maternal mortality mozambiqueMaternal health in Mozambique is a constant concern as the nation’s maternal mortality rate is one of the highest in the world. While some progress has been made, there is still much that needs to be done to ensure that mothers in Mozambique have to access high-quality healthcare. Recently, two initiatives have been created, the Mozambique-Canada Maternal Health Project and a project by the Maternal and Child Survival Program. They are working to improve maternal health in Mozambique.

The Current State of Maternal Health

In 2015, the maternal mortality rate was 489 deaths per 100,000 live births. Approximately one-fifth of these deaths are women under the age of 20. Maternal mortality has declined since 1990 when there were approximately 1390 deaths per 100,000 live births; however, maternal deaths remain high. It is clear that continued efforts are needed to improve the quality of maternal health in Mozambique. Each day, approximately 800 pregnant women die from preventable causes.

One of the primary factors determining maternal mortality rates is the availability of antenatal care. In regions where more women receive four or more antenatal visits, the maternal mortality rate is generally lower. Globally, 62 percent of pregnant women have at least four antenatal visits with a skilled health professional, while 86 percent of women have at least one. In Mozambique, only 51 percent of expectant mothers have at least four antenatal visits.

Additionally, only 54 percent of births are attended by skilled health personnel. Age is also a factor, with 40 percent of women 20-24 years old reporting that they gave birth before the age of 18. Younger mothers have an increased risk of death during childbirth, particularly if there is not someone with medical training present.

Early marriage logically leads to childbirth at a younger age and improving maternal mortality rates in the nation relies on protecting young women. In response to this, the government of Mozambique created the National Strategy to Prevent and Combat Early Marriage in 2016. This program includes better education about sexual and reproductive rights with the goal of empowering women to seek out appropriate care and understand their legal rights. For poorer women, this knowledge is often not enough, however, as they may not have the autonomy to make a legal case or have a healthcare facility readily available to them.

Maternal and Child Survival Program (MCSP)

The Maternal and Child Survival Program (MCSP) has launched a project in Mozambique’s Zambézia Province focused on treating pregnant women with malaria. Malaria currently accounts for 9.6 percent of deaths in the nation, and the rate in the Zambézia Province higher than the average. This project seeks to improve maternal health in Mozambique by tackling maternal and newborn deaths due to malaria.

Malaria during pregnancy has many consequences, including higher rates of maternal anemia and low birthweight babies. These factors increase the likelihood of maternal death as well as stillbirth. A treatment known as IPTs-SP exists that can prevent malaria in expectant mothers, but fewer than 22 percent of women in Mozambique receive adequate dosages during their pregnancy.

The MCSP project is empowering healthcare providers in Mozambique to treat malaria cases in pregnant women regardless of their complexity. For example, a young pregnant woman who had malaria but was also HIV-positive could not receive IPTp-SP treatments because the drug is incompatible with her HIV treatment. However, a different medication was able to be prescribed by an MCSP-trained nurse who had been trained on how to handle a variety of malaria cases.

The project also implemented a Standards-Based Management and Recognition for Malaria program in 58 health facilities in the Zambézia Province. This program is working to collect better data about malaria cases and more effectively implement initiatives for prevention and treatment.

Mozambique-Canada Maternal Health Project

Improving maternal health in Mozambique is a priority for the University of Saskatchewan as well. Researchers from the university are working with Mozambique’s health ministry and the NGO Women and Law in Southern Africa (WLSA) to empower women in 20 different communities through the Mozambique-Canada Maternal Health Project.

Education is a key piece to this project, providing information on maternal, reproductive and sexual health to community members in a way that is participatory and engaging for adolescents and adults. The project is also prioritizing the education of health practitioners to improve the quality of care for mothers in Mozambique.

Additionally, the project seeks to improve resources in the community that can improve maternal and newborn health. They intend to provide local ambulances, establish maternal waiting homes nearby to clinics and support local midwives. The latter is the most important, as having locals who are trained health personnel can greatly benefit rural women who may not have the time or financial resources (particularly in situations of poverty) to travel to a clinic.

These efforts indicate that maternal health in Mozambique is continuing to be a priority. The work that these organizations are doing is focused on empowering women to make their own decisions about their sexual and reproductive lives, ensuring health personnel are properly trained and accessible and meeting the needs of poorer women.

Sara Olk

Photo: Flickr

Child Marriage in Africa
Child marriage, defined as a situation in which a person is married before the age of 18, is considered to be a violation of fundamental human rights. Child marriage generally affects more girls than boys and has been found to limit educational attainment and work opportunities, result in early pregnancy, lead to social isolation and increase the risk of domestic violence.

Globally, child marriage occurs at the highest rate in sub-Saharan Africa, where four in 10 young women are married before the age of 18. While some African countries have been able to make significant progress in reducing child marriage, overall progress throughout the continent has been slow, making child marriage in Africa a primary concern of UNICEF and other international humanitarian organizations.

Global and Regional Trends

The child marriage rate in sub-Saharan Africa is 10 percent higher than in any other region in the world. These figures vary in various regions, with 30 percent of young women married under the age of 18 in South Asia, 25 percent in Latin America and the Caribbean, 17 percent in the Middle East and North Africa and 11 percent in Eastern Europe and Central Asia. Within sub-Saharan Africa, child marriage occurs most frequently in West Africa, where 41 percent of young women are married before 18. This rate is 38 percent in Central Africa, 36 percent in Southern Africa and 34 percent in Eastern Africa.

Regionally, some progress has been made in reducing child marriage in Africa, as the rate in Western Africa was 44 percent in the early 2000s, the rates in Central and Eastern Africa were 42 percent. Only Southern Africa has shown no regional progress, remaining at 36 percent for the past 15 years. These reductions are not occurring quickly enough and UNICEF predicts that child marriage rates will remain above 30 percent in Western and Central Africa and above 20 percent in Eastern and Southern Africa even until 2030.

Age and Gender of Child Marriage in Africa

While a majority of child marriages occur between the ages of 15 and 18, there are many women who were married before the age of 15 as well. In sub-Saharan Africa, 12 percent of young women were either married or in a union prior to being 15 years old.

Data on boys affected by child marriage in Africa is limited, but it is still recognized to be a significant problem in some countries. The Central African Republic has one of the highest rates of child marriage for boys in the world, with 28 percent of young men married by the age of 18. This rate is 13 percent in Madagascar and 12 percent in Comoros.

Progress in African Countries

There are some African countries with low levels of child marriage, however, including Algeria, Djibouti, Eswatini, Namibia, Rwanda, South Africa and Tunisia, that all have rates of child marriages under 10 percent. In the early 2000s, only Algeria, Djibouti, Namibia and Tunisia were under 10 percent. Notably, child marriage is the lowest in Tunisia, the country that has a rate of child marriage at 2 percent.

There have also been countries with high child marriage rates that have made significant progress over the last 15 years. Ethiopia had a child marriage rate of 60 percent in the early 2000s, that has since decreased to 40 percent. Zambia decreased their rate from 46 to 31 percent, and Guinea-Bissau decreased its rate from 44 to 24 percent.

Child Marriage in Ethiopia and Tanzania

Ethiopia provides an interesting case study for child marriage in Africa. Research conducted by the Forward UK, an organization dedicated to improving the lives of girls and women in Africa, reveals the cultural beliefs that cause child marriage to remain prevalent. Marrying girls young is a social norm in the nation, and families whose daughters are not married as children are often viewed in a negative light.

In part, this stems from the importance placed on virginity, and many believe that the earlier a girl is married the more likely she is to be a virgin. Girls may also be married to priests, as this is a way for religious leaders to gain respect. Priests must marry virgins, however, and therefore tend to have the youngest brides. Families also often perceive child marriage as a way out of poverty, as they receive a bride price and no longer carry the financial burden of caring for their married daughter. Some families also want to ensure they will have grandchildren before they die.

The organization conducted similar research in Tanzania, where girls may be married as young as 11 and where most marriages are arranged by the girl’s father without consideration of what she wants. Domestic violence is widespread in the nation, greatly impacting the health and wellbeing of child brides. Husbands generally do not have patience with child brides who may be too young to effectively complete the domestic tasks required of them, making them more likely to beat younger wives. Polygamy is also legal in Tanzania, which can negatively impact young brides.

Moving Forward

To effectively reduce child marriage, Forward UK recommends increasing community programs aimed at raising awareness about the negative impacts of child marriage, providing programs that will empower girls, improving girls’ access to education and establishing legal and medical services aimed towards girls and young women.

It remains to be seen whether progress in reducing child marriage in Africa will begin to occur at a faster rate. This progress would have a large impact and could help millions of girls across the continent.

– Sara Olk

Photo: Flickr

Child Marriage in India
India is one of the countries with the highest rates of child marriage. Approximately 27 percent of women are married in the country by the time they turn 18. Out of the total of 29 states in India, the states of Bihar and Rajasthan lead the country with 69 percent and 65 percent of girls married under the legal age, respectively. The mean age when girls marry in these regions is only 16.6 years and more than 13 million girls in India remain child brides.

Causes of Child Marriage in India

The prevalence of child marriage in India is caused mainly by social traditions and poverty within many states. Young girls are often deemed an economic burden by their parents. The greatest expenses that families must bear are paying for education and housing and these expenses increase as a child gets older. To alleviate the economic pressure that female children create, they are transferred to a husband, that can be viewed as a guardian.

The rates of these unions have decreased in girls under 15 years of age, but have increased between in girls aged between 15 and 18. After the marriage, the male guardian becomes responsible for the female child. The child is often subjected to domestic violence and sexual abuse. Nearly 39 percent of husbands report either sexual or physical abuse toward their wives.

Health Risks and Education

The health of the child is put at greater risk because of sexual violence. Girls between the ages of 15 and 19 are two times more likely to die in childbirth. The lack of protection also exposes them to sexually transmitted infections (STIs), including HIV/AIDS. Young women aged from 15 to 24 years are 44 percent more likely to contract HIV/AIDS than men from the same age group. This is due to many factors including lack of access to adequate health care services and inter-partner violence resulting in unsafe sex.

In addition, these child brides have less educational opportunities than girls who are not subjected to early marriages. They are directly correlated due to the fact that new brides are expected to be mothers and homemakers. This relationship goes both ways, as girls who have access to secondary and higher education are three times less likely to marry by the age of 18.

Preventing Child Marriage in India

India itself only reports that 27 percent of girls were married in the country by the time they are 18. This percentage has decreased from 50 percent in the last decade. India lowered child marriage rates drastically with new legislation. The country began improving the situation in 2006 with the Prohibition of Child Marriage Act. This act outlawed marriage in girls below the age of 18 and boys under the age of 21.

However, this act has had negative effects on the regulation of child marriage. Marriages in states like Bihar and Rajasthan are more of a social construct rather than a matter of legal documentation. The rates of child marriage remain high in these regions due to cohabitation of an older male guardian and a female child. This cohabitation is usually accompanied by a ceremony declaring martial union without registering it with the state.

It is much more difficult to regulate cohabitation, but the country drafted legislation to prevent this type of union. In 2013, the National Action Plan to Prevent Child Marriage was introduced nationally. This strategy aims to effectively end child marriage in India and make it a child protection issue. While the act is not yet finalized, as of 2017, men can be held legally accountable if they are involved in child marriages. India’s Supreme Court ruled that sex with an underage wife is considered rape. This offers an opportunity to regulate child marriage, even when it is performed as a social exchange without official documentation.

Moreover, India has joined the South Asian Initiative to End Violence against Child Marriage and UNICEF’s Global Programme to Accelerate Action to End Child Marriage. The country is making great strides to prevent this violation of human rights.

Women Peer Groups

When the state fails to protect the children, the women of India rise up. An activist grassroots movement of boycotting underage marriages has been incredibly effective. Over 100 Women Peer Groups are set up across five rural Indian states. These independent groups and individuals work to stop marriages in person, lobby for legislation against child marriage and improve resources for children that find themselves in these situations. Malti Tudu is one of the members of these groups that now comprise of over 2,800 women dedicated to ending illegal unions.

Child marriage is a definitive issue that the Indian government is focusing on. Through new legislation and governmental strategies, along with the aid of grassroots movements, the country can effectively create a safe landscape for children, especially young girls, to grow in.

Emily Triolet
Photo: Pixabay

Child Marriage in Mexico
Child marriage in Mexico is more common than most people realize. In comparison to Mexico’s regional counterparts — specifically the United States and Canada — child marriage is a large problem that contributes to, and is caused by, Mexico’s poverty crisis.

Ages of Consent

In comparison to other NAFTA countries, the rate of child marriage in the United States — a much more densely populated country — is highest in West Virginia. Between 2000 and 2010, 248,000 children were married in the United States.

Canada’s data on this topic is not comprehensive; however, the government of Canada has taken massive steps to mitigate the problem of child marriage; in fact, most said marriages actually take place and are moved to other countries.

In Mexico, one out of every four girls is married before the age of 18. This is permitted by Mexican law, as the age of consent in Mexico is 14 years old (with parental consent). This is a striking difference compared to the U.S. and Canada, where the age of consent is averaged at 18 years in most parts of both countries.

Child Marriage in Mexico

Child marriage in Mexico is directly related to the pervasive poverty levels in Mexico, both in that the socioeconomic status causes child marriage, and child marriage, in turn, contributes to poverty levels.

The high levels of child marriage in Mexico are highly correlated with teenage pregnancy. Teen pregnancy is a large driver of negative economics and individual poverty.

Teenage pregnancy is highly correlated with not finishing education (which creates a lower likelihood of finding a stable career), a higher likelihood of ending up impoverished and increased healthcare costs.

Poverty’s Power

The main driver of child marriage in Mexico is poverty. The poverty in Mexico has caused unprecedented levels of violence, and many see marriage as a way of fleeing such brutality. Such behavior applies to the girls within the 20 million impoverished children of Mexico, as they often fall into the peculiar consent and marriage laws as a means to flee poverty.

Lack of job stability, education and political omission are all factors that drive the high levels of child marriage in Mexico.

Such a complex topic, which derives from various socioeconomic and cultural baggage, requires complex problem solving, of which the lack thereof perpetuates the moral crisis. Making recommendations to Mexican policymakers cannot just involve raising the age of consent, as various cultural factors also drive the state of affairs.

Methods of Mitigation

Actions to mitigate the problem of child marriage in Mexico started with the Mexican government outlawing the practice in 2014. This alone will not help; women’s empowerment must also go hand-in-hand when such legislation. Mexico’s Ministry of Public Education has joined with the Mexican Academy of Science and the Organization of Economic Cooperation and Development to promote STEM in girls’ education in Mexico.

The University of Texas at San Antonio is working with Mexican Universities to teach various concepts of STEM. The U.S. Mexico foundation has also taken up a program called “Mujeres en STEM” to encourage more women to be involved in the STEM fields.

Girls’ education in Mexico is improving slowly, and will ultimately lead to women’s empowerment and slow down the prevalence of child marriage in Mexico. Women are increasingly enrolling in universities, even with the current levels of insufficient gender equality.

Improvement in Female Education and Employment

Women are also seeking paid employment, and the fact that about 20 percent of senators have been female since 2006 suggests the influence of women in politics is also increasing. If such development continues, these efforts will work to help eliminate child marriage in Mexico.

Policymakers need to also take geography into consideration — poverty occurs in mostly rural areas, therefore most of the resources designed to mitigate the problem must be litigated toward these communities. As the late Christopher Hitchens once said: “The cure for poverty has a name: it’s called the empowerment of women.

Mexico lacks sufficient women’s empowerment — women are told to drop out of school to assume household duties; rates of violence against women are high; and indeed many of these early marriages are forced. Promoting women’s empowerment will work for, as Hitchens also said: “it works everywhere it has been implemented”.

– Daniel Lehewych
Photo: Flickr

FGM/C and Poverty
Female Genital Mutilation/Cutting (FGM/C) is a practice that has occurred for generations — a female, often in childhood, is subjected to some form of cutting to her genitalia in the promotion of religious following and the detraction of desire for sexual interaction. Its purpose is to reduce sexual desire in women, thereby making them less likely to be interested in intercourse outside of marriage. It is also highly symbolic to many groups of people who practice it as a religious necessity; however, there is no known religion that demands this practice.

FGM/C and Poverty

FGM/C and poverty are connected in developing countries as the girls who undergo FGM/C are often from poor families who are then married as children, never continue their education and subsequently repeat the cycle of poverty. Recently, there has been a decline in FGM/C practitioners, which should lead to lower levels of extreme poverty on an individual basis.

Countries such as Burkina Faso, Egypt, Kenya, Liberia and Togo have experienced a decline in FGM/C prevalence, with Egypt reducing prevalence from 69 percent to 55 percent between ages of 2005 and 2014. As the correlation with lower education becomes more well-known, it can be inferred that the decline in FGM/C victims has led to a higher attendance rate for girls at school, which can, in turn, affect the poverty in the region.

Millennium Development Goals

The Millennium Development Goals (MDGs), a program designed to create social equality throughout the world, works to end poverty in developing countries. A primary focus of the organization is to work to end FGM/C and poverty because the list of side effects and results of the practice leave women often unable to contribute in their society because they are traumatized, physically incapacitated, unable to maintain strength and nutrition, and in some cases, do not survive the procedure.

When injuries or death result, the cost of caring for these women or paying for their funeral causes strain on family members and communities. Such a responsibility can, in turn, increase the poverty issues already at play. Disability due to the trauma from FGM/C can also lead to a woman’s decreased productivity level, thereby bringing in less money for the family and continuing the cycle of poverty.

The Beginning of the End

The decline of the practice is increasing in developing countries, with more people wanting FGM/C to end. In 2010, a Burkina Faso survey determined that 90.6 percent of women wanted FGM/C to end, a staggering increase from 75.1 percent in 1999. With such a trend beginning, countries should encourage education, discourage FGM/C and lower the poverty levels by introducing a new way of thinking.

FGM/C and poverty are both declining, but it can be agreed that the decline is not occurring quickly enough. More must be done to protect young girls from the sexual alterations that are often completed without consent.

By not cutting into perfectly healthy and innocent girls, developing nations can promote a stronger and healthier workforce. FGM/C and poverty are connected, and one cannot be reduced in isolation — it is imperative that both be tackled to end the other.

– Kayleigh Mattoon
Photo: Flickr