Friday, 28 December 2012

The girls of Sierra Leone - Marriage as a way out of poverty, and the implications of poor Healthcare

Has Sierra Leone really recovered from civil war?

After 11 years of civil war within Sierra Leone order has been restored. Hundreds took refuge in Kroo Bay to escape the massacres and other war crimes being committed to only find themselves in an environment that is a far cry from ideal.

However is it really the case that order has been restored? After such horrific ordeals, in particular the ‘hellish cycle of rape, sexual assault, and mutilation’ of women and girls...” (1) does this represent a reoccurring attitude towards women/girls in general within Sierra Leone, if so what is the ongoing consequences of this?

Like many countries that have been awash in civil war it takes a long time to heal and to recover, not just economically but also socially. Sierra Leone is a typical example of this as when civil war broke out refugees were forced to flee, resulting in a slum area created from the rubbish tip in Kroo bay.

Healthcare in Sierra Leone

For a refugee living here in the present day, this is but the tip of their problems as Malaria, Pneumonia, Cholera and infections are rife amongst the inhabitants of this Shanti town. Many inhabitants are not able to get basic health care as they can’t afford to pay for the treatment so the health clinic is ineffective. (2) This is turn means that most of the people here will die by the age of 35, leaving behind vulnerable children. This would normally be a situation that would be challenging for any country. For Sierra Leona it’s a greater challenge still as they have limited resources resulting in a country where basic social welfare can’t be met.
This is a pressing matter as the cycle that follows is truly horrific.

When a child is left without parents they quickly find themselves in a dire situation. The basic need of food is now their main concern and without money (or a way to make money) they are without doubt in great need. Boys tend to mine Kroos stretches of water for copper cable which they sell on to recyclers (3) this “work” is deemed too dangerous for girls. For girls to survive it is much harder and it seems that due to attitudes toward them they are in much more dangerous territory! 

Marriage at a young age as a way out of poverty - Gender, Marriage and Healthcare in Sierra Leone

Juliet who is now 14 explains- she had lost both her parents and she was very frightened as they had no money for food, however “..almost straight away (once her parents had died) men came.” Although it is acknowledged that she was not physically forced Juliet states that “She didn’t want to lie down with him (she was 12 at this time) she did it because she knew he would feed her.” (4) The lack of money for basic needs such as food or clothes drives girls towards transactional sex. (5)

This is sadly not a solitary occurrence but one that is a continuous problem as many males tend to use the girls lack of money for food to their advantage. This in itself is a shocking situation as Sierra Leona is meant to be part of the E.U where children are meant to be protected against such abuse. 

Many Girls in Sierra Leona have their first pregnancy between the ages of 12-14 years old. (6) This in itself is a problem as these girls are often suffering from malnutrition so their pelvic bones have been stunted. This, as well as the traditional Female genital mutilation, causes further complications in childbirth and increases the chances of Fistula. 

Sadly Fistula can be prevented although the chances are much higher due to circumstances outlined above, despite this though due to the girls immature bodies and also the combined circumstance of “....lack of proper training, leading to gross incompetence” (7) as although there is free healthcare since 2010 as little as 137 trained midwives practice and there are only 16 emergency obstetric facilities.(8) This healthcare service is simply inadequate for the demand and many girls are left in the care of untrained women.

It’s believed that as many as 1 in 8 women in Sierra Leona suffer from Obstetric Fistula. (9)
Obsteric Fistula is a condition which occurs from an obstructed labour that is left unrelieved and untreated. (10) It results in the girl being permanently incontinence of urine (vesicovaginal fistula) and/or faeces (rectovaginal fistula)(11) Now due to their inability to have more children and their terrible odour many girls hide due to the stigma attached to this condition. (12) 

They are in turn ostracized by their community as in Sierra Leona it is perceived that “..If men don’t want you, you are nothing.” (13) Also the terrible stench that results from this condition results in people staying away and there is no way that the girls can combat this due to the constant stream of urine/faeces.
This condition is not only a terrible physical blow but also an emotional one, as it strips the woman of the only dignity that she has left. There is only one facility in Sierra Leona that provides Fistula repairs which is funded by the British charity Freedom. This in itself provides much needed care and rehabilitation, despite this though what happens when this person returns to her community? 

Still the downward spiral continues, as Kadiatu states “my only means of survival is to hawk fruits in the market and rely on favours from men who promise love...” (14)

In retrospect to be able to combat this issue there is so much more needed than just providing adequate medical facilities, medical training and social care. Though it is accepted that these facilities would ease the suffering of many, it would simply address the symptoms rather than the root cause. 

The people in Sierra Leona, in particular the women need changes in perceptions and attitudes. For instance “there is such importance given to girls marrying as virgins that the age of marriage often coincides with the first occurrence of female menstruation”. (15) This in turn leads to consummation of the marriage and in a country where there is little sex education or indeed birth control she will quickly fall pregnant.

To combat this there needs to be access to sex education and to birth control, which will in turn address the issues of young girls becoming pregnant (often a result from transactional sex.) The transactional sex needs to be addressed and measures taken, such as better social care provided for orphans who are prone to this coercion.

Men who are guilty of transactional sex should also be lawfully convicted of this crime, especially as the E.U states that child abuse-“ Involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening.” (16) This would also address the situation as many women who suffer from Fistula are underage girls, the description of underage would apply to many girls who have suffered with Fistula as the consensual age is 16 years old.

Much more needs to be done here to protect such vulnerable girls who due to attitudes, perceptions and economic situation have fallen prey to such circumstances that they can’t seem to escape.
This is why it’s so important that not only the symptoms are addressed but the root cause of the suffering. Behaviours must change for communities to recover if there is to be any hope for the present generation in Sierra Leone.

  1. The Sunday Times Magazine, July 08 2012-12-02
  2. The Sunday Times Magazine, July 08 2012-12-02
  3. The Sunday Times Magazine, July 08 2012-12-02
  4. The Sunday Times Magazine, July 08 2012-12-02
  7. The Sunday Times Magazine, July 08 2012-12-02
  8. The Sunday Times Magazine, July 08 2012-12-02
  9. Children Act 1989


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