Seven percent of all young boys are married before the legal age in Pakistan. Credit: Irfan Ahmed/IPS

By Irfan Ahmed
LAHORE, Jul 16 2014 (IPS)

At first glance, there is nothing very unusual about Muhammad Asif Umrani. A resident of Rojhan city located in Pakistan’s eastern Punjab province, he is expectantly awaiting the birth of his first child, barely a year after his wedding day.

A few minutes of conversation, however, reveal a far more complex story: Umrani is just 14 years old, preparing for fatherhood while still a child himself. His ‘wife’, now visibly pregnant, is even younger than he, though she declined to disclose her name and real age.

The young couple sees nothing out of the ordinary about their circumstances; here in the Rajanpur district of Punjab, early marriages are the norm.

Girls in rural areas are often given in marriage in order to settle disputes, or debts. Some are even ‘promised’ to a rival before they are born, making them destined to a life of servitude for their husband’s family. -- Sher Ali, a social activist in Rojhan city
Umrani’s father, a small-scale farmer, tells IPS he is “proud” to have married his son off and “brought home a daughter-in-law to serve the family.”

Similar sentiments echo all around this country of 180 million people where, according to the latest figures released by the Pakistan Demographic Health Survey (2012-2013), 35.2 percent of currently married women between 25 and 49 years of age were wed before they were 18.

According to the UNICEF Innocenti Research Centre, seven percent of all boys are married before the legal age in Pakistan.

Families like Umrani’s are either blissfully unaware of, or completely indifferent towards, domestic laws governing childhood unions.

Intazar Medhi, a lawyer based in Lahore, tells IPS that the Child Marriage Restraint Act of 1929 – which prohibits girls under the age of 16 and boys under the age of 18 from being legally wed – is one of the least invoked laws in the country.

While the Act is in force in every province, and was recently amended by the government of Sindh to increase the legal marriage age of both boys and girls to 18, it is hardly a deterrent to the deeply embedded cultural practice.

For one thing, violators are fined a maximum of 1,000 rupees (about 10 dollars), what many experts have called a “trifling sum”; and for another, the law doesn’t extend to the many thousands of ‘unofficial’ marriage ceremonies that take place around the country every day.

In a country where 97 percent of the population identifies as Muslim, few nikahs (marriage agreements under Islamic law) are registered with an official state authority.

Scores of married couples live together for years without any documentary evidence of their union, with many families preferring to avoid legal formalities.

It is thus nearly impossible for government officials to estimate just how many such ‘illegal’ unions are taking place, or to dissolve contracts that entail nothing more than the presence of a religious person and witnesses for the bride and groom.

Some advocates like Intezar believe the problem can be rectified by following the example of the Sindh province, whose amendment of the 1929 Act upped its punitive power to include a three-year non-bailable prison term and a 450-d0llar fine for offenders.

He thinks setting 16 as the official marriage age – the same age at which Pakistanis receive their Computerised National Identity Cards (CNICs) – will make it easier for law enforcement officials to take action against those responsible for marrying off young children.

The government, he says, must also take steps to ensure timely birth registrations as millions spend lifetimes without any documentary proof of their existence.

Tradition trumps law enforcement

But for Sher Ali, a social activist based in the same city as Umrani’s family, a single law will not suffice to clamp down on a centuries-old practice that serves multiple purposes within traditional Pakistani society.

For instance, he tells IPS, girls in rural areas are often given in marriage in order to settle disputes, or debts. Some are even ‘promised’ to a rival before they are born, making them destined to a life of servitude for their husband’s family.

Various tribes also have different standards for determining an appropriate marriage age. For example, Sher explained, in some regions like the Southern Punjab, a girl is deemed ready for marriage and motherhood the day she can lift a full pitcher of water and carry it on her head.

In a country where the annual per capita income hovers at close to 1,415 dollars and 63 percent of the population lives in rural areas, girls are considered a burden and cash-strapped families try to get rid of them as early as possible.

Perhaps the greatest obstacle to ending child marriages is the Council of Islamic Ideology (CII), an unofficial parliamentary advisor, which also wields tremendous power to influence public opinion.

When the Sindh government announced its plans to extend the marriage age, CII Chairman Maulana Muhammad Khan Sherani denounced the move as an effort to “please the international community [by going] against Islamic teachings and practices.”

Comprised of prominent religious scholars, the Council has repeatedly urged the parliament to refrain from setting a “minimum marriage age”. Though parliament is not legally bound to any suggestions made by the body, many allege that the extent of its political power renders any ‘advice’ a de facto order.

Indeed, repeated assertions by religious groups that puberty sanctions marriage has led to a situation in which girls between eight and 12 years, and boys in the 12-15 age bracket, find themselves husbands and wives, while their peers are still in middle-school.

Speaking to IPS over the phone from Malaysia, Dr. Javed Ahmed Ghamidi – who is known as a moderate and had to leave the country after receiving several death threats from extremists – said that since Islam does not specify an exact marriage age, it is up to the government to draft necessary laws to protect the rights of its citizens.

He fully supports the implementation of a law that only allows legal unions between people who are old enough to run a household and bring up children.

“Such laws are not at all in conflict with the teachings of the religion,” he insisted.

Qamar Naseem, programme coordinator of Blue Veins, an organisation working to eliminate child marriages, pointed out that such a law is not only a domestic duty but also an international obligation, since the United Nations Human Rights Council (UNHRC) adopted a resolution against child, early and forced marriages in 2013.

Supported by over 100 of the world body’s 193 members, the resolution recognises child marriage as a human rights violation and vows to eliminate the practice, in line with the organisation’s post-2015 global development agenda.

Various studies have documented the impact of child marriage on Pakistani society, including young girls’ increased vulnerability to medical conditions like fistula, and a massive exodus from formal education.

Experts say Pakistan has the highest school dropout rate in the world, with 35,000 pupils leaving primary education every single year, largely as a result of early marriages.

Slowly, thanks in large part to the tireless work of activists, the tide is turning, with more people becoming aware of the dangers of early marriages.

But according to Arshad Mahmood, director of advocacy and child rights governance at Save the Children-Pakistan, much more needs to be done.

He told IPS there is an urgent need for training and education of nikah registrars, police officers, members of the judiciary and media personnel at the district level in order to discourage child marriages.

Effective laws must be coupled with the necessary budgetary allocation to allow for implementation and enforcement, he added.

“People will have to be informed that child marriages are the main reason behind high maternal and newborn mortality ratios in Pakistan,” he concluded.

(END)

Naz Bibi is awaiting treatment for fistula at the Koohi Goth Women’s Hospital in Pakistan. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Jun 17 2014 (IPS)

The word on the street was that if there were one place on earth that could treat Mohammad Lalu’s wife, it would be the Koohi Goth Women’s Hospital in Pakistan’s port city of Karachi.

The 50-year-old stone crusher hailing from the remote village of Dera Bugti in the southwest Balochistan province had spent 30 years searching for a facility that would treat his wife, Naz Bibi, who suffers from obstetric fistula.

Sitting upright on a plastic sheet draped over one of the hospital beds, Bibi told IPS, “It took us two days of non-stop travel to get here and we spent 12,000 rupees (roughly 120 dollars) on the bus fare alone.”

It is a princely sum for a family of extremely modest means, in a country where the average income is less than 1,200 dollars a year. But for Lalu and his wife, the expenditure will be worth it if it can cure Bibi of her terrible affliction.

“Obstructed labour is especially common among young, physically immature women giving birth for the first time.” – United Nations Population Fund (UNFPA)
While virtually unheard of in the developed world, obstetric fistula is still common in many Asian and African countries: the World Health Organisation (WHO) estimates that it affects nearly three million women annually.

While country-specific data is harder to find, local experts suggest that anywhere from 4,000 to 5,000 women in Pakistan are suffering from fistula.

Caused by prolonged or stressful labour, the condition arises when the baby’s head puts undue pressure on the lining of the woman’s birth canal, eventually ripping through the wall of the rectum or bladder and resulting in urinary or faecal incontinence.

Medial professionals say young women, whose bodies have not yet matured enough to endure the birthing process, are most vulnerable, as well as those who lack adequate nutrition or live too far away from modern healthcare facilities.

Because fistula causes a woman to lose control over her bodily functions, there is a huge stigma around the condition. Those afflicted by it often smell bed, and are sequestered away from their communities and families, forced to suffer in silence.

This is particularly traumatic for young mothers, who end up spending the better parts of their lives having little to no contact with the outside world.

Lalu told IPS that Bibi’s trouble started soon after she delivered a stillborn baby boy when she was just a teenager during her first marriage.

“I am her second husband,” he said. “Her parents married her to me after her husband left her, but did not disclose she was suffering from this dreadful problem.”

Unlike many other husbands, Lalu did not turn away from his new wife; instead, he has gone to great lengths to find her the necessary treatment. This hasn’t been easy, since fistula can only be managed through reconstructive surgery, which is cost-prohibitive for thousands of women.

Koohi Goth is one of 12 centres set up under the United Nations Population Fund’s (UNFPA) Fistula Project that offers the service for free.

Now in its eighth year, and assisted by the Pakistan National Forum on Women’s Health (PNFWH), it has trained 38 doctors to carry out the surgery. These numbers, experts say, pale in comparison to the scale of Pakistan’s maternal health crisis.

‘100 percent preventable’

According to the country’s latest Demographic and Health Survey, 276 women out of every 100,000 die during childbirth.

“All these deaths are 100 percent preventable if we can provide quality of care and stop child marriages,” Dr. Sajjad Ahmed, head of the Fistula Project in Pakistan, told IPS.

He believes that delaying the age at which a woman experiences her first pregnancy would be a huge step forward in preventing conditions like fistula.

According to the UNFPA, “For both physiological and social reasons, mothers aged 15-19 are twice as likely to die of childbirth than those in their 20s. Obstructed labour is especially common among young, physically immature women giving birth for the first time.”

But changing the mindset that sees nothing wrong with the idea of a child bride will not be easily accomplished, especially in rural Pakistan.

Dr. Suboohi Mehdi (Surgeon at Koohi Goth Hospital, Karachi) on Fistula Cases from IPS News on Vimeo.

Thirteen-year-old Shahbano, hailing from the village of Sanghar in Pakistan’s Sindh province, occupies the bed next to Bibi. She tells IPS she was married at 11 and developed fistula three weeks ago, during prolonged labour involving her first child.

Luckily, both Shahbano and her baby son survived the ordeal, but she must now hope that her surgery goes well, so she is not afflicted by incontinence for the rest of her life.

“In our culture, when a girl first begins to menstruate, her parents are obliged to marry her off,” Shahbano’s husband, Abid Hussain, told IPS.

Neither he nor his teenage wife had any idea that the Sindh provincial assembly passed the Child Marriage Restraint Act last month, prohibiting the marriage of children under 18 years of age. Violation of the bill could earn offenders a three-year prison term or a 450-dollar fine.

In 1929, the official marriage age stood at 14 years, and in 1965 the law changed, making it illegal to marry anyone under the age of 16. Today, Sindh is the only province to have recognised 18 as the bare minimum age for marriage – a decision that has elicited vehement opposition from religious groups.

Maulana Muhammad Khan Sherani, chairman of the Council of Islamic Ideology, which acts as an unofficial parliamentary advisor, said in reference to the amendment: “Some people want to please the international community [by going] against Islamic teachings and practices.”

“Such proclamations act as a spanner in our fight against early marriage and early pregnancy,” Ahmed asserted.

He says if he could give girls like Shahbano one piece of advice it would be to educate their children, especially their daughters.

“It will take a generation to put things right, but education will automatically bring about a cultural change, which could delay marriages. I see that as the only way to eradicate this condition,” he stressed.

Currently, the country only has the capacity to handle 2,000 cases of fistula, but doctors end up treating just 500 to 600 women a year.

Ahmed says this is largely due to the fact that people do not know the condition is preventable or treatable, and so avoid seeking out medical assistance. Many women live in rural areas without access to televisions, radios or cell phones, making it hard to spread awareness.

To circumvent the problem, hospitals have mobilised ‘lady health workers’ – women who go door-to-door in remote areas delivering information on sexual reproductive health and rights.

“We have a huge brigade of almost 100,000 lady health workers,” Ahmed said. Although they cover just 60 percent of the country, they act as a bridge between rural populations and urban-based care providers.

Perhaps these sustained efforts will enable Pakistan to see the day when conditions like fistula are nothing but a distant memory.

(END)