From unplanned pregnancies, high infant and maternal deaths to unregulated doses of growth hormone, Mahboobnagar’s child brides face vicious health repercussions.
As is the mother, so is her daughter, says an old adage. As profound as it sounds, it is also bewildering when the mother is a child herself. In India, the transition from wife to mother, in the case of child marriages, usually occurs nearly a year after marriage as young couples expect to have their first child soon after their wedding.
Such is the story of Sirisha* (all names changed). Just when she had begun figuring out the physical changes in her body after attaining puberty, 12-year-old Sirisha was married off to a man more than double her age. At 13, Sirisha is a mother. Not only a victim of child marriage but also of an early and unplanned pregnancy.
Malnourished and crippled, she lies on a bed after her delivery. Her eyes fixated on the new-born baby girl, she says, “I do not know what to do with this baby. I don’t understand how to take care of her.” Sirisha’s helplessness is evident as her parents wanted her to deliver the baby at home – an example of how home deliveries are such a dominant part of child marriages.
Sirisha hails from Mudwyn village in Makhtal mandal of Mahboobnagar district in Andhra Pradesh. A district report says that one in four deliveries takes place at home, in the absence of a skilled birth attendant. Mahboobnagar has the highest number of child marriages in the state. Over 52 per cent of girls below 18 are married in the district, claims a National Rural Health Mission (NRHM) report.
Why child marriages?
The majority of child marriages take place in Golla, Kurma and Lambada communities in this district, reveals Mamatha Raghuveer, Founder-Director, Tharuni (an NGO) and a member of the state-level committee on child rights. With Mahboobnagar district being a severely drought-hit district of Andhra Pradesh and its population dependent majorly on agriculture, child marriages are inevitable, given that they are performed with an intention of providing a secure life for their daughters.
“Drought is a normal thing here. What is unusual is the rain,” quips Yadaiah, a farmer, who reflects the plight of farmers in Mahboobnagar and their financial instability. Yadaiah also got his daughter married when she was 14.
Emphasis on virginity is also inherent in child marriages. “Most of them look at a girl’s body as a site of family’s honour that should be sold off as quickly as possible before it is violated (at the youngest age),” explains Mamatha Raghuveer, adding “the younger, the better.”
This also raises concerns over the age at which girls become sexually active. Women who are married before the age of 18 have more children than those who marry later in life, a UNICEF report claims.
Also, the pressure to demonstrate fertility and responsibility to raise children while still children themselves has drastic health repercussions on the physical and mental health of these young brides.
Complications of early, unplanned pregnancies
“Until a girl is 20 or 21, her body is not ready to bear a child,” says Dr Aparna Khulbey, General Physician. The physical and nutritional demands of pregnancy on still-maturing and inadequately nourished bodies can endanger adolescents’ health and increase the risk of their children falling sick or dying in infancy, said Guttmacher in her report on teen pregnancy.
UNICEF states that 66.6 per cent of the married girls aged between 15 and 19 are more likely to experience delivery complications compared to 57 per cent of women between 20 and 24 years. Neonatal and child mortality rates are much higher for younger (married) girls. Girls under 15 are five times more likely to die in childbirth than women in their 20s.
Girls under 15 are five times more likely to die in childbirth than women in their 20s.
“Girls below 18 are at high risk of anaemia and pregnancy-related injuries like fistula and anal ruptures,” says Achyuta Rao, president of Andhra Pradesh Balala Hakkula Sangham.
According to the Mahboobnagar District Health Report for 2011-12, neonatal mortality rate constitutes 75 per cent of all the infant deaths in the state. Surprisingly, the study, states that no cases of maternal complications or high risk pregnancies were reported despite having one of the highest infant and maternal deaths in the state.
Teen pregnancies expose girls to high risk of HIV/AIDs and sexually transmitted diseases. With AP having the highest number of HIV positive cases, there is evidence that a significant number of these cases may be connected to child marriages. A study shows that only two per cent of men in Andhra Pradesh use condoms during sexual intercourse. Interestingly, men who had married child brides have had pre-marital sex, but their wives were virgins before marriage. “The risk of multiple sexual partners within and outside the institution of marriage exposes them to high risk of STDs,” explains Mamatha Raghuveer.
Genital ulcers, itching in the genitals, bad-smelling urethral and vaginal discharge are common symptoms, says Dr. Khulbey.
Even their mental health goes for a toss. “Depression, isolation and stress is what they usually go through,” describes Jim De, a rights professional. Early pregnancy also limits them to the roles of wives and mothers, rendering them powerless.
“Unregulated doses of growth hormone are given to these girls if their physical attributes are not grown,” says Achyuta Rao, pointing out to the emerging trend in child marriages. Growth hormones are available at a few pharmacy stores without even providing a prescription—an example of how stringent measures under the Indian Pharmacy laws are not implemented. “They are mostly administered by quacks who pose as doctors,” he explains.
Dismal health services
To make matters worse, adolescents aged 18 or younger are significantly less likely to receive any skilled prenatal or delivery care than older women.
Even the funds disbursed for healthcare services in the district are met with undue interference of politicians, making it extremely difficult to address health needs of a district languishing in despair.
Astonishingly, the Janani Surakasha Yojana (JSY) that promises cash incentives to women having institutional deliveries at public health institutions is not being used, given that the services at public hospitals are depressing.
“Even if all the public institutional deliveries and home deliveries get cash incentives under JSY, about 20 per cent of reported deliveries still miss the payment. This, amid low registration of births,” explains Dr Rachana, a health inspection officer.
According to Mamidi S. Chandra, director, Carped and a member of the Integrated Child Protection Unit, “District health workers, ANMs, ASHA workers are also a cause for the miserable state of medical services.” Of the 3,646 ASHA workers in the district, about 1,000 have stopped working and half of the mid wives who have performed deliveries do not know how to use the delivery kit. “ASHA workers and ANMs do not spread awareness about early pregnancy risks,” he adds.
Interestingly, the low awareness levels are directly proportional to low literacy levels (below 39 per cent according to a district report) and inversely proportional to drop-out rates of kids from schools.
We try to educate as many girls about the risks involved in early marriages. They lack support at home. Most of them oppose, but their resistance doesn’t last long.
Pawani Kumari, a teacher from Akwaipally village of Mahboobnagar says, “We try to educate as many girls about the risks involved in early marriages. They lack support at home. Most of them oppose, but their resistance doesn’t last long.”
Though there were no child brides in the school during my visit, most of the girls were soon to be brides. “Almost, all our parents want us to get married this year or may be, by next year,” rues Chaitanya, an VIII standard student.
On probing about Sirisha’s wedding, the headmaster of Mudhwyn High School initially admitted that she belonged to the school. Later, he denied that she was ever his student.
Inherent risks of HIV/ STDs
Gopal, a teacher from the school, beams as he states that no child marriage victims belong to his school. In contrast to his statement, Ramya*, Lavanya* and Mahima* were seen with mangalsutras and toe rings (a clear indication of their marriage).
On enquiry, the three 14-year old girls state that they were married off to men between 23 and 28 years of age. Lavanya further reveals that on an average, about 15-20 child marriages take place in this village in a year. Child rights activists, however, say that the number is much higher.
“During the summer vacation, I was married off to my maternal uncle’s son,” quips Ramya, adding that she likes the feeling of being married. On further probing about the nature of her relationship with her husband, Ramya reveals, “He kisses me and we do a lot of things (referring to sex)… I like all of it. I love him and do not oppose to anything he does …both of us enjoy it.”
Unfortunately, Ramya admits she has no idea about using protection while having sex or about the risks of unprotected sex.
The health catastrophes of girls in early matrimony are more than just bruises and breaking bones. Often, they cause serious emotional harm. “Child marriage is a vicious cycle. Every problem begins with this,” Mamatha Raghuveer says, adding, “Everything that has beginning has an end.”
(This article has been written as part of the Asmita Media Fellowship 2012-13)
Pic credit: The picture used is a stock image courtesy rammorrison used under a Creative Commons license. It is meant to be illustrative of children free to enjoy childhood and is not an image of children in Mahboobnagar.