A/HRC/41/19 and Sri Lanka in order to access State subsidies for marrying and starting a family. A survey conducted by the United Nations Children’s Fund (UNICEF) in Yemen indicated that the high rate of child marriage among the internally displaced population was driven by the loss of property and homes and the worsening of living conditions, as many people could no longer afford adequate housing and food.16 IV. Consequences of child, early and forced marriage in humanitarian settings 16. Child, early and forced marriage is associated with a wide range of consequences, which were also addressed in the previous report (A/HRC/26/22, paras. 21–24). Women and girls living their entire lives in contexts of heightened risk and in humanitarian settings experience limited access to services and information, increased potential exposure to sexually transmitted infections, unintended pregnancies, unsafe abortions, a heightened risk of maternal mortality and morbidity and the risk of gender-based violence (A/HRC/39/26, para. 30). 17. Girls who are subjected to child marriage are often less able to make important decisions about their sexual and reproductive health, such as negotiating safe sex and contraceptive practices, or to access services. The Center for Reproductive Rights noted in its submission that this may be because of uneven power dynamics within their relationships or a lack of knowledge and information or laws, or it may be because of policies and practices that otherwise limit the decision-making power of adolescents. Among the countries with the 30 highest rates of child marriage, more than half are in a situation of conflict.17 18. The disintegration of health infrastructure can have critical impacts on the sexual and reproductive health and rights of girls and women. In countries designated as fragile States, the estimated lifetime risk of maternal mortality is 1 in 54, compared with a 1 in 180 lifetime risk globally. Every day, around 500 women and girls die from complications due to pregnancy and childbirth in countries in humanitarian and fragile situations.18 What is more, adolescents who have been married are more at risk of pregnancy-related injuries such as obstetric fistula, intimate partner violence and sexually transmitted infections, including HIV. 19. In crisis settings, child, early and forced marriage increases the likelihood of dropping out of school. Whereas adolescent boys may drop out of school to find work, the lack of economic opportunities for adolescent girls makes them more reliant on men, which can make it more likely that they will experience early pregnancy and early marriage.19 For instance, 65 per cent of the children who dropped out of school following the 2015 earthquakes in Nepal were girls, and respondents to a survey stated that early marriage was the primary reason for dropping out.20 According to the Global Coalition to Protect Education from Attack, girls and women in at least 18 countries have been targeted because armed groups were opposed to them getting an education. 20. Child, early and forced marriage can result in situations that meet the international legal definition of slavery. The practices concerned include servile marriage, sexual slavery, human trafficking and forced labour (A/HRC/26/22, para. 21), and can give rise to activities by organized crime groups. In a report on conflict-related sexual violence, the Secretary-General noted that, in countries such as the Central African Republic, Mali, 16 17 18 19 20 6 United Nations Children’s Fund (UNICEF) and Youth Leadership Development Foundation, “Tadhafur program for safe age of marriage: child marriage survey”, May 2017. See Inter-Agency Working Group on Reproductive Health in Crises, Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings (2017). UNFPA, “Humanitarian action 2019 overview”, p. 3. Global Coalition to Protect Education from Attack, Education under Attack 2018 (Education Above All and Columbia University, 2018). See the work of the Commonwealth Initiative for Freedom of Religion and Belief, and the Girls Not Brides submission.