. INTRODUCTION
 Child Marriage is one of the burning problems of Indian society. In India, despite amended laws advocating 18 as the legal minimum age at marriage for females, a substantial proportion i.e. every third adolescent girl in the age group of 15-19 year is married and every second married adolescent girl has given birth to a child. According to the Registrar General of India (RGI) Report (2001) Rajasthan has the highest (40.8) percentage of females ever married among 15-19 year old girls as compared to India (24.9 %) followed by Bihar (39.6 %), Madhya Pradesh (34.1%), Jarkhand (32.9%) and Andhra Pradesh (32.3%). Among the various districts of Rajasthan, Bhilwara is at the top with 61.9 percent.

 Reflecting the country’s diversity, few women (12%) marry before age 18 in Goa and Himachal Pradesh, while nearly 57 to 61 percent do so in Rajasthan, Jharkhand and Bihar. Differences by area of residence are also stark: 28% in urban areas vs. 53% in rural areas. Yet, there has been a slow trend toward delaying marriage: Nationally, the proportion of women marrying before their 18th birthday declined by five percent from 1993 to 2006 (50% to 45%).NFHS5

 Vicious Circle of Girl Child's NeglectHigh MortalityMal NutritionNon-Preference for Girl ChildLow Expenditure on Health Care of GirlsLow Awareness LevelDowry,Child MarriageLow Literacy Level, Low Investment on Girl EducationVictims of OppressionGirls are socialized from the very beginning to accept the culture of male supremacy, which willingly or unwillingly, subjects them to discriminatory practices. They actually adopt, support, promote and transmit inter-generationally the dominant social and cultural values. Gender inequality begins even before birth and is consistently becoming adverse throughout the life of the Indian women. The plight of rural women in India irrespective of their age is a matter of concern.
 Child Marriage: Age viewProhibition of Child Marriage Act, 2006, India defines Child marriage is a marriage of individuals before they attain the legal age i.e. 18 years for girls and 21 years for boys. UN's Convention on the Rights of Children define the union of children or adolescents under the age of 18 as child marriage. IAC (2003) Child marriage, also known as early marriage, is defined as “any marriage carried out below the age of 18 years, before the girl is physically, physiologically, and psychologically ready to shoulder the responsibilities of marriage and childbearing.Early Marriage: In the present study the term early marriage used, is understood as child marriage i.e. below the age of 18 years for female as prescribed by law.7

abstract
Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls’ education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls’ financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school.

Child marriage, defined as marriage of a child under 18 years of age, is a silent and yet widespread practice. Today, over 60 million marriages include girls under the age of 18 years: approximately 31 million in South Asia, 14 million in sub-Saharan Africa, and 6.6 million in Latin America and the Caribbean (Figure 1). Each day, 25,000 girls are married and an anticipated 100 million girls will be married in 2012.1 Over 60% of girls are married under the age of 18 in some sub-Saharan countries and Bangladesh, and 40% to 60% of girls undergo child marriage in India (Figure 2). | Figure 1Number of women aged 20–24 who were married or in union before age 18, by region (2006). CEE/CIS, Central and Eastern Europe and the Commonwealth of Independent States. Reproduced with permission from United Nations Children’s Fund. Progress (more ...) | | Figure 2Percentage of women aged 20–24 who were married or in union before age 18 (1987–2006). Reproduced with permission from United Nations Children’s Fund. Progress for Children: A World Fit for Children Statistical Review. New York: (more ...) |
Child marriage has been referred to as early marriage or child brides, but these terms are not optimal. Early marriage does not imply that children are involved, and the term is vague because an early marriage for one society may be considered late by another. The term child brides glorifies the tradition by portraying an image of joy and celebration. Most of these marriages are arranged by parents, and girls rarely meet their future husband before the wedding. The girls know that after the wedding they will move to their husband’s household, become the responsibility of their in-laws, and might not see their own family or friends for some time.
Although child marriage includes boys, most children married under the age of 18 years are girls. In Mali, the ratio of married girls to boys is 72:1; in Kenya, it is 21:1; in Indonesia, it is 7.5:1; in Brazil, it is 6:1; and even in the United States, the ratio is 8:1.2–4 * Other Sections▼
Human and Children’s Rights
The United Nations and other international agencies have declared that child marriage violates human rights and children’s rights. The Universal Declaration of Human Rights states that individuals must enter marriage freely with full consent and must be at full age. In 1979, the Convention on the Elimination of All Forms of Discrimination Against Women stated that child marriage is illegal. In 1989, the Convention on the Rights of the Child defined children as persons under the age of 18 years. Many countries passed laws changing the legal age of marriage to 18 years, but enforcement of these laws, and of laws requiring marriages to be registered, is weak.5 For example, although the legal age of marriage is 18 years, in Mali 65% of girls are married at a younger age; in Mozambique, it is 57%; and in India, it is 50% (Figure 3). In some parts of Ethiopia, although the legal age of marriage is 15 years, 50% of younger girls are married, and in Mali, 39% of younger girls are married. Furthermore, in some regions, an arranged marriage occurs at birth.6 | Figure 3(A) Percentage of girls (aged 15–19 years) who are currently married. (B) Percentage of women aged 20 to 24 years married before age 18. Reproduced with permission from Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health (more ...) | * Other Sections▼
Factors Driving Child Marriage
Three main forces drive child marriages: poverty, the need to reinforce social ties, and the belief that it offers protection. Child marriage is predominantly seen in areas of poverty. Parents are faced with 2 economic incentives: to ensure their daughter’s financial security and to reduce the economic burden daughters place on the family.
Child marriage is first and foremost a product of sheer economic need. Girls are costly to feed, clothe, and educate, and they eventually leave the household. Marriage brings a dowry to the bride’s family. The younger the girl, the higher the dowry, and the sooner the economic burden of raising the girl is lifted.
By marrying their daughter to a “good” family, parents also establish social ties between tribes or clans and improve their social status. Parents also believe that marrying their daughters young protects them from rape, premarital sexual activity, unintended pregnancies, and sexually transmitted infections, especially human immunodeficiency virus (HIV) and AIDS.5 * Other Sections▼
Health Consequences of Child Marriage
Isolation and Depression
Once married, girls are taken to their husband’s household, where they assume the role of wife, domestic worker, and, eventually, mother. These new homes can be in a different village or town. Because of the high dowry paid, husbands are usually much older than the girls (and thus have little in common with them) and their new brides are expected to reproduce. Polygamy may also be acceptable in some of these regions. As a result, the girls feel rejected, isolated, and depressed. Some girls realize that survival requires embracing their new environment and proving their fertility. They lose their childhood and miss the opportunity to play, develop friendships, and be educated.
Risk of Sexually Transmitted Infection and Cervical Cancer
Parents believe that marrying their daughters early protects them from HIV/AIDS. Research has shown the opposite: marriage by the age of 20 years is a risk factor for HIV infection in girls.7 In Kenya, married girls are 50% more likely than unmarried girls to become infected with HIV. In Zambia, the risk is even higher (59%). And in Uganda, the HIV prevalence rate of married girls and single girls between the ages of 15 and 19 years is 89% and 66%, respectively. Their husbands infected these girls. Because the girls try to prove their fertility, they had high-frequency, unprotected intercourse with their husbands. Their older husbands had prior sexual partners or were polygamous. In addition, the girls’ virginal status and physical immaturity increase the risk of HIV transmission secondary to hymenal, vaginal, or cervical lacerations.5 Other sexually transmitted infections, such as herpes simplex virus type 2, gonorrhea, and chlamydia, are also more frequently transmitted and enhance the girls’ vulnerability to HIV. Research demonstrates that child marriage also increases the risk of human papillomavirus transmission and cervical cancer.8
Risks During Pregnancy
Pregnant girls in malaria regions were found to be at higher risk for infection. Of the 10.5 million girls and women who become infected with malaria, 50% die. Their highest risk is during their first pregnancy. Pregnancy not only increases the risk of acquiring malaria, but pregnant girls under the age of 19 have a significantly higher malaria density than pregnant women over the age of 19.9 They are also at significant risk of malaria-related complications such as severe anemia, pulmonary edema, and hypoglycemia.
Rates of HIV and malaria coinfection are highest in Central African Republic, Malawi, Mozambique, Zambia, and Zimbabwe, where more than 90% of the population is exposed to malaria and more than 10% are HIV positive. Having both diseases complicates the management and treatment of each. HIV-infected patients have a higher likelihood of getting a more severe form of the malaria parasite, Plasmodium falciparum. They are less likely to respond as well to antimalaria medication. Malaria increases HIV viral load and increases the mother-to-child HIV transmission rate. Data demonstrate that the combination of these diseases proves deadly to the young pregnant mother.10
Risks During Labor and Delivery
Deliveries from child marriages are “too soon, too close, too many, or too late.”11 Forty-five percent of girls in Mali, 42% in Uganda, and 25% in Ethiopia have given birth by the age of 18. In Western nations, the rates are 1% in Germany, 2% in France, and 10% in the United States (Figure 4). Girls between the ages of 10 and 14 years are 5 to 7 times more likely to die in childbirth; girls between the ages of 15 and 19 years are twice as likely.12 High death rates are secondary to eclampsia, postpartum hemorrhage, sepsis, HIV infection, malaria, and obstructed labor. Girls aged 10 to 15 years have small pelvises and are not ready for childbearing. Their risk for obstetric fistula is 88%.13 | Figure 4Percentage of women, aged 20 to 24 years, married and giving birth by age 18. Reproduced with permission from Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center (more ...) |
Risks for Infants
Mothers under the age of 18 have a 35% to 55% higher risk of delivering a preterm or low-birthweight infant than mothers older than 19 years. The infant mortality rate is 60% higher when the mother is under the age of 18 years. Data demonstrate that even after surviving the first year, children younger than 5 years had a 28% higher mortality rate in the young mothers cohort.14 This morbidity and mortality is due to the young mothers’ poor nutrition, physical and emotional immaturity, lack of access to social and reproductive services, and higher risk for infectious diseases. * Other Sections▼
Discussion
Disheartening as this information may be, there is encouraging news. Data show that in countries where poverty has decreased, such as Korea, Taiwan, and Thailand, the incidence of child marriage has also declined.
Media attention raises awareness of the issue and can prompt change. After a highly publicized story in 2008, in which a 10-year-old Yemeni girl fled her husband 2 months after being married and successfully obtained a divorce, Yemen increased the legal age for marriage from 15 to 18 years. More importantly, numerous children, inspired by this case, have sued for divorce.15
Research has long enforced the importance of education for girls and their families. Child marriage truncates girls’ childhood, stops their education, and impacts their health and the health of their infants. Governmental and nongovernmental policies aimed at educating the community, raising awareness, engaging local and religious leaders, involving parents, and empowering girls through education and employment can help stop child marriage. Programs that have shown success are those that give families financial incentives to keep their daughters in school, those that feed children during school hours so parents do not have to bear that responsibility, and those that promise employment once girls have completed their schooling.1 Education not only delays marriage, pregnancy, and childbearing, but school-based sex education can be effective in changing the awareness, attitudes, and practices leading to risky sexual behavior in marriage.
Main Points * Over 60 million marriages include a girl under the age of 18 years. * The main forces that drive child marriage are poverty, the need to reinforce social ties, and the belief that marriage at an early age protects girls from rape, unintended pregnancy, and sexually transmitted infection. * Marriage before the age of 18 increases the rate of human immunodeficiency virus (HIV) infection in girls. * High death rates during pregnancy are secondary to eclampsia, postpartum hemorrhage, sepsis, HIV infections, and obstructed labor. The infant mortality rate is 60% higher when the mother is under the age of 18 years. * Education not only delays marriage, pregnancy, and childbearing, but school-based sex education can be effective in changing the awareness, attitudes, and practices leading to risky sexual behavior in marriage.