Family planning for married girls: lessons learned from ICFP 2016

The 4th International Conference on Family Planning (ICFP 2016) held in Bali, Indonesia, offered a global forum to build our understanding of how to improve family planning policy and practice.

The contraceptive needs of young people were a focal point of this conference. Participants discussed how to reach more diverse young populations and provide them with high quality and youth-friendly information and services. Child marriage in particular was identified as a major barrier to women and girls’ reproductive autonomy.

While much of the work on child marriage focuses on prevention, the conference emphasised something that does not get enough attention: the need to support family planning for the 15 million girls who marry each year. Here is what we learned.

Child marriage and use of family planning

Research findings from over ten countries – Ethiopia, Nepal, Mexico, Bangladesh, India, Jordan, the Philippines, Benin, Nigeria, Niger, Zimbabwe, and Uganda – pointed to a common pattern:  child marriage is associated with a lower likelihood of using contraceptives.

The reasons behind this pattern are similar from one country to another. Child marriage usually occurs in areas where traditional norms favour boys’ education and employment over girls’ own opportunities, and where young wives are expected to prove their fertility early in marriage.

As a result, they regularly face pressure from their husbands, in-laws and others in the community not to use contraceptives.

Violence against women and girls limits access to family planning

Studies also showed that marital relationships resulting from child marriage are more vulnerable to poorer communication and at an increased risk of male violence, both of which are associated with higher levels of unmet need for family planning throughout a woman’s life.

Research on child brides in Jordan revealed that violence from in-laws or natal family in conjunction with spousal violence increases the risk of unmet need for family planning by four times. Research about child brides in South Asia found that poverty intensifies the effect of spousal violence on unintended pregnancy.

A study from Mexico found that among rural adolescent girls with little education, early union and unintended pregnancy lead to greater risks for sexual exploitation and trafficking later on.

Taken together, these findings reiterate the close links between child marriage, gender-based violence and other inequities such as poverty and lesser education for girls. They showcase that these intersections compromise adolescent wives’ safety and autonomy over their reproductive lives.

Uneven progress

While there were some consistencies across countries and regions, there were also important differences that demonstrate how and where family planning works for adolescent wives.

The use of modern contraceptives among married adolescents varies greatly by country and region: over half of married adolescents in Peru and Columbia use modern contraceptives, as opposed to less than 5% of them in Benin and Guinea.

We are seeing rapid improvements in married adolescents’ use of family planning in some countries more than others. In the past decade, for instance, Ethiopia has experienced more than a seven-fold increase in the use of modern contraceptives, whereas Nigeria has seen a decline in the same timeframe.

Family planning that works for child brides

Family planning successes in Ethiopia have been attributed to government commitments, including the increase of Health Extension Workers trained to provide family planning counselling and short-acting contraceptives to married women regardless of age.

A comparative study of programmes in Oromia, Ethiopia, and Jharkhand, India, highlight the benefits of the Ethiopian approach. Not only were married girls in Oromia able to stay in school longer than their Indian counterparts, they also credited their access to family planning for their ability to do so.

What was the difference? Oromia’s school-based programme connected married girls with Health Extension Workers who provided injectable contraceptives. In Jharkhand, married girls had to rely on condoms obtained from the market instead.

These findings suggest one thing: in order to support married girls effectively, we need policies that call for coordinated family planning and education programmes

Moving forward

The conference offered clear evidence that child marriage affects adolescent wives’ reproductive autonomy, and that family planning programmes and policies to support married girls are inadequately prioritised by most countries. Evidently, more needs to be done.

Greater prioritisation can have a dramatic impact, as seen in Ethiopia. We also need to provide coordinated health and social services at all levels to ensure married girls’ access to family planning, particularly those facing marital difficulties or violence.

Community efforts to improve girls’ social standing, safety and opportunities as well as marital support for couples affected by child marriage will help, particularly if there is a strong focus on gender equity and girls’ empowerment.

There is no doubt that accelerating action to reduce child marriage will help to achieve the Family Planning 2020 goals and target 3.7 of the Sustainable Development Goals, which seek to increase contraceptive use, and ensure universal access to family planning services for all women worldwide respectively. Fewer child brides will mean fewer adolescent girls initiated into sexual relationships where they have little control over their reproductive choices and are pressured to become mothers at a young age.

However, we will not achieve these goals without also meeting the family planning needs of the millions of adolescent girls around the world who married as child brides.

For more information

• Explore abstracts from the International Conference on Family Planning 2016 here.
• Read: What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices, Global Health: Science and Practice, August 2015.

The authors would like to thank Dr Sarah Borg, MScPH at the London School of Hygiene and Tropical Medicine, and Sophie Drouet, Digital and Content Editor at Girls Not Brides, who provided feedback and helped with copy editing.