The sight of a 13 year old Amina whom I saw during one of the medical outreaches I participated earlier in the year keeps flashing through my mind. Her low timid tones, monosyllabic responses, her constant downward gaze despite my attempts to make her look at me straight in the eyes, my second attempt to embrace her got her startled as she perceived my gestures so strangely, and her decision to come around just about the time we were rounding up all gave me a clue, without doubts, to an underlying health or psychosocial problem.
About 2 minutes into our conversation, my nostrils became sensitive to the stench of ammonia emanating from her body. Alas, an obstetric fistula, I suspected. An Obstetric fistula of any kind is indeed a depressive condition. She is a victim of child-marriage. Oh yes! She has not only been deprived of the joy and fun of childhood, she now has a morbidity of early childbirth to contend with; Amina now leaks urine uncontrollably from her private. This was a complication that followed prolonged labour at the Traditional Birth Home where she had her first delivery at age 11, which lasted a whole 3days (72hours). Unfortunately, or as the medics may have anticipated, her baby couldn’t strive beyond few hours of life, she acknowledged the baby did not cry at all after birth. Amina was still trying to adjust to the loss when about 12days after she noticed tricks of urine flowing down her legs. She tried holding the urine but it was out of her control.
Amina recalled, through the sparing bits of English she could, the scenarios that led to her marriage. She was married off against her wish to a 40 year old man. Following the demise of her parents in an inferno in Kano, she was in custody of her paternal Uncle who could not afford to keep her in school, and had been inviting suitors to take a peep at his beautiful niece. She had little or no say as it was more of a family honor to be married off to a rich Businessman. Before long she became a wife at 11 years, just 3 months after the start of her first ever menstrual period (menarche) according to her Uncle. He reassured Amina it was for her protection as well as a fulfillment of the religious laws on early marriage. Definitely, I know marrying off under aged girls has being a long existing practice most prevalent in the Northern region of Nigeria but I have never been more touched by the challenges child-brides could be facing than when I met Amina.
Photo credit: www.plancanada.ca
Visibly notable are the ravaging effects of child marriage: it denies the girl child access to education which is one powerful tool that could provide her a leverage for economic empowerment, it also predisposes her to Gender Based Violence (GBV) as she is seen as a property acquired & could be manhandled by the ‘buyer’ at any point in time. Some suffer sexual assault, rape within these marriages and other forms of Intimate Partner Violence (IPV) but sadly, many of these victims are unable, perhaps too scared, to air their voices on their horrific experiences, talk even of boldly seeking for help and support.
For me as a Doctor, the problems associated with child marriage contribute largely to our poor health indices as a nation. Globally, pregnancy-related complications are the leading cause of death among girls aged 15- 19, it is also statistically documented that girls younger than 15 are 5 times more likely to die while giving birth. Nigeria presently accounts for 14% of Maternal Mortality Rates globally, makes me wonder when will we rise up to ensure the survival of our girls especially in the North.
The risk of Obstructed labour is far greater when, the female pelvis is underdeveloped – a tale of an 11year old girl-child labouring in a traditional birth home, and in the absence of skilled birth attendants. From prolonged and obstructed labour, our child brides are predisposed to developing obstetric fistulas all of which are cascades of events viciously revolving in cycles. The management of fistulas is not as simple as its prevention, requiring several stages to repair the tears, even after initial surgical repairs few girls might still leak urine as a result of residual incontinence prolonging the wears and tears of untold sufferings shed daily.
In our quest to achieving gender equality & empowerment for all women and girls, more vigorous efforts must be taken to extinguish the flames of all practices detrimental to the sexual and reproductive rights of women & girls in Nigeria. The judiciary should step up in upholding her duty of criminalizing child marriage and meting out appropriate punishments for its perpetrators.
‘The Urine Leaking Girl’ is an excerpt from the article, ’‘The Ravaging Effects Of Child Marriage; the urine leaking girl’ by Dr Gbemisola Ayeni. Read her full article : Here
Featured Photo credit: The Amnesty International USA Blog
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