I first met Shamsiya (not her real name) when she was barely 15 years old. She had been forced to marry a man in his forties and was pregnant and suffering mild anaemia. At secondary school, Shamsiya had dreamed of becoming a nurse, but marriage and motherhood dashed her hopes. Now aged 17, she is expecting her second child. She suffers from depression and has a vaginal injury from the birth of her first child. She often cries and has told me that she has thought about ending her life.
Shamsiya’s husband works as a local builder, and they struggle financially. If she could return to school and find work, not only would she be happier, but her whole family would benefit. I have asked her husband if he would allow his wife to go back to school, but he says he wants more time to think about it.
Shamsiya’s story is typical of millions of girls and women in Nigeria. We can no longer ignore the fact that marriage before the age of 18 puts their mental and physical health at risk. Child marriage also denies them education and perpetuates the cycle of poverty and ill health for them and their children.
Ending child marriage reminds me of the struggle to end polio. For many years, resistance to vaccination and reliance on traditional medicine and faith healers meant that hundreds of children died of polio every year. Gradually, with greater awareness, championed by government leaders, experts and prominent traditional rulers, people began to accept vaccination. This same approach, of raising awareness from a health perspective, could also be employed to eradicate the harmful impacts of child marriage.
About 43 per cent of girls in Nigeria are married before their 18th birthday and 16 per cent before the age of 15. Nigeria is ranked 11th globally and third highest in absolute numbers of women married or in a union before the age of 18. This not only means a high level of suffering, but also a significant drain on public health and the economy.
The high rates of child marriage are driven by several factors. The latest official data shows that rural women marry at younger ages than their urban counterparts and regionally, women in the north-west marry at a much earlier average age (15.8 years) than women in the south (23.6 years). Women with no education marry six years earlier than women with secondary education and women in the lowest socioeconomic group marry eight years earlier than women in the highest.
In health terms, the evidence against child marriage is clear. It initiates sexual activity when a girl’s body is still developing and when she is often not ready, physically or emotionally, for childbirth. According to the World Health Organization, complications from pregnancy and childbirth are the leading cause of death of girls aged 15-19 globally. It can also have serious effects on the child with higher risks of stillbirth or infants dying in the first few years of life.
Child marriage often compromises a girl’s development due to social isolation with mental and psychological effects and limits her opportunities for career and vocational development.
As a doctor, I see the impact of child marriage all the time in girls and in grown women. I frequently encounter patients with psychological, sexual and reproductive health problems such as vesicovaginal fistula, recto-vaginal fistula as well as a higher risk of caesarian section and vaginal scarring as a result of obstructed labour caused by inadequate pelvic capacity. In many cases, they will be affected for life. Few of these patients have someone to talk to, nor are there platforms or services available to support them.
According to the Federal Child Rights Act, the minimum age of marriage in Nigeria is 18, but not all of Nigeria’s 36 states have adopted this law. In some states, a girl can be married at just 12 years old. It is important that all states implement the Child Rights Act so that all girls are protected.
As a nation, we need a national awareness-raising campaign about the health risks of child marriage. Some say that child marriage is part of their tradition but no family wants to harm their child. I know that when I present parents with the facts about child marriage and early pregnancy, they usually change their minds. Traditions are important, but when we learn that they cause harm, we can change. This is already happening with Female Genital Mutilation.
I hope that I can persuade Shamsiya’s husband that his wife will be happier and his whole family will benefit if she is allowed to go back to her studies. At present, her unhappiness is costing the whole family dearly. This is not the way to build a strong and vibrant country. Shamsiya deserves to have a chance to fulfil her potential, and in doing so she can also contribute positively to Nigeria’s future.
We must end the damage to girls and women’s mental and physical health by speaking with husbands, fathers, local leaders, teachers, young people and medical professionals about the facts. We have celebrated the eradication of a disease like polio with awareness and education, we can also eradicate the damaging health impacts of early marriage.
Dr Tijani Salami is a Physician at the Federal University of Technology Minna. He is the founder of Sisters Caregivers Project