors.

CHILDREN OF CHILDREN

Fatou Diakhate in western Senegal was one of the lucky ones.

Married at 13 and pregnant by 16, she survived the birth of 12 children and went on to rally the people of her village, Keur Issa, to ban child marriage in 1998.

"What you often see is that a girl gets married and within a month she becomes pregnant," she says in a TrustLaw documentary, Child marriage: Denying girls' rights, perpetuating poverty. "That's where the problems start because your body is not ready... Their reproductive organs aren't mature enough."

Children of child brides also are at risk, health experts say. Babies born to mothers younger than 18 are more likely to be underweight or stillborn, Plan UK says.

Such babies are 60 percent more likely to die before their first birthday than are children born to mothers older than 19, according to the Elders, an influential group of leaders founded by former South African President Nelson Mandela.

Girls forced into early marriage are also at an increased risk for sexually transmitted diseases and HIV/AIDS.

“Often they are married to older, more sexually experienced men with whom it is difficult to negotiate safe sexual behaviours, especially when under pressure to bear children,” Anju Malhotra, a senior researcher at ICRW, said in testimony to the U.S. House of Representatives Human Rights Commission last year.

HORRIFIC INJURIES

Married girls aged 15-19 are 75 percent more likely to become infected with HIV than their sexually active but unmarried contemporaries, according to a 2004 study conducted in Kenya and Zambia.

Similar rates were found in 29 countries across Africa and Latin America in a 2006 report by the U.S.-based Guttmacher Institute on the link between HIV/AIDS and early marriage.

Because their bodies are still immature and many give birth unattended at home, child brides are at increased risk of obstructed or prolonged labour, experts say.

Without necessary medical intervention, such as a caesarean section, this can cause obstetric fistula, a tear in the tissue between the vagina and the rectum or bladder.

In places where female genital mutilation is practiced and the vaginal opening is almost completely stitched closed, efforts to reopen it during labour can also produce fistula.

The condition causes a constant leaking of faeces and/or urine, creating discomfort and odour and restricting activity outside the home.

Without corrective surgery, “the condition lasts the rest of the girl’s life,” the ICRW's Malhotra said in her testimony to the U.S. House of Representatives.

Many women and girls with the condition are abandoned by their husbands, shunned by their communities and plunged into deep depression.

"People would ask who is making that bad smell, coughing and covering their noses," said Farhiya Mohamed Farah, a 20-year-old Somali refugee who was treated for fistula at Nairobi's Kenyatta National Hospital after living with the condition for several years.

"So I was always isolating myself... This problem has separated me from my husband and forced him to divorce me."

The World Health Organisation estimates that fistula affects 2 million women worldwide, mostly in Africa.

A survey of nine African countries by the U.N. Population Fund found that most fistula patients were poor, uneducated teens who developed the condition giving birth to their first child.

Child brides also are more vulnerable to domestic violence and sexual abuse, a recent ICRW report showed.

And, if not broken, the cycle of lifelong health problems caused by child marriage will continue.

“Girls from poverty are the most likely to become child brides, and child brides are more likely to live in poverty and raise children in poverty,” Malhotra said.

Kanta Devi, 26, was 16 when she got married in Badakakahera village in India's Rajasthan state.

"It's not a good thing for such young children," she said. "It ruins their health. Young children have babies -- your life is ruined, your education is ruined. You become upset with everything in your life."