Pakistan International Peace & Human Rights Organization
Nindo Shaher District Badin Sindh Pakistan


SPECIFIC CONCLUSION
Age at marriage is on the increase throughout the world, although a substantial
number of adolescent girls still marry early. Data from 40 Demographic and Health
Surveys in developing countries show that up to 50 percent of women marry by age
18. Singh and Samara (1996) note that studies identify the socioeconomic factors
most influencing a woman�s age at marriage as: female labor force participation,
acquisition of formal education, and urbanization. In countries with a higher
proportion of women with secondary education, the proportion of women who marry
in adolescence is lower.
The consequences of early marriage for the development of young women in
particular have yet to be adequately researched. One reason for this is that the
needs of adolescents are not yet recognized as specific and valid enough to ensure
major program and policy interventions. Mensch et al. maintain �that a girl remains
an adolescent � with stage-specific vulnerabilities, capacities, and development
opportunities � roughly from the time she turns 10 until she turns 20, whether or not
she marries or gives birth. Recognition of this fact will help to bring much-deserved
attention to the large proportion of adolescent girls who become wives before they
become adults� (Mensch et al. 1998: 70).
In Pakistan, the average age at marriage is increasing for both men and
women, and at a faster rate for the latter. The singulate mean age at marriage
according to the Pakistan Fertility and Family Planning Survey 1996-97 (Hakim et al.
1998) is 26.5 for men and 22 for women. PCPS data show the traditionally larger
age gap between spouses is shrinking, with only 18 percent of married women ages
15-19 married to men ten or more years older, while 28 percent of married women
35-39 are married to men over a decade older. Age at marriage is slightly lower for
both men and women in rural than in urban areas, and is substantially higher,
particularly for women, with increased levels of education. (Population Council et al.
1998)
According to the most recent figures, as shown in Table 11, a substantial
proportion of adolescents and youth are married. There is a strong bias in favor of
females marrying younger than males, most dramatically so among adolescents.
While the PFFPS figures show that the proportion of married adolescent girls is less
than in earlier surveys, there is still clearly a strong tendency toward girls marrying at
a young age, and particularly before age 25. In rural areas, the earliest age at
marriage is lower for both males and females than in urban areas. For example, at
age 19, 85 percent of females in major urban areas are single, while only 58 percent
are single in rural areas. (Hakim et al. 1998)
The figures in Table 12 provide further data adding depth to the reality of age
at marriage figures. Whereas Table11 shows how many adolescents are currently
married, it cannot predict how many have yet to marry by age 19. Table 12 shows
that over half of women ages 20-24 were married as adolescents (i.e., before age
20). Even among men the comparable figure of 13 percent is much higher than the
proportion of current adolescents who are married. An analysis of Pakistan
Integrated Household Survey 1990-91 data (Durrant 1998) finds that the factors
associated with higher rates of marriage as an adolescent were: being female, living
in a rural area, living in the NWFP or Balochistan, never having attended school, and
having illiterate parents and/or parents with low levels of education.
Adolescents, particularly girls, who marry do not necessarily wish to do so. A
study of female autonomy and relations within marriage in Egypt found that among
girls who married before age 16, only 1 in 10 chose their husband, while 40 percent
of those who married after age 25 selected their spouse. (Mensch et al. 1998) In
Pakistan, arranged marriages are still the norm and female status is significantly
lower than that of males. In this context, girls� decisionmaking power in timing and
choice of spouse is obviously limited, but further research is required to determine
under what circumstances early marriage is against the will of the adolescent girl.
A series of focus group discussions (Population Council 1999) with
adolescent boys and girls in rural Punjab revealed that they have different
approaches to the question of marriage timing and choice. While boys felt the ideal
age at marriage was between 18-29 years, girls limited the range to 20-25 years
only � out of the adolescent years. Interestingly, boys said that the choice of spouse
should rest with both the boy and girl and that they did express their own views on
the matter, while girls generally felt that parents should be trusted to find them a
suitable match but girls ought to be consulted.
Singh and Samara (1996) point out that married adolescent girls are likely to
find motherhood the sole focus of their lives, at the expense of development in other
areas, such as formal education, training for employment, work experience, and
personal growth. The fact that Pakistan still has a substantial number of married
adolescent girls implies, using Singh and Samara�s analysis, that these girls have
not had the education or employment opportunities associated with delayed
marriage and reside predominantly in the rural areas. This is supported by the
analysis in the PCPS report showing that age at marriage is lowest in rural areas
and increases with education. (Population Council et al. 1998)
Risks Associated with Early Childbearing
There are numerous negative consequences of bearing children while one is still
young. It brings not only risks to the mother�s health, but reduces her life options in
terms of education and economic independence. Although the broader
consequences of early childbearing have rarely been studied, findings from some
countries suggest girls who give birth during adolescence are likely to be more
economically disadvantaged than those who give birth later are. (Mensch et al.
1998)
The overall context of maternal mortality and morbidity in Pakistan is weak:
only 20 percent of women are assisted by a trained provider during delivery, the
country ranks third in the world in numbers of infants who die of neonatal tetanus,
and the maternal mortality ratio is 340 per 100,000 live births. (Tinker 1998) Only
limited information is available on the consequences of early childbearing among
young Pakistani women, and that comes only from general maternal morbidity and
mortality studies that do not focus specifically on adolescents.
First, infant mortality is strongly linked with mother�s age at first birth, with
younger mothers associated with the highest mortality figures. The Demographic
and Health Survey 1990-1991 found that neonatal deaths occur at a rate of 70 per
1,000 births for mothers under 20, and post-neonatal occur at a rate of 51 per 1,000
births. The figures drop as the age of mothers increases, and only climbs again for
mothers 40 years or older. (NIPS/IRD 1992)
Existing research shows that adolescents figure prominently in deaths
associated with childbearing. In a survey of 30 hospitals and private clinics across
Pakistan, covering 104,551 live births, there were 703 maternal deaths (Jafarey n.d.)
Ten percent of those whose ages were determined were between 15-20. Patients
who were not enrolled in regular antenatal care and suffering primarily from direct
causes, such as hemorrhage, hypertensive diseases, and sepsis, accounted for
most of the deaths. Jafarey identified social, economic, cultural, and logistical factors
as preventing women from seeking medical advice even though they were urban
residents.
As expected, the data are revealing for what they imply about severe and
unapprised problems for adolescents. In a four-year review of maternal deaths in a
Quetta hospital, 10 maternal deaths (8 percent) of women between ages 16-20 were
caused by the same triad of disorders mentioned in the Jafarey study. (Ashraf 1996)
Seventeen deaths (13 percent) were primigravida and 6 women died from induced
septic abortion.
Jafarey and Korejo (1995) conducted a study in Karachi between 1981-1990
into the causes of delay that resulted in women arriving at hospitals already dead.
Out of the 150 pregnant or recently delivered women who were dead on arrival at
hospital, 10 were under age 20. Twenty-two (15 percent) of the women were
primigravida; as a guess, this number probably included most if not all of the
adolescent girls. The researchers found that most of the deaths were preventable
had health services been accessed in time. The most disturbing finding was that all
but 5 of the women who were dead on arrival lived only 5-10 kilometers away from
the hospital, but a combination of social and economic factors delayed their access
to the facility. Reasons for delay included: lack of available transport and finances,
reluctance of family to bring the woman to hospital, absence of husband from the
house, and inadequate maternal services that failed to refer the patient to the tertiary
care facility in time.
Although all of the studies reviewed show that the risk of death increases with
higher parity and that the causes of death are easily preventable, the specific
reasons for mortality among adolescents, who obviously have little or no history of
previous births, need to be identified. Findings mentioned earlier in this section on
the restricted mobility and access to health care experienced by adolescent girls
could be explored further to ascertain causes of adolescent maternal deaths in
hospital. For example, it is important to establish whether adolescent girls who are
pregnant have more difficulty seeking regular antenatal care and reaching the
hospital in time in case of emergency. If they do, then it is important to develop
interventions to overcome these restrictions.
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PAKISTAN INTERNATIONAL PEACE & HUMAN RIGHTS ORGANIZATION
P.O NINDO SHAHER DISTRICT BADIN SINDH PAKISTAN
POSTAL CODE NO:72250
PHONE NO:092-227-720227
Email: [email protected]
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