Despite international agreements and national laws, marriage of girls <18 years of age is common worldwide and affects millions. Child marriage is a human rights violation that prevents girls from obtaining an education, enjoying optimal health, bonding with others their own age, maturing, and ultimately choosing their own life partners. Child marriage is driven by poverty and has many effects on girls' health: increased risk for sexually transmitted diseases, cervical cancer, malaria, death during childbirth, and obstetric fistulas. Girls' offspring are at increased risk for premature birth and death as neonates, infants, or children. To stop child marriage, policies and programs must educate communities, raise awareness, engage local and religious leaders, involve parents, and empower girls through education and employment.

Awareness of reproductive health issues in developing nations is growing. Critical issues are the high prevalence of HIV/AIDS among young people; childbearing by young girls, which can lead to obstetric fistulas and death of the mother; and child marriage.

Child marriage, defined as marriage of a child <18 years of age, is an ancient, worldwide custom. Other terms applied to child marriage include "early marriage" and "child brides." Early marriage is vague and does not necessarily refer to children. Moreover, what is early for one person may be late for another. Child bride seems to glorify the process, implying a celebration and a bride who is happy to start a loving union with her spouse. But for the most part, girl brides do not know--and may have never met--their groom.

Poverty plays a central role in perpetuating child marriage. Parents want to ensure their daughters' financial security; however, daughters are considered an economic burden. Feeding, clothing, and educating girls is costly, and girls will eventually leave the household. A family's only way to recover its investment in a daughter may be to have her married in exchange for a dowry. In some countries, the dowry decreases as the girl gets older, which may tempt parents to have their daughters married at younger ages. These are not necessarily heartless parents but, rather, parents who are surviving under heartless conditions. Additionally, child marriages form new alliances between tribes, clans, and villages; reinforce social ties; and stabilize vital social status.

Another study explored why married girls in Kenya and Zambia had a higher risk for HIV infection. This study concluded that because married girls are under intense pressure to prove their fertility, they have more unprotected intercourse. The study also found that husbands were substantially older (5-14 years) than their wives and were 30% more likely than boyfriends of single girls to be HIV infected. Because of their age alone, the husbands had already had numerous sex partners. Additionally, in these areas of Africa, polygamy is common.

In some countries, child marriage has been declining. Increasing mean age for marriage often results in part from overall advancement of an economy. In some countries, such as Korea, Taiwan, and Thailand, decreasing poverty effectively decreased child marriage by enabling these countries to improve education, increase employment, and provide better health care for the whole nation. Education is a key factor for delaying first sexual activity, pregnancy, marriage, and childbearing. Programs that specifically focused on the status of girls may have directly or indirectly reduced the number of child marriages. Successful programs have provided economic and educational opportunities to young women and their families by employing girls with the specific goal of delaying marriage (40), giving families financial incentives to keep their daughters in school (1), or feeding children during school to decrease families' expenses. Keeping girls in school or vocational training not only helps protect them from HIV infection, pregnancy, illness, and death but also enhances their earning potential and socioeconomic status. Educated girls can contribute to the health and welfare of their family and marry men of their own choosing and age.

Lack of enforcement renders laws against child marriage ineffective. Through media campaigns and educational outreach programs, governments need to take responsibility for stopping this practice. Local, regional, and national governments can also implement health outreach programs for girls and boys. Learning about reproductive and sexual health, STD prevention, contraception, AIDS, and how to seek health care helps girls negotiate safer sex. Governments must incorporate preventive and treatment programs for reproductive health issues into their health services. Necessary preventive services include supplying mosquito netting and condoms; educating patients about contraceptive methods; providing diagnostic screening for HIV and HPV; and offering treatment options such as medications, cesarean sections, and postpartum care.

Ending child marriage requires a multifaceted approach focused on the girls, their families, the community, and the government. Culturally appropriate programs that provide families and communities with education and reproductive health services can help stop child marriage, early pregnancies, and illness and death in young mothers and their children.