Child r/iarriage in Afnc2 bones are not ready for childbearing and de livery. Their risJ.; for fisrula is as high as 88~ o (36). Once a fistub is formed. fec:Jl or urinary incontinence and peroneal nerw pzdsy may rt>sult and may lead to humiliation, ostraci'-111. and rt>:;tdtam depression. Unless the fistula is surgic::llly repairt>d. these girls have limited chances of living a normal life and bearing children. Effects on Offspring Child marriage affects more than the young girls: the next generation is also at higher risJ.; for illness and de3th. Adolescent mothers have a 35r~o-55% higher risk than older women for delivering infants who are preterm and of low bi1ihweight. I\1ortality rates are 73% higher for infants born to mothers <20 years of age than for those born to older mothers (3 7). The infant mortality rates in Mali are 181 per 1,000 children born to women <20 years and 1ll per 1,000 born to mothers ages 20-29 years; in Tanzania these rates are 164 and 88, respectively (1). These deaths may be pa1ily because the young mothers are unhealthy, immature, and lack access to social and reproductive services. Their babies are also at high risk of acquiring HIV at delivery and during breastfeeding. Mothers who have h<Jd malaria are at increased risk for premature delivery, anemia, and death. Untreated STDs such as gonorrhea, chlamydia, syphilis, and herpes simplex virus infection can have deleterious effects on neonates, such as premature delivery, congenital neonatal infections, and blindness. Even the mo1iality rate for cl1ildren <5 years can be 28% higher for children born to young mothers than for those born to mothers >20 years (38). Discussion Child marriage has far-reaching health, social, economic, and political implications for the girl and her community. It truncates a girl's childhood, creates grave physical and psychologicall1ealth risks, and robs her of internationally recognized human rights. Ending child marriage requires the consent of all those involYed, including fathers and religious, community, and tribal leaders. To break the cycle of poveJiy, programs are needed to educate and empower women. ln 2000, eight Millennium Development Goals outlined a vision that committed member countries to eradicate extreme pove1iy and hunger, educate all children through primary school, empower women, reduce childhood death, improve mothers' health, combat HJV/AJDS and malaria, ensure environmental sustainability, and develop a global pmincrship for development by the year 2015. Most of these goals directly affect child marriage. Data show that improvements are being made and that sub-Saharan Africa has the most obstacles to overcome (39). Jn some countries, child marriage has been declinin:.>. lncrea;:ing mean ''ge for marriage often resuhs in pan j]·o~-1 overall adnncement of an economy. Jn some coumries. such as Korea, Taiwan. and Tl1aiLjnd. decrea<;ing pm en: effectively decre:1sed child marriage b:. enablin!2 tlks 2 cc,untries 10 improve education. increase employm;m. and provide beTter health care for the whole mnion. Education is a key factor for debying first <;exual activity. pregnancv. marriage. and childbearing. Programs then specificaliv focused on the sta1u~ of girls may haYe direct]) or indireclJy reduced rhe number of child marriages. Successful programs have provided economic and educational oppmiunities to young women and their families b\ employing girls with the specific goal of delaying m<nriac:-e ( 40), giving families financial incentives to heep th~ir daughters in school (1), or feeding children during school to decrease families' expenses. Keeping girls in school or vocational training not only helps protect them from BJV infection, pregnancy, illness. and death but also enhances their earning potential and socioeconomic status. Educnted girls can contribute to the health and welfare of their fznnily and marry men of their own choosing and age. Lack of enforcement renders laws ngainst child marriage ineffective. Through media campaigns and educational outreach programs, ge>Yernmems need to take responsibility for stopping tl1is practice. LocaL regional. and national governments can also implement health outreach programs for girls and boys. Learning about reproductive and sexual health, STD prevention, contraception, AIDS, and how to seek health care helps girls negotiate safer sex. Governments must incorporate preventive and treatment programs for reproductive health issues into their health services. Necessary preventive services include supplying mosquito netiing and condoms: educnting patients about contraceptive methods; providing diagnostic screening for HJV and HPV; and offering treatment options such as medications, cesarean sections. and postpaJium care. Ending child marriage requires a muliifaceted approach focused on the girls, their families, the community, and tl-Je government. Culturally nppropriate programs thnt proYide families and communities with education and reproductive health services can help stop child marriage, early pregnancies, and illness and death in young mothers and tl1eir children. Dr Nour is a board-certified obstetrician-gynecologist anc! direc\Clr of the African Womcn·s l-lealtl; Center at the H~n ardaffiliated Brigkm1 nnd Women's Hospital in Bos10ll. She i;; commiTted to the eradication of female genital culling. ln 2(103. Dr Nour rccei-1 ed a MacArthur Foundation Fellows '·geniu, gront" for creating t]·,is coumry's onl) center thm fixuscs on is:;m::c Emerging Infectious Diseases • www.cdc.gov/eid ·Vol. 12, No. 11, November 2006 1647