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Our View from the Ground: Learning to Speak Up

Photo of Jane Wickstrom

Jane Wickstrom is Senior Manager, Family Planning and Reproductive Health at EngenderHealth

How did EngenderHealth get involved with helping to prevent early marriage in Nepal?

We began working in the southeastern part of Nepal’s terai region, a socially conservative area where both early marriage and dowry payments are widely practiced, and maternal mortality rates are among the country’s highest. Young women and men, especially the newly married, weren’t getting the information and services they needed. With funding from the U.S. Agency for International Development and with the assistance of local authorities, we focused on increasing young couples’ use of family planning and other services (like HIV testing and counseling), sensitizing health providers to the needs of adolescents, and raising community support for married adolescents making decisions about their health and families.

EngenderHealth trained local peer educators and health workers to engage every tier of the community to make sure they all supported these goals. One of the key strategies was engaging mothers-in-law, which Kristof and WuDunn mention as some of the worst perpetrators of violence against young women. They became supportive once the peer educators explained how increasing young couples’ access to maternal health and family planning positively impacts the entire family.

As young married women, what are the challenges they face in accessing sexual and reproductive health information and services?

Adolescent marriage and early pregnancy are major health risks in Nepal. After a young woman is married, she must prove her fertility by having a child as soon as possible. And the numbers illustrate this: Forty-one percent of women are pregnant with their first child by age 19.

Adding to the problem is their limited access to maternal and reproductive health care, with many young girls dying in childbirth as a result. Girls are less educated than boys and can be very hard to reach with information. So even if family planning and maternal health care are available, young women may not know about the services or have the means of accessing them. Fundamentally, it is a question of rights, and these young women are socialized not to recognize these rights and to have little say over their own bodies and health.

Can you describe any successes?

In many ways the results have been remarkable. There’s evidence that the attitudes of young people, community members, and health providers changed and the quality of health services for adolescents significantly improved. There are more young women and men visiting health clinics, obtaining family planning and other services. The proportion of women making four or more prenatal visits to a doctor rose from 29% to 50%. Perhaps most significantly, the age of marriage in our project area increased significantly, from 14 to 16 years old. Youth groups were empowered to participate in local government and community development forums, and they now participate in health management committees and even theater groups. What’s heartening is the proactive participation of the young women and men—who seem to have found a new and powerful voice.

Why are girls so at risk of early marriage in Nepal?

In Nepal, nearly 60% of girls are already married by the time they are 18. Although this is the legal minimum age, in most rural areas, cultural pressures and expectations outweigh the law. The older a girl gets, the more dowry is expected for her marriage—even though the dowry custom is outlawed as well. In a country where the gross national income is $320, girls can become a huge financial burden the longer they remain unmarried.

What can Americans do to help stop early marriage?

That’s an interesting question, and I’m happy to say that while it is a complicated subject and change will take time, there’s something we can all take a moment to do. Until recently, there were basically two camps in the United States who were working to stop early marriage: women’s rights groups, and Christian activists. These aren’t groups you typically find on the same side of an issue. But this is another great example of how change can happen: The International Protecting Girls by Preventing Child Marriage Act has been proposed in Washington, and it authorizes U.S. foreign aid programs to prevent child marriage and help provide educational and economic opportunities for girls in developing countries. You can urge your representatives to support this critical legislation.