What Can We Do About Child Marriage?

Lauren Farmer’s article “Child Marriage: When does a cultural practice become a global health issue?” appearing in Berkeley’s Public Health Advocate magazine issue of fall 2013, encourages readers to rethink how passively we approach the issue of child marriage in developing countries, as it is protected by the limitations on our cultural prowess due to ideals of reverence and appreciation of societies different from our own that have emerged since the fall of Western imperialism. We understandably fear overstepping our boundaries as it could provoke subdued emotions regarding the era of colonialism in the countries that we—the West—had once oppressed, resulting in numerous political problems that I, as a science major, can only guess at. The only problem here is, what if our regard for another’s culture enables the suffering of millions of young girls around the world every year to take place?

As an individual pursuing the medical and public health track, I don’t look at the photograph in the article of teenage fiancés who are meeting for the first time on their wedding day being wed as an expression of a culture and tradition that are hundreds of years old—I see only the injustice being carried out that results in the numerous medical problems detailed in the article, and this doesn’t even begin to explain the human rights and mental health issues at stake. Chief among these problems are early and frequent childbirths that has been causally linked to seizures, hemorrhaging during labor, chronic incontinence, infections, and even death of the child and the mother.

              The problem tree continues to grow: when a girl is married young and is made to start a family young, she is generally sexually assaulted by her husband—especially as she cannot really consent—she drops out of school, she loses the opportunity for a job, and she ends up minimally contributing to society, the economy, and her country (unless, of course, she produces a number of male offspring).

              When all of these undesirable consequences are occurring with child marriage at the root of the problem, can we really coax ourselves into thinking we have no say in that cultural realm? And if not, how can we reconcile cultural differences into a feasible solution while inviting minimal amount of hostility from those whose culture we are criticizing? I am not naïve and recognize that a glorious solution with which all parties involved will be happy is not going to occur, but the faction of impoverished female children with opportunities being snatched from them before they are even old enough to know what those might have been, has been given the short end of the stick for far too long.

              We need policy change, we need action. We need to make a better world for the children who are being veiled not only in a wedding outfit but by the notion of cultural boundaries and the inability of those with power to take a risk to reach out behind the veil and help them.

CSEC and Systems of Oppression

In addition to my PE, another meaningful thing I’m engaging with this semester is called Project HONEY, which stands for Helping to Empower Oakland and Neighbors’ Exploited Youth. Project HONEY is a supplementary program to a local non-profit in Oakland called MISSSEY (Motivating, Inspiring, Serving and Supporting Exploited Youth). MISSSEY is a safe physical space where survivors of sex trafficking can go for after-school fun but also provides various forms of social support. The goal of the DeCal is to understand sex trafficking of minors in the Bay Area so we can eventually act as advocates and mentors for the children. The main class activity in the DeCal is to create a workshop to present to the children at MISSSEY to add to their after-school activities program as well as give us base knowledge for a future of working with at-risk youth. I can't even begin to scratch the surface at how much this class has taught me, but I'll try to speak a little about it.


In the DeCal we often discuss the use of language when talking about the clients of MISSSEY. The term that we feel best describes the clients are CSECs, or commercially and sexually exploited minors. We feel like this is an all-encompassing term because it highlights the struggles that these children face: being just a middle-person in a monetary exchange in which they receive no benefit, and being part the process which exploits them sexually. We refrain from calling them “child prostitutes” because we feel that this phrase connotes a level of choice in their situations and lives, but this choice is simply not there. It is true that many girls go back to their pimps after they escape the life, but we must consider that the average age of entry into commercial exploitation of a CSEC is 12 years old. It’s clear that there’s a connection to the return and their own trauma, PTSD and Stockholm Syndrome as a cause for this relapse. When you’re baseline for normal is abuse and exploitation, it requires a lot of counseling and social support to have the courage to leave for good. We are also careful to call them “survivors”, not “victims” because we believe that they are strong and can take an active role in going forth with their lives.


Through this class I had the pleasure of meeting and talking with Minh Dang, a survivor and advocate for the movement as well as a new Cal graduate from the MSW program. Minh gave us a very interesting lecture about domestic human trafficking. Why, in a society that supposedly works to protect children, are CSECs not getting the help and support that they need? Minh asserted that our society creates the conditions for this type of slavery to occur, and many systems of oppression are in play to create these conditions. Racism, sexism, homophobia, poverty, and many more all play a role in the commercial and sexual exploitation of minors. To rid society of this system of exploitation, we must also examine issues that appear to be separate because they do in fact play a major role. Minh blog about these issues very eloquently and I’d encourage everyone to check out her blog: http://minhspeakstruth.tumblr.com/

The Emergency Room as a Place of Change

"If airports can become shopping malls and McDonalds can become a local playground, surely we can reinvent the clinic waiting room."

Above is a Ted Talk by Rebecca Onie, founder of Health Leads. The goal of Health Leads is to connect low-income hospital patients to basic needs and resources such as food, housing and health insurance. The idea behind Health Leeds is to put "health" back into the healthcare system by viewing it in a holistic. In her Ted Talk, Rebecca Onie discusses using a hospital waiting room as place of social change and cites a man named Dr. Jack Gieger as her primary influence. In 1965, Dr. Gieger founded one of the first two community health centers in the United States, located in some of the poorest areas of the country and he noticed that although many of his patients came in with a variety of symptoms and ailments, most were suffering from malnutrition. He began to notice that the root causes of most of their illnesses went back to being starving; he began prescribing food as a result. The patients would then take these prescriptions to the grocery store and the pharmacy budget would be charged to cover the cost. After his funders got upset and told him he was supposed to use the budget for medical purposes only, Gieger responded "Last time I checked my medical textbooks, I read that the cure for malnutrition was food." Dr. Gieger's powerful words laid the foundation for Health Leads: that good health health starts at basic needs and hospital visits should be about more than making basic clinical diagnoses.

Health Leads as it exists today trains doctors and other healthcare professionals to recognize the social determinants of health and incorporate them into traditional models of care. When physicians treat someone that has health needs that go beyond the parameters of biomedicine, they refer them to the Help Desk that situated in the hospital waiting room. This way the patients can work with a volunteer advocate at the Help Desk to get other aspects of their health situated while they’re waiting for their "traditional" prescriptions to be filled. The volunteers, typically undergraduates interested in a career in health care, connect the patients out to the existing landscape of community resources. For example, doctors might treat asthma by prescribing a medication for it but people at the Help Desk would try to instead identify a cause; perhaps the patient has mold in the walls of their apartment, so in response we would try to find them better housing and get them a lawyer to advocate for their tenant rights. These sorts of Help Desks exist as a two-fold: to make a positive impact on people's lives in the waiting room, and also to train the next generation of healthcare professionals to recognize health needs beyond a basic clinical diagnosis. Help Desks aim to treat the cause, not the illness. Health Leads is currently working on providing a business case as to why the healthcare system as at large should pay for this type of care in addition to what they already provide in addition to policy work.

Help Desks like Health Leads are gaining ground across the country and more and more every year are being incorporated into traditional models of care. My PE at Highland Hospital is modeled after Health Leads except it is run on a purely volunteer basis, whereas Health Leads has paid employees as overseers. Berkeley students reached out to Health Leads in 2012 to start help desks in the Bay Area, but at that time Health Leads was not ready to expand so the Berkeley students did it themselves through Big Ideas at Berkeley [http://bigideas.berkeley.edu/winners/highland-health-advocates/]  Highland Health Advocates is just a part of the Bay Area Regional Health Consortium, which is a team of doctors, lawyers nad undergrads devoted to helping those in poverty acheive good health. According to their Big Ideas at Berkeley page,"The goal of this interdisciplinary approach is to improve the health of low-income patients, enhance the patient experience, reduce emergency room utilization by high frequency patients and ultimately lower healthcare costs in outpatient clinics and the emergency department." The pilot Help Desk through the Consortium was founded at Highland Hospital in Fall 2012 with 8 undergraduate volunteers and has since grown to over 60 undergraduate volunteers in Highland Hospital, Oakland Children’s Hospital, and San Francisco General Hospital.

If anyone is interested in volunteering with us, let me know! We require a minimum of one semester. We’re also looking for summer research interns.

The idea of Poverty just fills me with unsettling questions

One of Ananya Roy’s stories in lecture recently struck me, in which a boy asked her why in America there are homeless; rather, why do we not allow informal housing of the extremely impoverished in America. Of course, I realize there do exist "encampments" hidden underneath seams of the urban fabric, such as in the brush at the Albany Bulb or under bridges, however there are still so many trying to sleep on the concrete around my warm, secure home. Often in the Bay I have witnessed despicable verbal and physical violence toward bodies trying to rest on the streets. I wonder how, after being exposed to all the noxious elements of life on the streets throughout the day, these individuals also manage to survive sleeping on the cold concrete unable to lock out the dangerous, bad, or drunk people out that scare us all. I feel like the reason we don’t allow informal housing, is that cities feel compelled to be able to say the individuals without homes on their streets are just transients, and thus not reflective of the city, nor responsibility of the community. Do we not allow informal housing because we think the homeless are easier to regulate and police when they have no privacy? No running water, no mirror, no place to store their things, no toilet, no refrigerator or stove? Do we refuse to allocate space for makeshift dwellings, because it is easier to pretend like the problem doesn’t exist? Is it that we fear a built environment exposing the raw and inhumane conditions of Americas most poor would render the problem visible? I know many individuals who would build themselves a makeshift house in a dangerous slum on the outskirts of town and feel blessed to have walls surrounding them, as temporary, fragile, and illegal as they may be. I understand that slums pose many unimaginable dangers, but I wonder if they could possibly be worse than what we already have in America. How can we have so many people in this country of abundance wealth living in a culture of conspicuous consumption yet suffering from such extreme poverty that they cannot even afford a place to call home? My best guess is that we don’t allow anyone access to free land, due to the fear that it would be unfairly taken advantage of. Nonetheless I can’t help but wonder sometimes if "third world" slum establishments in fact might serve society better than how the poorest are forced to live in Berkeley.

http://lebbeuswoods.wordpress.com/2011/02/08/the-barrios-of-bogota/

Class Infographic | Fall 2013