“I wanted to be a bride,not a wife”: Accounts of child marriage in the Bedouin community in Israel

Abstract

This article presents a qualitative study of the experience of child marriage among Bedouin in Israel. We conducted semi-structured interviews with a convenience sample of 17 young Bedouin women, aged 17–21, who were married between the ages of 12–17. The interviewees’ descriptions indicate that child marriage is a powerful cultural practice that has evolved into a “natural” and “obvious” tool for supervising girls and women. All the interviewees reported domestic violence, despair, and reported suicide attempts as a response to their existential suffering in their marriage and as an act of daily resistance to a powerful and oppressive cultural practice. These findings raise challenges in the case of global mental health interventions since these interventions not only require cultural sensitivity to avoid the constraint of Western psychiatric diagnoses and classifications, but also more critical thinking about the interactions between global and local, universalist and culturalist perspectives.

Keywords

Bedouin community child marriage global mental health structural vulnerability

Introduction

An in-depth analysis of the research literature on child marriages shows that most studies focus (mainly through quantitative research) on causes of, consequences of, and attitudes toward child marriages in different cultures around the world (Zaher, 2013). There are few studies based on in-depth interviews with women who were married as children (however, see Wahi et al., 2019), and with the girls themselves while they are married are especially rare, particularly when they are close to the age of 18 years, which is considered in many countries to be the age at which a girl is no longer underage (Kalamar et al., 2016). Our study aimed to address this lacuna.

This research is extremely important in light of key findings in the literature about Bedouin women aged 17–21 who married between the ages of 12–17. The accounts include their understanding that underage marriage is a strong cultural script that is legitimized by religious and social authorities (Swidler, 2001). One of the consequences of strong cultural scripts is the difficulty of expressing agentic resistance in everyday life. At the same time, many studies describe how this strong cultural script is reflected in their experiencing exploitation, depression, suicide attempts, and extensive health problems (Wahi et al., 2019; Zaher, 2013). In other words, our interviewees offer unique dialectics of the relationship between structure and agency in the health field (Abel & Frohlich, 2012; Williams, 2003) that can be expressed through the concept of “structural vulnerability” (Quesada et al., 2011). This concept emphasizes positionality in a specific social structure:

… the vulnerability of an individual is produced by his or her location in a hierarchal social order and its diverse networks of power relationships and effects … individuals are structurally vulnerable when they are subject to structural violence in its broadest conceptualization. This includes the interface of their personal attributes − such as appearance, affect, and cognitive status − with cultural values and institutional structure. (Quesada et al., 2011, p. 341)

This positionality raises challenges in the case of global mental health (GMH) interventions (Kirmayer & Pedersen, 2014) since these interventions not only require cultural sensitivity to avoid the constraint of Western psychiatric diagnoses and classifications (which are based on assumptions of universalism) (Shoshana, 2019), but also more complex thinking about the interactions between “global and local, universalist and culturalist, emic and ethical perspectives” (Bemme & Kirmayer, 2020, p. 3). Furthermore, research suggests that these interactions require major actors in GMH to have cultural and epistemological sensitivity, which requires attention to local idioms and expressive norms (Kidron & Kirmayer, 2019).

Child marriage around the world

Child marriage is defined as marriage under the age of 18, pursuant to the Convention on the Rights of the Child's definition of childhood. This type of marriage is increasingly identified as a violation of human rights (Godha et al., 2013). Surveys around the world further show that rates of child marriage are particularly high among females in sub-Saharan Africa and South Asia (Efevbera et al., 2017; Nasrullah et al., 2014).¹ This cultural practice is more prevalent in areas that are rural, undeveloped, and poor (Islam et al., 2016). The girls who are married at an early age in these areas tend to be uneducated or have low levels of education and are likely to be married in an “arranged, unwanted, and unexpected” manner. The negotiations and the decision regarding marriage are made between the father of the intended bride and the father of the intended groom. Women are not usually informed about the negotiations, and therefore the wedding often comes as a surprise to them (Erulkar, 2013, p. 513). The girl being married has almost no involvement in decisions related to family planning, child rearing, and the use of maternal and child health services.

An in-depth study of the research literature shows that most relevant articles focus on the causes and consequences of child marriages. Child marriage is described as “maintained by structures of power” and cultural practice (Ferdousi, 2014) in religious, traditional, and patriarchal societies. The patriarchal ideology encourages the marriage of minors as a means of preventing premarital sex because of the moral-cultural value for women of maintaining virginity until marriage. Early marriage is described as a practice that protects young girls from men who might defile their bodies, their identity, and their family's honor. The sexuality of the woman, and therefore the age of her marriage, is a central focus of social supervision (Ghosh, 2011).

Studies also report that in this context, poverty, lack of employment, lack of education (or low levels of education), and rural residence increase the chance of child marriage (Kamal et al., 2015). Additionally, educated husbands are less involved in child marriages in areas where they are prevalent (Hossain et al., 2015). In families living in extreme poverty, young girls might be perceived as an economic burden and the marriage of a young girl to an older man is a survival strategy for her family (also called a price bride; see Mulenga et al., 2018).

The research literature on child marriage around the world offers sweeping findings about the negative implications of these marriages in terms of health, education, family relations, and economics. Child marriage is associated with a high probability of complications during pregnancy, including miscarriage and stillbirth.

Research suggests that there are several reasons for the connection between underage marriage and pregnancy complications, including incidents of miscarriage and stillbirth, miscarriage and stillbirth. For example, adolescent mothers are more likely to experience fistulae, pregnancy complications, and even death during childbirth than are older mothers. Young mothers experience higher rates of maternal mortality and higher risk of obstructed labor and pregnancy-induced hypertension because their bodies are unprepared for childbirth (Raj et al., 2009). Furthermore, “child marriage is associated with lower educational attainment and reduced levels of literacy, which, in turn, lead to reduced economic participation. Girls who marry early often begin childbearing early as well …” (Kalamar et al., 2016, p. S17), thus leading to stunting and underweight among the children born. Moreover, “girls who bear children before age 15 are five times as likely as older mothers to die of pregnancy-related causes” (Erulkar, 2013, p. 6). Married young girls are at a higher risk of HIV infection, even when compared with their unmarried peers who are sexually active.

Studies have also reported relatively high rates of depression, suicidal ideation, and suicide attempts among married young girls (e.g., Gage, 2013). Studies also report intergenerational effects of these health problems on the mental well-being of the children of underage girls (Efevbera et al., 2017). In the field of education, it is clear that not only do these young girls drop out of school, but they are also denied access to education. With regard to intimate relations, the research reveals high levels of domestic violence, abuse, and pressures from the husband and his extended family. The woman must remain in the marriage, even if it involves exploitation and violence (Mwambene & Mawodza, 2017). In addition, most studies report that the economic situation of these girls usually does not improve with marriage, and they suffer from severe poverty and social exclusion (Wodon et al., 2016).

In addition to research on the causes and consequences of child marriage, there are also studies that focus on attitudes toward this type of marriage. A study carried out in the populous slum areas of Lahore, Pakistan by Nasrullah et al. (2014) revealed that most of the interviewees were not aware of the negative health implications of child marriage. Indeed, the interviewees expressed satisfaction with this cultural practice and even opposed attempts by activists to ban the marriage of minors. Religious attitudes toward family structure and the status of women were found to be critical to these findings (for similar findings in Afghanistan, see Zaher, 2013). A study by Stark (2018) examined the attitudes of women and men in low-income urban neighborhoods in Dar es Salaam in Tanzania with regard to child marriage and found that economic hopes for a better future were a common motivation. Child marriage was also seen as a way to prevent premarital sex or “premarital transactional sex,” which is a custom in which girls engage in sexual intercourse in return for money and material gifts from boys and men (Stark, 2018).

Child marriage has also been described as a cultural choice that would allow girls to achieve economic independence and self-sufficiency. The benefit of a transition from being controlled by their parents to being married to a husband who can enable the girl to achieve female adulthood and a measure of independence has been offered as an explanation for the support for child marriages (Ghosh, 2011). In other words, “early marriage is often viewed as the only culturally approved way of becoming a productive adult” (Stark, 2018, p. 898). It is important to note in this context that the main challenge to achieving economic independence is related to the gender hierarchy prevailing in patriarchal societies. Women in these societies are expected to function as mothers and wives and not work in the labor market. Marriage to a working man will enable a woman to live under conditions of a secure income (even if it is obtained by the husband), which will allow her more independence than if she were single or living in her parents’ house (Ghosh, 2011). Finally, support for child marriage has been described by both men and women as an option that allows economic survival in situations of poverty (Ghosh, 2011; Wahi et al., 2019). In a study that focused on the responses of social actors in West Bengal, Ghosh (2011) also found that early marriage was viewed as an important means of preventing exogamous marriages.

The characteristics of the Bedouin community

The Bedouin community in Israel has unique characteristics. It is estimated that the population of Bedouins living in the Negev comprises approximately 220,000 people (Monthly Bulletin of Statistics, 2017). This is a traditional, tribal, and patriarchal society that lives in familial clans. The permanent Bedouin communities are ranked in the lowest percentiles on the national economic measure of standard of living. However, only half of the Bedouin population live in these recognized communities; the other half live in unrecognized settlements, where there are no basic municipal services. Women in the Bedouin community do not have a role in the public sphere. Their responsibilities are limited to their household: maintaining the family tent, procreating, and raising their children are their only duties. Bearing many children, especially boys, reinforces the social status of a woman in the Bedouin community. In addition, there is a barrier between them and the outside world for a variety of reasons, particularly distance from urban centers, insufficient means of transportation and road infrastructure, cultural restrictions on women's independence and movement (e.g., a woman is not allowed to leave the area surrounding the tent without a male escort like her father, husband, or brother), lack of child care, and responsibility for a large number of children. In fact, many Bedouin live without basic conditions, such as water and electricity (Manor-Binyamini & Shoshana, 2018).

In the Bedouin community, the man is viewed as the breadwinner and family protector. Gender determines the division of labor, which maintains the existing social structure and places men in the highest position of authority in the management of the family and the tribe (Dwairy, 2004).

Study design and research questions

Ethnographic interviews were used to explore the experience of young Bedouin women who were married at an early age. Two main questions formed the basis of our research: How do young Bedouin women who were married as underage girls define, experience, and explain the cultural practice of child marriage? How do they describe their daily lives since their marriage?

Method

Sampling procedure

Potential interviewees were located using a snowball approach. This was initiated by Soher,² a social worker working with the community, who was familiar with this phenomenon, who told the first author about her observations, and asked the first author to investigate the phenomenon. To initiate the process with each participant, a request was made to both the young woman and her husband and the following information was given: the purpose of the study; who could be included; what the study involved; how the participants’ information and views would be kept secure and confidential; any disadvantages there might be to participating; what will happen to the results of the study; and who would be reviewing the study. Interviews were conducted only with those couples where both husband and wife agreed that the women could be interviewed.

All the women interviewed for the study had been married between three and five years. Of the 46 women contacted, 17 (37%) were interviewed. Each woman received US$50 for her participation in the study. The decision to provide a US$50 honorarium was made in response to our initial difficulty in recruiting interviewees. One of our hypotheses was that this difficulty stemmed not only from honor codes (Abu-Lughod, 1986) and the family approvals that young women must obtain, but also their challenging financial situation. As a result, we asked social workers in the Bedouin community to sensitively inquire among the women whether a modest US$50 fee might encourage their consent to be interviewed. After answering positively, we decided to utilize this payment.

Study participants

Each interviewee first completed a demographic questionnaire. Table 1 shows the sample characteristics of the participants.

Table 1.

Sample characteristics (N = 17).

Participant	Age at marriage	Education^a	Location of residence^b	Number of children
1. Soher	14	BHS	US	2
2. Sara	15	HS	City	1
3. Hanan	17	HS	City	1
4. Miryam	12	BHS	US	2
5. Hiat	13	BHS	US	3
6. Neama	15	HS	City	1
7. Magda	12	BHS	US	4
8. Hiba	14	BHS	US	1
9. Amany	12	BHS	US	3
10. Sllwa	16	HS	City	1
11. Asia	13	BHS	US	2
12. Minan	14	BHS	US	3
13. Sappa	14	BHS	US	2
14. Dalal	16	HS	City	1
15. Gamila	12	BHS	US	3
16. Isra	14	BHS	US	1
17. Isma	17	HS	City	1

BHS – Below high school; HS – High school diploma.

U-S − Unrecognized settlement.

Data collection methods

First, approval for the research was received from the ethics committee of the Ministry of Social Affairs (Authorization for Research #20/025). The Ministry of Welfare's ethics authorization requirements are much stricter than those of the university's ethics committee, since the Ministry of Welfare's ethics authorization not only examines the characteristics of the research and researchers but also makes sure to test the levels of sensitivity toward the interviewees, throughout the study, and ensures their anonymity as well as that of their family. All participants signed informed consent forms before the interview and were told that participating in the study was voluntary and that there were no consequences for refusal or withdrawal. The women were assured that the interviews would remain completely confidential and that their names would be replaced by pseudonyms.

Next, in-depth, semi-structured ethnographic interviews were conducted. In the first part, demographic information was obtained (see Table 1); the second part included open-ended questions to address the research questions. The interviews relied on two main types of questions: a) a structured interview guide with questions prepared in advance to cover essential topics; and b) probe questions asking the interviewee to clarify and expand on their replies to provide more descriptive detail.³

Due to the sensitivity and “silence” that surrounds this issue within the Bedouin community, as well as the need to protect the details of the women's lives, all the interviews were conducted in Arabic by one master's-level Bedouin student, a 36-year-old research assistant. The interviews took place at each participant's tent/home and lasted from one to two hours. The interview phase of the study took nine months.

Data analysis

The authors performed a thematic analysis of the interviews using steps of familiarization, highlighting, and memo/note-writing techniques (Burnard, 1991). Thematic analysis was applied as a multiple-stage procedure, with the first step involving the interpretation of individual interviews. Themes were then developed based on this analysis and were then cross-checked and compared with those of other interviews, thus enabling a comparison between individual and collective understanding. Categories that were not raised in every interview were merged as a subcategory under a broader theme. This procedure allowed for the comparison of the themes generated in each individual interview with those generated by other participants from the group. This process of combining the experiences of individual participants into one group provided an overview of the young women's experiences as a whole. Narralizer software (www.narralizer.com) was used for data management and the organization of the interview transliterations.

In the process of generalizing the themes and categories, the authors carefully followed coding practices that reflected the main message of the data while maintaining the participants’ original wording as much as possible. This coding system was then tested by member-checking to assure reliability through blind double-coding by two colleagues who had not taken part in the study. Following this, apparent validation was performed: The interviews and preliminary analyses were given to the women, who were then asked to read the description of the interview and the first analysis and to respond to them in terms of their accuracy in capturing their experience.

Findings

A powerful religious and cultural practice

An analysis of the research findings revealed that every interviewee in this study believed that marriage is necessary and an obligation based on the Sunnah (Islamic custom according to Muhammad the Prophet). Similarly, all the interviewees stated that almost all the decisions concerning their marriage were made by their fathers. This is a norm in their culture and community. One of the interviewees clarified:

I was married at the age of 12 because my father decided that I would; the authority to make this decision is his, not mine … he is responsible for us and he protects us, especially the girls, because it is a matter of family honor. (P.7)

In all cases, the girls stated that their consent to the marriage was not required and while some were not vehemently opposed to the union, many were forced to get married despite their objections. The girls did not meet the legal requirement for the age of consent for marriage in Israel, which is 18 years old. For example, one interviewee stated: “I didn’t really have a choice, I had to do what my father told me to do … everyone around here, from the tribe, is forced into marriage” (P. 7).

The interviewees explained why young girls accept a marriage that their parents arrange for them. For example, the same interviewee stated:

From an early age, they teach us girls how to do all the housework because they will get married and move into their husband's house, where they will have to run the household. But they don’t teach them about sexuality, about marital relations between husband and wife. (P.7)

Many of the interviewees referred to the concept of shame (Abu-Lughod, 1986) that is associated with the practice of child marriage. One of the interviewees stated: “If the daughter falls in love with someone, people will say that her parents are responsible because they didn’t raise her properly; it is a disgrace to the family” (P.3). The interviewees noted that this kind of shame can affect the family for many years, as inappropriate behavior by one girl could harm the marriage prospects of the other girls in the family: “When a girl does something against the traditional norms, the shame of it will follow her to the grave … she will be punished” (P.8).

Another interviewee stated:

It seems that the Bedouin society is developing and advancing, but it seems to me that there are more and more incidents of marriages involving minors; I can see it here, in the city … there is a law against it but they go around it. You chose a Shara’im marriage … it never gets registered anywhere, and no one knows that you got married. (P.1)

The emergence of the sexual maturity of women, according to the interviewees, was one of the reasons for early marriage due to the fear of the potential shame that the girls might bring to the family. Sexual maturity turns the girl into a target of sexual attention by men. The process of female sexual maturity comes with many restrictions for the girl/woman. For example, one of the interviewees describes the following: “The moment my body started to show these physical changes … my breasts started to grow … I wasn’t allowed to leave the house without covering myself … and not just outside the house, but inside, at home as well, within the family” (P.3).

It is important to note that most of the interviewees indicated that they believed that a girl's sexual maturation was a sign of their readiness for marriage, despite their young age. The physical changes of adolescence were considered to be proof of sexual desire and contributed to the assumption by the family that these young women were emotionally and mentally ready for marriage.

Many interviewees emphasized that marriage is an important element in Bedouin culture. A man must marry a woman in a traditional way if the two want to live together. If they are seen together in the public sphere out of wedlock, they will be accused of adultery, which is forbidden according to Islam. In addition, extramarital sexual relations are considered forbidden—“haram” (see Qur’an Sura, 23:5–7). For example, one of the interviewees provides the following perspective: “If a girl is marrying at the age of 12, her family will say it's God's will because marriage takes place in heaven” (P.15).

According to the interviewees, it is important that the mullah perform the marriage ceremony. According to Bedouin tradition, the mullah reads the contract in front of witnesses, two from each side (the bride's and the groom's), and all parts of the marriage are performed orally. Marriage in a courthouse is not common.

The interviewees also noted that the mullah's approval of the marriage of the young girl is a significant factor in the sanction of child marriage. Without the mullah's participation, a girl cannot be married. Interviewees described the Bedouin culture as very respectful of the mullahs. For example, one interviewee said:

I don’t know why the mullahs agree to marry [such] young girls; either they do it for the money that they receive for the ceremony, or for the tradition … but, in my opinion, this is what gives these marriages the label that it is okay to do. (P.2)

Many interviewees also described how religious practices that support child marriage were meant to protect young girls: “Here, in the village, there was a case of an uncle who raped a 12-year-old in their tent, not once, but again and again and again … my father wanted to protect me [by arranging the marriage]” (P.2).

The breakdown of the dream

The following interviewee, who was married at the age of 14, clearly expresses the dynamics of what we would like to call the “the breakdown of the dream” that was prevalent in the interviews:

When I was eight years old, I used to play with my dolls, and my favorite game was one where I married another boy when I was 12. I always dreamed of getting married. I didn’t know anything about marriage and what it meant to be a bride. I just liked the idea of wearing a wedding dress. I was married at the age of 14 and I was very happy. I was completely unaware of what was going to happen after the marriage until I experienced it. (P.13)

Many interviewees described their many childhood dreams of being married as a hope of escaping their harsh reality, hope for a better economic future, and a childish anticipation of “being a bride” for one evening. The imagination of a better future through marriage included notions of material and emotional rewards and freedom from the limitations that a young girl/woman were subject to when she was dependent on her original family. The following statements from some interviewees affirm this yearning: “I wanted to get married; it meant I could get good clothes, jewelry and a wedding ceremony … [the thought of] it made me happy” (P.11); “I was sick of life with my family … There was such poverty … hardship … I wanted to improve my status…” (P.15).

All the interviewees who described similar dreams and fantasies also described the disappointment, difficulties, pain, and suffering they experienced immediately after their marriage. None of the interviewees reported that her “dream-of-rescue” fantasies had been fulfilled. Moreover, most described a new, more violent reality that reflected the rapid transition from childhood to womanhood, the experiences of childbirth, the difficulties of pregnancy, their mental state (including suicidal ideation and suicide attempts), the daily hardships of housework, and the attitudes of their husband's extended family.

From girl to married woman

When a woman in the Bedouin community is married, she is obliged to move in with her husband and his entire family. Most of the interviewees spoke about the abruptness of this transition from childhood (in their parents’ home) to marriage. For example, one of the interviewees described her wedding night:

On the day of the wedding, my husband took me away from my parents … and I had to stay with a man that I didn’t even really know … He took me to his home and that evening, when we were left alone, he took his clothes off in front of me for the first time. I ran away … I ran back to my parents. After 10 days they brought me back to him … The next time he took his clothes off, my body just went into a state of shock … he had to take me to the hospital. (P.8)

Other interviewees described how unprepared they were for what marriage meant: “I didn’t know what I was getting into … no one told me … no one prepared me … I lived in a world of helplessness … I didn’t really understand what marriage is … what it is to live with another man” (P.11); and “I wanted to be a bride, not a wife … There is no help here … they could teach me how to be a woman, what I need to do…” (P.16).

Another group of interviewees spoke about their feelings, especially the feelings of anger and helplessness they experienced initially—and continue to experience—as well as their feelings about what they lost by getting married early:

I have a lot of anger, toward my parents who stuck me with this man … for taking my childhood away … for not allowing me to continue at school … Nobody helped me, everyone around me kept silent … I think they think that that's our tradition … the hardest thing is that your own parents … betray you … .You can’t even ask for help because you have no one to ask … you’re alone. (P.12)

Other interviewees spoke about the implications of marriage for them:

I will tell you what my life looks like since I got married … I’m not in school anymore, I don’t have a family … I have health problems all the time … and I’m pregnant … .I don’t really want to be alive anymore since I got married. (P.8)

The difficulties of pregnancy

Most of the mothers spoke with great pain about the process of getting pregnant:

Ever since we got married, my husband has wanted sex all the time. But I didn’t even know what it was … and then he started to force me … very soon after the wedding … .I got pregnant … twice … Both children died because I was so young … I couldn’t [sustain the pregnancies]. (P.6)

Other interviewees spoke about the importance of their children to them:

My children are the reason that I stayed … I had two miscarriages in the first year. After that I gave birth to a boy when I was 13, my daughter was born when I was 14, and then another boy when I was 15. I had problems with every one of my pregnancies … I was a child the first time I got pregnant … not really developed … I had a lot of health problems. (P.5)

The births of the children

Approximately half of the interviewees mentioned the subject of childbirth following the marriage. They shared their experiences with tears:

I was married off when I was 13 years old. I got pregnant when I was 15 years old. I didn’t know anything about pregnancy; there aren’t any tests here or a health clinic … I asked one woman here, in the tribe, and she told me that the child is born after nine months … .After the nine months had passed, my husband's family started making all kinds of remarks. What's going on with you? … I had pains, and I thought that I’d be giving birth soon … .One morning, it was like something just opened up … and I felt like a river was coming out of me … .There was blood everywhere … .They took me to the hospital … .I lost a lot of blood … and my baby was born dead. (P.5)

Another interviewee spoke about her anger and fears related to giving birth and the effect that those feelings had on her care of her child:

I was 14 years old when I got pregnant. When I had the child, I had no experience and my mother was far away … At first, I couldn’t hold my baby, and for months I was afraid that I would hurt him … .I didn’t know how to feed him … .I was here all alone without my mother and my husband's family didn’t help me at all … .I didn’t have any friends … .Sometimes I hit my baby because he kept crying and crying. (P.11)

The attitude of the husband and the husband's family

All of the interviewees spoke extensively about the attitudes of their husbands and their husbands’ families toward them since they started living with their husbands: “My husband was very tough with me, because I didn’t know what marriage was and what I should be doing as his wife” (P.1); “You end up feeling that you’re not a human being … .This isn’t how people treat a human being … maybe I’m a prisoner … .I have no one to turn to, I have no rights … .I’m someone else's property … I have no way to protect myself” (P.4).

Other interviewees spoke of the attitudes of their husband's family toward them: “I am really unhappy in this marriage … The only reason that my husband's family married off their son was because they wanted, they needed a servant … that's what I am to them” (P.7).

Against this backdrop, many interviewees described their daily life in terms of loneliness, being closed off, misery, and Sisyphean work. For example, one interviewee describes the following: “What kind of life is this? I’m home all day long, cleaning all day long, can’t go outside … closed off in here … I have no one to talk to … I’m not really in touch with my husband's parents … I have a miserable life” (P.7); “My hands are broken … from work … all day long I do housework … it's all I do” (P.4).

From parental supervision to husband's supervision, domestic violence, and suicide

Many interviewees spoke about the transition from being under parental supervision to being under their husband's supervision: “At first everything was fine… and then one day he started checking my cellphone messages…. Ever since then, he won’t let me talk to anyone, including my own brothers, without his permission … it's getting worse” (P.7).

More than half of the interviewees spoke of violence that they had experienced in their relationships with their husbands. They noted that this violence was the most difficult experience for them and that it was ongoing:

I was raped by a member of my family, inside my own home … so my father took me to the hospital to have hymen reconstruction surgery. After a few months, he arranged for me to get married so that no one would find out about what happened around here … .But my husband, he also … hurts me … .I don’t want to live anymore … .I tried to commit suicide twice … but he caught me. (P.5)

Another interviewee shared:

He [the husband] is constantly beating me … .You see [she shows the interviewer] I have scratches on my hands, my legs; he punctured a hole in my ear and broke my nose … .One day he hit me so hard that he had no choice but to take me to the hospital. … One of the doctors there asked him if he's beating me … so he took me out of the hospital … (P.7)

It is important to emphasize that the majority (14 of 17) of interviewees reported suicide attempts:

I grew up in a very traditional family … I never heard anything about sexual relations from any friends or family members … .So, the first night of my marriage was … a trauma … .I hadn’t met my husband before the wedding … He … he forced me to sleep with him … I didn’t know anything about sex … he [she's crying] … I haven’t wanted to live since. (P.1)

Another interviewee shared this:

I feel like I have no air, I can’t breathe … [with] everything that's happening to me … I tried to commit suicide twice. He [the husband] said that if I tried to commit suicide again and he caught me, he’d turn me out of the house … .I don’t want to live anymore … I can’t sleep at night; I keep thinking about how I could end my life … there's no one to help me … (P.11)

Other interviewees noted that the reasons for their suicide attempts are abuse and feelings of helplessness and hopelessness:

Two years into the marriage, after the children were born, the violence started … .He whips me with a rope, pulls out my hair, violently rapes me … .After I filed a complaint against him with the police, his family decided to punish him and me … .They took my children away from me, and they were so little [she's crying]. I really regret filing that complaint. I was so young, only 12 years old … for allowing them to take my children away from me. (P.9)

One of the interviewees explicitly described her suicide attempt as an expression of her resistance to the treatment of women in her situation in Bedouin society and as an act of “daily resistance” (Scott, 1985): “I decided to commit suicide so that maybe somebody would finally understand” (P.9).

These descriptions reveal the everyday vulnerabilities of the women in our study, which included the lack of family protection (following the departure from their biological family and residence in their husband's family home), helplessness, hopelessness, lack of knowledge about sex, physical and sexual violence on the part of the husband, concealment of information from doctors following the receipt of medical treatment in hospitals due to the husband's violence, and coerced removal of children by their husband's family as punishment.

Discussion: Structural vulnerability and challenges to global mental health

This article offers a portrait of the mental health and personal consequences of child marriages through in-depth interviews with young Bedouin women aged 17 to 21 who had been married a few years earlier, between the ages of 12–17. This study is important, not only because there are few such accounts based on interviews with young girls or women who have experienced such “child marriages,” but also because of their daily accounts that reveal a unique structural vulnerability (Quesada et al., 2011).

All the interviewees reported domestic violence, despair, feelings of suffocation, an absence of existential escape routes, and an erasure of their sense of self (and their bodily autonomy) after their marriage. In addition, the interviewees also made frequent use of metaphors of oppression (e.g., “prisoner,” “maid”) to describe their situation following their marriage. Marriage to an older man was described as a “childish” fantasy of little girls who imagined being a bride in ways similar to playing with a doll, as well as a fantasy of survival and escape from the life of violence, female oppression, and economic poverty that they experienced in their parents’ home. All of the interviewees who pinned their hopes on their future weddings described at length the breakdown of this hope and the violence against them that was perpetrated by their husbands and their extended families. The interviewees described a sudden transition from having an identity as a girl to that of a woman and mother who was expected to have sex and to devote themselves to having children without any previous preparation. Life as a married woman and mother was described in harsh terms of oppression, isolation, and separation from their previous world (their family of origin) and their social world (i.e., they were prevented from leaving the house of their husbands and their extended families).

While all the interviewees described a position of structural vulnerability, their objections to this vulnerability were expressed mainly through “internal conversations” (Archer, 2003), that is, in conversations that these girls had within themselves about the social and personal pain they were experiencing. This vulnerability was also expressed in the real risks of disclosing this pain to significant others. One dramatic expression of this structural vulnerability was the mention in all of the interviews of suicide as a “logical” life option and a history of multiple suicide attempts. Some of the interviewees explained that these suicide attempts were an expression of routine resistance to the social hierarchic order.

Implications for Global Mental Health

The results of this study pose challenges to GMH interventions that are based on the desire of various social actors (WHO; philanthropists; social activists; local and international NGOs) to make access to health care a basic human right, in particular among subaltern populations living under geographical and social alienation, such as the Bedouin in Israel. Thus, one of the stated goals of GMH interventions is to reduce structural inequalities in relation to health. Equipping subaltern populations with knowledge, resources, and medical facilities in the local community are some of the practices needed to achieve this goal. At the same time, as this case study of child marriage suggests, achieving these objectives may require stepping back from universal biomedical epistemologies to develop a complex understanding of local and traditional epistemologies.

As their accounts suggest, the local epistemologies by which the women in our study live are related to traditional structures of patriarchy: moral regulation of women, femininity, and the female body (modest dress, virginity, emphasis on the use of the female body for reproductive purposes); the rapid transition from being controlled by the biological family to being controlled by her husband's family; and the direct transition from childhood to adulthood without the bridge of adolescence. In Western social-cultural norms, adolescence is a liminal period that allows for a moratorium and gives structural legitimacy to the search for identity and accumulation of experiences before the consolidation of an adolescent identity (Erikson, 1968). In the Bedouin context, adolescent experience is shaped by multiple cultural values and institutions: the management of everyday life through religion and religiosity; the social expectation that young women conceal the characteristics of coupledom and intimacy and refrain from reporting it to the biological family, friendships, and authorities outside the family (such as doctors or religious leaders); and the absence of a cultural system that defines and encourages individual human rights. In this context, a study by Merry (2003), which dealt with women who experienced domestic violence, found that a change in women's consciousness of human rights occurred when the women redefined the act of violence as a modifiable behavior. Her research also shows how cultures and groups that expose subaltern women to rights consciousness, through knowledge of rights and through experiences that exercise rights, encourage critical thinking (which includes a broad systemic-political understanding) toward oppressive cultural conditions, identifying life experiences as abusive while reducing self-blame, locating sources of help, and claiming for changes.

The traditional structures of patriarchy of the Bedouin society in Israel reveal the many structural vulnerabilities that characterize the women in our study and need to be addressed by parties seeking to offer intervention. As Levitt and Merry's (2009) study of local uses of global women's rights in Peru, China, India, and the United States indicates, vernacularization practices (e.g., finding local language to express personal and social vulnerabilities) are extremely important for addressing structural inequalities in health care. Similarly, our research points to the need for the culturally sensitive application of global health ideas (which involve “top-down” applications of Western biomedical knowledge or psychiatric nosology), paying attention to frictions between cultural encounters, alongside local ways of addressing complex cultural and personal phenomena such as underage marriage in Bedouin society in Israel. Culturally sensitive interventions that aim to convey information and support people within the community to seek avenues of change may begin with presenting findings concerning the negative consequences of marriage at an early age to authorities in the Bedouin community such as religious leaders, teachers, doctors, and nurses who have the mandate to support the health of their community. These authority figures may then be able to culturally mediate changes in the experiences of girls marrying at an early age with their family members. Further, it is possible that community interventions, such as encounters with members of different populations in Bedouin society (including boys and men), based on developing and expressing social solidarity with young women, may also provide a culturally sensitive local approach. Certainly, the development of culturally sensitive interventions that address child marriage necessitates a complex approach that includes reflexivity concerning the relationship between local and global knowledge as advocated in recent writing on the challenges facing Global Mental Health interventions (Bemme & Kirmayer, 2020; Kirmayer & Pedersen, 2014; Lovell et al., 2019).

Limitations and suggestions for future research

This article is based on interviews with 17 young Bedouin women. The small number of interviewees is related to the difficulty of recruiting interviewees to discuss the sensitive issue of child marriage. It is important to interview more women in the future as well as others among additional cultural-religious groups. A second limitation is related to the use of snowball sampling started with just one social worker, which may have resulted in a biased sample. In future studies, we propose to expand the sources of recruitment for a larger, representative sample and also to interview Bedouin men, parents, religious authorities in the community, and social workers to better understand the cultural meaning and social dynamics of underage marriage in Bedouin society. Finally, this study, which was focused on the experience of young women, did not address their suggestions, and those of other group members (men, parents, religious figures, social workers, teachers) in the community, about culturally sensitive solutions. This emic perspective is essential to determine whether Western interventions suit the cultural-local contexts of Bedouin society in Israel and develop culturally grounded approaches to address the mental health needs of girls and young women.

Conclusion

These accounts of underage marriage in Bedouin society presented in this study reveal it as a deeply rooted cultural-religious practice that poses challenges to GMH interventions founded on Western norms (Kirmayer & Pedersen, 2014). Addressing this challenge requires incorporating complexity on local and global levels to develop culturally sensitive interventions that take into account both the key players in the community and the voices of the women themselves.

Participants’ depictions of child marriage reveal the structural vulnerability of the women in our study that arises from the patriarchal social order, which they experienced as personal and gender oppression. Their vulnerability was also experienced through the rapid transition from childhood to womanhood. Furthermore, the descriptions reveal the emotions and emotional experiences that appear with structural vulnerability: helplessness, anger toward parents, loneliness, the experience of relinquishing a previous life, and separation from family members.

These vulnerabilities in women's health status are the targets of various social agencies involved in GMH, which are committed to exposing social inequalities that impact health and addressing the lack of knowledge and community access to health services (Kirmayer & Pedersen, 2014). Furthermore, these vulnerabilities raise the importance of the ongoing dialogue about human rights, and women's rights in particular, in subaltern populations (Levitt & Merry, 2009).

These descriptions also reveal additional characteristics of the vulnerabilities experienced by the women in our study: lack of knowledge about the physical changes throughout pregnancy, the fear of physical changes, experiences of physical pain and emotional suffering, the pressure exerted by the husband regarding the changes during pregnancy due to his lack of knowledge, woman's lack of knowledge about child feeding, and lack of support and advice from significant others or professionals in the medical field. These vulnerabilities should be considered by GMH practitioners and require developing culturally sensitive interventions. Furthermore, these reports not only describe the biomedical sources of pain, suffering, and ill health, but also their social, cultural, and political sources and the dialectic between structure and agency in relation to their health (Williams, 2003). Addressing this intersection of structural and meaning-centered issues requires interaction with local cultural and religious institutions (Lovell et al., 2019).

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article

ORCID iD

Iris Manor Binyamini

Notes

Iris Manor Binyamini is an associate professor (Visiting) at the Faculty of Medicine, Technion, Israel. Her research sits at the intersection between culture and disability and illness, studying both Western and non-Western cultural contexts. Her main academic interests are: coping of parents and siblings of children with disabilities and illness in different culture groups, patient (children and family) experiences, and collaboration between interprofessional teams and family and parents in support services.

Avihu Shoshana is a professor in the Faculty of Education at the University of Haifa, Israel. His research deals with the link between culture, emotions, and the self-concept, that is, the diverse ways in which cultures and social locations within them influence the personal self, emotions, social identities, and life trajectories. His main academic interests are psychological anthropology; psychology of class, ethnicity and race; everyday racism and microaggression; anthropology of education; and everyday inequalities.

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