Source: Diplomat
Mekdes Murgeta does not remember her actual wedding, but her family told her it happened when she was five. Pointing at her own five-year-old daughter she confirms she was her age.

Murgeta lives in Mosebo, a rural village in the Amhara region in central Ethiopia. There, as in the rest of Ethiopia, it is illegal to be married before the age of 18.

According to the United States Agency for International Development (USAID), Amhara has some of the highest rates of child marriage in the world. Estimates in 2009 show at least 50 percent of women marrying before they reach 18. Murgeta thinks she is around 28 now, but is unsure. Keeping track of your age is not common here.

She is six months pregnant with her second kid. "I want to adequately serve them, adequately feed them. If I have many children, I can't do that," she explains.

Murgeta is part of a growing number of Ethiopian women, many of them child brides, who are taking control of their reproductive lives.

On the 19th of every month, she has an appointment with the village health extension worker. It was the health extension worker that gave her the injection that kept her from getting pregnant for five years. They taught her about spacing her pregnancies. "They teach me everything," she says.

In 2003, Ethiopia launched its health extension worker programme, a large-scale project aimed to teach basic illness prevention methods across the country. Before that, health extension workers did not exist. Now, there are 38,000 of them around the country. One of their main goals is keeping women healthy.

'Political priorities'

"The country made maternal health one of the top political priorities," says Addis Woldemariam with the Ministry of Health. Every week, he says, Ethiopia's regional presidents are charged with auditing the cause of each maternal death in their region.

The effects have proved dramatically benefical in tackling women's health issues. Save the Children reports that since 2000, Ethiopia has reduced the risk of maternal mortality by two-thirds, the most of any African country.

But Woldemariam admits a persisting tragic problem. "The women still dying are very young," he says, adding: "There is still some practice of early marriage."

Child marriage remains a major health concern. One of the primary causes of death for girls aged 15-19 is pregnancy.

Girls who bear children before the age of 18 are five times more likely to die of pregnancy-related causes compared to older mothers.

There is often pressure to consummate new marriages as soon as possible, to prove the bride's fertility. Murgeta says her parents pressured her to have as many babies as possible, but she sided with the health worker instead.

Women who are married young also tend to have older husbands. Murgeta is not sure how old her husband is but she says he is much older.

In Amhara, the age difference between husband and bride can be 15 years or more. Older husbands are more likely to be sexually experienced and married couples are less likely to use condoms.That leaves their wives 50 percent more likely to contract HIV, according to a 2004 study by the Population Council.

The health extension worker that Murgeta sees is just a five-minute walk from her house. She is lucky, as that is not the case for everyone. Child brides tend to live in the poorest, most remote areas of Ethiopia. Poor roads and limited means of transport could mean that some people are several hours, even days, away from any health facility.

Some villagers may not know the laws prohibiting child marriage. Some believe that once the marriage ceremony ends, they are no longer breaking the law. Even if the law is enforced, divorced women in Amhara are often stigmatised, prompting them to remain married out of fear.

Successful work

Annabelle Rokar is the country director for the Population Council in Ethiopia. Her organisation has done some of the most successful work ending child marriage. "We don't want to reach 500 girls or 600 girls. We have to reach millions of girls at risk of child marriage," she says.

Rokar explains how they have used the goat project to solve the problem. It is actually quite simple. Families who marry their daughters early are typically poor and sometimes early marriage is a way to transfer the burden of one more mouth to feed. Giving a family a goat can provide extra income.

Peer pressure also goes into effect. When one family gets a goat for not marrying their daughter at a young age, other families want to mirror their success.

The goat project worked reasonably well at delaying marriage for a few years, according to the Population Council's study. But for the Ethiopian government, one goat per family was too expensive.

So CARE and the International Centre for Research on Women took a different approach. Rather than try to prevent child marriage, they would work with the brides already married. They provided health care and economic education, even a social network for the girls.

Jeff Edmeades was the researcher on the project. When he first arrived in Amhara, he was unsure he would find any child brides. He was told by one government official that the law banning child marriage was so effective, child brides no longer exist.

He soon learned that was not the case. He now estimates there are tens of thousands of child brides in Amhara alone. He understands the spirit of the law banning child marriage, but he worries it may be adversely affecting the girls themselves.

"It's harder to do research. Effectively, they become more hidden in communities than they were," he says. It became his job to draw them out.

With help, he taught the girls how to pool their money and invest in small businesses. They also learned about reproductive health. The lessons helped, but Edmeades said putting the girls in an environment where they could listen to each other and be heard was one of the most exciting aspects of the project.

In the beginning, the girls were quiet. They would hardly talk. "And by the end of the project," he said, "these girls were just very active, very vocal, very comfortable talking about a whole range of topics."

IRCW documented 70 child marriages prevented in the year the project took place.

But as successful as that project was, it had to end. Many girls, like Ashkalash Thomas, were left behind.

Filling out the paperwork at an abortion clinic in Addis Ababa, the capital, she wrote her name and her age, 15.

She came from a village in Woliata, south of Ethiopia. The only health care worker she knew was hours away. Thomas' parents told her she would be married a year ago. She never learned the groom's name. She did the only thing she thought she could: She ran away.

She found a job in a factory and some friends to live with. She even met a boy. He told her he loved her. Three days later, she was pregnant and he was gone.

She has not told her parents. "They can kill me," she said.

Instead, she came to get an abortion. She said she felt better and says she was not ready to have a child. She walked out of the building but stopped at the street. Thomas lingered seeming not to know where to go or who to turn to next.

• Ethiopia