Presentation Transcript

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
18. 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
19. Thank You QUESTIONS? COMMENTS?