ABUJA, Nigeria — At age 14, Amina should have been in school. Instead she became a bride, and six years later, living in abject poverty, she still endures the painful aftermath of the prolonged labor that led to the death of her baby during childbirth.

In the rural Hausa tradition in northern Nigeria, it is expected that women give birth at home. Any woman who cries out while in labor is presumed to be weak. But when Amina’s situation got worse, she had to be rushed by her siblings to the hospital. By the time she got there she had lost her baby.

The prolonged obstructed labor left Amina with a fistula, which causes a constant leaking of urine and/or feces through the vagina. “I had a stillbirth, and developed fistula at the same time,” said Amina, who lives in Borno State. “It still makes me angry.” But Amina is not alone in her suffering.

“Obstetric fistula is common among teenage girls and occurs mostly to those without mature enough pelvises to allow the delivery of a child,” says Walter Ebam, a medical doctor who spent nearly two years treating fistula patients in the northern Nigeria town of Keffi. “It is a hole between the birth canal and the bladder or rectum, or both, caused by prolonged labor without prompt medical intervention, which eventually leaves victims with a life of misery.”

Nigeria has the highest prevalence of obstetric fistula in the world, with between 400,000 and 800,000 women living with the problem and about 20,000 new cases each year. Ninety percent are untreated. This implies that about 55 women are afflicted by obstetric fistula every day.

The problem is made worse by adolescent pregnancy resulting from child marriage. A recent report by the United Nations Population Fund says girls who become pregnant before age 15 in low- and middle-income countries have double the risk of maternal death and obstetric fistula compared to older women.

In the same vein, a significant proportion of adolescent pregnancies result from non-consensual sex, and most take place in the context of early marriage, according to the U.N. report.

Child marriage is common in the northern part of Nigeria. Those who practice or support it believe that when a girl is married off early, she does not have the opportunity to become promiscuous. Many in the region believe that it is permissible for a man to marry a child as young as the age of 11 as long as he does not have sexual relations with her until she has attained puberty. But in most cases, this is not adhered to and the child brides are involved in sexual intercourse with their spouses soon after marriage, sometimes as a result of intense pressure from their husbands and in-laws to prove their fertility.

According to the UNFPA 84 percent of first births to adolescent girls in Nigeria occur within marriage. Indeed, among married girls aged 15–19, 62 percent have already given birth, and almost one out of four married girls gave birth before the age of 15.

Many girls are married without their free and full consent. By international conventions, 18 years has been established as the legal age of consent to marriage. If the timing of marriage does not change, over 100 million girls will be married as children in the next 10 years.

The Nigerian government made child marriage illegal in 2003, but figures from the organization Girls Not Brides indicate that 17 percent of girls in the country are married off before their 15th birthday. In the northwest region, the figure is as high as 76 percent.

The Child Rights Act of 2003 does set the national legal minimum age of marriage at 18. However, the federal law may be implemented differently at the state level, and to date, only 23 of the country’s 36 states have begun developing provisions to execute the law.

Attempts to make child marriage illegal have come under severe criticism from parliamentarians in northern Nigeria, who say it contravenes cultural and religious norms of people in the region. Indeed, teenage marriage is common among Nigerian politicians.

The issues became a huge talking point in the country two years ago after senators failed to amend a controversial part of the constitution that defines adulthood for girls.

Ahmed Yerima, senate representative for Zamfara West in northern Nigeria, who made headlines back in 2010 when he married a 13-year-old Egyptian girl, persuaded his northern colleagues to defeat a motion that would have removed a clause in the constitution that can be interpreted to mean girls under the age of 18 are to be considered adults as soon as they get married. In an interview on Nigeria’s Channels TV, Yerima argued that Islamic law allows that once a girl reaches the age of puberty and is assumed by her parents to be mature, she can be given out in marriage.

But while many child brides—who themselves are uncomfortable with early marriage—have found ways of escaping from their matrimonial homes, others have taken the law into their own hands and are facing justice as a result.

For example: Maimuna Abdulmunini was arrested in 2007 when she was just 13, and charged in court for burning her 35-year-old husband to death. Five years later, at the age of 18, Abdulmunini was convicted of murder and sentenced to death. Last year, a court ruled that the sentence is a violation of her rights. But nothing has changed. She still waits on death row.

Wasila Tasi’u, 14, admitted to killing her 35-year-old husband, Umar Sani, last year, after a forced marriage. Just like Abdulmunini, she was charged for murder, and prosecutors sought the death penalty.

According to police, Tasi'u confessed to putting rat poison in food that she prepared for a party two weeks after her April 2013 wedding in Unguwar Yansoro, a remote village close to Nigeria’s second-largest city, Kano.

Soon after she was arrested, The Guardian reported Tasi’u told her lawyer Hussaina Ibrahim that she had been tied to the bed and raped by Sani on their wedding night. When she appeared in Gezawa high court for the first time back in the autumn, she could barely say her own name, turning her back to the court when the charges were read, breaking down in tears.

Fortunately for Tasi'u, pressure from human rights groups who argued that she was a minor in need of rehabilitation and could not be charged as an adult with murder forced state prosecutors to withdraw charges against her.

These developments explain the difficulties girls pass through in northern Nigeria. In a region where more than 200 schoolgirls were kidnapped from their dormitory a year ago, and over 90 percent of female children lack secondary education, being a girl comes with huge challenges.

To make matters worse, many women with obstetric fistula are regarded as social outcasts and marriages have been dissolved as a result.

“I can’t imagine the pain and stigma these girls go through,” says Musa, a commercial tricycle rider in Maiduguri who has transported many victims to hospitals. “It is really unfortunate that our culture has failed them.”