guest columnBy Isatou Touray
When I was ten years old, my mother said to me: "you are going to be a woman". I was taken to the bush, songs were sung, I was laid down and my clitoris was cut. I was told it was my faith. I accepted.
For millions of girls around the world, being cut is a first step to early marriage. When girls have been cut, they are deemed ready to marry - however young they might be. It was my husband who encouraged me to take a stand. He is a medical doctor and throughout his career has seen the negative health effects of girls marrying as children; health effects that endure throughout a woman's life.
In my country, Gambia, an estimated 36% of girls are married before they are 18. In rural areas of the country, the rate is thought to be much higher. Globally, some 14.2 million girls a year are thought to be married as children.
The impact on these girls' health is devastating. Social pressure to prove their fertility often results in early and frequent pregnancies, with dangerous consequences: girls who give birth before they are 15 are 5 times more likely to die in childbirth than girls in their 20s. Death in childbirth is one of the biggest killers of girls aged 15-19 in the developing world. A link that is rarely highlighted, however, is the fact that 90% of adolescent pregnancies take place within marriage.
There's often a reluctance to talk about practices perpetuated by religious or traditional beliefs. Child marriage is a deeply ingrained tradition that few have addressed for fear that criticising such practices was taboo. But if we are going to see better outcomes for girls and women worldwide we have to confront the practices, like child marriage, that cause them harm.
The Girl Summit 2014 promises to do just that. Hosted by the UK government, the Summit puts ending child marriage and female genital mutilation at the heart of its agenda. This week, heads of state, civil society organisations, survivors and community groups will discuss how to bring change for millions of girls and women. It is of critical importance that the Summit moves beyond words of condemnation and commit to action.
A big part of the work ahead must focus on developing a culturally sensitive response. By this I don't mean a response that condones or apologises for child marriage, rather an approach that understands and addresses why people resist calls to end such practices.
Child marriage continues not because people want to preserve something that it is dangerous; it is about preserving a practice in which they believe. So you have to provide an alternative. I consult with men, the community gatekeepers. I give them power and say: "You are the decision makers. Tell me what you want for your daughters. You want them to live safe, healthy lives? You can offer them something better than child marriage. Let them marry as adults and they will raise healthier, more prosperous children."
My organisation, GAMCOTRAP, holds these conversations throughout a community: by the well, under the baobab tree, at the market or in schools. They can take place at healthcare facilities, too.
I strongly believe that hospitals, clinics and health centres should partner with organisations like ours that are working to establishing dialogue with communities on harmful practices. Healthcare programmes that incorporate community outreach will be key if we are to reduce the practices that result in high maternal and infant mortality rates.
It is also crucial that maternal health programmes take into account the unique needs of adolescent girls. It is very difficult for child brides, for example, to assert their wish to use contraception to their often older husbands. Effective family planning programmes must take this on board.
Similarly, child brides rarely have any understanding of their own sexual and reproductive health. In addition to reaching out to their male guardians, we need to develop health education programmes that inform girls about their sexual and reproductive health rights. Married adolescent girls are often shy, isolated and vulnerable. We need training for medical professionals on how to best interact with and support them.
Improving the health of adolescent girls, married and unmarried, is only part of the wider range of programmes that are needed to end child marriage. Ensuring girl's access to safe and quality education and viable economic opportunities, working in partnership with traditional and religious leaders to change mentalities, and developing strong legal frameworks, all of these will be needed. Child marriage is a complex problem with complex solutions; discussions at the Girl Summit this week must reflect that.
GAMCOTRAP is a member of Girls Not Brides, a global partnership of more than 350 civil society organisations that are determined to end child marriage. We are learning from each other about the work that is being done to dissuade communities from marrying off their daughters as children and about effective partnerships to ensure the wellbeing of adolescent girls and child brides.
Make no mistake, addressing traditional practices and their harmful impact on girls is not easy. It takes months, even years of patient persuasion. But we can no longer shy away from addressing practices like child marriage, which threatens to rob 140 million girls in the next decade of their health and childhood.
Dr Isatou Touray is the founder and Executive Director of the Gambia Committee on Traditional Practices Affecting the Health of Women and Children (GAMCOTRAP), an organisation which has campaigned for women's and girls' rights since the 1980s. GAMCOTRAP has been a leader in the struggle to eliminate harmful traditional practices such as Female Genital Mutilation and child marriage. GAMCOTRAP is a member of Girls Not Brides: The Global Partnership to End Child Marriage.