Understanding Early Marriage and Transactional Sex in the Context of Armed Conflict: Protection at a Price

By Hutchinson, Aisha; Waterhouse, Philippa et al. | International Perspectives on Sexual and Reproductive Health, March 2016 | Go to article overview

Understanding Early Marriage and Transactional Sex in the Context of Armed Conflict: Protection at a Price


Hutchinson, Aisha, Waterhouse, Philippa, March-McDonald, Jane, Neal, Sarah, Ingham, Roger, International Perspectives on Sexual and Reproductive Health


Approximately 1.5 billion people in about 40 countries currently live in states considered to have active armed conflict, and thus face significant threats. (1) Young women in such situations are particularly vulnerable to threats to their sexual and reproductive health, not only from violence directly related to the conflict but also from the breakdown of law and order and community cohesion. (2) Identifying risk and protective factors for sexual and reproductive health outcomes will facilitate the development of appropriate policies and programs and will help target women vulnerable to negative outcomes. (3)

Armed conflict has the potential to dramatically change the way young women obtain access to and benefit from structures that promote their sexual and reproductive health. These structures may include legislative justice mechanisms, stable governance and policing that protect them from sexual violence and coercion, and the health and education infrastructures that facilitate access to good-quality sexual and reproductive health services. In addition, conflict may disrupt political processes, such as voting and taking part in demonstrations, that allow young women to voice their concerns. The development of progressive social policy for sexual and reproductive health--which facilitates sexual education and access to family planning methods--as well as economic safety nets to prevent destitution may also become inhibited.

Infrastructure and resources designed to support young women's sexual and reproductive health, which may have taken years to develop, can be quickly destroyed during conflict. For example, during the Rwandan genocide, an estimated 80% of health care professionals were killed or fled the country, and medical supplies and equipment were heavily looted and destroyed. (4) In addition, access to health services may become restricted because providers lack security and fear reprisal and attack. (5-7) During Shia-Sunni hostilities in Gilgit Town, Pakistan, hospital and clinic staff who belonged to certain faith-based groups were killed or were prevented from providing services, which reduced provision of and access to obstetric services and resulted in increased maternal morbidity and mortality. (8)

Forced migration and displacement further increase young women's vulnerability by breaking down family and community structures. Although refugee camps and other settlements initially may be viewed as places of safety, they may themselves offer new threats. (9,10) Moreover, economic stagnation or decline may limit economic opportunities, which may in turn decrease the lifestyle (including sexual) options available to young women. (11,12)

The social and economic breakdown precipitated by armed conflict raises questions about how young women can protect themselves against threats to their survival and to their sexual and reproductive health. There is increasing consensus that notions of risk and protection are largely context specific and consequently are not universally applicable in predicting outcomes. (3,13-15) Yet, despite this recognition, universal frameworks of risk and protection continue to be adopted in the field of sexual and reproductive health, with little consideration of their relevance to distinct groups or contexts. In this article we demonstrate the limitations of this indiscriminate application through consideration of early marriage and transactional sex in the context of conflict. We present these issues to highlight the challenge of supporting sexual and reproductive health in settings of armed conflict, where protection and survival can come at a price, especially given the short- and long-term consequences of sexual and reproductive health choices.

EARLY MARRIAGE

Globally, one-quarter of females aged 20-24 were married before age 18; (16) this figure is much higher in less developed countries. International organizations are committed to preventing the occurrence of early marriage for a variety of social, educational and medical reasons. …

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