CHILD MARRIAGE

1. CHILD MARRIAGE Analysis of Current Intervention Strategies Worldwide & Recommendations for the Future

2. What is Child marriage? • A ‘legal’ or customary union between two people, one or both of whom is below the age of 18 • Legal ?? • Violates statutes of Article 1 of the Convention on the Rights of the Child

3. Why should we care?Child Marriage: A Public Health Concern The link between child marriage and socioeconomic development: • It prevents the achievement of MDGs 2 – 5 • Maternal morbidity and mortality is a leading cause of death among girls aged 15-19 in developing countries • Overall economic burden/loss at country level (lost potential, man hours lost, number of years lost due to poor health, health care expenditure) • Population growth issues

4. Millennium Development Goals (MDGs)[UNDP Project] 189 participating countries. Signed in 2000. Target 2015 • MDG 1 – Eradicate extreme poverty and hunger • MDG 2 – Achieve universal primary education • MDG 3 – Promote gender equality & empower women • MDG 4 - Reduce child mortality • MDG 5 - Improve maternal health • MDG 6 - Combat HIV/AIDS, malaria and other dxs • MDG 7 – Environmental Sustainability • MDG 8 - Global partnership for development

5. Existing Programs • Most appear to be theory based • Most programs were based on one or two theories or random combinations of constructs from one or more theories • Does not appear to be any deliberate method or pattern of choosing any particular theory • Considerations appear to be driven by program director’s choice, sociocultural climate, political will, budget

6. Existing Programs Contd… • 5 Main Approaches: • 1. Empower girls by building their skills and enhancing their social assets (SLT, SCT) • 2. Improve girls’ access to quality formal education (TRA, TPB, Socio-ecological Theory) • 3. Mobilize communities to transform detrimental social norms (Community Theories) • 4. Enhance the economic situation of girls and their families (Systems theories, Social Network theory, Social Cognitive Theory, Behavioral Economics) • 5. Generate an enabling legal and policy environment (Systems theories)

7. CASE STUDY 1:ETHIOPIA • Girls’ clubs serve as avenues for social supportmentoring, and learning new skills. (SLT, SCT, Social Network Theory) • ‘Husbands’ clubs (SLT, Soc Net Theory) • Community outreach (Community theories) • Dialogue • Priests discouraged from performing weddings Economic incentives for families of at-risk girls (BE, SCT, ?HBM) * Most successful. Programs outcomes were positive and sustained after 3years

8. CASE STUDY 2: MALAWI • UNFPA worked with Malawi’s National Youth Council to advocate for the repeal of a law that would have allowed for marriage of individuals under the age of eighteen. (Systems theories) • Targeting girls at risk with non-formal education, protection from violence, mentoring, improved access to sexual and reproductive health and HIV services. (SL, SCT, TRA) • Advocacy efforts resulted in federal government program for poverty reduction, highlighting girls’ education and delayed marriage as essential to social development (Systems theories)

9. CASE STUDY 3: NEPAL • Peer mobilization/support groups(Soc Net Theory, SCT, SL) • Mentoring (SL) • Health education (reproductive and sexual) TRA, HBM • Life skills (problem solving, negotiation, decision making skills) (SCT) • Awareness of legal and other rights (SCT) • Stimulation of parent-child dialogue (Social theories) • Community involvement (Community theories)

10. CASE STUDY 4: NIGER • Practice of child marriage has religious undertones • Community involvement - traditional chiefs, religious leaders • Mass media – information dissemination on religious fora, addressing link b/w maternal health and child marriage (? Social Marketing) • School of husbands – child marriage prevention curricula, input/publicized approval from traditional/religious leaders (SL, SCT, Soc Network theory)

11. CASE STUDY 5:PAKISTAN • Obstetric fistula repair project • Child marriage prevention activities piggy-backed on the project (? Social Marketing) • Raising awareness through workshops for media personnel (womens’ rights, child marriage, fistula prevention) • Community health talks that discuss maternal health and the links b/w child marriage, early pregnancy and obstetric fistulae (HBM, ?TRA) • Raising awareness in the community through youth networks • Advocating for youth policies that address child marriage and early pregnancy (systems theories)

12. ENDING CHILD MARRIAGE THROUGH AN INTEGRATIVE APPROACH The Theory of Triadic Influence as a Model for Sustainable Change

13. Consensus on the Need for an Integrative Framework • “A growing body of evidence suggests that successful efforts reach across sectors to integrate a range of approaches that address the root causes of child marriage and simultaneously promote girls’ human rights.” (United Nations Population Fund 2012 Report)

14. CASE STUDY 6: NIGERIA Vital Facts: • Nigeria is considered a secular state • Three different legal systems operating simultaneously—civil, customary, and Islamic (Sharia law) • State and federal governments have control only over marriages that take place within the civil system. • Rates of child marriage among the highest in the world • Prevalent in NE and NW Nigeria • Sharia (Islamic) based judicial system predominant in these regions • The practice of child marriage in Nigeria has seeming religious undertones • Polygyny is also prevalent in this region • NE and NW typically resistant to ‘Western’ influence (western education, family planning methods/fertility control, immunization programs etc) • NE and NW of Nigeria have the highest rates of Maternal M&M, child mortality, female illiteracy, fertility and socioeconomic stagnation.

15. TARGET GROUPS • Children (BOTH boys (potential husbands) and girls) • Men’s clubs (fiancées, fathers, guardians) • Peers • Parents/guardians (including teachers, Islamic scholars and other potential mentors) • Religious leaders • Traditional leaders • Law enforcement agencies • Politicians/Legislators

16. The Dilemma • Where do we concentrate our energies (time and funds)? • Within the overarching framework of the TTI, which niche do we invest most in so as to get maximum outcomes for available input? • UNDFPA – Girl empowerment (does not appear to have had much effect since statistics have remained constant for years) • An alternative approach – Social norms, Knowledge/Expectancies and Interactions with systems/institutions

17. Rationale • Q: What makes a girl in a country with a high prevalence of child marriage different from one in a country with low prevalence of child marriage? • A: Social norms, Expectations and interactions with systems/institutions

20. RECOMMENDATIONS • Evidence based programs • Theory based programs (to aid implementation & evaluation) • Programs should be based on integrative theories as these have been shown from practice to yield the best and most sustainable results • While working on every niche within these frameworks, scarce resources should be preferentially targeted at changing social norms, interactions with social institutions, knowledge/expectancies • For sub-projects, future efforts should be directed at creating an algorithm (or set of guiding rules) for fitting the right theory to the right program • Consensus among behavioral and public health experts is fundamental to this process

21. Thank You QUESTIONS? COMMENTS?