Gender Inequality and Reproductive Health
For many millions of young people, adolescence is now a critical passage in which they gain life experience through schooling, job training, work experiences, community activities, youth groups and relationships. A majority also have their first sexual experiences during the adolescent years.
Adolescents also learn the social and gender norms that prevail in their communities; some protect their health and rights, and some do not. These norms confront girls with special challenges—including restrictions on their independence and mobility, inequality in educational and employment opportunities, pressure to marry and start bearing children at an early age, and unequal power relations that limit their control over their sexual and reproductive lives.
DISCRIMINATION IS PERVASIVE Throughout much of the world, families and societies treat girls and boys unequally, with girls disproportionately facing privation, lack of opportunity and lower levels of investment in their health,(1) nutrition(2) and education.(3 ) Gender-based discrimination continues in adolescence and is often a constant feature of adulthood.
Prevailing gender norms also stymie adolescent girls’ access to schooling and employment opportunities. Institutionalized legal inequality underpins laws that keep land, money and other economic resources out of girls’ and women’s hands,(4) closing off avenues for redress of discrimination and creating the conditions for gender-based violence and exploitation.(5)
Unequal power relations between females and males lead to widespread violations of health and human rights. Among the most persistent and pernicious are early or child marriage, sexual trafficking, sexual violence and coercion, and female genital cutting.
Recent international agreements, changes in countries’ laws and policies, research efforts and a variety of programmes explicitly address discrimination against girls and women, challenging the underlying values that perpetuate gender inequality.
Despite a shift towards later marriages in many parts of the world (see below), 82 million girls in developing countries who are now aged 10 to 17 will be married before their 18th birthday.(6) In some countries, the majority of girls still marry before age 18. These include: 60 per cent in Nepal, 76 per cent in Niger and 50 per cent in India.(7)
Factors perpetuating early marriage include poverty, parental desire to ensure sexual relations within marriage, a lack of educational or employment opportunities for girls, the sense that girls’ main value is as wives and mothers, and dowry systems. Girls who become pregnant may face extreme pressure from families and communities to marry.
The age at which people marry in a particular culture reflects the way family life is organized and the opportunities young men and women have as they assume adult responsibilities.(8)
Early marriage violates a number of girls’ human rights (see Box 7) and vastly increases the risks to girls’ and infants’ health and opportunities.
RIGHTS DENIED BY CHILD OR EARLY MARRIAGE
Early marriage of girls undermines a number of rights
guaranteed by the Convention on the Rights of the Child:
- The right to education (Article 28).
- The right to be protected from all forms of physical or
mental violence, injury or abuse, including sexual abuse
(Article 19) and from all forms of sexual exploitation
- The right to the enjoyment of the highest attainable
standard of health (Article 24).
- The right to educational and vocational information and
guidance (Article 28).
The right to seek, receive and impart information and
ideas (Article 13).
- The right to rest and leisure, and to participate freely in
cultural life (Article 31).
- The right to not be separated from their parents against
their will (Article 9).
- The right to protection against all forms of exploitation
affecting any aspect of the child’s welfare (Article 36).
AGE AT MARRIAGE RISING The proportion of marriages in which the woman is in her teens has declined considerably over the past 30 years.(9) The reduction has been largest in Africa: over 0.75 per cent per year. Declines in South and South-east Asia and in the Arab States have also been notable but smaller, over 0.5 per cent per year.
While earlier sexual debut and marriage are more common among less-educated women,(10) increases in educational enrolment explain only a small share of the documented increase in marriage age. Declines in arranged marriages, changes in marriage laws,(11) increases in urbanization and changing norms about the desirability of early marriage all contribute.
MEN MARRY LATER Differences between the age at marriage for men and women (as well as how the marriage is decided and the kind of union) can significantly affect the power balance between spouses and the closeness of their partnership. Men marry much later than women.(12) Only in Middle Africa and South Central Asia are more than 5 per cent of men 15-19 married.(13) In the developed countries, less than 1 per cent of men marry so young.(14) In contrast, more than a quarter of women 15-19 in sub-Saharan Africa and South Central Asia—and in some countries more than half(15) —are married.
In all subregions in the developing world, between 9 and 40 per cent of men have married by age 20-24, compared to between 24 and 75 per cent of women of the same age group.(16) Sixty-five per cent or more of women 20-24 years of age are married in several subregions in Africa and Asia.(17)
Age differences between spouses vary by region, with the smallest difference—under 3 years—observed in Latin America, most of Oceania and the more-developed regions. Differences above 6 years are found in sub-Saharan Africa. The younger the girl, the larger the age gap is likely to be, and in 16 sub-Saharan African countries husbands of girls 15-19 are on average at least 10 years older.(18) These age differences reflect expectations about male earning capacity, female fecundity and a balance of power that favours men over women.
For many girls, marriage (and their sexual experience) starts when they are young, to husbands who are much older and chosen for them by their parents, sometimes to men they have not met prior to their wedding day.
AFGHAN TEENS SPEAK OUT AGAINST EARLY
After a forum in Afghanistan on World Population Day 2003, adolescent girls spoke in favour of
delaying early marriage to continue their education. “If my parents tried to force me to marry, I would refuse,” declared Zohal, 16, as her fellow students nodded in agreement. The
Afghan teenagers had just heard government leaders say
that early marriage closes girls’ educational prospects and
threatens their health. Such outspokenness is rare in a country
where conservative traditions hold firm, daughters bring a
dowry and early pregnancy contributes to soaring rates of
Zohal wants to go to university and study economics. She
wishes all Afghan girls could attend school. “Our country has many problems after 20 years of war,” Zohal added. “We need good doctors to help our people. We need schools; in many
villages, there are no schools. People have to be literate to
develop Afghanistan. Girls have to finish their studies; they
have human rights.” The Afghan Deputy Minister of Health,
Deputy Minister of Women’s Affairs, General Director of the
Literacy Department and UNFPA Chief of Operations in
Afghanistan all emphasized the importance of educating girls,
protecting their health and delaying marriage and childbirth.See Source
EDUCATION INTERRUPTED Young women in the developing world who marry in their early teens are denied much of what young people elsewhere take for granted: education, good health and access to care, economic opportunities and the right to associate with their peers, to name a few. Early marriage almost inevitably disrupts education, reducing opportunities for future independence through work.
Married girls are rarely found in school (often due to laws or school practices), and girls who are not in school rarely have much contact with their peers or people outside their families.(19)
Research from Bangladesh shows that expectations that husbands should be better educated than wives causes parents worried about over-educating their daughters to pull them out of school.(20) However, increased school enrolment contributes to later marriage: in India and Pakistan, for example, girls’ staying in school longer has contributed directly to a decline in marriage before age 14.(21)
The consequences of early marriage for adolescent girls’ sexual and reproductive health and rights are significant (see Chapter 4). Their exposure to STIs and HIV rises. Married girls are generally unable to negotiate condom use or to refuse sexual relations, and are more likely to be married to older men with more sexual experience who are more likely than single men to be HIV-positive.(22) Indeed, recent research in Kenya and Zambia suggests that married girls are more likely to be HIV positive than their unmarried counterparts.(23)
Young married women often cannot seek health care without the permission of their husbands or other family members, generally cannot pay for health care independently and may experience periods of depression. Husbands and families also apply considerable pressure on young wives to have a child soon after marriage, increasing their risk of maternal death or injury and hampering efforts to prevent STIs and HIV through regular condom use. Early childbearing often goes hand in hand with high rates of poverty, lower levels of education, less mobility and fewer attended births.(24)
In addition, adolescent girls’ relative lack of power is often linked to violence in marriage, which is associated with unwanted pregnancy and STIs.(25) Child or adolescent brides have very little ability to leave abusive partners, and many live in isolation with little chance to secure social or legal support to remedy their situation.
DELAYING EARLY MARRIAGE In most places, persistent early childbearing is a public health concern. Efforts to delay marriage and increase age at the first birth include enforcement of existing laws, expansion of schooling and provision of job training.
The Government of Nepal, in collaboration with UNFPA, has educated adults about the harm that very early marriage can cause, and has created materials encouraging parents to delay marrying their daughters before age 20.(26) The Chinese Government has made efforts to reduce very early marriages arranged by parents.(27)
One district in Rajasthan, in northern India, has conducted a public education campaign encouraging families to prolong engagements—often entered into when girls are age 7 or 8—before the marriage is consummated and brides move to the grooms’ homes.(28) In southern India, the NGO Myrada has organized children’s groups in one community to address child marriage and bonded labour.(29) Working with parents and other adults, the children were able to convince some businesspeople to free children from servitude and parents to delay the marriages of their young daughters.
Providing opportunities for girls to continue their education or earn money is another strategy for delaying marriage as well as expanding life skills and choices. The garment industry in Bangladesh has extended the period before marriage by providing young women with the means to earn a living.(30) Also in Bangladesh, a secondary school scholarship programme for girls, requiring a commitment that girls remain unmarried through the tenth standard final examination, was so successful that the Government has expanded it to the national level.(31) There was an immediate effect in delaying marriage.(32) In areas targeted by the project, female enrolment more than doubled between 1994 and 2001.(33)
Several Indian states have also developed long-term investment programmes that offer young women money or gifts when they have completed a certain level of schooling and are still unmarried.(34) And countries in Eastern Europe and the Baltic States experienced rapid declines in adolescent fertility in the 1990s as a result of increasing school enrolment.(35)
ENSURING MARRIED ADOLESCENTS’ REPRODUCTIVE
In Bangladesh, Pathfinder has developed a Newlywed Programme to support young couples in planning
their childbearing, in delaying the first birth, spacing their children,
and in seeking prenatal care. An assessment found that
female newlyweds rarely leave the home, and they report that
life is worse since marriage because they have so little freedom.
Young married men, in contrast, have a much wider
social range, and spend much of their free time outside the
Young couples have many concerns about sexuality. They
identified programme staff as having an important influence
on their decision-making. Further work needs to be done to
reduce the barriers young women face in seeking out health
services and information outside their marital households.See Source