Child marriage and associated outcomes in northern Ghana: a cross-sectional study

Prevalence and Associated Factors of Adolescent (15-19 Years) Childbearing in Ghana

Background: Adolescent pregnancies continue to be a global issue that affects more high-income, middle-income, and then low-income countries, with the latter experiencing the majority of cases. Aim: The current study looked into the prevalence and variables predicting adolescent childbearing in Ghana. Methodology: Data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017-2018 was used to conduct an analytical cross-sectional study. The results were examined with SPSS Version 20 (IBM Corp., 2011, and NY). Pearson's chi-square and binary logistics analyses were done for associations. A p value of 0.05 was used to determine the analysis's statistical significance. Results: The total number of adolescents isolated from the 2017 Ghana MICS dataset for this study analysis was 2974. The mean age of the study participants was 16.9 ± 1.4 years with a modal age of 15 years. The prevalence of adolescent childbearing according to this study analysis was 12.3%. The predictive factors for adolescent childbearing were increasing age, decreasing educational level, Volta regional originality, ethnic originality of the study participants, and low economic status. Conclusion: The prevalence of adolescent childbearing in this study was significant and needs the attention of all. Programs to improve adolescent reproductive health must take into account multiple levels of elements, such as the individual, family, community, institutions, national, and international challenges that have an impact on such programs.

Prevalence of and factors associated with female child marriage in Indonesia

Statistics from the 2018 National Social and Economic Survey revealed that one out of nine young females in Indonesia have been in female child marriage, and the prevalence remains high. Considering the serious consequences of female child marriage and that Sustainable Development Goal 5 on gender equality has targeted the elimination of female child marriage by 2030, a study concerning the prevalence and determinants of female child marriage needs to be conducted in Indonesia. In this paper, we examined the prevalence of and factors associated with female child marriage in Indonesia using binary logistic regression. We examined data from the Indonesia Demographic and Health Survey conducted in 2017. A sample of 9,333 young females aged 15-20 years was included in the study. Our analysis involved descriptive and binary logistic regression analysis. The results are presented in percentages and odds ratios (OR), with their respective confidence intervals. Our findings indicate that health insurance and sex of household head did not significantly influence female child marriage. The prevalence of female child marriage in Indonesia was quite high, reaching about 12.53%. Females with no education [OR = 76.448; (CI = 29.73-196.70)], not working [OR = 1.662; (CI = 1.41-1.94)], those with the poorest wealth index [OR = 3.215; (CI = 2.336-4.425)], those living in the east of Indonesia [OR = 1.451; (CI = 1.132-1.862)], and those living in rural areas [OR = 0.718; (CI = 0.609-0.844)] had the higher odds of experiencing female child marriage. Meanwhile, females with a secondary education level [OR = 16.296; (CI = 11.098-23.930)], those with a rich wealth index [OR = 1.940; (CI = 1.404-2.681)], and those living in the middle of Indonesia [OR = 1.263; (CI = 1.074-1.487)] were less likely to experience female child marriage. Educational background was the most significant factor influencing the high prevalence of female child marriage in Indonesia. Female empowerment through education as well as poverty alleviation were factors that could be strengthened to ensure that female child marriage is reduced or eliminated in Indonesia. Equality of access to information and better quality of education also need to be prioritized.

Early marriage, education and mental health: experiences of adolescent girls in Mozambique

Introduction and background

Early marriage and maternity represent a violation of human rights and a barrier to achieving gender equality in education. Studies conducted across various regions and countries, including Mozambique, have highlighted the negative consequences of early marriage and maternity, particularly on adolescent girls' physical, educational and mental health. Adolescent girls who marry before the age of 18 are more prone to a broad spectrum of mood, anxiety, and other psychiatric disorders. In the districts of Maganja da Costa and Morrumbala in Zambézia Province, Mozambique, high rates of early marriage persist despite government policies and interventions.

Purpose statement

This study aims to understand early marriage's socio-cultural, economic, and psychological drivers and impacts on adolescent girls' lives, focusing on education, mental health, and well-being.

Design and methods

This paper used a qualitative research design. We employed a life-story approach and used purposeful sampling to identify participants. Semi-structured interviews were conducted with 25 participants and the data were analysed using Tesch's thematic analysis approach.

Results

Elements contributing to early marriage and pregnancy are intricately linked with socio-cultural elements. These include the induction into specific societal roles, the affirmation of childbearing, the perceived importance of dowry, the impact of rite-of-passage ceremonies, and the cultural significance associated with a girl's initial menstruation. School dropout often originates from geographical and transportation challenges, nudging adolescent girls towards early marriage. In some instances, termination of pregnancy was viewed as a solution, while engaging in sexual activities was seen as a means to inject purpose into their lives or as a response to poverty. Positive changes and emotions were evident, yet regrettably, the ramifications of early pregnancy and marriage were primarily detrimental. These influenced the adolescent girls' interpersonal connections, educational and career opportunities, emotional well-being, and access to support networks.

Conclusions

The modern perspective, which advocates for equal educational rights for boys and girls and posits that marriage should occur after the age of 18, contradicts the socio-cultural perspective of adulthood.

Contribution

This study adds to the ongoing efforts to prevent and combat early marriage and maternity in Africa.

Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals

INTRODUCTION

Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions.

METHODS

This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators.

RESULTS

While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse.

CONCLUSION

There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Reaching young people living with HIV & AIDS and young people in detention with comprehensive sexuality education (CSE): a preparatory formative study in Ghana

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted.

Early marriage and its associated factors among women in Ethiopia: Systematic reviews and meta-analysis

BACKGROUND

Early marriage is defined as the union of one or both partners before reaching the age of 18 for the first time. This practice is widely prevalent in underdeveloped countries, particularly in Ethiopia, and has been observed to have detrimental effects on the educational and personal development of both male and female individuals.

METHODS

The present study conducted a comprehensive search of the Science Direct, Scopus, Google Scholar, EMBASE, and PubMed databases. The data were extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To examine publication bias, a forest plot, rank test, and Egger's regression test were utilized. Heterogeneity was assessed by calculating I2 and conducting an overall estimated analysis. Additionally, subgroup analysis was performed based on the study region and sample size. The pooled odds ratio was calculated.

RESULTS

Out of a total of 654 articles, 14 papers with 67,040 research participants were included in this analysis. The pooled prevalence of early marriage among women in Ethiopia was 56.34% (95% CI: 51.34-61.34), I2 = 78.3%). The Amhara region exhibited the highest prevalence of early marriage, with a rate of 59.01%, whereas the Oromia region demonstrated the lowest incidence, with a prevalence rate of 53.88%. The prevalence of early marriage was found to be 58.1% for a sample size exceeding 1000, and 50.9% for a sample size below 1000. No formal education (AOR = 5.49; 95%CI: 2.99, 10.07), primary education (AOR = 3.65; 95%CI: 2.11, 6.32), secondary education (AOR = 2.49; 95%CI: 1.60, 3.87), rural residency (AOR = 4.52; 95%CI: 1.90, 10.74) and decision made by parents (AOR = 2.44; 95%CI: 1.36, 4.39) were associated factors.

CONCLUSION AND RECOMMENDATION

In Ethiopia, there was a high rate of early marriage among women. The research findings indicate that early marriage is more prevalent among mothers who possess lower levels of educational attainment, reside in rural areas, and are subject to parental decision-making. Our stance is firmly in favor of expanding the availability of maternal education and promoting urban residency. Furthermore, the promotion of autonomous decision-making by clients regarding their marital affairs is of paramount importance to family leaders.

Prevalence and factors associated with child marriage, a systematic review

BACKGROUND

Girl child marriage is increasingly recognized as a critical barrier to global public health and gender discrimination. There are still more gaps in the global rate of child marriage and the underlying factors. Thus, the present systematic review aimed to explore the prevalence of child marriage and the underlying factors.

METHODS

A comprehensive search was conducted for all English-language studies that measured the prevalence of child marriage and its correlates from 2000 to March 2022, indexed in PubMed, Scopus, Web of Science, Poplin, and Google Scholar databases. Child marriage is defined as marriage under the age of 18. In the present study, Joanna Briggs' quality assessment checklist was used for data collection. Two independent reviewers reviewed all the articles.

RESULTS

In total, 34 eligible prevalence articles and 14 trend articles were included in the study with data from 127,945 participants. The prevalence of child marriage ranged between 1.8% to 90.85%. In most studies, the trend of child marriage was decreasing. The most important individual factors include the respondent's education and occupation, interpersonal factors such as the education and occupation of parents and husband, family size and type. Community factors include socioeconomic status, region, residence, ethnicity, and religion at the social level.

CONCLUSION

Despite a central focus of research and policies on interventions that decrease child marriage, this phenomenon is still prevalent in many places. Therefore, further specific interventions are required to improve education, reduce poverty and inequality. This may help achieve the 2030 Sustainable Development Goals.

Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana

Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.

The Impact of Intimate Partner Violence on Young Women's Educational Well-Being: A Systematic Review of Literature

Research highlights that romantic relationships of young people are not all 'puppy love' but can be also abusive. Intimate partner violence (IPV) is a gendered phenomenon as it primarily affects women who are at a higher risk of more severe forms of violence and also suffer more severe consequences than young men. IPV leads to substantial negative outcomes such as mental health decline, economic insecurity and/or academic underachievement. Particularly for young females, education is a powerful protective factor against re-victimisation and economic dependence which often forces women to remain trapped in abusive relationships. This review was conducted to integrate and summarise research available on IPV and its impact on young women's educational well-being to fill a significant gap in the literature. Under the guidance of PRISMA, terms related to the criteria of young women aged 10-24, IPV and education were searched in the databases EBSCO, PsycINFO, Scopus, ProQuest and CINAHL. While the initial search yielded 6005 articles, we were left with only 10 articles for the analysis. In summary, the evidence suggests that females tend to display issues around concentration, absenteeism and academic disengagement, as well as decline in performance such as failing grades and higher drop out rates.

Spatial distribution and multilevel analysis of factors associated with child marriage in Nigeria

BACKGROUND

Child marriage among women has become a major threat to the rights of women, especially in low- and middle-income countries. The marriage of girls below age 18 y is a major public and global health challenge. Therefore, this study examined the spatial pattern and factors associated with child marriage in Nigeria.

METHODS

The data were sourced from the 2018 Nigeria Demographic and Health Survey. The study included a total of 4283 young women aged 20-24 y. The findings were provided in the form of spatial maps and adjusted ORs (aORs) with 95% confidence interval (CI).

RESULTS

Hotspot areas for child marriage in Nigeria were located in Sokoto, Kebbi, Katsina, Kano, Jigawa, Yobe, Bauchi, Niger, Borno, Gombe, and Adamawa. The prevalence of child marriage in Nigeria was 41.50%. The likelihood of child marriage in Nigeria was high among those currently working (aOR=1.31; 95% CI 1.11 to 1.55) compared with young women who were not working. On the other hand, young women whose partners had secondary education and above (aOR=0.57; 95% CI 0.45 to 0.73) were less likely to report child marriage in Nigeria compared with those whose partners had no education.

CONCLUSIONS

The findings of the study indicate that there are several hotspots in Nigeria that need to be targeted when implementing interventions aimed at eliminating child marriage in the country.

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

BACKGROUND

Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia.

METHODS

Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013-14 and 2018. A pooled weighted sample of 9990 women aged 20-29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models.

RESULTS

The prevalence of child marriage among women aged 20-29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26-0.49] and [aOR = 0.07, 95% CI = 0.03-0.18] and those whose age at first birth was (15-19 year) or (20-29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15-1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained.

CONCLUSION

Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

The association of child marriage with morbidities and mortality among children under 5 years in Afghanistan: findings from a national survey

BACKGROUND

There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge.

METHODS

A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15-24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (< 18y) with morbidities (diarrhea, acute respiratory infection, and fever in the last 2 weeks), mortality (neonatal, infant, child), and size at birth among the children under 5 born to women aged 15-24 years, before and after adjusting for the effect of sociodemographic and structural inequalities.

RESULTS

Approximately two-thirds of births in the past 5 years belong to 15-24 years old mothers who married at ages < 18. The majority of them were born to mothers residing in rural areas (75.67%) with no education (51.68%) from poor households (39.39%). As compared to the births to women married at ages ≥ 18, there was a significantly higher likelihood of neonatal mortality among births to women married at ages < 18 (crude OR = 2.30, 95% CI: 1.52-3.49 & adjusted OR = 1.94, 95% CI: 1.25-3.01) and higher infant mortality among the births to the women married at ages ≤ 14y (crude OR = 1.94, 95% CI: 1.06-3.53). However, it disappeared for neonatal mortality after adjustment for adequacy of antenatal care (ANC) and infant mortality after adjustment for sociodemographic inequalities.

CONCLUSION

Although the births to women married as a child (< 18) were more likely to die at an early age, this association disappeared after adjustment for the adequacy of ANC. Given the unavoidable practice of child marriage in Afghanistan, this finding emphasizes the importance of providing adequate ANC for young brides to prevent child mortality. In addition, strong global advocacy is required to empower and support young Afghan women in negotiating their reproductive and maternity rights with their partners by reducing social and gender-based inequalities.

Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey

BACKGROUND

Adolescent pregnancy and motherhood have been linked to several factors stemming from social, cultural and to a large extent economic issues. This study examined the socio-economic factors associated with adolescent pregnancy and motherhood in Ghana.

DESIGN

This was a secondary analysis of the 2017 Ghana Maternal Health Survey, which was a nationally representative cross-sectional survey. Data from 4785 adolescents aged between 15-19 years were included in the analysis. Adolescent pregnancy was defined as adolescents who have ever been pregnant, whiles adolescent motherhood was defined as adolescents who have ever given birth. Weighted logistic regression was used to assess the association between the socio-economic variables and adolescent pregnancy and motherhood.

RESULTS

Of the 25062 women aged between 15 and 49 years included in the 2017 maternal health survey, 4785 (19.1%) were adolescents between 15-19 years. Adolescent pregnancy was reported in 14.6% (CI:13.2% -16.1%) of the respondents, whereas 11.8% (CI: 10.5% -13.1%) of the respondents had ever given birth. In the multivariate regression analysis, zone (p<0.001), wealth index (p<0.001), age (p<0.001), marital status (p<0.001) and level of education (p<0.001) were all significantly associated with adolescent pregnancy and motherhood. The odds of pregnancy and motherhood were significantly higher in the Middle and Coastal zones (p<0.001), and among older adolescents (p<0.001). However, the odds of pregnancy and motherhood was significantly lower among adolescents from households with the highest wealth index (p<0.001), among those who were never married (p<0.001) and among adolescents who had secondary/higher education (p<0.001).

CONCLUSION

Several socio-economic variables including education, household wealth, marital status and zone of residence were significantly associated with adolescent pregnancy and adolescent motherhood. Sexual and reproductive health education should be intensified among these populations. Adolescent friendly corners should be made available and accessible to all adolescents in Ghana irrespective of where they live or their age.

Disability among Women and Men Who Married in Childhood: Evidence from Cross-Sectional Nationally Representative Surveys Undertaken in 37 Low- and Middle-Income Countries

Child marriage, which the UN's Sustainable Development Goal seeks to eliminate by 2030, represents a violation of the human rights of children. These concerns are driven by the negative impact of child marriage on the health of children married in childhood and their children. Little is known about the association between child marriage and disability. We sought to estimate the strength of association between disability and child marriage among women and men in middle- and low-income countries (LMICs). Secondary analysis was undertaken of nationally representative samples involving 423,164 women in 37 LMICs and 95,411 men in 28 LMICs. Results were aggregated by random effects meta-analysis and mixed effects multilevel multivariate modelling. The prevalence of disability was significantly greater among women and men who were married in childhood, especially among those married under the age of 16. The strength of these associations varied by age group and age at first marriage. Further research is required to understand the causal pathways responsible for the increased likelihood of disability among women and men married in childhood. National initiatives to eliminate child marriage may need to consider making reasonable accommodations to policies to ensure these are equally effective for women and men with disabilities.

Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review

Background

Adolescent pregnancy is a public health challenge that has well-defined causes, associated health risks, and social and economic consequences for adolescent, their families, communities, and society. The purpose of this scoping review is to summarize studies published on socio-cultural determinants of adolescent pregnancy in Ghana.

Methods

Search for records was done in four major databases, including PubMed CENTRAL, Science Direct and JSTOR. Records from Google and Google Scholar were also added, and results and findings from published and unpublished studies were included. All the 22 studies that met the eligibility criteria, were critically appraised. The guidelines for conducting scoping reviews by Arksey and O’Malley were followed.

Results

The result revealed that poverty, peer influence, low level of education, dysfunctional family, lack of communication between parents and their daughters, lack of sexual and reproductive health education, child marriage, coerced sex, misconception and non-usage of contraceptives, and decline in cultural values such as puberty rites and virginity inspection are some of the determinants of adolescent pregnancy in Ghana. The study also showed that there is a lack of high-quality observational studies that adjust for confounding variables.

Conclusion

Interventions and policies should be designed to take into consideration the needs, context, and background of adolescents. Programmes to enhance adolescent reproductive health need to consider multilevel factors such as person, family, community, institutions, national, and global issues that affect such programmes.

Residential district multi-hazard risk is associated with childhood undernutrition: evidence from Bangladesh

Child undernutrition and natural disasters are major public health concerns in Bangladesh, but research into their relationship is lacking. This study assessed the association between residential district multi-hazard-risk and undernutrition among children aged less than 5 years (under-5) in Bangladesh. Data for 22,055 under-5 children were extracted from the 2019 Multiple Indicator Cluster Survey of Bangladesh. Multi-hazard risk was categorized as low (score<10), moderate (score 10-20), and high (score>20) using a combined score of four major hazards: tornado, cyclone, earthquake, and flood. We found that children from high multi-hazard risk districts were 19% more likely to be stunted and 23% more likely to be underweight compared to low-risk districts. However, wasting was not associated with multi-hazard risk. Strategies such as agricultural adaptation and coping mechanisms, long-term post-disaster nutritional response, extended periods of relief supports, and enhanced quality maternal and child care services may help to reduce undernutrition burdens in Bangladesh.

Adverse obstetric and neonatal outcomes of adolescent pregnancies in Africa: a scoping review

BACKGROUND

Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse pregnancy outcomes and risk factors associated with adolescent pregnancy in Africa.

METHOD

PubMed Central, Science Direct and JSTOR were the main databases for the literature review. Other online sources and experts were consulted for relevant studies. In all, 11,574 records were identified and 122 were considered as full-text studies for evaluation after thorough screening and removal of duplicates. Finally, 53 studies were included in this review for thematic synthesis.

RESULTS

The 53 studies sampled 263,580 pregnant women, including 46,202 adolescents (< 20 years) and 217,378 adults (> 20 years). Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Factors of poor pregnancy outcomes included low socioeconomic and educational status, poor utilization of antenatal care, risky lifestyles such as alcohol consumption, and unattractive health care factors. Maternal health care utilization was identified as an important factor to improve pregnancy outcomes among adolescents in Africa.

CONCLUSION

To prevent adolescent pregnancy, stakeholders need to help lower socioeconomic inequalities, poor utilization of antenatal care, alcohol consumption, and improve adolescents' health care and their educational status. Issues such as child marriage, abortion, poor health care infrastructure and non-adolescent friendly health facilities need to be addressed.

A multilevel analysis of prevalence and factors associated with female child marriage in Nigeria using the 2018 Nigeria Demographic and Health Survey data

BACKGROUND

Globally, there has been a decline in female child marriage (FCM) from 1 in 4 girls married a decade ago to approximately 1 in 5 currently. However, this decline is not homogenous because some regions are still experiencing a high prevalence of FCM. As such, the United Nations reiterated the need for concentrated efforts towards ending FCM to avoid more than 120 million girls getting married before their eighteenth birthday by 2030. Following this, we examined the prevalence and factors associated with FCM in Nigeria using multi-level analysis.

METHODS

We used cross-sectional data from the women's file of the Nigeria Demographic and Health Survey (NDHS) conducted in 2018. A sample of 4143 young women aged 20-24 was included in the study. Our analysis involved descriptive, chi-square (χ2) and multi-level analyses. Results were presented in percentages, frequencies, and adjusted odds ratios (aOR) with their respective confidence intervals (CIs).

RESULTS

The prevalence of FCM in 2018 was 65.30%. Young Muslim women aged 20-24 [aOR = 1.40; 95% CI (4.73-7.52)], those with parity between one and two [aOR = 5.96, 95% CI 4.73-7.52], those residing in North East [aOR = 1.55; 95% CI (1.19-2.10)] and North West [aOR = 1.59; 95% CI (1.18-2.16)] had a higher odd of practicing FCM respondents with secondary education and above [aOR = 0.36; 95% CI (0.29-0.46)], those within the richer wealth index [aOR = 0.35; 95% CI (0.23-0.54)] and young women living in communities with high literacy level [aOR = 0.74; 95% CI (0.59-0.92)] were less likely to get married before age 18 years.

CONCLUSION

Our findings indicate that FCM is high in Nigeria. Formal education, being rich and living in communities with high literacy levels were some protective factors that can be strengthened to ensure that FCM is reduced or eliminated in Nigeria. On the other hand, residing in North-East or North-West and having children between one and two were some prevailing factors that exacerbated the odds of experiencing FCM in Nigeria. Therefore, attention should be channelled towards mitigating these prevailing negative factors.

Adding to her woes: child bride's higher risk of hypertension at young adulthood

BACKGROUND

Child marriage is associated with various adverse socio-economic and pregnancy outcomes. However, there remains a dearth of research on the long-term health implications of child marriage. As such, this study sought to expand upon the growing literature on child marriage, specifically examining the associations between child marriage and hypertension during young adult age.

METHODS

We obtained data of 5369 women aged 20-34 from the Tajikistan Demographic and Health Survey 2017. Using multivariable logistic regression framework, we estimated the adjusted odds in favor of being hypertensive for women who were married before the age of 18. We also explored the presence of several stressors to understand the role of probable medication factors.

RESULTS

We found that the odds of being hypertensive for young adult women married before the age of 18 were 1.6 (95% confidence interval: 1.1-2.4) times that of those who were not. Likelihood of having stressors, such as pregnancy loss or child death, marital control and spousal violence, was found higher among child brides compared to their peers.

CONCLUSIONS

Findings suggest that child marriage may increase the risk of hypertension among young adult women. This work reinforces recommendations by the United Nations to the end child marriage.

Child Marriage in Relation to the Syrian Conflict: Jordanian and Syrian Adolescents' Perspectives

PURPOSE

Although the average age of marriage has increased in many countries in the Middle East in recent years, child marriage is thought to become more common among certain populations in Jordan, notably the refugees. This study explores the perspectives of Jordanian and Syrian adolescents on child marriage in relation to the Syrian conflict as members of refugee populations and host communities.

METHODS

This study used data from in-depth interviews with 64 Jordanian and Syrian adolescents between the ages of 15 and 19 years. Interviews consisted of a narrative, flexible dialog in which participants discussed their life histories using the creation of a visual timeline as a tool. Data analysis was iterative, inductive, and based on the grounded theory approach. Themes were identified through ongoing interaction with the data.

RESULTS

Three major themes emerged from the data relating to child marriage: (1) the influence of intermingling between Syrian and Jordanian communities, (2) vulnerability and control interact to fuel increases in child marriage in displacement, and (3) finding agency by rejecting child marriage.

CONCLUSIONS

The Syrian conflict has changed practices relating to child marriage, fostering a renewed reliance on child marriage in light of increasing instability, leaving both Jordanian and Syrian adolescents increasingly vulnerable. Many adolescents reject the practice, thus offering an opportunity for social change.

Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries

CONTEXT

Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above.

METHOD

Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630).

RESULTS

Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics.

CONCLUSION

Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

The health consequences of child marriage: a systematic review of the evidence

Background

Child marriage, defined as marriage before 18 years of age, is a violation of human rights and a marker of gender inequality. Growing attention to this issue on the global development agenda also reflects concerns that it may negatively impact health. We conducted a systematic review to synthesize existing research on the consequences of child marriage on health and to assess the risk of bias in this body of literature.

Methods and findings

We searched databases focused on biomedicine and global health for studies that estimated the effect of marrying before the age of 18 on any physical or mental health outcome or health behaviour. We identified 58 eligible articles, nearly all of which relied on cross-sectional data sources from sub-Saharan Africa or South Asia. The most studied health outcomes were indicators of fertility and fertility control, maternal health care, and intimate partner violence. All studies were at serious to critical risk of bias. Research consistently found that women who marry before the age of 18 begin having children at earlier ages and give birth to a larger number of children when compared to those who marry at 18 or later, but whether these outcomes were desired was not considered. Across studies, women who married as children were also consistently less likely to give birth in health care facilities or with assistance from skilled providers. Studies also uniformly concluded that child marriage increases the likelihood of experiencing physical violence from an intimate partner. However, research in many other domains, including use of contraception, unwanted pregnancy, and sexual violence came to divergent conclusions and challenge some common narratives regarding child marriage.

Conclusions

There are many reasons to be concerned about child marriage. However, evidence that child marriage causes the health outcomes described in this review is severely limited. There is more heterogeneity in the results of these studies than is often recognized. For these reasons, greater caution is warranted when discussing the potential impact of child marriage on health. We provide suggestions for avoiding common biases and improving the strength of the evidence on this subject.

Trial registration

The protocol of this systematic review was registered with PROSPERO (CRD42020182652) in May 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12707-x.

Child marriage and its association with morbidity and mortality of under-5 years old children in Bangladesh

INTRODUCTION

Child marriage is a significant social and health concern in many low- and middle-income countries (LMICs). This harmful practice violates children's rights and continues to be widespread across developing nations like Bangladesh. This study investigated the mortality trend among Bangladeshi children and the impact of child marriage on under-5 children morbidity and mortality in Bangladesh.

METHODS AND MATERIALS

A sample of 8,321 children under-5 years old was analyzed using bivariate and multivariate statistical techniques collected from the recent 2017-18 BDHS data. Chi-square test and logistic regression (unadjusted and adjusted) were used to determine the influence of covariates on the target variable.

RESULTS

Results revealed that child mortality was significantly higher among children whose mothers married at an early age than their counterparts. Although the general trend in the prevalence of different childhood mortality in Bangladesh was declining gradually from 1993 to 2018, it was still high in 2018. Also, marriage after 18 years lessens likelihood of diarrhea (adjusted OR = 0.93; 95% CI: 0.76-1.16) and cough (adjusted OR = 0.91; 95% CI: 0.78-1.17) among children. Furthermore, findings reveal that likelihood of different child mortality is higher among early married women.

CONCLUSION

Immediate intervention through rigorous enforcement of policies and different programs to raise the age at marriage and by lessening socioeconomic disparities can combat the prevalence of high morbidity and mortality of under-5 years old children. Findings from this study will be helpful to accelerate strategies for achieving the Sustainable Development Goals (SDGs) related to child and maternal health by 2030.

Factors Influencing HIV Status Disclosure to Partners Among Antiretroviral Therapy Clients in the Upper East Region, Ghana

In Ghana, HIV status disclosure to partners is voluntary. This study sought to determine the factors associated with HIV status disclosure to partners among antiretroviral therapy (ART) clients in the Upper East Region. A matched case-control study (1:1) was carried out in nine ART sites in the Upper East region in which 100 ART sexually active clients who had not disclosed their status to their partners were compared with 100 ART sexually ART clients who had disclosed their status to their partners. To each of the 200 study participants, a structured questionnaire was administered to elicit relevant responses. Discordant pair analysis was done with Mantel-Haenszel matched test to determine associations between variables. The study found persons with informal education more likely to disclose HIV status, whereas persons living apart or not having children with a partner were less likely to disclose their status to their sexual partners. On the other hand, active involvement or participation in ART-related services were more likely going to impact HIV status disclosure. Early initiation of ART, while adherence to ART services and the use of treatment monitors were less associated with disclosure. Active participation in ART related services such as prompt initiation of ART following diagnosis, adherence promotion, and treatment monitoring should be encouraged to promote HIV status disclosure among sexual partners.

The development of adolescent agency and implications for reproductive choice among girls in Zambia

Background

A substantial proportion of adolescent girls in Zambia lack the ability to decide their reproductive future. We examined the role of agency in early and unwanted adolescent childbearing.

Methods

Using latent transition analysis, we characterized a multi-dimensional profile of adolescent agency annually over a four-year period. We investigated the influence of early life access to resources and time-varying predictors (school retention, violence, early marriage and unwanted/mistimed pregnancy and childbearing) on agency profile membership as well as transitions in agency status over time.

Results

Four agency profiles were identified, with differences by age cohort (10–14 years vs. 15–19 years). Three profiles identified in both age cohorts were: Low-moderate agency, Self-assured gender conformers, and High agency. Unique to younger girls was the Gender conscious, low belief in abilities status, while among older girls was the Self-assured selective gender conscious status. While younger girls were likely to transition to the highest agency status over time, high agency membership declined among older girls. Early life resources were associated with augmented agency while exposure to negative events, particularly early marriage, were associated with detraction from high agency status. Girls who expressed high self-efficacy but gender-conforming values were most at risk of early marriage and unwanted/mistimed pregnancy while High agency girls were at comparatively low risk.

Conclusions

Results show agency is dynamic but less mutable with increasing age. Early adolescent strategies which address inequitable gender norms and limit early marriage, may guard against losses to agency which contribute to unwanted fertility outcomes.

•

Findings support agency as a dynamic, multidimensional construct in adolescence.

•

In general, access to resources promoted agency across dimensions.

•

Time-varying events, particularly early marriage, detracted from agency status.

•

Agency dimensions combined in unique ways with distinct implications for early/unwanted fertility.

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.

The impact of a maternal mental health intervention on intimate partner violence in Northern Ghana and the mediating roles of social support and couple communication: secondary analysis of a cluster randomized controlled trial

BACKGROUNDS

Diverse intervention efforts are implemented to address intimate partner violence (IPV) against women. Via a syndemics theory lens and emerging empirical evidence, mental health interventions demonstrate promise to partially ameliorate IPV. However, the mechanisms of change underlying many IPV interventions are not well understood. These gaps impede our efforts to strengthen or integrate effective components into the current mental health resources, especially in low- and middle-income countries (LMICs). This study aims to examine the impact of a maternal mental health intervention called Integrated Mothers and Babies Course & Early Childhood Development (iMBC/ECD) on IPV and whether social support and/or couple communication mediates the intervention effects among women in rural, Northern Ghana.

METHODS

The current study is a secondary data analysis of a cluster randomized controlled trial. IPV was measured at baseline and 8 months post-intervention (~ 19 months post-baseline). At baseline, 84.8% of the women enrolled in the study (n = 374) reported some type of IPV in the past 12 months. Logistic regression models and multiple mediation analyses were used to address the study aims.

RESULTS

iMBC/ECD did not reduce IPV in the intervention group compared to the control group. Social support and couple communication did not mediate the intervention effects on IPV as indicated by the indirect effects of the multiple mediation models. However, increase in social support reduced women's odds of experiencing emotional violence by 7%, odds ratio (OR) = 0.93, p = 0.007; b = - 0.07, 95% confidence interval (CI) = (- 0.13, - 0.02), and improvement in couple communication demonstrated promise in reducing women's odds of experiencing controlling behaviors by 7%, OR = 0.93, p = 0.07; b = - 0.07, CI = (- 0.14, 0.005), though the improvements were not due to the intervention.

CONCLUSION

This maternal mental health intervention did not reduce IPV; however, the findings extend our knowledge about the impact of such interventions on IPV and the potential mechanisms of change via social support and couple communication. Future research evaluating the impact of mental health interventions on IPV and mechanisms of change is essential for the development of effective interventions. Future programs addressing IPV in LMICs should consider risk factors beyond relationship level (e.g. poverty and gender inequity).

TRIAL REGISTRATION

ClinicalTrials.gov # NCT03665246 , Registered on August 20th, 2018.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data

OBJECTIVE

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

DESIGN

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

SETTING

Countrywide, covering rural and urban areas in Ghana.

PARTICIPANTS

Non-pregnant adolescent girls aged 15-19 years.

RESULTS

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

CONCLUSIONS

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Examining the intersection between marriage, perceived maturity and child marriage: perspectives of community elders in the Northern region of Ghana

Child marriage is a widespread global phenomenon that is prevalent in many developing countries including Ghana. The practice of child marriage has its roots in how marriage, adolescence and readiness for marriage are construed in practising communities. This study presents the views of community elders towards the practice and examines constructions of marriage and maturity and their influence on child marriage. Data were collected from seven elders from selected communities in the Northern region of Ghana. Individual in-depth interviews were used to gather participants' perceptions of constructions of marriage and markers for determining maturity of girls for marriage. An inductive qualitative method was used to analyse transcribed data. Elders' views indicated that early marriage was strongly influenced by community constructions of marriage and social indicators of readiness for marriage. The main indicators of maturity for marriage for men were economic independence and an awareness of sexual desire while the overt markers of physiological development and mastery of domestic tasks were indicators for girls. Knowledge about the cultural construction of marriage and readiness for marriage is helpful to influence policy making and interventions on early marriage.

Individual/Household and Community-Level Factors Associated with Child Marriage in Mali: Evidence from Demographic and Health Survey

Background

Child marriage is a major public health problem globally, and the prevalence remains high in sub-Saharan African countries, including Mali. There is a dearth of evidence about factors associated with child marriage in Mali. Hence, this studyaimed at investigating the individual/household and community-level factors associated with child marriage among women in Mali.

Methods

Using data from the 2018 Mali Demographic and Health Survey, analysis was done on 8,350 women aged 18-49 years. A Chi-square test was used to select candidate variables for the multilevel multivariable logistic regression models. Fixed effects results weree xpressed as adjusted odds ratios (aOR) at 95% confidence intervals (CI). Stata version 14 software was used for the analysis.

Results

The results showed that 58.2% (95% CI; 56.3%-60.0%) and 20.3% (95%; 19.0%-21.6%) of women aged 18-49 years were married before their 18^th and 15^th birthday, respectively. Educational status of women (higher education: aOR = 0.25, 95% CI; 0.14-0.44), their partner's/husband's educational status (higher education: aOR = 0.64, 95% CI; 0.47-0.87), women's occupation (professional, technical, or managerial: aOR = 0.50, 95% CI; 0.33-0.77), family size (five and above: aOR = 1.16, 95% CI; 1.03-1.30), and ethnicity (Senoufo/Minianka: aOR = 0.73, 95% CI; 0.58-0.92) were the identified individual/household level factors associated with child marriage, whereas region (Mopti: aOR = 0.27, 95% CI; 0.19-0.39) was the community level factor associated with child marriage.

Conclusions

This study has revealed a high prevalence of child marriage in Mali. To reduce the magnitude of child marriage in Mali, enhancing policies and programs that promote education for both girls and boys, creating employment opportunities, improving the utilization of family planning services, and sensitizing girls and parents who live in regions such as Kayes on the negative effects of child marriage is essential. Moreover, working with community leaders so as to reduce child marriage in the Bambara ethnic communities would also be beneficial.

The missing link between legal age of sexual consent and age of marriage in sub-Saharan Africa: implications for sexual and reproductive health and rights

Child marriage is a fundamental violation of human rights and a threat to access to education, sexual and reproductive health care, and employment. It also threatens freedom from violence, reproductive rights, movement, and the right to consensual marriage. In most countries in sub-Saharan Africa, the legal age of marriage is 18 years. Hence, girls who marry before 18 years are considered as victims of child marriage. Closely knitted to legal age for marriage is the issue of age for sexual consent, which refers to the minimum age at which a person is considered to have the legal capacity to consent to sexual intercourse. While there seem to be a standard legal age for marriage, the legal age for sexual consent varies in most countries in sub-Saharan Africa and is often lower than the legal age of marriage. In this commentary, we argue that the gap between the legal age of sexual consent and marriage partly accounts for some of the sexual and reproductive health challenges such as intimate partner violence, sexually transmitted infections, adolescent pregnancy, early childbirth, including unsafe abortions among adolescent girls in sub-Saharan Africa and infringements on their sexual and reproductive health rights. This commentary highlights strategic potential interventions that could help address the identified gaps. We argue that aligning the age for sexual consent and marriage is not the solution to the problem. However, what is critical is the education of young people about sexual and reproductive health issues and comprehensive sexuality education through advocacy networks at the national and local levels. Thus, the key is to provide accurate, timely, and non-judgmental sexual and reproductive health and rights information to young people irrespective of the prevailing age of consent. This provision will empower them to make informed decisions about their sexual and reproductive health.

Sociodemographic factors and early marriage among women in Bangladesh, Ghana and Iraq: An illustration from Multiple Indicator Cluster Survey

Early marriage is a form of violation of child rights to grow and develop. The Sustainable Development Goals had included early marriage in target 5.3, aiming to eliminate by 2030. This study examines the socio-demographic factors associated with women's early marriage in Bangladesh, Ghana, and Iraq using information extracted from 2019, 2017-2018, and 2018 Multiple Indicator Cluster Surveys (MICSs) of Bangladesh, Ghana, and Iraq, respectively. The chi-square test examined the association between socio-demographic factors and early marriage separately in all three countries. In logistic regression, key factors were primarily evaluated for determining effects on early marriage separately in all three countries. The mean age of the mother at first marriage was found to be 16.86, 20.23, and 20.05 years in Bangladesh, Ghana, and Iraq successively. According to surveys conducted in Bangladesh, Ghana, and Iraq, education levels of household heads and women, wealth status, mass media, number of household members, and residence were significant factors linked to early marriage. The odds of getting married early were significantly higher among women with no formal education and primary education than women with secondary or higher education in all three countries. In terms of economic status, a negative association was found between wealth status and early marriage in both Bangladesh and Ghana. Based on the findings, the study recommended that government take the necessary steps to reduce child marriage in all three countries by raising women's education and campaigning women by media to harmful effects of early marriage, particularly women from low-income families.

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.

The pitfalls of modelling the effects of COVID-19 on gender-based violence: lessons learnt and ways forward

Since early 2020, global stakeholders have highlighted the significant gendered consequences of the COVID-19 pandemic, including increases in the risk of gender-based violence (GBV). Researchers have sought to inform the pandemic response through a diverse set of methodologies, including early efforts modelling anticipated increases in GBV. For example, in April 2020, a highly cited modelling effort by the United Nations Population Fund (UNFPA) and partners projected headline global figures of 31 million additional cases of intimate partner violence due to 6 months of lockdown, and an additional 13 million child marriages by 2030. In this paper, we discuss the rationale for using modelling to make projections about GBV, and use the projections released by UNFPA to draw attention to the assumptions and biases underlying model-based projections. We raise five key critiques: (1) reducing complex issues to simplified, linear cause-effect relationships, (2) reliance on a small number of studies to generate global estimates, (3) assuming that the pandemic results in the complete service disruption for existing interventions, (4) lack of clarity in indicators used and sources of estimates, and (5) failure to account for margins of uncertainty. We argue that there is a need to consider the motivations and consequences of using modelling data as a planning tool for complex issues like GBV, and conclude by suggesting key considerations for policymakers and practitioners in using and commissioning such projections.

Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys

Introduction

Anemia during pregnancy is a public health problem that leads to different life-threatening complications and poor pregnancy outcomes. So far, the evidence is scarce on pooled prevalence and determinants of anemia during pregnancy in East Africa for integrated intervention. Therefore, this study aimed to assess the prevalence and determinants of anemia among pregnant women in eastern Africa using recent Demographic and Health Surveys.

Method

Secondary data analysis was conducted using data from recent Demographic and Health Survey datasets from 10 East African countries. A total of 8583 (weighted sample) pregnant women were included in the analysis. The multi-level mixed-effects generalized linear model (Poisson regression with robust error variance) was fitted to identify determinants of anemia. Finally, the adjusted prevalence ratio (aPR) with 95% CI and random effects for the multilevel generalized linear mixed-effects model was reported.

Results

In this study, the overall prevalence of anemia among pregnant women was 41.82% (95% CI: 40.78, 42.87) with a large difference between specific countries which ranged from 23.36% in Rwanda to 57.10% in Tanzania. In the multi-level analysis, teenage pregnant women (aPR = 1.22;95%CI:1.02, 1.40), unmarried women (aPR = 1.14; 95% CI;1.02,1.28), pregnant women who had unimproved toilet facility (aPR = 1.17;95%CI:1.06,1.27), and those women from countries with high illiteracy level (aPR = 1.12;95%CI; 1.07,1.18) had a higher prevalence of anemia during pregnancy.

Conclusion

Anemia is still a public health problem in East Africa. Therefore, enabling the households to have improved toilet facilities by strengthening the existing health extension program, reducing teenage pregnancy, and improving the community literacy level is vital to reduce the prevalence of anemia during pregnancy in East Africa.

Challenges and strategies to end child marriage

OBJECTIVES

Child marriage is one of the most important challenges of the current era that threatens women's health and violates human rights. The present study aimed to systematically review studies evaluating the challenges and strategies to overcome child marriage.

CONTENT

Medical databases (CINAHL, EMBASE, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science, ProQuest Nursing and Allied Health Source, and Social Science Research Network, as databases for English studies and IranMedex, Google Scholar, SID, Magiran, and Iran Doc as databases for Persian studies) were systematically searched from January 2010 to February 2020. To better identify appropriate studies, reference lists of relevant studies were searched. All potentially relevant abstracts and full-text were screened by two independent reviewers. Disagreements between two reviewers that could not be resolved were resolved via arbitration or consultation of a third author.

SUMMARY AND OUTLOOK

From 225 articles included in this review, 16 research articles met our inclusion criteria. Most of the articles were dedicated to negative health outcomes related to child marriage. Ten studies addressed the program of overcoming the Child marriage and six studies reported challenges of it. Although, many studies have shown the efficacy of strategies to decline Child marriage. On the basis of the available evidence, it seems there are a number of obstacles to end Child marriage. To delineate the most effective strategy to end Child marriage is required further research.

Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis

OBJECTIVE

This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Ethiopia.

PARTICIPANTS

Reproductive age group women.

PRIMARY OUTCOME

Unmet need for family planning.

METHODS

This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables.

RESULTS

The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning.

CONCLUSION

Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.

Drivers and consequences of child marriage in a context of protracted displacement: a qualitative study among Syrian refugees in Egypt

Background

Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls’ wellbeing.

Methods

This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding.

Results

A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls’ education, protection concerns, and livelihood insecurity were found to exacerbate girls’ vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls’ mobility as well as challenges with marriage and birth registration which accentuated their vulnerability.

Conclusion

Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10718-8.

Child Marriage and Sexual Autonomy among Women in Sub-Saharan Africa: Evidence from 31 Demographic and Health Surveys

Child marriage has a variety of undesirable consequences at the peril of women's health and autonomy. In this study, we examined the association between child marriage and sexual autonomy among women in sub-Saharan Africa. We utilised data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2019. A total of 218,578 women aged 20-49 were included in this study. Multivariable binary logistic regression models were used to show the association between child marriage and sexual autonomy. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were used in presenting the results. The prevalence of child marriage and sexual autonomy was 44.51% and 83.35%, respectively. Compared to women who married at 18 years or above, those who married at less than 18 were less likely to have sexual autonomy, and this persisted after controlling for important covariates. In terms of the country-specific results, women who experienced child marriage were less likely to have sexual autonomy in Burundi, Congo DR, Nigeria, and Niger. With the covariates, lower odds of sexual autonomy were found among women with no formal education, those whose partners had no formal education, those who were not exposed to media, and non-working women. Child marriage was found to be associated with sexual autonomy. There is a need to strengthen policies and programmes such as compulsory basic education, poverty alleviation, and an increase in access to media that aim at reducing child marriage. These interventions will help to improve sexual autonomy among women, especially in this 21st century where individuals and organisations incessantly advocate for gender equality.

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.

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

INTRODUCTION

In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa.

METHODS

We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy.

RESULTS

Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy.

CONCLUSION

The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

Spatial distribution and associated factors' of early marriage among reproductive age women in Ethiopia: a secondary data analysis of Ethiopian Demographic and Health Survey 2016

Background

Besides, the presence of national law, the country has to set up its own mid-term and long term goals to bring about a significant reduction in child marriages in Ethiopia. As my search concerned, there is no study conducted on the spatial distribution of early marriage in Ethiopia. Determining the spatial distribution of early marriage and factors associated is important for government, other concerned bodies, program implementers, and policy developers to end up early childhood marriage. Thus, this study aimed to assess the spatial distribution and associated factors of Early marriage among reproductive-age women in Ethiopia.

Methods

This study analyzed retrospectively a cross-sectional data on a weighted sample of 11,646 reproductive age women after requesting from Ethiopian Demographic and Health Survey 2016. ArcGIS and SaTScan software were for spatial analysis. Multiple logistic regression analysis was used to identify factors associated with early marriage. Finally, variables with a p-value of less than or equal 0.05 were considered as statistically significant.

Results

In this analysis, about 62.8% (95% CI 61.9, 63.74%) of the study participants were married before they reached 18 years. The overall median age at first marriage was 17.1 with IQR 5 years. The high clustering of early marriage was located in Amhara, Afar, and Gambella Regions. In spatial Scan statistics, 87 clusters (RR = 1.28) significant primary clusters were identified. The associated factors of early marriage were lesser among women’s attending primary (AOR = 0.60; 95% CI 0.51, 0.71), secondary (AOR = 0.19; 95% CI 0.13, 0.26) and tertiary education (AOR = 0.11; 95% CI 0.07, 0.18). Similarly, women found in Addis Ababa were at a lesser risk of early marriage compared to other regions of the country.

Conclusion

Marriage below age 18 is high in Ethiopia. High-risk area of early marriage was located in Amhara, Afar, and Gambella. Governmental and non-governmental organizations should design an effective intervention in these regions to reduce Early marriage. Therefore, providing educational opportunities to young girls was important in addition to inhibiting the marriage of girls under 18 years.

Defining and deconstructing girl child marriage and applications to global public health

An estimated 650 million girls and women alive today married before their 18th birthday. Referred to as girl child marriage, the formal or informal union of the girl-child before age 18, the practice is increasingly recognized as a key roadblock to global health, development, and gender equality. Although more research than ever has focused on girl child marriage, an important gap remains in deconstructing the construct. Through an extensive review of primary and secondary sources, including legal documents, peer-reviewed articles, books, and grey literature across disciplines, we explore what the term "girl child marriage" means and why it more accurately captures current global efforts than other terms like early, teenage, or adolescent marriage. To do this, we dive into different framings on marriage, children, and gender. We find that there has been historical change in the understanding of girl child marriage in published literature since the late 1800s, and that it is a political, sociocultural, and value-laden term that serves a purpose in different contexts at different moments in time. The lack of harmonized terminology, particularly in the global public health, prevents alignment amongst different stakeholders in understanding what the problem is in order to determine how to measure it and create solutions on how to address it. Our intent is to encourage more intentional use of language in global public health research.

Health Co-morbidities and Early Marriage in Women of a Rural Area of Nepal: A Descriptive Cross-Sectional Study

Introduction:

Early marriage is defined as the marriage of a young person less than 18 years. Early marriage is more prevalent in South Asia as more than half of all child marriage occurs here. Thirty-seven percent of girls in Nepal marry before age 18 years. This study was done to find out the health consequences of early marriage in women of a rural area of Nepal.

Methods:

A descriptive cross-sectional study was conducted from 10^th to 15^th Feb 2020 February in 358 women from Panauti, Kavrepalchowk. The convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee. Economic status was assessed by using Kuppuswamy's socioeconomic scale. The collected data were analyzed using the Statistical Package for Social Science version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

Results:

The prevalence of early marriage was 187 (52.2%) (47.03 to 57.37 at 95% confidence interval). One hundred sixteen (62%) early marriage women had gynecological problems followed by depression problem 85 (45.5%) and miscarriage 32 (17.1%). The mean age of marriage was 17.2 years. The majority, i.e. 167 (89.3%) of respondents who married earlier were Hindu by religion. Early marriage was observed in 104 (55.6%) of illiterate women.

Conclusions:

The prevalence of early marriage was high. Early married women had a lower level of socio-economic status, lower level of education, which harmed the participants' health status.

Spatial Distribution and Determinants of Early Marriage among Married Women in Ethiopia: A spatial and Multilevel Analysis

BACKGROUND

Early marriage is a global public health problem that is mainly practiced in South Asia, Latin America, and sub-Saharan Africa including Ethiopia. It raises the risk of early childbearing of women, higher rates of divorce, and an increased risk of maternal and child death. However, little is known about the spatial distribution and determinants of early marriage in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of early marriage among ever-married women in Ethiopia.

METHODS

A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was conducted. A total weighted sample of 11,646 reproductive-age married women were included in the analysis. To identify significant hotspot areas of early marriage the Bernoulli model was fitted using SaTScan version 9.6 software. Additionally, to explore the spatial distributions of early marriage across the country ArcGIS version 10.1 statistical software was used. For the determinant factors, the multilevel logistic regression model was fitted. Deviance was used for model comparison and checking of model fitness. In the multivariable multilevel analysis, Adjusted Odds Ratio (AOR) with 95% CI was used to declare significant determinants of early marriage.

RESULTS

The finding of this study revealed that the spatial distribution of early marriage was significantly varied across the country with Global Moran's I = 0.719 and p value < 0.001. The primary clusters were detected in Tigray, Amhara, and Afar regions. Both individual and community-level factors were associated with early marriage. Having no formal education (AOR = 4.25, 95% CI 3.13-5.66), primary education (AOR = 3.37, 95% CI 2.80-4.92), secondary education (AOR = 1.75, 95% CI 1.32-2.33), and a decision made by parents (AOR = 1.88, 95% CI 1.68-2.09) were individual-level factors associated with higher odds of early marriage. Among the community-level factors, the region was significantly associated with early marriage. Thus, living in Afar (AOR = 1.82, 95%CI 1.37-2.42), Amhara (AOR = 1.77, 95% CI 1.38-2.77), and Gambela (AOR = 1.44, 95% CI 1.09-190) was associated with higher odds of early marriage. Whereas, living in Addis Ababa (AOR = 0.50, 95% CI 0.36-0.68) was associated with a lower chance of early marriage.

CONCLUSION

The spatial distribution of early marriage was significantly varied in Ethiopia. Women's education, women's autonomy, and region were found to be the significant determinants of early marriage. Therefore, public health interventions targeting those identified significant hotspot areas of early marriage are crucial to reduce the incidence of early marriage and its consequence. In addition, enhancing women's education and empowering them to make their own choices are vital for changing the customs of the community and eliminating early marriage in Ethiopia.

Exploring married girls' subjective experiences of well-being and challenges

INTRODUCTION

The well-being of married girls is often significantly affected by their early transitioning into the institution of marriage. This is accompanied by a normative shift in their focus from education and personal development to family life and motherhood. However, it is important we understand married girls' perspectives of what their marriage mean to them and how that affects their well-being. Therefore, this study explored the subjective experiences of well-being and challenges among married girls in the Northern region of Ghana.

METHODS

A phenomenological approach was used to gather data through in-depth interviews. Twenty-one married girls between the ages of 12 and 19 years in Sagnarigu, Tolon and Mion districts of the Northern Region of Ghana were interviewed and data were analysed using thematic analysis.

RESULTS

Findings revealed that girls who perceived their marriage as early reported negative emotions whereas those who perceived their marriage as timely reported positive emotions. Married girls' positive experiences were characterised by child bearing, higher social status, received social support and satisfaction of needs in their marriage. Challenges identified included poor socio-economic status, inadequate parenting skills, pregnancy and childbirth related distresses.

CONCLUSIONS

Married girls expressed more positive outcomes in their marriage than they did for negative outcomes despite their general perception of their marriage being early. Implications for interventions and policy decision making are discussed.

Prevalence of child marriage and its impact on fertility outcomes in 34 sub-Saharan African countries

Background

The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women’s health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes.

Methods

Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models.

Results

In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively.

Conclusion

Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born.