Shazia Mehboob Islamabad: “My first child died during delivery at home as I could not reach the hospital,” said Haleema Sadia, a resident of Adiyala Road, Rawalpindi. She has a two-and-a-half-year-old daughter now, and is expecting for the third time. We met when Haleema was visiting the Benazir Bhutto Hospital (BBH) in Rawalpindi for her checkup. She is in the seventh month of her pregnancy. But all is not well for her. “She is anaemic and needs blood,” said Dr Uzma Almas. “Anaemia is a common occurrence in almost pregnant women, particularly those who get married at a young age,” said Dr Uzma. Since she lives in Rawalpindi, Haleema regularly visits BBH for checkups, where she is attended to by Dr Uzma. Hailing from South Punjab herself, Dr Uzma highlighted the widespread prevalence of early-age marriages in the region. She noted that the practice is considered commonplace, and people perceive no harm in it. Dr Uzma further mentioned that her own mother was married at the tender age of 16. Recalling a recent tragedy, Dr Uzma shared that just last week, a young woman from Gujrat was brought to the hospital in critical condition. Unfortunately, she lost her life a few hours later, although her child survived.  According to a recent survey conducted by UNICEF, in South Punjab, specifically in districts such as Muzaffargarh, Rajapur, Lodhran, Chiniot, and Khanewal, early-age marriages are prevalent. Following Haleema’s checkup, another pregnant woman, in her ninth month, took her place as she left the chair. Dr Uzma, on evaluating the new patient’s health, stated, “I am admitting you because you urgently require a blood injection.” Her next patient was Shukria Bibi, a 21-year-old woman from Peshawar district. At the tender age of 15, Shukria entered into marriage. Now, after six years of married life, she is expecting for the second time, all while contending with anemia. Hailing from a remote village in Peshawar district, Shukria’s husband is also married to another woman. Shukria’s father died when she was quite young, and her mother is dependent on her children. Shukria was living with her sister at her in-laws’ house in Rawalpindi when she entered into marriage with her brother-in-law’s friend. Regarding pregnancy complications in young women, Dr Uzma, a consultant gynecologist at Holy Family Hospital (HFH), said that young patients often experience anemia due to a lack of sufficient iron stores, leading to blood deficiency. Young women in their pregnancies are at a higher risk of Antepartum Hemorrhage (APH), a health issue characterized by excessive bleeding from the genital tract in the second half of pregnancy. APH remains a significant cause of perinatal mortality and maternal morbidity, particularly in the developed world, she said.  The gynecologist added that due to low hemoglobin levels, APH patients are also susceptible to cardiac failure. Post-delivery bleeding is another high-risk factor for young women, serving as a leading cause of death in Pakistan, she maintained. The excessive bleeding may also force the doctors into removing the uterus, lending the woman unproductive for the rest of her life. Fistula is another risk factor for young women’s health, she said, adding that fistula among women in Pakistan is a serious health concern, particularly affecting those who experience prolonged, obstructed labor without access to timely medical intervention. Obstetric fistula remains a significant issue in Pakistan, especially in rural areas where access to quality maternal healthcare services may be limited. The prevalence of fistula is often associated with factors such as early marriages, early pregnancies, and a lack of skilled birth attendants. Most of the young women who visit the BBH with pregnancies are from South Punjab and KP’s far-flung regions, where the level of awareness is low and customs are strong, said Dr Hadia Abbas at the BBH. Dr Hadia is responsible for keeping records of pregnant women who visit the hospital for checkups. When questioned about the ratio of maternal mortality among young women, she responded that there is no record available of age-wise deaths. As per United Nations Children’s Fund (UNICEF) Pakistan statistics, the district of Shangla in Khyber-Pakhtunkhwa (KP) recorded 48 incidents of child marriage in 2019, marking the highest number reported in any district across the country. Additionally, other KP districts such as Malakand, Lower Dir, Swat, Tor Ghar, Hangu, Kohat, Lakki Marwat, and Peshawar also reported a significant number of child marriages in the same year. Regarding the prevalence of child marriage incidents in Shangla, when approached, Shangla police spokesperson Umar Rahman stated that early-age marriage is a customary practice in the region, and there is no objection to it, even among the police. He said local administrations often run awareness campaigns on the issue, but we don’t stop people by force. However, he said police take action whenever someone registers a complaint against underage marriage, but there is no law to stop such practices. When questioned, Deputy Chief of the KP Child Protection and Welfare Commission, Ijaz Khan, said that KP possesses a dynamic culture, with regions like nearly merged district (FATA) exhibiting entrenched traditional cultures and norms, leading to the reporting of such incidents. In KP, there exists a national child marriage restraint law enacted in 1929. This existing law exhibits numerous flaws and gaps that necessitate updating, adding that the law lacks provisions specifying a role for the police or any other relevant department, and there is no mention of a registrar. “The current Child Restraint Act neither empowers the police nor designates authority to any other department,” said Ijaz Khan. He said the KP Child Protection and Welfare Commission is tasked with overseeing laws and regulations under the KP Child Protection Act of 2010. Following, the KP Child Protection Commission, incorporating various stakeholders, including gynecologists, was established under this law. After comprehensive reviews of national and Islamic countries child restraint laws, a law was drafted, and the KP government and the law department vetted the draft and placed it before the cabinet, but later the government directed for more consultations from different stakeholders, … Continue reading Child Marriage: A Menace Robbing Women’s Right to Live, Learn