Hanna Ingber Win, the Huffington Post's World Editor, was recently invited by the U.N. Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 3,418 chance of dying from complications due to pregnancy, childbirth or unsafe abortion. In Ethiopia, a woman has a 1 in 7 chance of dying. Here is a piece about what she learned on her trip.
ADDIS ABABA, Ethiopia — The first time Tadu Gelana's mother suggested she get married, Tadu thought she was kidding. Only 14 years old, Tadu had not yet finished school or had her first menstruation cycle. Tadu laughed at the suggestion. The second time her mother mentioned it, Tadu told her she wasn't interested.
Her mother did not relent.
Tadu's brother, who was about twice her age and had taken care of her for many years, had recently passed away. Tadu felt she should be grieving for the loss of her big brother, not preparing for a joyous wedding ceremony.
"My beloved brother died at that time, and I had that sorrow in me," she says, wiping away tears. "I was very much against [getting married]. I wanted to continue my education with my friends."
Tadu, wearing a gray hooded sweatshirt and black T-shirt, looks like a typical teenager. Her braided hair is pulled back into a bun and small shiny earrings add a sparkle to her face. She tells me her story as we sit in Biruh Tesfa ("Bright Future"), an informal school for runaway girls in Ethiopia's capital, Addis Ababa. The school receives funding from the U.N. Population Fund (UNFPA), which has sponsored my trip, is operated by the Ethiopian government and gets technical support from an international non-governmental organization called Population Council.
Tadu never formally met the man whom she was assigned to marry but she saw him in her small town in central Ethiopia. He was tall with brown skin. She does not know how old he was — only that he was "an adult."
"When I was alone, I was afraid of him," she says. "When I was with other girls, they protected me. We all laughed at him."
Tadu solicited her uncle to try to convince her mother to let her stay in school and not get married. Her mother agreed. But after Tadu's uncle left, her mother again demanded that Tadu get married.
"My mother told me, 'Either you have to marry, or you leave this house,'" she says, as she stares down at the school's metal desk.
Tadu decided to leave her mother, friends and school and move from Ambo to Addis with her aunt and uncle. Her aunt found her a job as a domestic worker with her neighbor. Tadu, now 16, lives with her employer and spends her days cleaning the house, washing clothes and dishes and cooking for the family.
I ask Tadu about her friends in Addis and what they do for fun. I try to get her to smile and laugh like other girls her age, but she does not. She maintains a solemn look, staring down at her hands or the desk, quietly answering my questions.
For a few hours every day, the family allows Tadu to go to Biruh Tesfa, where we meet one morning in late August. Two centers in Addis serve about 600 girls between the ages of 10 and 19, says Habtamu Demele, the project coordinator of the center.
Most of them have escaped early marriage. Even though the legal age to marry in Ethiopia is 18, more than 30 percent of girls living in rural parts of the country are married by age 15, according to the Population Council. In Amhara region, where most of the girls at the center come from, almost half of the girls have married by age 15 and close to two-thirds by age 18. Ethiopia ranks among the top 10 countries for child marriage, according to the International Center for Research on Women's analysis of the country's Demographic and Health Survey data.
Families marry their daughters early due to cultural beliefs and practices related to attempting to keep a girl's chastity, ensuring a young bride's obedience and subservience, maximizing childbearing years and enhancing a family's status, according to UNFPA.
Early marriage can cause higher rates of maternal and infant mortality, vulnerability to HIV/AIDS, abuse, isolation and long-term psychological trauma from forced sex, according to UNFPA.
Girls aged 15 to 20 are twice as likely to die during childbirth as women in their 20s and girls under the age of 15 are five times more likely to die of maternal causes, according to UNFPA. This is because girls' bodies are often too young and undeveloped to endure child birth. When a girl gives birth before her body is fully developed, she often has difficulty during labor and there is a higher chance of developing a maternal complication such as hemorrhaging or obstetric fistula.
A 2005 U.N. Children's Fund (UNICEF) on child marriage also found that girls who marry young have a much higher chance of being victims of domestic violence.
The majority of the girls at the Biruh Tesfa center fled their rural villages, took a bus to Addis and got off at a bustling, chaotic station close to the program site. They arrived in Addis alone without access to services or support, says Habtamu.
"These girls are the invisibles. No program is covering them," he says.
So-called brokers found the girls at the bus station and got them jobs as domestic workers for low-income Ethiopian families in Addis. They often work under demeaning and difficult conditions, with no time to go to school or make friends.
The Biruh Tesfa project employs mentors, young women who come from the community, to go to the homes where the girls work and convince their employers to let them participate in the program.
Aynalem Kibebew, 25, lives in a tiny house made of corrugated metal across the street from the center and serves as a mentor for about 30 of the girls. Since the employers often do not allow the girls to attend school, the mentors like Kibebew provide them with informal education for an hour or two every day at the center. They also teach the girls life skills like reproductive health, HIV education and hygiene. Once the girls finish the program, they are eligible to enter formal school in the fourth grade, Habtamu says.
Another girl at the center, Kelemua Wondimu, says she fled her village in Amhara region to Addis when she was 17 because she too did not want to get married. She had seen what happened to her older sister and did not want that life for herself.
When her sister turned 15, Kelemua says, her parents prepared a wedding ceremony and made her marry a man she had never met. She then had a baby within a year.
"I saw that and decided not to marry at that age," Kelemua says, clutching her notebook as she sits at a desk in one of the center's classrooms. Charts teaching numbers and punctuation marks cover the walls. "Instead, it is better to continue my education and learn more."
To read more of Win's series on Ethiopian maternal health or to see her photographs, click here.