Traditions can imprison women.

Cultural customs and gender norms can lock girls and women into relationships in which nonconsensual sex is inescapable. Child marriage, for example, is a custom that often results in girls experiencing forced and traumatic first sex with their husbands, as well as subsequent forced sex within their marriages. (1) Age 18 has been deemed by many governments and several international agreements to be the minimum legal age for marriage. But, over the next decade, more than 100 million girls in developing countries (excluding China) are expected to be married before age 18. (2)

In many parts of the world, societal gender norms support the notion that marriage entitles men to sex with their wives. Even adult married women may be unable to escape forced sex within marriage. This gender-power gap widens with child marriages, since wives tend to be much younger than their husbands. Research from 16 sub-Saharan African countries found that 15- to 19-year-old wives were, on average, at least 10 years younger than their husbands. (3)

The relative helplessness of girls and female adolescents to negotiate sexual matters and resist sexual coercion within their marriages raises their risk of HIV infection. Forced sex with older, HIV-infected husbands may explain in part why married adolescent girls have some of the highest HIV rates of any group. (4) Data from Kenya and Zambia, for example, show that young married girls are more likely to be HIV-positive than are their unmarried peers because they have sex more often, use condoms less often, are unable to refuse sex, and have partners who are more likely to be HIV-positive. (5)

Coercive marital sex, coupled with a girl's naivete about sexual matters and unfamiliarity with contraception, may also result in unintended pregnancy. (6) Girls who are married young and become pregnant may feel that they are meeting cultural and familial expectations to prove their fertility. But a young girl whose pelvis is not fully developed may suffer prolonged or obstructed labor during childbirth that can kill or seriously harm both baby and mother. (7)

The long-standing, widespread custom of child marriage has deep historic roots. It has been viewed as a way to maximize fertility, secure family alliances or lineage, and protect a girl from pregnancy outside of marriage. And dowries--the money, goods, or estate that a woman brings to the marriage--are often less costly when brides are young.

Child marriage is also facilitated by the tradition of lobola. Also called bridewealth, this custom is the opposite of a dowry: A man's family gives goods or property to his prospective wife's family as compensation for her obligation to bear children and the loss of her labor. A young girl's high productive and reproductive potential makes her especially valuable in such marital arrangements. Yet, once married, a young woman may have little control over sexual matters. Three-quarters of some 1,000 women responding to a South African survey said that the prevailing view in their culture was that a man who had paid lobola owned his wife and could have sex with her whenever he chose. (8)

Among other cultural traditions that support coercive sex are:

* Wife inheritance. This practice can take different forms. Commonly, however, a man may inherit his brother's widow. In Zimbabwe, a widow passes to her deceased husband's brother in a traditional practice called "kugara nhaka," which could fuel HIV transmission if the woman's deceased husband was HIV-infected, she has become HIV-infected, and she transmits the virus to her husband's brother. (9) In Kenya, this custom persists among the Luo, although widows have been reported to resist being inherited and may attempt to protect their sexual health by insisting that their partners use condoms or permanently abstain from sexual intercourse. (10)

* Virginity testing. This practice, in which a young girl's mother, aunt, neighbor, or even prospective husband inserts a finger into her vagina to verify her virginity, may take place in ceremonies sanctioned by rural chiefs, as well as in churches and the home in Zimbabwe (see article, page 14). Although performed in the name of culture," we say the insertion of a finger or anything in a child's vagina is sexual abuse," says Betty Makoni, director of the Girl Child Network (GCN) in Zimbabwe. (11)

References

(1) Sharma V, Sujay R, Sharma A. Can married women say no to sex? Repercussions of the denial of the sexual act. J Fam Welfare 1998;44(1):1-8.

(2) Bruce J, Clark S. The implications of early marriage for HIV/AIDS policy. Brief based on background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents. New York, NY: Population Council, 2004.

(3) United Nations Children's Fund (UNICEF). Early Marriage: Child Spouses. Florence, Italy: UNICEF, 2001.

(4) Bruce.

(5) Clark S. Early marriage and HIV risks in sub-Saharan Africa. Stud Fam Plann 2004;35(3):149-60; Luke N, Kurz K. Cross-generational and transactional sexual relations in sub-Saharan Africa: prevalence of behavior and implications for negotiating safer sexual practices. Washington, DC: International Center for Research on Women and AIDSMARK, 2002.

(6) Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center for Research on Women, 2003.

(7) Henrion R. Female genital mutilations, forced marriages, and early pregnancies. Bull Acad Natl Med 2003;187(6):1051-66.

(8) Jewkes R, Penn-Kekana L, Levin J, et al. He Must Give Me Money He Mustn't Beat Me. Violence against Women in Three South African Provinces, Technical Report. Pretoria, South Africa: Medical Research Council, 1999.

(9) United Nations Office for the Coordination of Humanitarian Affairs. Zimbabwe: tackling the impact of customs on AIDS. Integrated Regional Information Networks (IRIN), August 17, 2004. Available: http://www.irinnews.org/print.asp?ReportID=42722.

(10) Luginaah I, Elkins D, Maticka-Tyndale E, et al. Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows. Soc Sci Med 2005; 60(6):1219-28.

(11) United Nations Office for the Coordination of Humanitarian Affairs.