Sherien Abbas, a Specialist in gynecology, obstetrics, and its surgery
Child marriage is a complicated social and humanist phenomenon that has caused a wide range of collapses in the lives of individuals and communities. Even though the world is marching toward progress in various fields regarding children’s rights, many aspects of traditions, beliefs, and local laws disrupt this path. Many kids in Syria, especially girls, are pressured by these traditions, making them vulnerable to forced marriage at a young age.
Child marriage is a matter that contradicts fundamental human rights and social evolution. This case includes various dimensions, ranging from children’s health and psychological aspects to its impact on entire societies’ economic and social future. Such issues should be handled thoroughly and with a sharp humanistic perspective to understand their challenges and work toward finding practical solutions to confront them.
During my work as a gynecologist, I have witnessed many complex cases of my patients, which encourages me today to share some of them with you so that we can deeply examine this issue by highlighting the most critical health effects of early marriages. I will only go into the health aspects so that these words reach mothers and fathers and increase the knowledge that the marriage that their daughters – who have not reached the age of eighteen – are being pushed into is nothing but hell and an absolute disaster.
Our Syrian society has its own legal, human rights, health, and social crises, and the years of the war, which reached its twelfth year, have consolidated these crises and turned them into real problems for which solutions must be earnestly sought. Child marriage is an urgent problem that cannot tolerate postponement. First, it is necessary to delve into a set of basic definitions to differentiate between them.
Who is a child?
According to the UN definition, a child is anyone under 18.
Child marriage is any formal marriage or informal union between a child under 18 and an adult or another child. In medical terms, we call it an early marriage, but from a human rights and feminist perspective, it should be amended to a forced early marriage to avoid normalizing this practice. Imposing early marriage and teenage pregnancy profoundly affects girls’ mental, psychological, physical, and productive health.
Anxiety, depression, poor social effectiveness, post-traumatic stress disorder (PTSD) symptoms, and generalized physical pain were described. Additionally, married individuals under 25 exhibited higher levels of depressive symptoms compared to those who married later. The husband’s violence impacted that, especially in forced early marriage, where the percentage of domestic and family violence increases.
Moreover, adolescent girls, especially those under the age of 15, are unable to tolerate sexual intercourse and marital life due to the small size of the pelvis and genitals.
Does reaching puberty mean a girl can be married?
Puberty represents the natural physiological transition from childhood to sexual and reproductive maturity. During puberty, the pre-pregnancy sexual characteristics in the pubic area, pituitary gland, and ovaries undergo a complex maturation process, leading to the development of secondary sexual characteristics such as breasts and pubic hair, along with limited acceleration in body growth. Puberty does not signify complete physical maturity, and the onset of menstruation does not indicate constant ovulation or the ability of a girl to bear pregnancy and childbirth.
Is any pregnancy occurring before the age of 19. Pregnancy and childbirth are the most common causes of death among girls aged 15 to 19. So, what happens to a girl if she becomes pregnant before age twenty?”
Some studies have shown that women who give birth before their twentieth birthday experience higher levels of depression, postpartum depression, anxiety, and general physical symptoms such as fatigue, exhaustion, and cardiovascular issues compared to women who give birth later. They also suffered more from physical illnesses and used medication regularly.”
Still, I feel nothing with him.
A woman came to me complaining about severe coldness in her sexual relationship and her inability to satisfy her husband, who has been with her for ten years. He is now threatening to marry someone else. I was surprised to learn that she is only twenty-five years old and already has four children from a marriage that began ten years ago.
I asked her, ‘You mean you got married when you were 15?’ She replied, ‘Yes, doctor, I swear. And she smiled, then added, ‘Don’t be surprised, doctor. We marry girls early.’
I thought about her early material life and childhood that she left behind too soon. I asked, ‘I’m sorry for the question, but I have to ask about your sexual experience with your husband, especially the first time.’
She asked with shyness and surprise, ‘What does it have to do with this, doctor? You are taking me far back in memories. ‘
I explained the importance of physical experiences and their connection to psychological states. As I explained, I saw tears filling her eyes.
She said, ‘I swear, doctor, I got engaged, got married after 15 days, and I’ve only seen him twice. My mother didn’t tell me anything because it’s considered shameful, and girls here must let their husbands teach them. I went, and I didn’t know anything. Suddenly, we were in the room, and I was embarrassed. I didn’t understand what was happening or why they locked the door. I felt numbed, doctor. He just attacked me, and I was screaming and shouting, but no one responded. No one came, and then they took me to the hospital unconscious, covered with my blood everywhere. They stitched me up for an hour.
They told me it’s not a big deal that every girl goes through such stories and tales on her first night. I said it’s normal because more than one girl from our village has experienced the same thing.
- Anemia: Anemia often occurs before pregnancy and persists during pregnancy due to nutritional deficiency and neglect of health and medical care, both before and during pregnancy.
- Deficiency in general vitamins and nutritional problems, as the pregnant adolescent mother requires more nutrition than an adult, as her body is still growing.
- Early Bone Density Loss: Due to insufficient intake and increased need for calcium, vitamin D, and early pregnancy.
- Anemia and nutritional deficiency.
- Increased occurrence of fetal deformities due to general vitamin deficiencies.
- Inadequate weight gain during pregnancy.
- Pregnancy-induced hypertension: Especially between the ages of 13 and 16, with a lower occurrence rate compared to adults. It has various health, maternal, and fetal effects, including chronic arterial hypertension, severe placental abruption leading to hemorrhage, liver and kidney failure, and seizures, culminating in cerebral insufficiency and death. These effects also extend to the fetus and newborn, causing low birth weight, premature birth, respiratory distress, and cerebral palsy.
- Preterm labor and premature birth.
- Neonatal death.
- Recurrent infections.
God is generous, and hopefully, she will bear other kids.
She entered the emergency department eight months pregnant, experiencing severe acute bleeding, and was diagnosed with early placental abruption. The fetus was deceased. She was taken to the operating room, and the fetus was delivered. She came out, everyone believing that things had become better – at least the mother, who was eighteen years old, was saved. She already has a daughter. God is generous, and hopefully, she will bear other kids.
After leaving the operating room, she started having seizures due to pre-eclampsia syndrome. Her condition deteriorated, leading to kidney failure. Her case was managed, but she couldn’t endure it. Within three days, she underwent kidney dialysis and passed away.
- Failure to progress in labor and failure to deliver the fetus naturally due to an underdeveloped and smaller pelvis compared to the size of the fetus.
- Prolonged labor due to a mismatch between the pelvis and the fetus.
- Injuries from natural childbirth due to the smaller size of reproductive organs in adolescents compared to the fetus, leading to tears in the cervix and perineum.
- Postpartum hemorrhage and its associated risks, potentially leading to the death of the adolescent mother.
A living child without a womb… Or a child mother with a deceased child in her womb!
Rushed into the emergency department in an ambulance with great speed; a young girl no older than seventeen was lying in a sea of blood. We all hurried to her, each knowing their role, from starting IV lines, resuscitation, and providing initial medical care. A doctor took her medical history from an elderly woman.
Uncontrolled bleeding after a problematic childbirth… Bleeding that could lead the mother to death.
We entered the operating room facing a difficult decision: either send the mother deceased with her womb to let her son survive, marked by the tragedy of his mother’s death, or save her life and remove the uterus to save the young girl—a painful decision.
There is an increase in the occurrence of postpartum depression, as well as problems and difficulties in breastfeeding for young mothers.
The newborn of the young mother:
Children born to young mothers suffer from low birth weight and congenital deformities due to inadequate body mass and general deficiency in folic acid and vitamins.
- The beginning is not marrying girls under the age of eighteen.
- Prevent unplanned pregnancies.
- Take folic acid and increase healthy nutritional intake.
- Blood pressure monitoring is essential for young pregnant women.
- Perform an ultrasound (echo) in the first trimester of pregnancy to accurately determine gestational age, monitor fetal growth, and detect early neurological abnormalities.
- An ultrasound (echo) should be done between weeks 18 and 20 to detect fetal abnormalities.
- Monitor fetal growth and conduct an ultrasound (echo) between weeks 32 and 34 to detect intrauterine growth restriction and fetal weight loss.
- Discuss postpartum contraception methods with the young mother.
- Looking for anemia and vitamin/mineral deficiencies after childbirth and during breastfeeding.
- Mothers should receive breastfeeding advice and postpartum follow-up to reduce the occurrence of postpartum depression and diagnose it early.
By examining the alarming reality of forced early marriage for girls, we fully comprehend that this phenomenon leads to grave consequences that encompass all aspects of their lives. Ignoring these effects indirectly acknowledges that the well-being of girls is not a priority. We must be strictly committed to safeguarding children’s rights and providing safe environments and appropriate education for girls. The will must be strong and efforts continuous, as ending forced child marriage requires integrated efforts from governments, non-governmental organizations, and civil society. We should strive to raise awareness of the dangers of this practice through awareness campaigns and education. We can build a brighter future by empowering girls and giving them opportunities to develop their potential.
 United Nations Convention on the Rights of the Child
 William Gynecology third edition page 319
 Adolescence, as defined by the World Health Organization, is the second decade of life (ages 10 to 19). It is a period characterized by significant physical, psychological, and social changes.