Delaying early marriage and pregnancy in Eastern Sudan

Dr. Angela Obasi, Rachael Thomson and Dr. Rachel Tolhurst of the Liverpool School of Tropical Medicine (LSTM) were recently awarded £150,000 by the Medical Research Council Public Health Intervention Development Scheme (PHIND) to investigate novel interventions aimed at delaying early marriage and pregnancy in Eastern Sudan. The project is to be run in conjunction with Epi-Lab, a Sudanese Research organisation who have led several successful community research interventions.

1 in 7 girls in sub-Saharan Africa are married before the age of 15. These young marriages are particularly widespread in conservative African Islamic communities and young women in these communities are particularly vulnerable to being married at a young age. In Sudan, there is currently no minimum age limit for marriage and the current law allows girls as young as 10 years old to be married with permission from a judge.

There are many negative outcomes associated with marriage at such a young age. Young married women are more likely to have more frequent sexual encounters, often with older partners and low levels of contraceptive use, than unmarried women of a similar age.  This in turn significantly increases pregnancy at a young age, which is a major cause of maternal and neonatal ill-health and death.

Early marriage is also associated with low levels of schooling and high illiteracy, which is a pattern that has repeated generation after generation. Poor social development outcomes are also a factor, with women married at a young age suffering from higher levels of social isolation, low levels of domestic authority and higher levels of domestic violence. Finally, young married women show a decrease in their ability to access vital health services, further affecting their well-being.

Our project will be based in the Kassala Region of Eastern Sudan, which is one of Sudan’s most conservative Regions. Two thirds of adults support female genital mutilation (FGM); less than half of girls attend school, 46% of girls are married by the age of 18 and 20% by age 15. By designing an intervention that delays marriage, improves educational levels and increases contraceptive uptake, we hope to decrease early pregnancy with its associated adverse consequences and improve reproductive health for young women in these communities. The intervention will build on previous research conducted in Asia which showed that increased educational opportunities through cash transfers and participatory community interventions have the potential to delay early marriage; however, this is the first time that these methods will be tried in a conservative Islamic setting.

We also plan to explore whether entrenched restrictive practices (such as adherence to traditional gender norms) in conservative Islamic settings undermines the role of older women who act as mentors to young women. For example, 69% of married women in Kassala intend to circumcise their daughters despite the negative physical effects that this has.

We are currently constructing our teams in LSTM and EpiLab in Sudan, prior to project commencement in July 2014. Stay tuned for further developments!

By Geraldine Foster (HEART Research Officer and LSTM Research Co-ordinator) and Dr. Angela Obasi (Senior Clinical Lecturer at the LSTM)

This research is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement.



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