Higher Child Marriage Rates Linked to Higher Maternal and Infant Mortality.

Countries in which girls are commonly married before the age of 18 have significantly higher rates of maternal and infant mortality, according to a report in the online issue of the journal Violence Against Women co-authored by a BU School of Public Health researcher.

The study — by Anita Raj, a professor in the Department of Medicine at the University of California who was formerly affiliated with BUSPH, and Ulrike Boehmer, an associate professor of community health sciences at BUSPH — is the first published ecological analysis of child marriage and maternal mortality. The study demonstrates that a 10-percent reduction in girl child marriage could be associated with at 70-percent reduction in a country’s maternal mortality rate.

Ulrike BoehmerCountries with higher rates of child bride marriages have higher rates of maternal and infant mortality, the study found. Girl child marriage is defined as the marriage of girls age 17 and younger. Although the practice has generally declined in recent years, it remains relatively common in regions such as South Asia and sub-Saharan Africa, where up to 70 percent of females in some countries are married as minors.

Worldwide, the United Nations estimates more than 60 million women and girls are affected, with child marriage considered to be a health and human rights violation.

Raj and Boehmer said certain social contexts increase the likelihood of child marriage — among them, rural and impoverished areas with low access to health care and girls’ education. Regional conflicts and instability tend to worsen the situation.

“Girl marriage is viewed as a means of protection from both economic instability and rape, due to perceptions of sexual availability of unmarried girls and women,” said Raj. “Poverty and conflict can exacerbate parents’ desire to have their girl married at a younger age.”

Child brides also are more likely to experience social inequities – reduced status and access to education or jobs – and suffer gender-based abuse. The effects extend into personal health: Girls married as minors are more likely to bear children as minors, resulting in higher risks for delivery complications, low infant birth weight and child malnutrition.

The new study builds on earlier findings. Raj and Boehmer compared maternal and child health indicators and HIV prevalence with girl child marriage rates for 97 nations in which relevant data was available. While they found strong associations between high child marriage rates and poor health indicators, there was no evidence of a link between higher child marriage and HIV prevalence.

The authors said the work underlines the need for greater advocacy and action to reduce child marriage rates. Some nations, such as Yemen and Saudi Arabia, are considering whether or not to alter policies allowing marriage of minor-aged girls.