Sanctity of marriage

Yesterday I had the pleasure of delivering a healthy baby girl from a 14 year old mother. She looked completely bewildered as this child was handed to her, almost as if she hadn't realised what had been growing inside her these past 9 months. Teenage pregnancy is not an unusual occurance, in fact it might even be the norm in this area, and one of the reasons is illustrated by another patient of mine. She is a 26 year old who has been left infertile and childless following an ectopic pregnancy. She is absolutely distraught as you might expect any 26 year old to be. However, it is not just her yearning for a child that distresses her but also her yearning for a husband as in Xhosa culture she has little chance of finding a man without first proving her fertility. With such high unemployment her only realistic chances of an income are a husband working in the mines and child support grants which means her future is far from secure. The impact on the HIV epidemic of the need to prove fertility before marriage is plain to see. These young women are clearly having unprotected sex with casual partners with little thought for their own health.

If a woman manages to avoid HIV infection whilst proving her fertility the problem is not over. Choosing to marry brings many advantages but it also comes at a price as she will be entering into a very unequal partnership. Put simply, most Xhosa men are very reluctant to use condoms and women do not have enough bargaining power within their marriage either to insist on their use or to persuade the husband to have an HIV test in the first place. Add to that the very high prevalence of HIV in men who spend most of their time woring away at the mines and this puts married women in a very dangerous position.

If a woman passes the fertility test without being infected with HIV she is actually in a much safer position should she choose to remain unmarried. Not only has she proven her fertility but because she is unmarried she is in a much stronger bargaining position when it comes to condom use. She is much more likely to be able to refuse sex if the man will not use a condom and as such unmarried women are in a better position to protect themselves from HIV than married ones.

Whether many women think of this dilemma when considering marriage I'm not sure but I do see many unmarried women with children who seem to have put aside the idea of marriage as they have become a little older and wiser. For these women the chance to build a future through education and training seems to me to be of the upmost importance and is one of the reasons I'm so keen on the idea of microfinance in this area.