Dr. Ali Al-Mudhwahi to Yemen Times:”The problem is not early marriage, it is premature marriage” [Archives:2008/1192/Health]

September 22 2008

Nadia Al-Sakkaf
Dr. Ali Al-Mudhwahi is the director general of the family health department at the Ministry of Public Health and Population. He believes in giving adequate childcare to children and providing them with an environment in which they can thrive. However, concerning defining a minimum age for marriage, he has a rather controversial point of view that could outrage the women's movement and female activists in Yemen. Nadia Al-Sakkaf interviewed Dr. Al-Mudhwahi on the issue of early marriage in Yemen.

You are of the opinion that the focus of the early marriage campaign should be redirected towards premature marriage and not early marriage. What do you mean?

I believe that marriage at the age of 18 or even 20 is an early marriage, although this is not perceived as malpractice. Some organizations are pushing towards issuing a law to prevent marriage before the age of 18, but, if we are taking this from a medical point of view, then we should be preventing early pregnancy. From a health point of view in which we are concerned with social, mental, physical and spiritual wellbeing, we must broaden our view of the issue for a more comprehensive understanding. In this regard, we need to agree upon a scientific definition to differentiate between early marriage after the age of 14, and premature marriage before the age of 13 – not a phenomenon in our national settings.

Are you saying that premature marriage is not as prevalent in Yemen as the media suggests?

According to the Family Health Survey conducted in 2003, it is clear that the average age of marriage for Yemeni women in urban and rural areas is 23.5 and 21.9 years old respectively. This shows us that we are focusing our efforts in the wrong direction, on a problem which is not statistically significant, yet has been perceived as a major maternal health problem. Rather, we need to focus on reproductive health issues like multiple pregnancies and home deliveries as main contributors to the high maternal mortality rate in Yemen.

So how do we prevent premature marriages?

By providing a conducive environment to enforcing laws and increasing public awareness, we can empower parents to take the right decisions for their children.

Does this mean that girls and boys should be allowed to marry at the age of 16 years old for example and start a family by having children?

It is all about educating people about their choices. If marriage at the age of 16 provides the needed protection for youth against risky behaviors, then it should be encouraged. The most important issue is to raise children in a healthy balanced environment where knowledge constitutes the potential for a better future, without forcing them to follow our desires but respecting their needs.

You are suggesting pregnancy control and not marriage control, but don't you see that your suggestion is not practical, especially as there is no telling what happens behind closed doors? You can't really prevent the pregnancy of married girls before 18 years of age, but you can prevent their marriage. What do you think?

That is why educating people is the main intervention we should implement as a shared responsibility. What might happen behind closed doors in the case of a pregnancy could also happen in cases of early marriage. It would be totally inappropriate to increase people's resistance to laws that don't respect their choices, especially concerning a matter that is not even common according to national statistics. Why create resistance without need? What should be done is to better consider the social determinants of health and respect that families want, and to rightly help them to find a balance between these desires and their actual needs.

What are the other issues that you feel Yemen should prioritize rather than early marriage?

Primary health care for all age groups must be a national priority. Exclusive breast-feeding for the first 6 months of infants' life would significantly reduce the infant mortality rate. Women and children nutrition is a high priority. Around 46 percent of our children under five are underweight. Moreover, safe motherhood with more focus on family planning, birth spacing and attended deliveries by qualified staff are major issues to be prioritized and efficiently tackled by all concerned sectors including the government, local councils, media, donors, the private sector and NGOs.

The stories of the victims of premature marriages have created worldwide attention. Is this a good or bad thing? And how do you recommend we make use of this attention for the sake of Yemen's development?

If we manage to understand the indicators of problems and redirect our efforts in the right direction, then it will be a positive thing. This widespread attention for the victims of premature marriage should help us to stand up to our responsibility to save many other victims. Victims of artificial bottle feeding, victims of pneumonia, victims of unattended deliveries, victims of diarrhea and victims of malaria all deserve to be saved by us all. Every year, we lose around 80,000 children under five and more than 2,900 women due to preventable illnesses. Our mandate is not to stand beside the riverbank to help drowning people, but to go upstream to prevent them from falling into the water in the first place. So let us refocus upstream. Let us think of health, not of diseases.