Ethnographic empathy and the social context of rights: “rescuing” Maasai girls from early marriage

The persistence of high rates of child marriage in Sub-Saharan Africa, the Middle East and North Africa, and Asia: A scoping review

While there is evidence that child marriage (CM) is reducing globally, rates in many contexts remain far too high. To understand the persistence of high rates of CM, we searched multiple databases for peer-reviewed, English language articles published between 2000 and 2023. High CM rates are continuing in circumstances of tenacious unequal gender norms, widespread poverty, limited schooling and economic prospects for girls, and weak awareness and enforcement of CM laws. Other contributing factors were opposition to women and girls' sexual, bodily, and reproductive rights; weak birth registration systems; a high proportion of women who married young in previous generations; early puberty; improved girls' agency; and the growing number of boys and young men who, having acquired locally prized masculinity resources, feel compelled to marry. We highlight the implications of the review findings for future research, policy and programmatic efforts aimed at addressing the persistence of CM.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022

BACKGROUND

Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia.

METHODS

This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies.

RESULTS

Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment.

CONCLUSION

From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

Why marry early? Parental influence, agency and gendered conflict in Tanzanian marriages

Global health interventions increasingly target the abolishment of 'child marriage' (marriage under 18 years, hereafter referred to as 'early marriage'). Guided by human behavioural ecology theory, and drawing on focus groups and in-depth interviews in an urbanising Tanzanian community where female early marriage is normative, we examine the common assumption that it is driven by the interests and coercive actions of parents and/or men. We find limited support for parent-offspring conflict. Parents often encouraged early marriages, but were motivated by the promise of social and economic security for daughters, rather than bridewealth transfers alone. Moreover, forced marriage appears rare, and adolescent girls and young women (AGYW) were active agents in the transition to marriage, sometimes marrying against parental wishes. Support for gendered conflict was stronger. AGYW were described as being lured into unstable relationships by men misrepresenting their long-term intentions. Community members voiced concerns over these marriages. Overall, early marriage appears rooted in limited options, encouraging strategic, but risky choices on the marriage market. Our results highlight plurality and context dependency in drivers of early marriage, even within a single community. We conclude that engaging with the importance of context is fundamental in forging culturally sensitive policies and programs on early marriage.

Maasai women hearing voices: Implications for global mental health

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.

'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya

Child marriage is associated with adverse health and social outcomes for women and girls. Among pastoralists in Kenya, child marriage is believed to be higher compared to the national average. This paper explores how social norms and contextual factors sustain child marriage in communities living in conflict-affected North Eastern Kenya. In-depth interviews were carried out with nomadic and semi-nomadic women and men of reproductive age in Wajir and Mandera counties. Participants were purposively sampled across a range of age groups and community types. Interviews were analysed thematically and guided by a social norms approach. We found changes in the way young couples meet and evidence for negative perceptions of child marriage due to its impact on the girls' reproductive health and gender inequality. Despite this, child marriage was common amongst nomadic and semi-nomadic women. Two overarching themes explained child marriage practices: 1) gender norms, and 2) desire for large family size. Our findings complement the global literature, while contributing perspectives of pastoralist groups. Contextual factors of poverty, traditional pastoral lifestyles and limited formal education opportunities for girls, supported large family norms and gender norms that encouraged and sustained child marriage.

Plurality of beliefs about female genital mutilation amidst decades of intervention programming in Narok and Kisii Counties, Kenya

Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.

Early marriage among Syrian refugees in Jordan: exploring contested meanings through ethnography

Early marriage remains a central concern among reproductive and sexual rights advocates worldwide. Mainstream researchers have often focused on the negative effects of early marriage on young women, presenting them as powerless victims of social and cultural traditions. Yet the voices and perceptions of young women remain strongly absent in many studies on early marriage. Our study addresses this knowledge gap by utilising participatory and ethnographic methodologies to better understand what early marriage means to those who have experienced it and how these emic perspectives may diverge from humanitarian paradigms. Since the war began in 2011, Syrians have become one of the largest groups of refugees worldwide, with over 5.5 million individuals seeking asylum abroad. Humanitarian organisations have called attention to high rates of early marriage within this population and its unique drivers in the specific context of displacement. We draw upon data collected between 2018 and 2020 during 90 individual interviews and 14 participatory action research meetings to explore how Syrian refugee women conceptualise the practice of early marriage and its drivers after displacement. Our findings reveal that early marriage is perceived as a practice that benefits young women and is justified in terms of its beneficial effects. Participants described early marriage as a rational solution to present-day problems, many of which they associate with the unique context of displacement. Our findings echo prior qualitative studies that illustrate the complexity of attitudes towards early marriage and the importance of understanding the specific contexts in which it is practised.

Married Too Young? The Behavioral Ecology of ‘Child Marriage’

For girls and women, marriage under 18 years is commonplace in many low-income nations today and was culturally widespread historically. Global health campaigns refer to marriage below this threshold as ‘child marriage’ and increasingly aim for its universal eradication, citing its apparent negative wellbeing consequences. Here, we outline and evaluate four alternative hypotheses for the persistence of early marriage, despite its associations with poor wellbeing, arising from the theoretical framework of human behavioral ecology. First, early marriage may be adaptive (e.g., it maximizes reproductive success), even if detrimental to wellbeing, when life expectancy is short. Second, parent–offspring conflict may explain early marriage, with parents profiting economically at the expense of their daughter’s best interests. Third, early marriage may be explained by intergenerational conflict, whereby girls marry young to emancipate themselves from continued labor within natal households. Finally, both daughters and parents from relatively disadvantaged backgrounds favor early marriage as a ‘best of a bad job strategy’ when it represents the best option given a lack of feasible alternatives. The explanatory power of each hypothesis is context-dependent, highlighting the complex drivers of life history transitions and reinforcing the need for context-specific policies addressing the vulnerabilities of adolescence worldwide.

"I have never seen something like that": Discrepancies between lived experiences and the global health concept of child marriage in northern Tanzania

BACKGROUND

The concept of 'child marriage' in global health distinguishes ostensibly harmful from healthy ages to marry at a universally-applied threshold of 18-years. With intensifying efforts to end child marriage, targeted communities are increasingly asked to change their perception of such marriages from relatively benign to profoundly problematic. The objective of this study is to understand how this shift in perception is navigated by adolescent girls and young women (AGYW).

METHODS

Using qualitative data collected in 2019 from a semi-urban community in Tanzania where marriage under 18-years is common and campaigns to end child marriage ongoing, we contrast reports of lived experiences of marriage under 18-years among AGYW to views of child marriage as an abstract concept. Thirteen in-depth interviews with AGYW, as part of a wider qualitative study, were recorded, transcribed, and analyzed using a framework analysis approach.

RESULTS

While many AGYW had heard of child marriage, the concept was routinely conflated with forced marriage, which is rare in the community, and non-marital teenage sex and pregnancy, which are common. As a likely consequence, participants disagreed on whether or not child marriage occurs locally. Furthermore, accounts of real-life marriages under 18 sometimes aligned with, but often departed from, common narratives about the purported causes and harmful consequences inherent to the global health concept of child marriage.

CONCLUSIONS

We argue that engaging with diverse local views and experiences of marrying young is essential to producing culturally-sensitive, effective initiatives addressing the vulnerabilities of female adolescence.

When marriage is the best available option: Perceptions of opportunity and risk in female adolescence in Tanzania

Global health studies typically characterise adolescent marriage as a fundamental risk to female wellbeing. In contrast, ethnographic research among communities 'at risk' identifies that early marriage is often viewed as an opportunity weighed against locally feasible alternatives. Addressing this contradiction, we document perceived risks and opportunities of marriage, positioning them among wider concerns facing female adolescents in north-western Tanzania. On the basis of these data, we then provide recommendations for global efforts to end the marriage of minors. Thirteen focus groups and 26 in-depth interviews were conducted in 2019 with female adolescents, young women and men, and parents of female adolescents from a semi-urban community where adolescent marriage is normative. Data were compiled to synthesise narratives of adolescent risk and opportunity. Marriage was viewed as an opportunity for adolescent girls, bringing benefits such as increased social status. Risks sometimes outweighed benefits of marriage, but marriage remained desirable when structural constraints, like poverty, limited feasible alternatives and when adolescents faced similar risks, like pregnancy, outside of marriage. We conclude that remaining unmarried does not shield adolescents from adversity, and campaigns targeting adolescent marriage via criminalisation, without diminishing other risks of adolescence, may further limit rather than expand options for adolescent girls.

What does the American public know about child marriage?

Global efforts to eradicate ‘child marriage’ (<18 years) increasingly target governments, the private sector and the general public as agents of change. However, understanding of child marriage may be subject to popular misconceptions, particularly because of ambiguity in the age threshold implied by the term ‘child’, and because awareness campaigns routinely emphasize extreme scenarios of very young girls forcibly married to much older men. Here, we ascertain public knowledge of child marriage via an online survey. Half of those surveyed mistakenly believed that the cut-off for child marriage is younger than the threshold of 18 years, and nearly three-quarters incorrectly believed that most child marriages occur at 15 years or below (it primarily occurs in later adolescence). Most participants also incorrectly believed that child marriage is illegal throughout the USA (it’s illegal in only 4/50 states), substantially overestimated its global prevalence, and mistakenly believed that it primarily takes place among Muslim-majority world regions. Our results highlight important popular misconceptions of child marriage that may ultimately undermine global health goals and perpetuate harmful stereotypes. Organizations seeking to empower women by reducing child marriage should be cautious of these misunderstandings, and wary of the potential for their own activities to seed misinformation.

"Child marriage" in context: exploring local attitudes towards early marriage in rural Tanzania

A global campaign to end "child marriage" has emerged over the last decade as part of growing international commitments to address gender inequities and improve female wellbeing. Campaigns typically assert that young brides have negligible autonomy in the marriage process and that marrying under 18 years has resolutely negative impacts on wellbeing. Yet, surprisingly few studies explore local attitudes towards marriage and its timing within contexts where early marriage is most common. As such our understanding of motivations and potential conflicts of interest leading female adolescents into marriage remain poorly informed by viewpoints of people purportedly at risk. We present an exploratory study of attitudes to early marriage in northwestern Tanzania where marriage before or shortly after 18 years is normative. We use focus group discussions, complimented by a survey of 993 women, to investigate local views on marriage. We explore (i) why people marry, (ii) when marriage is deemed appropriate, and (iii) who guides the marriage process. Contrary to dominant narratives in the end child marriage movement, we find that women are frequently active rather than passive in the selection of when and who to marry. Furthermore, marriage is widely viewed as instrumental in acquiring social status within one's local community. Our conclusions illuminate why rates of early marriage remain high despite potential negative wellbeing consequences and increasingly restrictive laws. We discuss our results in relation to related qualitative studies in other cultural contexts and consider the policy implications for current efforts to limit early marriage in Tanzania and beyond.

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.

Hearing the silences: Adult Nigerian women’s accounts of ‘early marriages’

‘Early marriage’ is a relatively common but under-researched global phenomenon, associated with poor physical and mental health and educational and occupational outcomes, particularly for young girls. In this article, we draw on qualitative interviews with six Nigerian women from Sokoto state, who were married between the ages of 8 and 15. The interviews explored young women’s experiences of the transition to marriage, being married, pregnancy and their understanding of the marital and parental role. Using interpretive phenomenological analysis, we explore women’s constrained articulations of their experiences of early marriage, as they are constituted within a social context where the identity of ‘woman’ is bound up in values and practices around marriage and motherhood. We explore the complexity of ‘hearing’ women’s experiences when their identities are bound up in culturally overdetermined ideas of femininity that function explicitly to silence and constrain the spaces in which women can speak.