Bringing an end to the silence: identifying priorities and solutions to addressing the mental health consequences of child marriage

Despite its inclusion in Sustainable Development Goal 5 to end all harmful gendered practices by 2030, child, early and forced marriages continue to be a pervasive problem globally. While there is consistent evidence on the physical health consequences of child marriage, there is a lack of evidence and inquiry into the mental health consequence. We completed a change-oriented Delphi study to establish consensus on priority areas of research and intervention in relation to the mental health consequences of child, early and forced marriages. Invited experts (n = 11), survivors (n = 27) and professionals (n = 30) participated in our Delphi. Four rounds of data collection included: a blended in-person and online workshop with invited experts, an online mixed-methods questionnaire, focus groups in Zimbabwe with women who are survivors of child marriage and a repeat questionnaire sent to the first round of experts. Quantitative data were analysed using descriptive statistics and ranking methods, consistent with other Delphi studies. Qualitative data were analysed using thematic network analysis. Findings coalesced around three areas: perspectives on the relationship between mental health and child marriage, policy actions and treatment-driven solutions. Consensus was reached on 16 items across these areas which included the need to prioritize psychosocial and social interventions to improve mental health outcomes for women and girls in existing marriages. They also called for new approaches to advocacy to drive awareness of this issue in policy circles. Implications for future practice are discussed

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning.

PURPOSE: Calls for "mutuality" in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. METHODS: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. RESULTS: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators' needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. CONCLUSION: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept

Decolonising the ‘safe space’ as an African innovation: The Nhanga as quiet activism to improve women’s health and wellbeing

Contemporary power and decolonisation discourses reflect how Eurocentric and Western analysis has shaped our understandings of the world. Decolonisation efforts within Global Health and feminist studies (including what counts as valid forms of women’s organising) also require a reclaiming of praxis developed within historically oppressed countries lost through erasures of knowledge-production. Our work contributes to these efforts through an analysis of a form of collective activism for women’s health and development in Zimbabwe: the Nhanga. This traditional cultural practice is anchored to intergenerational women only ‘safe spaces’, a praxis pre-dating second-wave feminist theorising on such ideas. Currently, Nhangas are used by the Rozaria Memorial Trust across community, national and global advocacy spaces to promote women’s health. Using collaborative autoethnography, each author’s personal accounts of engagement in the Nhanga interrogate the processes that promote change in women’s lives. Our analysis suggests that the Nhanga fractures systemic, institutional and relational power through leveraging culture, emotions and narrative, in spaces where such dynamics are often overlooked. We conclude that the method offers a valuable form of collective organising: fully engaging with the complex relational, political, social, and cultural environments that impact on health, through a quiet activism anchored to emotion, connection, and re-imagining of culture to promote change at individual, community, and global levels