Association of child marriage with suicidal thoughts and attempts among adolescent girls in Ethiopia

Child marriage and well-being in Central and Western Africa: A scoping review of costs and potential benefits for girls

INTRODUCTION

Child marriage is practiced widely in West and Central Africa with established links to several negative outcomes, particularly for girls. Although some reviews on predictors of the practice of child marriage exist, to date no review has focused on the costs and potential benefits to girls who have experienced child marriage.

METHOD

We conducted a scoping review of PubMed, African Index Medicus, Embase, PsycINFO, Web of Science, and Global Health and in the grey literature for studies on child marriage and adjustment up to October 2023. Studies were included if they assessed marriages where the female was younger than 18 at the time of marriage, were conducted in Central and Western African countries, explored positive and/or negative indicators of well-being and mental health in the context of child marriage, were written in English, were published in a peer-reviewed journal, or was a published thesis or dissertation, grey literature, or technical report, were conducted between 2014 and 2023, and presented qualitative, quantitative, or mixed-method data.

RESULTS

Based on the inclusion criteria, we included nine qualitative and four quantitative studies. Using the lens of Self-Determination Theory, we found that overall child marriage compromised needs for autonomy, competence, and relatedness. Further, child marriage was linked to negative mental health outcomes. However, for some girls, child marriage was associated with some benefits including social recognition and elevated status in society.

CONCLUSION

Future research on adjustment within the context of child marriage should focus on all aspects of well-being as well as the processes associated with adjustment for girls.

Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019

BACKGROUND

Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka.

METHODS

In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors.

RESULTS

The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV.

CONCLUSIONS

IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

Depression among currently married ever pregnant adolescents in Uttar Pradesh and Bihar: Evidence from understanding the lives of adolescents and young adults (UDAYA) survey, India

Background

Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar.

Methods

This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied.

Results

Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression.

Conclusions

This study confirms the pre-existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers.

Lived experiences of pregnant and parenting adolescents in Africa: A scoping review

BACKGROUND

Previous studies have not synthesized existing literature on the lived experiences of pregnant and parenting adolescents (aged 10-19) in Africa. Such evidence synthesis is needed to inform policies, programs, and future research to improve the well-being of the millions of pregnant or parenting adolescents in the region. Our study fills this gap by reviewing the literature on pregnant and parenting adolescents in Africa. We mapped existing research in terms of their substantive focus, and geographical distribution. We synthesized these studies based on thematic focus and identified gaps for future research.

METHODS

We used a three-step search strategy to find articles, theses, and technical reports reporting primary research published in English between January 2000 and June 2021 in PubMed, Jstor, AJOL, EBSCO Host, and Google Scholar. Three researchers screened all articles, including titles, abstracts, and full text, for eligibility. Relevant data were extracted using a template designed for the study. Overall, 116 studies met the inclusion criteria and were included in the study. Data were analyzed using descriptive and thematic analyses.

RESULTS

Research on pregnant and parenting adolescents is limited in volume and skewed to a few countries, with two-fifths of papers focusing on South Africa (41.4%). Most of the studies were African-led (81.9%), received no funding (60.3%), adopted qualitative designs (58.6%), and were published between 2016 and 2021 (48.3%). The studies highlighted how pregnancy initiates a cycle of social exclusion of girls with grave implications for their physical and mental health and social and economic well-being. Only 4.3% of the studies described an intervention. None of these studies employed a robust research design (e.g., randomized controlled trial) to assess the intervention's effectiveness. Adolescent mothers' experiences (26.7%) and their education (36.2%) were the most studied topics, while repeat pregnancy received the least research attention.

CONCLUSION

Research on issues affecting pregnant and parenting adolescents is still limited in scope and skewed geographically despite the large burden of adolescent childbearing in many African countries. While studies have documented how early pregnancy could result in girls' social and educational exclusion, few interventions to support pregnant and parenting adolescents exist. Further research to address these gaps is warranted.

Incidence of child marriage among refugees and internally displaced persons in the Middle East and South Asia: evidence from six cross-sectional surveys

OBJECTIVE

To examine incidence of child marriage among displaced and host populations in humanitarian settings.

DESIGN

Cross-sectional surveys.

SETTING

Data were collected in Djibouti, Yemen, Lebanon and Iraq in the Middle East and in Bangladesh and Nepal in South Asia.

PARTICIPANTS

Adolescent girls aged 10-19 in the six settings and age cohort comparators.

OUTCOME MEASURES

Cumulative incidence of marriage by age 18.

RESULTS

In Bangladesh and Iraq, the hazard of child marriage did not differ between internally displaced populations (IDPs) and hosts (p value=0.25 and 0.081, respectively). In Yemen, IDPs had a higher hazard of child marriage compared with hosts (p value<0.001). In Djibouti, refugees had a lower hazard of child marriage compared with hosts (p value<0.001). In pooled data, the average hazard of child marriage was significantly higher among displaced compared with host populations (adjusted HR (aHR) 1.3; 95% CI 1.04 to 1.61).In age cohort comparisons, there was no significant difference between child marriage hazard across age cohorts in Bangladesh (p value=0.446), while in Lebanon and Nepal, younger cohorts were less likely to transition to child marriage compared with older comparators (p value<0.001). Only in Yemen were younger cohorts more likely to transition to child marriage, indicating an increase in child marriage rates after conflict (p value=0.034). Pooled data showed a downward trend, where younger age cohorts had, on average, a lower hazard of child marriage compared with older cohorts (aHR 0.36; 95% CI 0.29 to 0.4).

CONCLUSIONS

We did not find conclusive evidence that humanitarian crises are associated with universal increases in child marriage rates. Our findings indicate that decision-making about investments in child marriage prevention and response must be attuned to the local context and grounded in data on past and current trends in child marriage among communities impacted by crisis.

Child marriage and the mental health of adolescent girls: a longitudinal cohort study from Uttar Pradesh and Bihar, India

Background

There has been much speculation about the role of inequitable gender norms and early marriage in mental health and suicide risks in girls and young women, but no prospective study has yet investigated this relationship. Understanding these links has become particularly important in the context of the COVID-19 pandemic which has led to increased risk of child marriage in the most vulnerable girls.

Methods

We examined the association between early marriage and mental health in girls using data from Understanding the Lives of Adolescents and Young Adults (UDAYA), a longitudinal study in adolescents in Uttar Pradesh and Bihar, India. The study included girls who were unmarried at wave 1 (2015-2016) and participated at wave 2 data collection (2018-2019). Information on mental health (Patient Health Questionnaire-9 (PHQ-9)), suicidal thoughts, plans and attempts were collected at both waves. Logistic regression with survey weights was used to estimate the association between marrying between the two waves and mental health.

Findings

Between waves 1 and 2, 1825 (23%) participants (n = 7864) married. Unmarried girls with depressive symptoms (PHQ score≥9) at wave 1 had greater odds of transitioning into marriage by wave 2 than those without (adjusted-OR 1.5; 95% CI 1.1 to 2.0). The odds of wave 2 depressive symptoms were higher in newly married vs unmarried girls (adjusted-OR 2.0; 95% CI 1.6-2.5). Among newly married girls, the odds of depressive symptoms were higher for those who experienced any abuse than those who did not (adjusted-OR 1.6; 95% CI 1.2-2.2). This effect was larger for girls who had not given birth (adjusted-OR 2.2; 95% CI 1.4-3.3).

Interpretation

Our findings show poor mental health preceded and was a consequence of child marriage. Mental health should be considered in policies and programming aimed at reducing early marriage; equally the mental health of young brides should be a focus for community and maternal health services.

Funding

Bill and Melinda Gates Foundation and David and Lucile Packard Foundation.

Girl child marriage and the social context of displacement: a qualitative comparative exploration of Syrian refugees in Jordan and Rohingya refugees in Bangladesh

BACKGROUND

There is growing global evidence that girl child marriage (CM) increases during humanitarian crises. Norms, attitudes, and policies that sustain CM are deeply entrenched within families and communities, and may be further exacerbated by conflict and displacement. The purpose of this study is to understand how the social and normative environment influences attitudes and practices related to CM in two diverse humanitarian settings.

METHODS

We held a total of eight focus group discussions, four in each country, with Syrian refugees in Jordan and Rohingya Refugees in Bangladesh. FGDs were conducted with fathers, mothers, and adolescent boys and girls.

RESULTS

Similar themes emerged from both settings. Participants discussed a desire to hold onto tradition in displacement and how norms are reinforced across generations. Social influence emerged in positive and negative ways, including peer pressure and conformity and the positive influence of host communities. In both settings, girls themselves described having little agency. Participants described resistance to change, which was exacerbated by conflict and displacement, though they discussed how social influence could be an effective way to challenge existing norms that drive the practice of girl child marriage.

CONCLUSIONS

Our findings represent a more robust understanding of how norms operate within the social ecological system, and how they are reinforced across social relationships, offering an opportunity to more effectively challenge norms that sustain the practice of girl child marriage.

Determinants of early marriage among married women in nine high fertility sub-Saharan African countries: a multilevel analysis of recent demographic and health surveys

BACKGROUND

Early marriage is global issue that seriously harms women's personal development and rights. Regarding this, information about married women's early marriage is inadequate in the world, including sub-Saharan Africa; therefore, this study aimed to assess the early marriage of women in the top nine highly fertile SSA countries.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 121,077 married reproductive-age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of early marriage. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.

RESULTS

Overall prevalence of early marriage was 55.11% (95% CI: 54.8, 55.4) and ranged from 28.11% in Burundi to 80.77% in Niger. The factors significantly associated with early marriage were women's educational status; primary education (AOR = 0.39; 95% CI: 0.38, 0.41), secondary and higher (AOR = 0.1; 95% CI: 0.09, 0.11), employed (AOR = 0.73; 95% CI: 0.71, 0 .75), classified as rich wealth index level (AOR = 0.87; 95% CI: 0.85, 0.91), a number of family size ≥ 7 (AOR = 1.28; 95% CI: 1.23, 1.33), community-level poverty, (AOR = 1.28; 95% CI: 1.23, 1.33) and rural residency (AOR = 1.16;95% CI: 1.12, 1.21).

CONCLUSION

Marriage before the age of 18 is moderately high in high-fertility countries. Therefore, the respective countries government should give due attention to access to education, and encourage the participation of women in making marriage-related decisions, especially those residing in rural areas.

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

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.

Direct and indirect factors associated with child marriage: Evidence from India using NFHS-4 data

BACKGROUND

Child marriage is a breach of the basic fundamental rights of a child and is a major concern for policy makers in many countries.

OBJECTIVE

The present study intended to identify the direct and indirect socio-demographic factors associated with child marriage among 15-17 years old girls in India.

PARTICIPANTS AND SETTING

The study used National Family Health Survey-4 data. The sample comprised of 1459 married girls and an equal number of unmarried girls aged 15-17 years at the time of the survey.

METHODS

Multivariable logistic regression was performed to identify the factors associated with child marriage. A hypothetical path model was constructed and tested. The path models were refitted after removing the insignificant path coefficients, and finally, the significance of direct as well as indirect effects were obtained.

RESULTS

Path analysis revealed that mother's education was the only factor that had both significant direct and indirect effects on child marriage (p < 0.001). Religion had only significant indirect effect (p = 0.047) through girls' education. Besides mother's education, the factors that showed significant direct effects on child marriage were wealth index (p = 0.012), caste (p = 0.009) and education of the girl (p = 0.009).

CONCLUSIONS

Education of both mothers and the girls, wealth index and caste had significant direct effects on child marriage whereas significant indirect effect was exerted by mothers' education and religion. Therefore, these factors should be given primary focus while formulating strategies to curb child marriage in countries like India.

Effect of Rural-Urban Migration on Age at Marriage Among Adolescent Girls in Bangladesh

Objectives

Bangladesh reports one of the highest rates of child marriage (CM) (59%) in the world and the highest rate within South Asia. Age at marriage of girls is a critical human rights and developmental issue in Bangladesh. Migration has been documented to be positively associated with age at marriage. Bangladesh experiences one of the highest rates of rural to urban migration in the world. An increase in rural-urban migration of adolescent girls has been observed over the last few decades in Bangladesh with the expansion of employment opportunities particularly in the ready-made garment industry (RMG). This analysis explores the effect of migration on age at marriage and CM among adolescent girls living in urban slums of Dhaka.

Methods

The sample was selected from icddr,b's Urban Health and Demographic Surveillance System (UHDSS) and comprises of never-married adolescent girls aged 15–19, who migrated in from rural Bangladesh to slums in and around Dhaka during 2015–2019. These in-migrants were matched with their rural counterparts from icddr,b's Matlab HDSS (MHDSS), using one to one nearest neighbor matching with caliper 0.1 using propensity score matching (PSM) method. The sample derived included a total of 2,700 never-married adolescent girls from Dhaka and Matlab. The association between migration and age at first marriage was estimated using a linear regression model and the effect of migration on CM was explored using logistic regression analyses.

Results

The in-migrants perfectly matched with their rural peers in terms of age, household wealth and religion. However, their income earning status was hugely different. Urban migrants had significantly higher age at marriage than the rural non-migrants for both 15–19 (Coefficient, 1.77; 95% CI, 1.07–2.46) and 20–24 years age group (Coefficient, 2.87; 95% CI, 2.18–3.55). The migrant girls aged 20–24 years were 71% (aOR, 0.29; 95% CI, 0.12–0.69) less likely to get married before CM age bar in Bangladesh compared to their rural counterparts.

Conclusion

Migration has a positive effect on delaying marriage and reducing CM among adolescent girls. Findings from this study suggest that CM can be reduced by creating educational and economic opportunities for females.

Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa

BACKGROUND

Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa.

METHODS

We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval.

RESULTS

Young women who experienced child marriage were less likely to have  ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors.

CONCLUSION

Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.

Child Marriage or Statutory Rape? A Comparison of Law and Practice Across the United States

PURPOSE

In many U.S. states, children can legally marry at an earlier age than they can legally consent to sex, leading to situations in which sex between spouses may be a criminal act. Some states exempt sex between married persons from their definition of statutory rape, which may create perverse incentives for child marriage. We estimated the number of child marriages that violated statutory rape laws across the United States since January 1, 2000.

METHODS

We created a longitudinal database of statutory rape laws in place from 2000 to 2020 in each state. Using data from marriage certificates filed in 44 states and Washington, DC, we compared the age of married spouses with the text of state-specific statutory rape laws in place at the time the marriages occurred.

RESULTS

Child marriages violated statutory rape laws in 14 states. The proportion of child marriages that violated statutory rape laws varied from 1% to over 50%. In 33 states, some or all statutory rape laws exempted sex between married couples from the definition of crimes. In these states, the proportion of child marriages that would have been crimes, without these exemptions, varied from less than 1% to over 80%.

CONCLUSIONS

Our results highlight the blurred legal and conceptual boundaries between child marriage and sexual violence. The simultaneous legality of child marriage and marital exemptions to statutory rape laws provide legal loopholes for sexual acts with children that would otherwise be considered crimes. Marital exemptions to statutory rape laws may also incentivize a substantial portion of child marriages.

Parental education and youth suicidal behaviours: a systematic review and meta-analysis

AIMS

Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations.

METHODS

We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity.

RESULTS

We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08).

CONCLUSIONS

The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.

Adolescent marriage and motherhood in Turkey: A qualitative study exploring determinants, impacts and opinions about preventive strategies

AIM

This study aimed to understand the determinants of child marriages, becoming a child mother, their impacts and opinions about preventive strategies.

DESIGN

The phenomenological research approach was adopted with one-to-one semi-structured interviews between December 2017 and May 2018.

METHODS

The population of the study consisted of 36 adolescent married mothers registered in the Family Health Centres. Interviews were recorded, transcribed and evaluated based on a thematic analysis was conducted.

RESULTS

In the study, four main themes and 12 subthemes were determined. Adolescent marriages determinants occurred as patriarchal cultural norms, the perception that girls would be safe under the protection of another man, and poverty. Adolescent brides experienced partner violence and were subjected to physical, psychological and sexual violence in their marriage. Adolescent mothers had low maternal self-confidence, childcare challenges and were late to take on childcare responsibilities, and their children were neglected. As a result of early marriage, the participants experienced psychological problems and burnout later in their lives. Improving family-child communication, and eliminating financial inadequacies were among the opinions on prevention strategies of child marriages.

CONCLUSION

The findings of this study identified the determinants and impact of adolescent marriages and revealed the problems experienced by adolescent brides and mothers.

IMPACT

The most important contribution of this study is that it deals with the motherhood experiences. In addition, it is one of the important findings of this study that it draws attention to their neglected children's due to lack of knowledge and experience of their mothers about childcare.

Child Marriage in Mainland China

Child marriage, defined as marriage before 18 years of age, has harmful consequences for health and development and is an indicator of gender inequality. We used publicly available data from the 2000 and 2010 censuses to estimate the national and provincial-level prevalence of child marriage across mainland China. Between 2000 and 2010, the prevalence of child marriage rose from 2.41 percent to 2.85 percent among women and from 0.54 percent to 0.77 percent among men. The 2010 estimates are equivalent to roughly 1.8 million women and 0.5 million men. Child marriage was more common in western provinces among both girls and boys. Provincial prevalence estimates ranged from 0.44 percent in Beijing to 12.94 percent in Qinghai among girls. Among boys, estimates ranged from 0.13 percent in Beijing to 5.03 percent in Tibet. The gender gap widened across much of the country between censuses. Our results indicate that child marriage continues across mainland China despite laws that ostensibly prohibit the practice. They also draw attention to the global nature of child marriage as a threat to gender equality.

Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran

BACKGROUND

Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.

METHODS

A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.

RESULTS

The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.

CONCLUSIONS

We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Overlooked and unaddressed: A narrative review of mental health consequences of child marriages

Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000-2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors.

Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors.

Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage.

Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Conceptualizing "agency" within child marriage: Implications for research and practice

BACKGROUND

The concept of child 'agency' has become increasingly important for international child-centric organizations, non-government organizations (NGOs) and United Nations (UN) agencies, particularly those responding to the issue of child marriage. Interventions to prevent child marriage often include awareness-raising activities focused on sharing information with children on the dangers of child marriage. Such interventions are often based on, and perpetuate, a belief that increased knowledge can lead to an increase in girls' agency. In this framing, agency is presumed to result in a 'good' decision and is positioned as a natural consequence of increased knowledge. This agency is said to enable girls to resist marriages forced upon them by their parents.

OBJECTIVE

This discussion paper aims to interrogate dominant conceptualizations of child agency through an exploration of child agency narratives on child marriage.

METHODS

This discussion paper is based on critical analysis of existing academic and grey (NGO and UN) literature that explores children's agency in the context of child marriage prevention.

RESULTS

This discussion paper suggests that academics, NGOs and UN actors use varied definitions to describe agency. While academic analysis shows that children's agency might be contested, contradictory and fraught, NGO and UN agencies tend to narrowly frame agency.

CONCLUSIONS

We suggest that adopting a broader definition of children's agency in research and implementation enables a more nuanced, complex understanding of the drivers of child marriage and the interventions required to address this practice.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage. Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Child marriage among Somali refugees in Ethiopia: a cross sectional survey of adolescent girls and adult women

BACKGROUND

Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences.

METHODS

A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15-49 and at least one adolescent female aged 10-19. In addition to calculating the proportion of girls married under age 18, we used survival methods - namely Kaplan Meier graphs and Cox proportional hazard models - to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls.

RESULTS

A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15-19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11-0.18), and 11% were ever married under age 18 (95% CI 8-15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls - particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94-22.40), and early childbearing was common (60%; 95% CI 45.56-72.89).

CONCLUSIONS

This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.

Self-Harm Among School-Going Adolescent Survivors of Sexual Violence Victimisation: A Cross-Sectional Study

Background: A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide. However, both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana. Objectives: To estimate the 12-month prevalence of self-harm, and to describe the associated factors and reported reasons for self-harm among school-going adolescent survivors of sexual violence victimisation during the previous 12 months in urban Ghana. Methods: Analytic data came from a regional-based representative cross-sectional survey including in-school youth (N = 1,723) conducted in 2017 within the Greater Accra Region of Ghana. Of these, 297 (17.2%) self-reported sexual violence victimisation in the previous 12 months; this proportion of the participants (n = 297) was the focus of the current study. Items measuring sexual violence victimisation, self-harm, and correlates were adopted from the 2012 Ghana WHO-Global School-based Student Health Survey and the Child and Adolescent Self-harm in Europe Study. Data analysis involved multivariable logistic regression models. Results: The estimate of self-harm ideation during the previous 12 months was 45.8% (95% CI: 40-52), whereas the estimate of self-harm behaviour was 38.7% (95% CI: 33-44). About two in five of the participants who reported self-harm wanted to die by their last episode of the behaviour. While bullying victimisation was associated with increased odds of self-harm ideation (aOR = 1.97, 95% CI 1.17, 3.31, p = 0.010) and behaviour (aOR = 2.76, 95% CI 1.59, 4.80, p < 0.001), weekly alcohol use (aOR = 2.56, 95% CI 1.32, 4.93, p = 0.005), conflict with parents (aOR = 2.30, 95% CI 1.28, 4.12, p = 0.005), and physical abuse victimisation (aOR = 1.80, 95% CI 1.03, 3.15, p = 0.037) showed strong associations with increased odds of self-harm behaviour in the past 12 months. Conclusions: The evidence underscores the need for both universal and targeted multi-level intervention and prevention programmes to mitigate the offence of sexual violence and reduce the chances of self-harm among adolescent survivors of sexual violence in urban Ghana.

The prevalence of mental health problems in sub-Saharan adolescents: A systematic review

Background and purpose

Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa.

Methods

A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer’s manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10–19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded.

Results

The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.

Is early marriage practice a problem for women living in Istanbul? A qualitative study

Early marriages (EM) adversely affect women's physical and mental health, education, and social status. The current study aimed to analyze effects of EM through the thoughts, experiences, and suggestions of women who were married under the age of eighteen in Istanbul, Turkey, and the key informants (e.g., social worker, psychologist, obstetrician) who have encountered EM. In-depth interviews were conducted with fifteen women who were married before age 18, recruited from psychiatry outpatient department and eleven key informants. Thematic analysis was used. Low educated, poor family environment with domestic violence and neglect of children, loss of parents, lack of access to education, and traditional social structure were stated as causes for EM. Families' attitudes about EM were characterized as their daughter's reputation would be tarnished which implied the daughter's premarital relationships would be perceived as immoral by community. All women experienced traditional, aggressive rituals for the first night of marriage, husbands were mostly insensitive, and coercive resulting a traumatic experience. Women were subjected to physical, sexual, psychological, and emotional violence; most of them were socially isolated after marriage with restrictions imposed by their spouses and spouses' family that limited communication with their loved ones. The women generally felt unprepared for adult sexual life and motherhood. In order to prevent EM, raising parents' awareness about EM, supporting girls' education, and enforcing legitimate regulations were recommended. Early marriages violate human rights, cause negative consequences for health both physically and mentally, and deepen social inequality for women. All the participants suggested a better functioning legislative arrangement. The male dominated society that legitimizes child marriages and other harmful traditional practices should be addressed.

Early Marriage and Its Determinants among Married Reproductive Age Group Women in Amhara Regional State, Ethiopia: A Multilevel Analysis

Introduction

Amhara region has one of the highest rates of female child early marriage in Ethiopia, with eighty percent of girls in the region being married at the age of eighteen. Therefore, this study was intended to assess the prevalence and determinants of early marriage among women, in Amhara regional state.

Methods

The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample of 2887 (weighted) married women from 645 clusters in Amhara regional state. The data were collected using a two-stage cluster design that includes the selection of enumeration areas as a first stage and selection of households as a second stage. A multilevel logistic regression model was fitted to determine the individual and community-level factors associated with early marriage.

Result

The study revealed that 73% [95% CI 71.38, 74.62] of women aged 15–49 years were married before 18 years old. In the multilevel multivariable model; living as a rural dweller (AOR = 4.33; 95% CI: 2.17, 8.64), no education (AOR = 2.52; 95% CI: 2.23, 9.51), attending only primary education (AOR = 2.31; 95% CI: 1.68, 8.53), parental decision-maker when to get marriage (AOR = 3.44; 95% CI: 2.20, 5.39), being poorer (AOR = 1.38; 95% CI: 1.16, 4.83), and poorest wealth status (AOR = 2.37; 95% CI: 2.19, 7.83) were the independent predictors of early marriage.

Conclusion

The prevalence of early marriage was high in Amhara region compared to other regions of the country. Therefore, the regional government should give due attention to access to education and encourage women's decision-making power upon the time of marriage especially those residing in rural parts of the region.

Evaluation of psychological reactions among teenage married girls in Palestinian refugee camps in Jordan

INTRODUCTION

Girls married at an early age are more likely to be victims of violence from their husbands or their in-laws. This may lead them to experience mental problems such as post-traumatic stress, depression, and/or anxiety. There are a lack of data related to the psychological reactions among teenage married girls living at the Palestinians refugee camps.

AIM

This study aimed to evaluate depression, anxiety, and stress symptoms among teenage married girls in Palestinian refugee camps in Jordan. It also aimed to identify factors correlating with the study selected psychological reactions.

METHODS

A cross-sectional, descriptive correlational design was used. The participants were recruited using non-probability sampling methods. The mental health symptoms were measured using the Depression, Anxiety, and Stress Scale (DASS).

RESULTS

A total of 205 participants were included in the study. Their mean age was 16.90 (SD ± 0.96) years. Of the participants, 39.6%, 35.6%, and 9.8% experienced moderate to extremely severe levels of depression, anxiety, and stress symptoms, respectively. There were significant relationships between all the mental health symptoms and participant age, parent's educational level, and exposure to previous trauma.

CONCLUSION

A high proportion of females living in Palestinian refugee camps married in their teenage years experienced moderate to severe mental health symptoms, particularly anxiety and depression. These results inform the need for psychological support to girls who are affected by teenage marriage.

Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India

Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.

Children on the brink: Risks for child protection, sexual abuse, and related mental health problems in the COVID-19 pandemic

In developing contexts such as India, children in adversity form a high-risk group, one that cannot be subsumed under the general category of children, who are generally considered as a vulnerable group in disaster and crisis situations. Child mental health issues in contexts of protection risks and childhood adversity tend to be over-looked in such crises. This article focuses on examining the impact of the COVID-19 pandemic and its socio-economic consequences on children in adversity, describing the increased child protection and psychosocial risks they are placed at, during and in the immediate aftermath of the COVID-19 crisis and its lockdown situation. It specifically links the lockdown and the ensuing economic issues to sexuality and abuse-related risks, as occur in contexts of child labour, child sex work and trafficking, child marriage and child sexual abuse, and that result in immediate and long-term mental health problems in children. It proposes a disaster risk reduction lens to offer recommendations to address the emerging child protection, psychosocial and mental health concerns.

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

BACKGROUND

Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa.

METHOD

We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.

RESULTS

Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.

CONCLUSION

Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Displacement-related factors influencing marital practices and associated intimate partner violence risk among Somali refugees in Dollo Ado, Ethiopia: a qualitative study

Background

Child and forced marriage have negative health consequences including increased risk of intimate partner violence (IPV) for women and girls. War and humanitarian crises may impact decision-making around marriage and risks of IPV for displaced populations. A qualitative study was conducted among Somali refugees in Dollo Ado, Ethiopia to understand the interplay of factors that contribute to IPV and to inform an intervention. This secondary analysis aims to explore the influence of displacement on marital practices and associated IPV risk.

Methods

Interviews and focus group discussions were conducted in 2016 in Dollo Ado, Ethiopia, among Somali women and men living in Bokolmayo refugee camp, host community members, non-governmental staff and service providers, stakeholders, and community and religious leaders (N = 110). Data were transcribed, translated to English, and coded and analyzed thematically using Dedoose software and a codebook developed a priori.

Results

Findings reveal numerous displacement-related factors that led to perceived shifts in marital practices among refugees, including reductions in child and forced marriages. NGO awareness-raising programs and Ethiopian laws prohibiting child marriage as well as increased access to education for girls were reported to have contributed to these changes, despite continued economic hardship and high perceived risk of non-partner sexual violence within the camp and host community. Polygamy was also perceived to have decreased, primarily due to worsening economic conditions. Forced marriage, polygamy and dowry were reported to contribute to physical IPV, and sexual IPV was reported as common in all types of marital unions. However, there was no evidence that changes in these marital practices contributed to any perceived declines in IPV within this context.

Conclusion

Safe access to education for girls should be prioritized in humanitarian settings. Interventions to address child and forced marriage should address gender and social norms. Intimate partner violence prevention programming should include specialized content taking into account marital practices including child and forced marriage and polygamy. Laws recognizing sexual IPV within marital relationships are needed to reduce sexual IPV.

Child marriage in Canada: A systematic review

Child marriage, defined by the United Nations as marriage before the age of 18, is considered a violation of human rights with negative consequences for girls' health. We systematically reviewed existing academic literature and news media to learn what is known about the frequency of child marriage in Canada and its effects on health. Approximately 1% of 15-19-year-olds in Canada were married or in common law unions in 2016. News reports document cases of child marriage among religious minority communities but no nationwide estimates of the frequency of marriage before the age of 18 were identified. Sources consistently show girls are more likely to marry as teens than boys. Information on married teens between 15 and 19 years of age suggests similarities in marriage patterns among this age group in Canada and child marriage practices globally. Further research is needed to measure Canada's progress toward eliminating child marriage.

Widening cracks in patriarchy: mothers and daughters navigating gender norms in a Mumbai slum

Inequitable gender norms can be harmful to girls' and boys' health and sexuality. Programmatic approaches that help renegotiate gendered power relationships are sorely needed. This qualitative study reveals how Parivartan, a sport-based intervention in a Mumbai informal settlement, helped families resist inequitable gender norms that limited girls' mobility in public spaces. Fifteen girl athletes were interviewed in two rounds of face-to-face in-depth interviews. Results identify the strategies girls' mothers used to support their daughters' participation in the programme when they feared their husbands' disapproval. Rather than openly confronting their husbands, mothers worked from within the patriarchal gender order, through its 'cracks', for instance initially hiding their daughters' participation from their husbands. At an appropriate moment, girls' mothers revealed to their husbands about their daughters playing sports, convincing them of the usefulness of the programme. Girls' participation profoundly and positively affected relationships between daughters, mothers and fathers. Over time, parents' trust that girls would not compromise family honour increased, eventually changing the acceptability of girls' playing sport in public in spite of the patriarchal gender order. Concluding remarks offer key implications for effective interventions, highlighting the historical nature of gender transformation processes.

Evaluation of child marriage in a Turkish sample: 8 years' data

This study aims to examine 167 adolescents who were referred by courts between 2008 and 2016 to prepare medical-legal reports on their suitability for marriage. Most were illiterate or graduates of primary/secondary school; only 17 (10.2%) were still at high school. A total of 95 girls (56.9%) had a religious marriage without a civil certificate, 63 girls (37.7%) were pregnant, and 15 (9%) had a child. According to medical reports, 91 of the girls were considered unsuitable for marriage; 76 girls who were pregnant and/or had a child were also considered unsuitable, so it was necessary to let the judge decide.

Impacts of early marriage and adolescent pregnancy on mental and somatic health: the role of partner violence

Researchers agree that early marriage (EM) and adolescent pregnancy (AP) can form severe risks for women's somatic, mental, and reproductive health, as well as on educational and social status. Yet, less is known about factors that may moderate or mediate these associations. This study examined, first, retrospectively the impacts of EM and AP on self-reported mental and somatic health among multicultural group of women living in Eastern Anatolia, Turkey. Second task was to analyze whether and how the partner violence would mediate and/or moderate between EM and AP and mental health problems. The participants were 1569 women (16-72 years of age), who reported their age of being married, first pregnancy, and demographic characteristics. They described their mental health status through General Health Questionnaire (GHQ-28: depressive, anxiety, social dysfunction, and somatization symptoms) and symptoms of posttraumatic stress disorder (PTSD; DSM-5). Women's reports of somatic illnesses were classified according to WHO-ICD-10. The revised conflict tactics scale, short form was used as a proxy to partner violence. Women who gave birth at 13-19 years of age reported more anxiety and somatization symptoms than later delivered, and those married younger than 25 showed a higher level of depressive symptoms than later married. Both AP and EM formed a heightened risk for somatic illnesses. The partner violence functioned as a moderator; AP was associated with especially high levels of depressive and anxiety symptoms among women exposed to sexual coercion in their marriage. Non-significant mediation analysis indicates that partner violence did not explain the severe impacts of the AP and EM on women's mental health. Yet, the AP and EM were associated with heightened level of partner violence. Adolescent pregnancy forms a comprehensive mental health risk, and both AP and EM were risks for somatic illnesses, such as cardiovascular problems. The mental health risk of AP further intensified if women experienced sexual coercion in their partnership. Our fundamental work is to abolish these patriarchal phenomena.

Why context matters for social norms interventions: The case of child marriage in Cameroon

Child marriage is a global health and human rights issue. In Cameroon, 30% of women are married before age 18 but little research exists on the drivers of child marriage in the country. This qualitative study contributes to understanding the role of social norms in sustaining child marriage in Far-North and East Cameroon. Participants in the study (N = 80) included women and men from four, ethnically different, rural communities (two in the Far-North, two in the East). Methods for data collection included 16 semi-structured focus groups, in which we investigated the system of social norms sustaining child marriage in these communities. We asked participants about typical age at marriage for girls (local practices) and whether they believed that age to be appropriate (their attitudes). We found the relation between practices and attitudes to be different in each community. We discuss the implications of these different relations for social norms interventions, enriching existing theoretical explanations. Evidence emerging from our findings suggest that effective social norms interventions should be embedded within cultural understandings of the relations between people's attitudes and practices.

Child marriage in Ghana: evidence from a multi-method study

BACKGROUND

Child marriage remains a challenge in Ghana. Over the years, government and development partners have made various commitments and efforts to curb the phenomenon of child marriage. However, there is little empirical evidence on the predictors, norms and practices surrounding the practice to support their efforts, a gap this study sought to fill.

METHODS

The study employed a multiple-method approach to achieve the set objectives. Data from the women's file of the 2014 Ghana Demographic and Health Survey (GDHS) was used to examine the predictors of child marriage using frequencies and logistic regression methods. Data from Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) collected in Central and Northern regions of Ghana were used to examine norms and practices surrounding child marriage using thematic analysis.

RESULTS

Two in ten (20.68%) girls in the quantitative sample married as children. The results revealed that girls who had never attended school compared to those who had ever attended school were more likely to marry as children (OR, 3.01). Compared with girls in the lowest wealth quintile, girls in the middle (OR, 0.59), fourth (OR, 0.37) and highest (OR, 0.32) wealth quintiles were less likely to marry as children. From the qualitative data, the study identified poverty, teenage pregnancy, and cultural norms such as betrothal marriage, exchange of girls for marriage and pressure from significant others as the drivers of child marriage.

CONCLUSIONS

The findings show that various socio-economic and cultural factors such as education, teenage pregnancy and poverty influence child marriage. Hence, efforts to curb child marriage should be geared towards retention of girls in school, curbing teenage pregnancy, empowering girls economically, enforcing laws on child marriage in Ghana, as well as designing tailored advocacy programs to educate key stakeholders and adolescent girls on the consequences of child marriage. Additionally, there is the need to address socio-cultural norms/practices to help end child marriage.

Suicidal behaviour in postnatal mothers in northwestern Ethiopia: a cross-sectional study

AIM

To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers.

METHOD

An institutional cross-sectional study was employed from March to April 2017.

SETTING

Two primary health centres and one referral hospital in northwestern Ethiopia.

PARTICIPANTS

A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included.

OUTCOME MEASURE

Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance.

RESULTS

The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours.

CONCLUSION

Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care.

Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes

BACKGROUND

While the determinants and impacts of child marriage among girls have been well documented, little research exists on the practice among boys. This paper explores the sociodemographic profile of men who married by age 18 and assesses whether they are more or less advantaged than their peers in terms of their sexual and reproductive health outcomes.

METHODS

This analysis used the most recent data from nationally representative household surveys for the 15 countries with the highest prevalence of marriage by age 18 among men aged 20-24 at the time of the survey. The prevalence of child marriage was then explored for the full cohort of men aged 20-49 through descriptive statistics and bivariate analysis. Available reproductive health indicators were explored, comparing men who married during childhood and men who married in adulthood. For the youngest and oldest cohorts, the total number of children fathered and the total ideal number of children were compared based on whether men married by age 18.

RESULTS

For this subset of countries, the prevalence of child marriage among men aged 20-24 ranges from 8.4 to 27.9%. The practice appears most common among respondents living in the poorest households and in rural areas, and with no education or only primary schooling. Men who married as children appear less likely to have comprehensive knowledge of HIV than their peers who married in adulthood. Little difference among men who married by age 18 and those who married in adulthood was observed regarding knowledge or use of modern methods of contraception. In almost all countries with data, the odds of having fathered three or more children among men aged 20-29 are higher for those who married as children compared to their peers. In four countries, the odds of exceeding one's ideal family size among men aged 40-49 also appear higher among those who married during childhood compared to men who married at older ages.

CONCLUSION

These results highlight the need for further research to identify drivers of the practice and short- and long-term outcomes for men who married during childhood, specifically concerning fatherhood, fertility preferences, and completed family size.

Child marriage and psychological well-being in Niger and Ethiopia

Background

Despite an understanding of the circumstances of child marriage, including how it limits agency and erodes childhood support systems, not much is known about the relationship between child marriage and mental health of child brides, especially in the sub-Saharan African context. To address this gap, we use large-scale population-based data from ever-married women aged 18–45 in Niger (n = 2764) and Ethiopia (n = 4149) to examine the association of child marriage with overall psychological well-being and its sub-domains: depression, anxiety, positive well-being, vitality, self-control and general health. We complement this with qualitative data from Ethiopia to further contextualize the psychological well-being of child brides.

Methods

Multivariate linear regressions were conducted to estimate the association between child marriage and overall psychological well-being and its sub-domains. Thematic qualitative analysis was conducted to further understand the lives of child brides.

Results

Our regression analysis found significant negative associations between very early marriage (marriage at 15 years or earlier) and overall psychological well-being in both Niger and Ethiopia. With the exception of self-control, all sub-domains of psychological well-being – depression, anxiety, positive well-being, vitality and general health – were negatively associated with very early marriage. In addition, in the qualitative analysis, Ethiopian child brides reported suffering emotional distress and depression induced by the burden of handling marital responsibilities at an early age.

Conclusion

The study highlights that even in settings where child marriage is normative, marrying very early is associated with negative outcomes. Further research is needed to understand the mechanisms that make those married during early adolescence particularly vulnerable to psychological distress, so that programs can address those vulnerabilities.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7314-z) contains supplementary material, which is available to authorized users.

Forced Sex and Early Marriage: Understanding the Linkages and Norms in a Humanitarian Setting

This mixed-methods study uses baseline data from a program evaluation in the Democratic Republic of Congo to examine two outcomes of interest: self-reported exposure to forced sex and belief that a girl’s community would force her to marry her hypothetical rapist, for married and unmarried 13- to 14-year-old girls ( n = 377). Married girls are more likely to report both outcomes. Qualitative in-depth interviews with girl participants ( n = 30) and their caregivers ( n = 31) were analyzed for themes related to forced sex and marriage, revealing the normalcy of girls marrying perpetrators and suggesting that some married girls in this setting may have been forced to marry their rapist.

Girl child marriage, socioeconomic status, and undernutrition: evidence from 35 countries in Sub-Saharan Africa

BACKGROUND

Girl child marriage, a formal union of a female before age 18, and undernutrition remain common in Sub-Saharan Africa. The aim of this study is to establish the extent to which girl child marriage contributes to socioeconomic status and underweight, a measure of undernutrition, among adult women.

METHODS

We used data from 103 Demographic and Health Surveys (DHS), representing 35 African countries from 1991 to 2014. Girl child marriage was coded both as a binary variable (before 18 years) and categorical variable (before 14, 14 to 15 years, 16 to 17 years). The primary outcome was underweight (body mass index less than 18·5). Secondary outcomes were early and multiple childbearing, secondary education completion, and wealth index. Logistic regression models were used to estimate associations.

RESULTS

Fifty-five percent of women married before age 18. Girl child marriage was associated with reduced risk of being underweight both in models adjusted for basic confounders (risk difference = - 0.020, 95% CI [- 0.026, - 0.014], p < 0.01) and in models adjusted for childbearing, women's relative status, and socioeconomic outcomes (risk difference = - 0.018, 95% CI [- 0.024, - 0.011], p < 0.01). Conditional on completing primary education and community fixed-effects, women married before 18 years had an increased risk of early motherhood (risk difference = 0.38, 95% CI [0.38, 0.38], p < 0.01) and of being in the poorest quintile (risk difference = 0.024, 95% CI [0.012, 0.036], p < 0.01), and were 27 percentage points less likely to complete secondary education (risk difference = - 0.27, 95% CI [- 0.28, - 0.26)], p < 001), compared to women married as adults.

CONCLUSIONS

Though associated with substantially reduced socioeconomic status, girl child marriage appears to be associated with slightly reduced risk of being underweight in the population studied. Further research is needed to understand the determinants of undernutrition in this context as well as the broader relationship between socioeconomic status and nutritional outcomes.

Parent-offspring conflict unlikely to explain 'child marriage' in northwestern Tanzania

Approximately 40% of women in sub-Saharan Africa marry before their eighteenth birthday¹. Within the international development sector, this phenomenon is referred to as 'child marriage', widely equated to forced marriage, and recognized as damaging to multiple dimensions of female well-being^1,2. An escalating global campaign to end early marriage typically assumes that its high prevalence is driven by a conflict of interests between parents and daughters, with parents coercing daughters to marry early for the parents' economic benefit³. However, a parent-offspring conflict model of early marriage has not been explicitly tested. Here we present a study of marriage transitions in rural Tanzania, where marriage before or just after 18 years of age is normative. Consistent with parental coercion, we find that bridewealth transfers are highest for younger brides. However, autonomy in partner choice is very common at all ages, relationships between age at marriage and female well-being are largely equivocal, and women who marry early achieve relatively higher reproductive success. We conclude that, in contexts in which adolescents have autonomy in marriage choices and in which marriage promotes economic and social security, early marriage may be better understood as serving the strategic interests of both parents and daughters.

The Lived Experience of Child Marriage in the United States

Despite international and domestic calls to end child marriage, 48 U.S. states permit the marriage of minors younger than age 18 as of August 2018. In developing nations, child marriage is associated with a wide range of adverse economic, health, and mental health outcomes, yet little research has been done to understand its effects on developed nations such as the United States. This study is the first to interview adults who were married as children in the United States, to investigate the reasons why the marriages occurred, and qualitatively understand the experiences of married American children. 21 participants (20 females and 1 male) self-selected into this study to complete an online questionnaire and be interviewed by phone. Participants were married between ages 13 and 17. Most participants (n = 18) reported physical, sexual, financial, or emotional abuse during their marriage as well as unwanted and/or unplanned pregnancies. This study shows some important social justice issues related to consent and the qualitative differences inherent in deciding to marry during childhood. Notably, this study did not find that pregnancy was the reason most participants married as minors, as some policy debates across the U.S. report.

Students and brides: a qualitative analysis of the relationship between girls' education and early marriage in Ethiopia and India

BACKGROUND

Early marriage (< 18 years) is associated with education cessation among girls. Little research has qualitatively assessed how girls build resiliency in affected contexts. This study examines these issues in Oromia, Ethiopia and Jharkhand, India among girls and their decision-makers exposed to early marriage prevention programs.

METHODS

Qualitative interviews were conducted with girls who received the intervention programs and subsequently either a) married prior to age 18 or b) cancelled/postponed their proposed early marriage. Girls also selected up to three marital decision-makers for inclusion in the study. Participants (N = 207) were asked about the value and enablers of, and barriers to, girls' education and the interplay of these themes with marriage, as part of a larger in-depth interview on early marriage. Interviews were transcribed, coded, and analyzed using latent content analysis.

RESULTS

Participants recognized the benefits of girls' education, including increased self-efficacy and life skills for girls and opportunity for economic development. A girl's capacity and desire for education, as well as her self-efficacy to demand it, were key psychological assets supporting school retention. Social support from parents and teachers was also important, as was social support from in-laws and husbands to continue school subsequent to marriage. Post-marriage education was nonetheless viewed as difficult, particularly subsequent to childbirth. Other noted barriers to girls' education included social norms against girls' education and for early marriage, financial barriers, and poor value of education.

CONCLUSION

Social norms of early marriage, financial burden of school fees, and minimal opportunity for girls beyond marriage affect girls' education. Nonetheless, some girls manifest psychological resiliency in these settings and, with support from parents and teachers, are able to stay in school and delay marriage. Unfortunately, girls less academically inclined, and those who do marry early, are less supported by family and existing programs to remain in school; programmatic efforts should be expanded to include educational support for married and childbearing girls as well as options for women and girls beyond marriage.