A/HRC/45/CRP.3 140. Food scarcity has a disproportionately adverse impact on women because gender constructs in household and social relationships incline women to prioritise feeding their children and the men over themselves, thereby exacerbating their own malnutrition. Societally, women and girls in South Sudan are primarily responsible for the organisation of food and the preparation of the meals. One study found that women and girls were more likely than men and boys to eat less food.283 Women also report suffering from depression as a result of being unable to care for their children and assure their health. In instances where there is not enough food for the household, women have been blamed and physically assaulted by their spouses for not serving meals, thus the stresses of food insecurity also fuel conflicts within the household, triggering domestic violence.284 Furthermore, food insecurity puts women at risk of turning to transactional sex in exchange for food or money,285 which has the additional effect of increasing their risk of being exposed to sexually transmitted diseases including HIV/Aids. 141. Early marriage has increased in South Sudan during the conflict, not only because families seek security and protection for their girl children, but also for economic reasons as girls’ families are able to obtain a bride price, and the girls then go to live with the husband’s family.286 Women with husbands have explained to the Commission how, when faced with acute food insecurity, the patriarchs of the family expect their young daughters to marry early in exchange for cattle, often with the threat or use of force.287 Early marriage is in violation of the right of health as it places young girls at greater risk of death or ill-health as a result of early pregnancy and childbirth. Their children also face significantly higher perinatal infant mortality and morbidity rates.288 More generally, security and structural barriers impede women’s access to maternal healthcare services. While some reasons are directly linked to the conflict, relating mainly to security concerns, others are structural and relate to the availability and quality of care provided, and associated costs, especially in public health facilities. Traditional social norms also contribute to some women being hesitant to seek pregnancy related health care. 289 142. Undernutrition often begins in utero and continues through childhood and adolescence into adulthood. The pernicious effects of malnutrition can also be 283 Adolescent Girls in Crisis: Voices from South Sudan, PLAN INTERNATIONAL, 2018, available at https://plan-uk.org/file/planuk-voices-from-south-sudan-reportpdf/download?token=D7xsjaUV. 284 Catherine Huser, Conflict and Gender Study – South Sudan: Addressing Root Causes Programme, AGENCY FOR COOPERATION AND RESEARCH IN DEVELOPMENT, January 2018; Nimule Conflict and Leadership Mapping Report, Together We Can: Supporting Local Peace Efforts in Nimule, SEARCH FOR COMMON GROUND, November 2016. 285 No Safe Place: A Lifetime of Violence for Conflict Affected Women and Girls in South Sudan, Main Results Report, THE GEORGE WASHINGTON UNIVERSITY, GLOBAL WOMEN’S INSTITUTE, 2017. 286 Adolescent Girls in Crisis: Voices from South Sudan, PLAN INTERNATIONAL, 2018, available at https://plan-uk.org/file/planuk-voices-from-south-sudan-reportpdf/download?token=D7xsjaUV. 287 ERN 103674 – 103679, para. 5. 288 See, e.g., Talking points: Child marriage and maternal and child health, GIRLS NOT BRIDES: THE GLOBAL PARTNERSHIP TO END CHILD MARRIAGE, internal citations omitted, available at https://www.girlsnotbrides.org/wp-content/uploads/2014/04/Childmarriage-and-maternal-health-Girls-Not-Brides-Updated-27-May-2013.pdf. 289 “This old Man Can Feed Us, You will Marry Him”: Child and Forced Marriage in South Sudan, HUMAN RIGHTS WATCH, March 2013, available at https://www.hrw.org/sites/default/files/reports/southSudan0313_forinsertWebVersion_0.pdf; NS Mugo et al., “The system here isn’t on patient’s side” - perspectives of women and men on the barriers to accessing and utilizing maternal healthcare services on South Sudan, BMC HEALTH SERVICES RESEARCH, 2018, 18:10, available at https://www.ncbi.nlm.nih.gov/pubmed/29316933; S. Gee et al., “We need good nutrition but we have no money to buy food”: sociocultural context, care experiences, and newborn health in two UNHCR-supported camps in South Sudan, BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS, 2018, 18:40, available at https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-018-0181-3; S. Kane et al., Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan, REPRODUCTIVE HEALTH, 2018, 15:51, available at https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0487-6; G. Vincent and F.M. Alemu, Factors contributing to, and effects of, teenage pregnancy in Juba, SOUTH SUDAN MEDICAL JOURNAL, Vol. 9, No. 2. May 2016, pp. 28-31, available at http://www.southsudanmedicaljournal.com/archive/may-2016/factors-contributing-to-and-effectsof-teenage-pregnancy-in-juba.html. 35