VILLUPURAM: NICEF defines child marriage as a marriage before age of 18 for girls, and 21 for boys, a violation of child rights affecting the mental and physical well-being of children. Despite the Child Marriage Prevention Act, people from lower income and less educated families tend to follow the practice for economic and cultural reasons.
However, while the immediate effects of child marriage on the child’s health are spoken of, the long-term effects on the woman’s health are less discussed. Marriage at a young age increases the possibility of the child contracting sexually transmitted infections (STIs), specifically HIV and HPV (human papilloma virus). Certain strains of HPV are the main cause for cervical cancer in women. Early sexual activity, multiple pregnancies and early pregnancies, all consequences of child marriage, are risk factors for cervical cancer.
Dr Rajiv Kumar, an oncologist at the Villupuram Government Hospital, said that exposure to sex at a younger age and teenage pregnancies open the door to STIs. Sexual activity under the age 21 in women will increase the chance of acquiring STIs by over 60 per cent and teenage pregnancy would most likely create inflammation in reproductive organs.
“By the time a girl (who has been married as a child) is 20, she already has two or three children causing the muscles around the lower abdomen to weaken. Alongside that, lower levels of hygiene will allow a viral infection such as HPC prevail up to a decade or two, which undiagnosed, may also lead to cervical cancer,” Dr Rajiv said.
This correlation between child marriage and cervical cancer has been noted in several research papers globally. However, instances seen in Villupuram bring immediacy to the issue at a local level.
“Villupuram district stands first in number of child marriages. We also see several cervical cancer patients, mostly aged 70 and above, with early marriage as a prime factor. The hospital is treating over 165 cervical cancer patients, some of whom were married at the age of 13. Some women were married even before they attained puberty,” Dr Shankarnarayanan, Dean, Villupuram Medical college said.
Additionally women who are married off as children come from lower socioeconomic groups and have little awareness of genital hygiene. “Most of them are still school goers when they are married off… They experience inflammation and pain in their genitals at a young age (due to sex) and so will fail to keep themselves hygienic. This will take a toll on their physical and mental well-being leaving them traumatised,” Dr Rajeshwari, head of the obstetrics and gynaecology department at the Villupuram Government Hospital said. Poor genital hygiene can lead to infections and can worsen infection caused by HPV.
Manjula*, a 35-year-old woman in Villupuram taluk, who gave birth to her first child at the age of 19, explained the impact the early marriage has had on her health. “I was married when I was 15, just four months after attaining puberty, due to pressure from our relatives. My husband is 10 years older than me. He has physically and sexually assaulted me,” she said.
“Now I have been advised to get screened for cervical cancer as I am suffering from genital tract infection. This is what child marriage has done to me. My life has been nothing but a piece of waste paper, like a withering hibiscus,” Manjula said.
Kumari*, who is over 80 years old, hails from Kandamangalam. She was married off at the age of 15 and delivered six babies -- only three of her children are alive today. Seven months ago, she was diagnosed with cervical cancer. “Only my daughter-in-law and two daughters know I have cancer.
Doctors said I am in the fourth stage of cervical cancer and that only painkillers to ease my pain can be given. It feels like my genitals are on fire. I the take pills at regular intervals to deal with the pain but I am not able to sit. I have to lie down in bed all day. I can only use the restroom with the help of someone. My days are over but I am determined not to get my grandchildren married at a young age, a key reason for my suffering now,” she said. Kumari’s daughter Deepa* said that the cancer had been diagnosed in a late stage and that doctors had said it could not be treated, leaving pain management as the only option.
Dr Rajiv noted that most women were not aware of the need for check-ups or screening for reproductive health issues so infections went frequently undetected for too long. This was among the reasons for development of malignant tumors in the subcutaneous layers of the cervix, he said. “Cervical cancer is treatable unless the tumor damages the uterus or affects the lymph nodes, which is the fourth and final stage of cervical cancer,” he explained.
Government officials said that the State government conducted weekly, monthly and yearly programmes on prevention and awareness of non-communicable diseases. The health department distributes sanitary napkins at government schools and anganwadis. Officials claimed it also conducted classes on reproductive health every Friday at government schools.
Further, the government works with schools with educate villagers about the effects of child
marriage, aside from taking legal action against parents and bridegrooms.Counselling centres at all GHs in Tamil Nadu have reportedly been set up to help victims of early sexual encounters through child marriage or commercial sex work. The National Family Health Survey-4 (NFHS) noted there had been a decline in women aged 20-24 years married before the age of 18 in India, from 47.4 to 26.8 per cent. In Tamil Nadu the fall was from 22.3 per cent to 16.3.