• Open access
  • Published: 14 February 2022

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

  • Suiqiong Fan 1 &
  • Alissa Koski 1 , 2  

BMC Public Health volume  22 , Article number:  309 ( 2022 ) Cite this article

29k Accesses

27 Citations

19 Altmetric

Metrics details

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.

Peer Review reports

Introduction

Marriage before the age of 18, often referred to as child marriage, is a violation of human rights that hinders educational attainment and literacy and may increase the likelihood of living in poverty in adulthood [ 1 , 2 , 3 , 4 , 5 ]. Girls are far more likely to marry than boys, and these consequences contribute to existing gender gaps in educational outcomes in some settings [ 6 , 7 ]. The United Nations Sustainable Development Goals list child marriage as an indicator of gender inequality and call for an end to the practice by the year 2030 [ 8 ]. Child marriage remains ongoing throughout much of the world despite intensifying efforts to eliminate it [ 9 ].

In addition to its consequences on education, growing attention to child marriage as a global development issue also seems to reflect increasing consideration of its potential impacts on population health. Multinational organizations including the World Bank, the United Nations Population Fund (UNFPA), and the United Nations Children’s Fund (UNICEF) include the potential for harmful consequences on health among the foremost concerns regarding this practice [ 2 , 10 , 11 , 12 , 13 ]. These organizations highlight relationships between child marriage and early childbearing [ 11 , 12 , 13 ], obstetric complications [ 12 , 13 ], violence [ 2 , 12 ], and sexually transmitted infections [ 12 ], among other adverse outcomes.

We undertook this systematic review to synthesize the results of existing research regarding the impact of child marriage on the health of persons who marry before the age of 18. We evaluated the range of health outcomes that have been studied and the geographic distribution of those studies. We also assessed the risk of bias in individual studies and the likelihood that their results reflect causal relationships.

We searched three databases for literature on the relationship between child marriage and health: MEDLINE, Embase, and Ovid Global Health. These databases were chosen because they focus on biomedicine and human health. We aimed to include as broad a range of health outcomes as possible and focusing our search within these databases allowed us to avoid defining specific health outcomes within our search terms. Instead, we searched for studies of child marriage within these databases. This approach made our search terms more concise and the range of outcomes more inclusive. Specific search terms used for each database are included in Supplementary File 1 . We registered our protocol with PROSPERO (CRD42020182652) in May 2020 and conducted our database searches shortly afterward.

We also searched Google Scholar to identify relevant grey literature. Haddaway et al. [ 14 ] found that the majority of grey literature tends to appear within the first 200 citations returned by Google Scholar and recommend focusing on the first 200-300 records. We followed this recommendation and evaluated the first 300 records returned, as sorted by relevance. Search terms used in Google Scholar are also included in Supplementary File 1 . We reviewed the bibliographies of all included studies in an effort to identify any relevant citations not picked up through searches of the databases described above. The search strategy was developed with assistance from a research librarian at McGill University.

Citations returned from searches of all four databases were imported into EndNote X9 and duplicate citations removed [ 15 ]. We transferred all unique citations into Rayyan to facilitate the review process [ 16 ]. A single reviewer (SF) examined the title and abstract of each unique citation for eligibility according to pre-defined criteria specified in the registered protocol. Articles were brought forward for full-text review if they described etiologic studies that used quantitative methods to estimate the effect of child marriage on one or more health outcomes. We defined child marriage as formal or informal union prior to the age of 18. If the title and abstract did not specify the age thresholds used to define child marriage, they were brought forward for full-text review. For example, abstracts that referred to the effect of adolescent or teen marriage without explicitly stating how those exposures were defined were brought forward. Eligible health outcomes included physical or mental health disorders or symptoms of those disorders, as well as health behaviours. Eligible health behaviours included actions like smoking or dietary habits as well as health care seeking, such as prenatal care. We restricted our review to studies in which outcomes were measured at the individual level and to those that measured the effect of child marriage on the individuals married; studies that examined the effect of age at marriage on the offspring of the persons who married were excluded. Studies written in English, French or Chinese were eligible for inclusion.

We excluded studies that used solely qualitative methods and quantitative studies that relied exclusively on hypothesis testing to indicate differences between groups. For example, studies that used chi-squared tests to indicate whether the distribution of some characteristic differed between persons married before the age of 18 and those married at older ages were excluded, even if the authors seemed to interpret their results as causal, because such testing does not result in a comparative effect measure (e.g., a risk difference or an odds ratio) and does not account for potential biases. We also excluded studies in which persons who married before the age of 18 were incorporated into a larger aggregate age category, making the effect of child marriage unidentifiable. For example, comparisons of outcomes among persons who married between 15 and 19 years of age with those who married between 20 and 24 years of age were not eligible for inclusion. Conference presentations and abstracts were also excluded.

Both authors read the full text of each article brought forward from the title and abstract review and independently judged their eligibility according to the inclusion and exclusion criteria described above. Discrepancies were resolved through discussion. The following information was extracted from each included study: authors, title, year of publication, the language of publication, country/region in which the study was conducted, study design, study population, sample size, data sources, statistical methods, outcomes, and results.

Risk of bias assessment

We assessed the risk of bias within each included study using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool developed by members of the Cochrane Bias Methods Group and the Cochrane Non-Randomised Studies Methods Group [ 17 ]. ROBINS-I is designed to evaluate the risk of bias in non-randomized studies by considering how closely the study’s design and methods approximate an ideal randomized trial. To illustrate, in a hypothetical cluster-randomized trial to estimate the causal effect of child marriage on a specified health outcome, the treatment or intervention would be marriage before the age of 18 years. All children in a specific area (a region, a state, a community, etc.) would be randomized at a very young age to one of two treatment groups: those randomized to the intervention would marry at some point prior to their 18th birthdays (a = 1), while those randomized to the control group would marry on their 18th birthday or any later age (a = 0). All children would then be followed up over a period of time sufficient to observe the specified outcome of interest. In the ideal randomized trial, all persons would adhere to their assigned treatment (i.e., remain married) and would remain in the study until follow-up was complete. After the follow-up period, the probability of the outcome among those assigned to a = 1 would be compared with the same probability among those assigned to a = 0. Under these conditions, we could expect that there would be no differences between those children who married before the age of 18 and those who married afterward aside from age at marriage. As a result, if the probability of the outcome among those randomly assigned to marry as children differed from the probability among those randomly assigned to marry after their 18th birthdays, one could interpret that difference as the causal effect of child marriage [ 18 ].

Of course, a randomized trial like this would be unethical and could never actually be conducted. Researchers interested in the effects of child marriage on health must rely on non-randomized study designs to estimate the causal effect of interest. Without the benefit of randomization, it becomes challenging to identify the causal effect of child marriage because those who marry as children are different from those who marry at later ages in many ways. For example, girls who marry before the age of 18 come from poorer households and from communities with greater gender inequality, on average, compared to those who marry at later ages. These differences are likely to affect their health through causal pathways other than age at marriage, such as the experience of violence or limited ability to access education or health care. This means that a naïve comparison of health outcomes between those who marry as children and those who marry as adults is likely to mix up the consequences of age at marriage with the consequences of childhood poverty and gender inequality.

The ROBINS-I tool requires assessors to carefully consider the potential for multiple sources of bias including confounding, inappropriate selection of participants into the study (i.e., selection bias), mishandling of missing data, and problems with the measurement of exposures and outcomes (i.e., information bias). The potential for bias in each domain is assessed through a series of signaling questions and a summary judgement of low, moderate, serious, or critical risk of bias is then made within each domain. A cross-domain judgement of the risk of bias for the entire study is made based on the risk within each individual domain. Both authors independently assessed the risk of bias in each included study. Disagreements in any single domain or across domains were resolved by discussion.

We identified a set of variables likely to confound estimates of the effect of child marriage on a wide range of health outcomes in advance to facilitate assessment of bias in this domain. These variables and their relationships to child marriage and health, broadly defined, are illustrated in the simplified Directed Acyclic Graph (DAG) in Fig.  1 . The prevalence of child marriage has fallen over time in many countries, which means that the likelihood of marrying before the age of 18 differs across birth cohorts [ 6 , 19 ]. As discussed above, childhood socioeconomic conditions and gender inequality may lead to child marriage. They may also influence health later in life through a variety of causal pathways. We also considered spousal characteristics a source of confounding because the presence of an available spouse may drive child marriage. For example, a potential husband willing to pay a bride price for a young wife may motivate a family to marry a girl child. The same characteristics of the spouse that may motivate the marriage, such as his age, wealth, and attitudes regarding gender equity, may influence the married child’s health later in life through mechanisms like controlling behaviour. In studies that use pooled data from across multiple regions or countries, it is also important to control for confounding by country/regional-level variables that affect both the probability of child marriage and health. The DAG also illustrates our assumption that the effects of child marriage on health are often mediated through educational attainment and socioeconomic conditions after marriage.

figure 1

Directed acyclic graph illustrating assumed causal relationships between child marriage and a wide range of health outcomes

We synthesized results narratively. Included studies considered a wide range of health outcomes, as intended given our search strategy. We found it most intuitive and pragmatic to synthesize results within broad outcome categories, such as the effects of child marriage on contraceptive use, on maternal health care, and on mental health. These categories emerged from the data and were not pre-specified. Meta-analyses were not conducted because the studies examined a wide range of health outcomes that were measured in different ways. The serious risk of bias in all included studies, discussed below, also made quantitative synthesis inappropriate.

Our search strategy returned a total of 2767 unique records from MEDLINE, Embase, Ovid Global Health and Google Scholar, as shown in Fig.  2 . After title and abstracting screening, the full text of 126 articles was reviewed. Fifty-six of these studies met our inclusion criteria and two additional eligible studies were identified through citation tracking, for a total of 58 included articles.

figure 2

PRISMA flow diagram illustrating the process used to identify eligible studies

Selected characteristics of all 58 studies included in our review are presented in Table  1 . These studies were published between 1989 and 2020 but the vast majority ( n  = 55, 95%) were published in 2010 or later and more than half ( n  = 31, 53%) were published between 2016 and 2020, which reflects the relatively recent rise of child marriage on global health and development agendas. Included studies were based in 70 countries across the globe, as illustrated in Fig.  3 . Nearly all studies, 57 of 58, were based in low- and middle-income countries according to World Bank classifications [ 20 ]; the single exception was a study based in the United States [ 21 ]. The geographic distribution of studies included in our review was heavily focused in South Asia ( n  = 30, 52%) and Sub-Saharan Africa ( n  = 27, 47%), which is perhaps unsurprising given that countries in these regions have some of the highest rates of child marriage in the world [ 9 ]. However, more than half of the studies included in our review were based in just three countries: India ( n  = 13), Bangladesh ( n  = 8) and Ethiopia ( n  = 11). Studies from regions other than South Asia or Sub-Saharan Africa were nearly all included in a handful of studies that analyzed survey data from multiple countries simultaneously [ 22 , 23 , 24 ].

Nearly all included studies, 55 of 58 (95%), were based on the analysis of cross-sectional survey data. More than half ( n  = 34, 59%) relied on data from a single source, the Demographic and Health Surveys (DHS), or their precursor, the World Fertility Surveys (WFS).

figure 3

Geographic distribution of included studies

Bias assessment

All studies included in our review were determined to be at serious or critical risk of bias based on assessment using ROBINS-I. The summary risk of bias assessment for each study is listed in Table  1 ; risk of bias within each ROBINS-I domain in each study is detailed in Supplementary File 2 . Confounding was the most prevalent concern. Every study was deemed to be at serious to critical risk of bias in this domain, most often because of failure to account for important sources of confounding and inappropriate adjustment for variables affected by age at marriage that are on the causal pathway. Cross-sectional surveys like the DHS often do not collect information necessary to control for confounding. Failure to control for major sources of confounding like childhood poverty and gender inequality may result in overestimation of the harmful effects of child marriage. The second common source of bias was adjustment for variables measured after marriage that are likely on the causal pathway between age at marriage and the health outcomes being studied. To illustrate, the authors of many studies included in this review acknowledged that age at marriage may dictate how long a girl stays in school and that her educational attainment may subsequently influence a wide range of health outcomes. Unfortunately, they then adjusted for educational attainment in regression analyses. This will very likely result in biased estimates because educational attainment was measured after marriage and is more likely to be a mediator than a confounder (Fig.  1 ) [ 79 , 80 ]. Adjusting for it may remove some of the effect of child marriage on health and lead to underestimates of effect. Given that these two issues may bias results in different directions, predicting the net direction of confounding within studies is challenging. Other sources of bias also affected many of the studies in this review, including selection and measurement biases. Few authors discussed the potential influence of bias on their estimates or their conclusions.

The health consequences of child marriage

Studies included in our review estimated the effect of child marriage on a variety of health outcomes. The most common outcomes were measures of reproductive health, such as fertility and fertility control, maternal health care utilization, intimate partner violence, mental health, and nutritional status. The following paragraphs synthesize the literature in each of these categories. In light of the serious risk of bias in all included studies, we interpreted these results with a high degree of caution. We assessed the direction of effect measures, meaning whether the study found that child marriage increased or decreased the probability of experiencing the outcome, and the consistency of directionality across studies within each outcome category. We also assessed the precision of effect measures by evaluating the width of confidence intervals surrounding those measures. We did not interpret the magnitude of the effect estimates from individual studies due to the risk of bias.

The effect of child marriage on the number and timing of births

Eleven studies estimated the effect of child marriage on the number of children born, though this outcome was not consistently measured. Some studies estimated the effect of child marriage on the odds of having given birth to any children [ 34 , 50 , 63 ], the odds of having three or more children [ 24 , 46 , 50 , 63 , 75 ], four or more children [ 34 ], five or more children [ 37 , 69 ], or a continuous measure of the total number of children ever born [ 24 , 25 , 30 , 46 , 54 ]. The age ranges of the people included in these studies also differed, leading to variation in the time frame over which these births could have occurred. Child marriage was correlated with higher fertility in nearly all studies regardless of how the outcome was defined. The only exception was a study from Ethiopia that found no effect [ 30 ]. Ten of these studies focused on fertility exclusively among women. Misunas et al. [ 24 ] focused on men and came to similar conclusions: child marriage increased the odds that men aged 20-29 had fathered three or more children and increased the average number of children fathered by the ages of 40-49 [ 24 ].

A second commonly examined outcome was the likelihood of giving birth within the first year of marriage. Four studies based on data from South Asia [ 39 , 46 , 50 , 63 ] and one study based on pooled data from multiple countries in Africa [ 75 ] examined this outcome. Three of these studies [ 46 , 50 , 75 ] reported that marriage before the age of 18 decreased the odds of giving birth within the first year of marriage. The remaining two [ 39 , 63 ] did not find any evidence of a relationship between child marriage and this outcome.

We also identified five studies that estimated the effect of child marriage on the likelihood of giving birth before a specified age, often referred to as early, teen, or adolescent pregnancy [ 23 , 26 , 31 , 32 , 34 ]. Three of these studies found that child marriage increased the odds of giving birth before the age of 20 [ 26 , 31 , 32 ], the other two reported that child marriage increased the odds of giving birth before the age of 18 [ 23 , 34 ]. Two studies also estimated the effect of child marriage on mean age at first birth and found that those who married before the age of 18 gave birth for the first time at younger ages, on average, than those who married at older ages [ 32 , 46 ].

Collectively, this evidence indicates that women who marry as children often begin having children of their own at earlier ages when compared to their peers who marry after their 18th birthdays, and that they tend to have a larger number of children over their lifetimes. This is not surprising, given that marriage changes sexual behavior in ways that increase the risk of pregnancy. Essentially, girls who marry at earlier ages spend a longer time at risk of pregnancy than those who marry later.

The effect of child marriage on birth intervals

The World Health Organization recommends an interval of at least 24 months between a live birth and a subsequent pregnancy to reduce the risk of poor maternal health outcomes [ 81 ]. Five studies included in our review estimated the effect of child marriage on the likelihood of repeated childbirths in less than two years [ 39 , 50 , 62 , 63 , 75 ]. All five used samples of women between the ages of 20 and 24 who were included in DHS. A sixth study based on a small cross-sectional sample of women aged 15-49 from Ethiopia estimated the effect on repeated childbirth in less than three years [ 27 ]. These studies came to different conclusions. Two studies by the same author reported that child marriage increased the odds of repeated childbirth within two years in India [ 62 , 63 ] but another study based on the same data source found that women who married as children were less likely to have two births within a two-year period than those who married at older ages [ 39 ]. There were also differences in the results of research from Pakistan: one study reported that child marriage made it more likely that women would have two births within two years [ 50 ] while another found no evidence that child marriage influenced this outcome [ 39 ]. Child marriage protected against short birth intervals in Nepal [ 39 ] and in an analysis of data from 34 African countries [ 75 ]. There was no evidence that child marriage influence the likelihood of short birth intervals in Bangladesh [ 39 ].

These results, which range from harmful to protective effects, indicate that child marriage is not clearly or consistently correlated with short birth intervals.

Child marriage, unwanted or mistimed pregnancy, and pregnancy termination

Seven studies estimated the effect of child marriage on the likelihood of experiencing a mistimed or unwanted pregnancy [ 39 , 46 , 47 , 50 , 62 , 63 , 75 ]. All seven were based on analyses of DHS data. The DHS typically asks women whether pregnancies were wanted at the time they occurred, wanted later (i.e., mistimed), or not wanted. Interestingly, six of the seven studies that examined this outcome reduced these categorical responses into a binary measure: women were categorized as having an unwanted pregnancy if they reported that they had a mistimed pregnancy or if they became pregnant when they did not want any more children [ 39 , 46 , 50 , 62 , 63 , 75 ]. The rationale for doing this was not explained in any of the studies. The remaining study [ 47 ] only categorized instances in which a woman became pregnant at a time when she did not want any more children as unwanted.

Estimates of the effect of child marriage on this outcome are mixed. A study from 34 countries in Africa reported that child marriage protected against mistimed/unwanted pregnancies [ 75 ]. Studies from India, Pakistan, and Nepal concluded that child marriage increased the odds of experiencing mistimed/unwanted pregnancy [ 39 , 50 ]. Three studies from Bangladesh came to different conclusions. One found no relationship between child marriage and this outcome [ 39 ] while another reported that child marriage increased the odds of mistimed/unwanted pregnancy [ 46 ]. The third used a different definition of the outcome and found that marriage before the age of 15 was positively associated with unwanted pregnancy (mistimed pregnancies were treated as wanted) but no evidence that marriage between the ages of 15 and 17 affected the likelihood of unwanted pregnancy [ 47 ].

Three of these studies also estimated the effect of child marriage on the likelihood of experiencing two or more mistimed or unwanted pregnancies [ 39 , 62 , 63 ]. Godha et al. reported a large effect of child marriage on having multiple mistimed/unwanted pregnancies in India, Bangladesh, and Pakistan but results were inconclusive in Nepal [ 39 ]. Two studies by the same author reported that child marriage increased the odds of having multiple mistimed/unwanted pregnancies in India [ 62 , 63 ].

We identified eight studies of the effect of child marriage on pregnancy outcomes [ 39 , 47 , 48 , 50 , 57 , 63 , 66 , 75 ]. Six of these relied on the DHS, which typically asks female respondents, “Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?” [ 82 ]. The wording of this question makes it impossible to examine these outcomes separately. As a result, most studies based on the DHS used a composite outcome that grouped these three events despite differences in their intendedness. Five studies based on the DHS concluded that child marriage increased the odds of having a pregnancy end in either miscarriage, abortion, or stillbirth [ 39 , 48 , 50 , 63 , 75 ]. Exceptionally, the 2007 Bangladesh DHS asked a yes or no question regarding whether a woman had ever terminated a pregnancy. Using responses to this question, Kamal reported that marriage before the age of 15 was correlated with higher odds of termination but no evidence that marriage between 15 and 17 years of age influenced this outcome [ 47 ].

Two studies from India used other cross-sectional data sources and defined their outcomes differently. Santhya et al. used a combined outcome of miscarriage and stillbirth and found that child marriage increased the likelihood of experiencing either of these birth outcomes. [ 66 ]. Paul considered stillbirth and miscarriage separately. Marriage before the age of 15 increased the odds of stillbirth and miscarriage, but marriage between the ages of 15-17 was no less risky in this regard than marriage at 18 or later [ 57 ].

Child marriage and contraceptive use

Fifteen of the studies included in our review estimated the effect of child marriage on various aspects of contraceptive use [ 23 , 24 , 32 , 39 , 40 , 41 , 43 , 46 , 53 , 56 , 62 , 63 , 65 , 66 , 75 ]. All were based on cross-sectional data and thirteen used data from the DHS.

Of these fifteen studies, eight estimated the effect of child marriage on the likelihood that women were using contraception at the time the surveys were conducted [ 32 , 39 , 40 , 46 , 53 , 62 , 63 , 65 ]. As with other outcomes, results were mixed. Child marriage reportedly increased the likelihood of using modern contraception in India and Bangladesh [ 39 ]. Results from Pakistan and Nepal indicate that the same may be true in those countries but the estimates were imprecise [ 39 ]. A second study from Nepal concluded that child marriage led to lower odds of using modern contraception [ 65 ]. The two studies from Nepal used different samples of women, which may partially explain the differences in their results. A study based on pooled data from 18 African countries found that child marriage was correlated with a lower likelihood of using modern contraception [ 53 ]. However, results varied markedly between countries and across geographic regions; in some, child marriage appeared to increase the likelihood of using modern contraception [ 53 ]. In Ghana, de Groot et al. found that child marriage was not correlated with the odds of using any form of contraception or with the use of modern contraceptives [ 32 ].

Two other studies investigated the effect of child marriage on the use of any method of contraception, including those not classified as modern [ 40 , 46 ]. Marriage prior to the age of 15 led to lower odds of contraceptive use in Rwanda, but there was no indication that those who married between 15 and 17 years of age were any more or less likely to use contraception than those who married at older ages [ 40 ]. In Bangladesh, women who married as children were more likely to be using some form of contraception at the time of the survey than those who married at the age of 18 or older [ 46 ]. In yet another iteration of this outcome, Yaya [ 75 ] reported that women who married as children were more likely to have ever used modern contraception. A single study estimated the effect of child marriage among men on the likelihood that they were using modern contraception [ 24 ]. In five of ten countries studied, child marriage was not related to modern contraceptive use. In two (Honduras and Nepal), child marriage seemed to slightly increase the odds of contraceptive use, but it decreased the likelihood in Madagascar [ 24 ].

A second outcome that has received particular focus is whether a woman used contraception before her first pregnancy. All four studies that examined the effect of child marriage on this outcome were based on data from South Asia [ 39 , 56 , 63 , 66 ] and concluded that marrying as a child decreased the likelihood that a woman used contraception prior to her first pregnancy [ 39 , 56 , 63 , 66 ]. The authors of these studies frequently interpreted their results as an indicator of uncontrolled fertility that may place girls and their children at risk of poor health outcomes [ 39 , 56 , 63 ]. However, this relationship is more challenging to interpret because the outcome variables used did not capture whether pregnancies were desired shortly after marriage or the outcomes of those pregnancies.

Four studies estimated the impact of child marriage on the likelihood that a woman had an unmet need for contraception [ 23 , 32 , 41 , 43 ]. This outcome was conceptually defined as a woman who is sexually active but not using contraception and who reports a desire to delay the next birth (a need for spacing), have no more births (a need for limiting), or a combination of the two. Once again, conclusions differ between studies. Using pooled DHS data from 47 countries, Kidman and Heymann found that marrying as a child increased the likelihood that women had an unmet need for contraception to either space or limit births [ 23 ]. An analysis of DHS data from Ethiopia found that women who married as children were less likely to have an unmet need for spacing and less likely to have an unmet need for limiting births compared to women who married at older ages [ 41 ]. In Zambia, child marriage was correlated with a greater unmet need for spacing and for limiting [ 43 ]. In Ghana, de Groot et al. found that child marriage was not correlated with an unmet need for limiting [ 32 ]. These studies all used different samples, which may partially explain the differences in their results.

Child marriage and use of maternal health care

Nine of the studies included in our review estimated the effect of child marriage on the use of health care during pregnancy, at the time of delivery, and during the post-partum period, which we collectively refer to as maternal health care [ 33 , 39 , 49 , 53 , 58 , 62 , 66 , 67 , 74 ].

Studies of prenatal care defined their outcomes as the receipt of at least one prenatal checkup [ 49 , 62 ], the receipt of four or more prenatal checkups [ 49 , 58 , 67 ], or a count of the total number of prenatal checkups received [ 39 , 53 ]. Once again, results within countries come to different conclusions. In Nepal, one study found that women who married as children were less likely to receive four or more prenatal checkups [ 67 ] while another found no evidence that child marriage influenced this outcome [ 39 ]. A study from India found no indication that child marriage affected prenatal care [ 39 ] but two others concluded that child marriage decreased the likelihood of receiving at least one checkup and of receiving at least four checkups [ 58 , 62 ]. In one study from Pakistan, women who married as children were less likely to receive any prenatal care than those who married at older ages, but there was no difference in the likelihood of receiving four or more checkups [ 49 ]. A separate study from the same country reported that child marriage had no effect on the number of prenatal care checkups [ 39 ]. The effect of child marriage on the number of prenatal care visits varied between geographic regions in Africa. In some, child marriage appeared correlated with a decrease the number of visits while in others there was no effect [ 53 ].

Compared to other outcomes, the results of studies that estimated the impact of child marriage on the likelihood of delivering in a health care facility were remarkably consistent. Across geographic locations, all seven studies that examined this outcome concluded that child marriage reduced the likelihood of delivery in a health care facility [ 39 , 49 , 53 , 58 , 66 , 67 , 74 ]. Six of the same studies also found that women who married as children were less likely to have a skilled health care provider present during delivery [ 39 , 49 , 53 , 58 , 67 , 74 ].

Only two studies considered post-natal care [ 58 , 67 ]. One reported that child marriage led to lower likelihood of a post-natal checkup within 42 days of delivery in India [ 66 ] while the other found a lower likelihood of a checkup within 24 h of delivery in Nepal [ 75 ].

Child marriage and intimate partner violence

Sixteen studies estimated the effect of child marriage on the likelihood of experiencing intimate partner violence [ 22 , 23 , 29 , 35 , 38 , 42 , 51 , 53 , 55 , 60 , 62 , 64 , 66 , 70 , 71 , 77 ]. Fifteen of these studies were based on cross-sectional data [ 22 , 23 , 29 , 35 , 38 , 42 , 51 , 53 , 55 , 60 , 62 , 64 , 66 , 70 , 71 ] and eight (50%) were based on the DHS [ 22 , 23 , 51 , 53 , 60 , 62 , 64 , 70 ]. The DHS measures intimate partner violence by asking female respondents a series of questions regarding their experience of specific acts. For example, physical violence is assessed by asking women whether they have been slapped, kicked, or pushed, among other actions. Sexual violence is assessed by asking whether the respondent’s husband has forced her to have sex or perform sex acts when she did not want to. Emotional violence is measured by asking whether her spouse has humiliated or threatened her [ 83 ]. Studies based on data from sources other than the DHS tended to use the same or very similar questions to measure the experience of violence.

Physical violence was the most frequently examined outcome but was measured over different time frames across studies. Some estimated the likelihood of ever having experienced physical violence from a husband or partner while others considered only the year prior to the survey. Still, others focused on the 3 months prior to the survey [ 35 ], the 9 months between survey waves [ 77 ], or during pregnancy [ 38 ]. Regardless of the time period during which violence was measured, the conclusions of these studies were fairly consistent: nearly all reported that marrying as a child increased the likelihood of experiencing physical violence [ 22 , 38 , 51 , 55 , 60 , 64 , 66 , 71 , 77 ]. A study from Ethiopia found no indication that child marriage had an effect on this outcome but it considered a relatively short time period of 3 months [ 35 ].

Estimates of the effect of child marriage on the experience of sexual violence were much less consistent. Two studies from India came to conflicting conclusions. Raj et al. found that child marriage did not increase the likelihood of experiencing sexual violence at any point or in the year prior to the 2005-06 National Family Health Survey [ 64 ]. However, a study by Santhya et al. based on survey data collected from five Indian states between 2006 and 2008 found that child marriage did increase the likelihood of ever experiencing sexual violence [ 66 ]. Studies from Bangladesh and Ghana reported that women who married as children were no more or less likely to experience sexual violence than those who married at later ages [ 60 , 71 ]. Two studies that pooled DHS data across multiple countries also found mixed results [ 22 , 53 ]. Olamijuwon used data from 18 African countries and found that child marriage increased the odds of experiencing sexual violence in Central, East, and Southern Africa, but there was no evidence of a statistical relationship in West Africa [ 53 ]. Kidman used DHS data from 34 countries across the globe and reported that child marriage seemed to increase the odds of experiencing sexual violence in the year prior to the surveys in all included geographic regions except Europe and Central Asia [ 22 ]. Erulkar found that women who married as children in Ethiopia were more likely to report that their first sexual experience was forced [ 35 ].

Only two studies, one from Pakistan and one from Ghana, considered emotional violence as a stand-alone outcome. Both concluded the child marriage led to an increase in the likelihood of ever experiencing emotional violence from an intimate partner [ 51 , 71 ].

Five studies considered only combined outcomes that mixed indicators of physical and sexual violence [ 62 , 70 ], or physical, sexual, and emotional violence [ 23 , 29 , 42 ]. All of these found that child marriage was associated with increased reporting of these composite measures of violence, but some results were sensitive to the sample used and were inconsistent across locations [ 70 ]. Hong Le et al. considered whether child marriage affected the likelihood of violence among boys but was underpowered to detect any effect [ 42 ].

Child marriage and mental health

Five of the studies included in our review estimated the effect of child marriage on various aspects of mental health. These studies relied on cross-sectional data collected from Ghana, Iran, Ethiopia, Niger and the United States [ 21 , 32 , 36 , 44 , 45 ]. Women in the United States who married before the age of 18 were more likely to report experiencing a wide range of mood, anxiety, and other psychiatric disorders in adulthood when compared to those who married at later ages [ 21 ]. The authors of a small study from a single county in Iran found that women who married as children reported more depressive symptoms than those who married at the age of 18 or older [ 36 ]. John, Edmeades, and Murithi examined the relationship between child marriage and multiple domains of psychological well-being in Niger and Ethiopia [ 44 ]. The authors found that marriage before the age of 16 was correlated with poorer overall psychological well-being, but no evidence that marriage between the ages of 16 and 17 was associated with poorer outcomes when compared to women who married at the age of 18 or later [ 44 ]. In Ghana, child marriage seemed to protect against measures of stress. The Ghanaian study also found no indication of differences in levels of social support between women who married before the age of 18 and those who married after their 18th birthdays, though these odds ratio estimates were very imprecise [ 32 ].

Child marriage and nutritional status

Six studies included in our review estimated the effect of child marriage on indicators of nutritional status [ 28 , 34 , 52 , 61 , 76 , 78 ]. Four focused exclusively on pregnant women. Two studies from Ethiopia examined the relationship between child marriage and mid-upper arm circumference (MUAC) [ 52 , 76 ]. One reported that pregnant women who married before the age of 18 were more likely to have an MUAC less than 22 cm, often interpreted as a marker of undernutrition [ 84 , 85 ], compared to those who married later on [ 52 ]. The other found that marrying before the age of 15 increased the likelihood of MUAC <22 cm but no evidence that marrying between the ages of 15 and 17 affected this outcome [ 76 ]. A third study from Ethiopia reported that child marriage led to an increase in the prevalence of Vitamin A deficiency among pregnant or recently post-partum women [ 28 ].

Two other studies focused on women who were not pregnant and used body mass index (BMI) as the indicator of nutritional status [ 34 , 78 ]. Their results diverge. Yusuf et al. found that women in Nigeria who married as children were more likely to have a BMI less than 18.5, frequently interpreted as underweight among adults. However, in a study of 35 African countries, Efevbera et al. reported that child marriage was protective against being underweight (BMI<18.5) [ 44 ]. Interestingly, the authors of these studies offered plausible explanations for effects in either direction. Efevbera et al. hypothesize that girls who marry as children may gain access to more plentiful food at an earlier age and that repeated pregnancies during adolescence might result in greater weight gain relative to those who marry at later ages [ 34 ]. In contrast, Nigatu et al. note that repeat pregnancies in quick succession may have a detrimental impact on cumulative nutritional status [ 52 ]. This suggests that the mechanisms through which age at marriage may affect subsequent nutritional status have not been thoroughly considered.

Other health consequences of child marriage

A few of the studies included in our review examined outcomes other than those discussed above. We note them briefly here. A case-control study from India reported that women diagnosed with cervical cancer were more likely to have been married before the age of 18 [ 72 ]. A large, pooled analysis of DHS data from 47 countries reported that child marriage was associated with symptoms of sexually transmitted infections [ 23 ]. A small, cross-sectional study from a single Indian state found no evidence that child marriage led to an increase in the odds of obstetric fistula [ 68 ]. A third study from India examined the effect of child marriage on the odds of experiencing at least one complication during pregnancy, delivery, or within two months after delivery [ 57 ]. Marriage before the age of 15 seemed to increase the likelihood of pregnancy complications, but there was no evidence of an effect for marriage between 15 and 17 years. Child marriage was not associated with delivery complications, but was associated with postnatal complications [ 57 ]. A study from Ghana found no indication that child marriage influenced the likelihood of self-reported poor health, of being ill in the two weeks prior to the survey, or of having a health insurance card but did report that child marriage increased the odds of having difficulty with activities of daily living, such as bending or walking [ 32 ].

Our systematic review synthesized research on the health consequences of marrying before the age of 18. Studies almost uniformly found that women who married before the age of 18 began having children of their own at earlier ages and gave birth to more children over the course of their reproductive lives when compared to those who married at the age of 18 or later. Whether these outcomes, considered alone, are harmful to health is not clear. Though there are many reasons to be concerned about adolescent childbearing, none of the studies of the effect of child marriage on the timing of births considered whether those pregnancies were planned or desired or whether they resulted in obstetric complications or maternal morbidity or mortality [ 23 , 26 , 31 , 32 , 34 , 39 , 46 , 50 , 63 , 75 ]. Similarly, having multiple births, especially at short intervals, may increase the risk of obstetric complications and subsequent morbidity or mortality. However, studies that compared the number of children born to women who married before the age of 18 with the number born to those who married at later ages also did not measure whether those pregnancies were planned or whether they led to harm [ 24 , 25 , 30 , 34 , 37 , 46 , 50 , 54 , 63 , 69 , 75 ]. Rather, studies seemed to assume that these are negative outcomes without directly measuring intentions or harms.

A separate set of studies that estimated the effect of child marriage on the experience of mistimed or unwanted pregnancies came to divergent conclusions: some found that child marriage increased the likelihood of these outcomes but others found that child marriage protected against them or had no effect. Studies of whether child marriage affected the likelihood of obstetric complications, miscarriage or stillbirth did not consider maternal age when those events occurred [ 39 , 47 , 48 , 50 , 57 , 63 , 66 , 75 ]. Moreover, the fact that child marriage corresponds with a larger number of pregnancies means that girls who married prior to the age of 18 had more opportunities to experience these events compared to those who married later; this was not discussed in any of the studies we identified.

The results of studies in other outcome domains are very mixed and challenge some common narratives regarding child marriage. To illustrate, studies included in this review came to conflicting conclusions regarding whether child marriage increases or decreases the use of modern contraception, the likelihood of giving birth within the first year of marriage, and the likelihood of repeated childbirth within two years. Conclusions regarding mistimed and unwanted pregnancies were also mixed, as noted above. Collectively, these results suggest that child marriage is not uniformly characterized by an inability to control the number or timing of births and suggests that a more cautious approach to discussions of agency within these marriages is warranted, at least regarding fertility and fertility control.

Across studies, women who married as children were less likely to give birth in a health care facility or with assistance from a skilled health care provider. These findings raise concerns about access to emergency obstetric care and subsequent birth outcomes for both mother and child. However, we found only one study that estimated the effect of child marriage on the likelihood of complications during pregnancy, delivery, and the postpartum period [ 57 ] and consideration of the consequences for the infants born was beyond the scope of this review. This statistical relationship could be confounded by lack of access due to geographic distance. Child marriage is more common in rural areas, where health care facilities and skilled health care providers may be more spread out. It may also be a function of gender inequality, which may manifest as an inability to seek care without permission. Future research should consider the potential for confounding by these and other variables and investigate whether place modifies this relationship.

Child marriage could plausibly affect many aspects of maternal and reproductive health through complex causal pathways. However, most of the studies included in our review did not discuss causal mechanisms in detail, which may have hindered their ability to identify and account for various sources of bias. More thorough consideration and discussion of these mechanisms would strengthen the theoretical underpinnings of this body of literature and help mitigate biases. For example, use of Directed Acyclic Graphs to illustrate assumed causal relationships would help to clarify the causal pathways being studied and identify sources of bias [ 86 ].

The effects of child marriage among boys have been almost entirely overlooked. Only 2 of the 58 studies included in this review considered boys or men and one of them was underpowered to generate informative estimates [ 42 ]. This intense focus on child marriage among girls reflects the gendered nature of the practice. However, a substantial proportion of boys also marry before the age of 18 in some countries [ 7 , 24 ] and further inquiry into the health consequences among boys is warranted.

The geographic distribution of research on child marriage and health is highly skewed. The focus on South Asia and sub-Saharan Africa may be justified since these regions have some of the highest rates of child marriage in the world. However, it is unclear why just three countries, India, Bangladesh, and Ethiopia, have received such focused attention while other countries in these regions have received very little. Child marriage is certainly ongoing in many other regions of the world that have received little or no research attention, including high-income countries [ 9 , 87 , 88 ].

The geographic distribution of these studies and the range of outcomes considered is clearly reflective of heavy reliance on the DHS. The DHS is appealing because it collects information on age at marriage that is comparable across settings and over time, data are readily accessible and of high quality, and samples are typically nationally representative. However, defaulting to this data source may also have restricted the range of outcomes studied. The DHS focuses primarily on reproductive health and our review included many studies of the effect of child marriage on fertility, contraceptive use, and intimate partner violence. Far less attention has been paid to other potential harms of child marriage that are not included in the surveys, such as indicators of mental health. Importantly, the DHS does not collect information on some of the strongest confounders of many relationships between child marriage and health, including childhood socioeconomic conditions and measures of gender equality. Other data sources will be necessary to increase the geographic scope of this body of research and to overcome some of the limitations inherent in the use of cross-sectional data to estimate causal effects.

All studies included in our review were at serious to critical risk of bias. Quantification of the net magnitude of different biases on the results of each study would have made the project untenable. Considering pervasive bias, we avoided interpreting the magnitude of reported estimates from individual studies and instead took only the directionality of the estimates at face value. This allowed us to assess the (in)consistency of conclusions within domains of health. However, it is entirely possible that bias could lead to a reversal of effects, i.e., estimating a positive effect when the true effect is negative or vice versa. The bias in these studies means that it is unclear whether any of the relationships described are causal.

Nearly all studies included in our review relied on cross-sectional data. There are severe limitations to using cross-sectional research designs to estimate causal effects, and more rigorous designs are needed to further our understanding of the consequences of child marriage. Quasi-experimental designs that more effectively mitigate confounding would strengthen this body of literature and have already been used to study the effect of child marriage on educational attainment and literacy. For example, Field and Ambrus and Sunder used age at menarche as an instrumental variable to study the effect of child marriage on these outcomes [ 3 , 4 ]. Encouragement trials that randomly assign exposure to interventions meant to prevent child marriage could also be used to estimate the effects of child marriage on health outcomes, though such trials are more resource intensive to conduct [ 89 ]. However, given that the DHS and other cross-sectional data sources will likely continue to be used to investigate these relationships, the use of quantitative bias analyses to examine how sensitive estimates are to various sources of bias would be an improvement [ 90 ].

There are several limitations to this systematic review. First, to capture as wide a range of health outcomes as possible, we searched databases focused on human health and biomedicine. Relevant studies from other academic disciplines such as economics and sociology may have been missed using this approach. Second, our search was conducted in English and all included studies were published in English. Eligible studies published in other languages may have been missed, which could influence our conclusions regarding the geographic distribution of research. Finally, as noted in the introduction, child marriage may have consequences beyond the domain of health. We focused our systematic review on the health consequences of child marriage in response to growing rhetoric regarding child marriage as a population health concern. Rigorous systematic reviews of the effect of child marriage on educational and economic outcomes would be a valuable addition to the literature.

Availability of data and materials

The PROSPERO protocol and the data extraction form are publicly available through the Open Science Foundation at https://osf.io/32mu7/ .

Abbreviations

Body Mass Index

Cross-Sectional

Directed Acyclic Graph

Demographic and Health Surveys

Mid-Upper Arm Circumference

Risk Of Bias In Non-randomised Studies - of Interventions tool

Socio-Economic Status

United Nations Population Fund

United Nations Children’s Fund

United Nations Office of the High Commissioner for Human Rights. Recommendations for Action Against Child and Forced Marriages [Internet]. 2017. Report No.: UNICEF/UN05222/Dragaj. Available from: https://www.ohchr.org/Documents/Issues/Women/WRGS/CEFM/RecommendationsForActionEbook.pdf

UNICEF. Early marriage: a harmful traditional practice. New York: UNICEF; 2005.

Google Scholar  

Field E, Ambrus A. Early Marriage, Age of Menarche, and Female Schooling Attainment in Bangladesh. J Polit Econ. 2008;116(5):881–930.

Sunder N. Marriage age, social status, and intergenerational effects in Uganda. Demography. 2019;56(6):2123–46.

Dahl GB. Early teen marriage and future poverty. Demography. 2010;47(3):30.

Article   Google Scholar  

Koski A, Clark S, Nandi A. Has child marriage declined in sub-Saharan Africa? An analysis of trends in 31 countries. Popul Dev Rev. 2017;43(1):7–29.

Gastón CM, Misunas C, Cappa C. Child marriage among boys: a global overview of available data. Vulnerable Child Youth Stud. 2019;14(3):219–28.

United Nations. The Sustainable Development Goals Report 2018. New York, NY; 2018.

Girls Not Brides. Child Marriage Atlas. [cited 2021 Jul 3]. Available from: https://atlas.girlsnotbrides.org/map/

UNICEF. Ending Child Marriage: Progress and Prospects. New York; 2014. Available from: https://www.unicef.org/media/files/Child_Marriage_Report_7_17_LR.pdf

Wodon Q. Child marriage: A persistent hurdle to health and prosperity. World Bank. 2015 [cited 2020 Jul 28]. Available from: https://blogs.worldbank.org/health/child-marriage-persistent-hurdle-health-and-prosperity

United Nations Population Fund. Marrying too young: end child marriage [Internet]. New York, NY: United Nations Population Fund; 2012 [cited 2020 Apr 27]. Available from: http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/MarryingTooYoung.pdf

UNICEF. Child Marriage. 2021 [cited 2020 Jul 30]. Available from: https://www.unicef.org/protection/child-marriage

Haddaway NR, Collins AM, Coughlin D, Kirk S. The Role of Google Scholar in Evidence Reviews and Its Applicability to Grey Literature Searching. PLOS ONE. 2015;17(9):e0138237.

Clarivate Analytics. EndNote. 2019 [cited 2020 May 11]. Available from: https://endnote.com/

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.

Article   PubMed   PubMed Central   Google Scholar  

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 [cited 2020 Apr 27];355. Available from: https://www.bmj.com/content/355/bmj.i4919

Hernán MA, Robins JM. Causal Inference: What If. Boca Raton: Chapman & Hall/CRC; 2020.

Male C, Wodon Q. Girls’ Education and Child Marriage in West and Central Africa: Trends, Impacts, Costs, and Solutions. Forum Soc Econ. 2018;47(2):262–74.

World Bank. World Bank Country and Lending Groups [Internet]. 2020 [cited 2020 Aug 17]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups

Le Strat Y, Dubertret C, Le Foll B. Child marriage in the United States and its association with mental health in women. Pediatrics. 2011;128(3):524–30.

Kidman R. Child marriage and intimate partner violence: a comparative study of 34 countries. Int J Epidemiol. 2016;dyw225.

Kidman R, Heymann J. Prioritising action to accelerate gender equity and health for women and girls: Microdata analysis of 47 countries. Glob Public Health. 2018;13(11):1634–49.

Misunas C, Gastón CM, Cappa C. Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes. BMC Int Health Hum Rights. 2019;19(1):25.

Agyei WKA, Mbamanya J. Determinants of cumulative fertility in Kenya. J Biosoc Sci. 1989;21(2):135–44.

Ali M, Alauddin S, Khatun MostF, Maniruzzaman Md, Islam SMS. Determinants of early age of mother at first birth in Bangladesh: a statistical analysis using a two-level multiple logistic regression model. J Public Health. 2020 [cited 2020 Jul 2]; Available from: http://link.springer.com/ https://doi.org/10.1007/s10389-020-01228-9

Ayane GB, Desta KW, Demissie BW, Assefa NA, Woldemariam EB. Suboptimal child spacing practice and its associated factors among women of child bearing age in Serbo town, JIMMA zone, Southwest Ethiopia. Contracept Reprod Med. 2019;4(1):4.

Baytekus A, Tariku A, Debie A. Clinical vitamin-A deficiency and associated factors among pregnant and lactating women in Northwest Ethiopia: a community-based cross-sectional study. BMC Pregnancy Childbirth. 2019 Dec;19(1):506.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Begum S, Donta B, Nair S, Prakasam C. Socio-demographic factors associated with domestic violence in urban slums, Mumbai, Maharashtra, India. Indian J Med Res. 2015;141(6):783.

Berlie AB, Alamerew YT. Determinants of Fertility Rate among Reproductive Age Women (15-49) in Gonji-Kollela District of the Amhara National Regional State, Ethiopia. Ethiop J Health Dev.:12.

Birhanu BE, Kebede DL, Kahsay AB, Belachew AB. Predictors of teenage pregnancy in Ethiopia: a multilevel analysis. BMC Public Health. 2019;19(1):601.

de Groot R, Kuunyem MY, Palermo T. Child marriage and associated outcomes in northern Ghana: a cross-sectional study. BMC Public Health. 2018;18(1):285.

Delprato M, Akyeampong K. The Effect of Early Marriage Timing on Women’s and Children’s Health in Sub-Saharan Africa and Southwest Asia. Ann Glob Health. 2017;83(3–4):557.

Efevbera Y, Bhabha J, Farmer P, Fink G. Girl child marriage, socioeconomic status, and undernutrition: evidence from 35 countries in Sub-Saharan Africa. BMC Med. 2019;17(1):55.

Erulkar A. Early marriage, marital relations and intimate partner violence in Ethiopia. Int Perspect Sex Reprod Health. 2013 Mar;39(01):006–13.

Fakhari A, Farahbakhsh M, Azizi H, Esmaeili ED, Mirzapour M, Rahimi VA, et al. Early Marriage and Negative Life Events Affect on Depression in Young Adults and Adolescents. Arch Iran Med. 2020;23(2):10.

Gebremedhin S, Betre M. Level and differentials of fertility in Awassa town, Southern Ethiopia. Afr J Reprod Health. 2009;13(1):93–112.

PubMed   Google Scholar  

Gebrezgi BH, Badi MB, Cherkose EA, Weldehaweria NB. Factors associated with intimate partner physical violence among women attending antenatal care in Shire Endaselassie town, Tigray, northern Ethiopia: a cross-sectional study, July 2015. Reprod Health. 2017;14(1):76.

Godha D, Hotchkiss DR, Gage AJ. Association between child marriage and reproductive health outcomes and service utilization: A multi-country study from South Asia. J Adolesc Health. 2013;52(5):552–8.

Article   PubMed   Google Scholar  

Habyarimana F, Ramroop S. The Analysis of Socio-Economic and Demographic Factors Associated with Contraceptive Use Among Married Women of Reproductive Age in Rwanda. Open Public Health J. 2018;11(1):348–59.

Hailemariam A, Haddis F. Factors Affecting Unmet Need for Family Planning In Southern Nations, Nationalities and Peoples Region, Ethiopia. Ethiop J Health Sci. 2011;21(2):77–90.

Hong Le MT, Tran TD, Nguyen HT, Fisher J. Early marriage and intimate partner violence among adolescents and young adults in Viet Nam. J Interpers Violence. 2014;29(5):889–910.

Imasiku ENS, Odimegwu CO, Adedini SA, Ononokpono DN. VARIATIONS IN UNMET NEED FOR CONTRACEPTION IN ZAMBIA: DOES ETHNICITY PLAY A ROLE? J Biosoc Sci. 2014;46(3):294–315.

John NA, Edmeades J, Murithi L. Child marriage and psychological well-being in Niger and Ethiopia. BMC Public Health. 2019;19(1):1029.

John NA, Edmeades J, Murithi L, Barre I. Child marriage and relationship quality in Ethiopia. Cult Health Sex. 2019;21(8):853–66.

Kamal SM. Decline in Child Marriage and Changes in Its Effect on Reproductive Outcomes in Bangladesh. J Health Popul Nutr. 2012;20(3):317–30.

Kamal SMM. Domestic Violence, Unwanted Pregnancy and Pregnancy Termination among Urban Women of Bangladesh. J Fam Reprod Health. 2013;7(1):11–22.

Kamal SMM, Hassan CH. Child Marriage and Its Association With Adverse Reproductive Outcomes for Women in Bangladesh. Asia Pac J Public Health. 2015;27(2):NP1492-506.

Nasrullah M, Zakar R, Krämer A. Effect of Child Marriage on Use of Maternal Health Care Services in Pakistan: Obstet Gynecol. 2013;122(3):517–24.

Nasrullah M, Muazzam S, Bhutta ZA, Raj A. Girl Child Marriage and Its Effect on Fertility in Pakistan: Findings from Pakistan Demographic and Health Survey, 2006–2007. Matern Child Health J. 2014;18(3):534–43.

Nasrullah M, Zakar R, Zakar MZ. Child Marriage and Its Associations With Controlling Behaviors and Spousal Violence Against Adolescent and Young Women in Pakistan. J Adolesc Health. 2014;55(6):804–9.

Nigatu M, Gebrehiwot TT, Gemeda DH. Household Food Insecurity, Low Dietary Diversity, and Early Marriage Were Predictors for Undernutrition among Pregnant Women Residing in Gambella, Ethiopia. Adv Public Health. 2018;2018:1–10.

Olamijuwon EO, Chisumpa VH, Akinyemi JO. Unveiling the realities of marrying too young: implications of child marriage on sexual and reproductive health of girls and infant survival in sub-Sahara Africa. (Special issue on family demography in Africa: determinants and consequences.). Afr Popul Stud. 2017;31(1):3594–610.

Onagoruwa A, Wodon Q. Measuring the impact of child marriage on total fertility: a study for fifteen countries. J Biosoc Sci. 2018;50(5):626–39.

Oshiro A, Poudyal AK, Poudel KC, Jimba M, Hokama T. Intimate Partner Violence Among General and Urban Poor Populations in Kathmandu, Nepal. J Interpers Violence. 2011;26(10):2073–92.

Pandey A, Singh KK. Contraceptive use before first pregnancy by women in India (2005–2006): determinants and differentials. BMC Public Health. 2015;15(1):1316.

Paul P. Maternal Age at Marriage and Adverse Pregnancy Outcomes: Findings from the India Human Development Survey, 2011-2012. J Pediatr Adolesc Gynecol. 2018;31(6):620–4.

Paul P, Chouhan P. Association between child marriage and utilization of maternal health care services in India: Evidence from a nationally representative cross-sectional survey. Midwifery. 2019;75:66–71.

Prakash R, Singh A, Pathak PK, Parasuraman S. Early marriage, poor reproductive health status of mother and child well-being in India. J Fam Plann Reprod Health Care. 2011;37(3):136–45.

Rahman M, Hoque MdA, Mostofa MdG, Makinoda S. Association Between Adolescent Marriage and Intimate Partner Violence: A Study of Young Adult Women in Bangladesh. Asia Pac J Public Health. 2014;26(2):160–8.

Rahman ML, Kile ML, Rodrigues EG, Valeri L, Raj A, Mazumdar M, et al. Prenatal arsenic exposure, child marriage, and pregnancy weight gain: Associations with preterm birth in Bangladesh. Environ Int. 2018;112:23–32.

Article   CAS   PubMed   Google Scholar  

Raj A. When the mother is a child: the impact of child marriage on the health and human rights of girls. Arch Dis Child. 2010 Nov 1;95(11):931–5.

Raj A, Saggurti N, Balaiah D, Silverman JG. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. The Lancet. 2009;30(9678):1883–9.

Raj A, Saggurti N, Lawrence D, Balaiah D, Silverman JG. Association between adolescent marriage and marital violence among young adult women in India. Int J Gynaecol Obstet. 2010;110(1):35–9.

Raj A, Vilms RJ, McDougal L, Silverman JG. Association between having no sons and using no contraception among a nationally representative sample of young wives in Nepal. Int J Gynecol Obstet. 2013;121(2):162–5.

Santhya KG, Ram U, Acharya R, Jejeebhoy SJ, Ram F, Singh A. Associations Between Early Marriage and Young Women’s Marital and Reproductive Health Outcomes: Evidence from India. Int Perspect Sex Reprod Health. 2010;36(03):132–9.

Sekine K, Carter DJ. The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016. Wilunda C, editor. PLOS ONE. 2019;14(9):e0222643.

Singh JP, Gupta SD, Khanna A, Sharma LS. Prevalence of Obstetric Fistula and Associated Factors in Rajasthan, India. J Health Manag. 2019;21(2):193–8.

Solanke BL. Maternal socio-demographic factors associated with low parity and grand multiparity in Nigeria. Women Health. 2019;59(7):730–47.

Speizer IS, Pearson E. Association between Early Marriage and Intimate Partner Violence in India: A Focus on Youth from Bihar and Rajasthan. J Interpers Violence. 2011;26(10):1963–81.

Tenkorang EY. Explaining the links between child marriage and intimate partner violence: Evidence from Ghana. Child Abuse Negl. 2019;89:48–57.

Thakur A, Gupta B, Gupta A, Chauhan R. Risk factors for cancer cervix among rural women of a hilly state: A case-control study. Indian J Public Health. 2015;59(1):45.

Thekdi KP, Mehta PI, Thekdi PI, Kartha GP. Fertility profile, anxiety, depression of married women and its association with reproductive tract infections in the rural area of Surendranagar district. Sch J Appl Med Sci. 2014;2(1):104–8.

Uddin J, Pulok MH, Johnson RB, Rana J, Baker E. Public Health. 2019;171:6–14.

Yaya S, Odusina EK, Bishwajit G. Prevalence of child marriage and its impact on fertility outcomes in 34 sub-Saharan African countries. BMC Int Health Hum Rights. 2019;19(1):33.

Yimer B. Under Nutrition and Associated Factors among Adolescent Pregnant Women in Shashemenne District, West Arsi Zone, Ethiopia: A Communitybased Study. J Nutr Food Sci [Internet]. 2016 [cited 2020 Jul 2];06(01). Available from: https://www.omicsonline.org/open-access/under-nutrition-and-associated-factors-among-adolescent-pregnantwomen-in-shashemenne-district-west-arsi-zone-ethiopia-a-communityb-2155-9600-1000454.php?aid=66531

Yount KM, Crandall A, Cheong YF, Osypuk TL, Bates LM, Naved RT, et al. Child Marriage and Intimate Partner Violence in Rural Bangladesh: A Longitudinal Multilevel Analysis. Demography. 2016;53(6):1821–52.

Yusuf OB, Gbadebo BM, Afolabi RF, Adebowale AS. Trends, pattern and socioeconomic predictors of underweight among young married women in Nigeria. Public Health Res. 2018;8(2):35–45.

Elwert F, Winship C. Endogenous Selection Bias: The Problem of Conditioning on a Collider Variable. Annu Rev Sociol. 2014;40(1):31–53.

Schisterman EF, Cole SR, Platt RW. Overadjustment Bias and Unnecessary Adjustment in Epidemiologic Studies. Epidemiol Camb Mass. 2009;20(4):488–95.

World Health Organization. Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13-15 June 2005. 2007;(WHO/RHR/07.1). Available from: https://apps.who.int/iris/handle/10665/69855

ICF International. Demographic and Health Surveys Methodology - Questionnaires: Household, Woman’s, and Man’s. [Internet]. Calverton, Maryland, USA; 2011. (MEASURE DHS Phase III). Available from: http://www.measuredhs.com/publications/publication-DHSQ6-DHS-Questionnaires-and-Manuals.cfm

ICF International. DHS Questionnaire Modules: Domestic Violence [Internet]. Calverton, Maryland, USA; 2019 [cited 2021 Jul 3]. Available from: https://dhsprogram.com/publications/publication-DHSQM-DHS-Questionnaires-and-Manuals.cfm

Kumar P, Sareen N, Agrawal S, Kathuria N, Yadav S, Sethi V. Screening Maternal Acute Malnutrition Using Adult Mid-Upper Arm Circumference in Resource-Poor Settings. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2018;43(2):132–4.

Ververs M, Antierens A, Sackl A, Staderini N, Captier V. Which Anthropometric Indicators Identify a Pregnant Woman as Acutely Malnourished and Predict Adverse Birth Outcomes in the Humanitarian Context? PLoS Curr [Internet]. 2013 Jun 7 [cited 2020 Aug 19];5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682760/

Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008;8(1):70.

Koski A, Clark S. Child Marriage in Canada. Popul Dev Rev. 2021;47(1):57–78.

Koski A, Heymann J. Child marriage in the United States: How common is the practice, and which children are at greatest risk? Perspect Sex Reprod Health. 2018;50(2):59–65.

Baird S, Chirwa E, McIntosh C, Özler B. The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ. 2010;19(S1):55–68.

Lash T, Fox M, MacLehose R. Applying Quantitative Bias Analysis to Epidemiologic Data [Internet]. 2nd ed. Springer International Publishing; 2021 [cited 2021 Jul 6]. (Statistics for Biology and Health). Available from: https://www.springer.com/gp/book/9783030826727

Download references

Acknowledgements

We thank Genevieve Gore at the McGill University Library for her assistance in developing the search terms used in this review.

No funding was received for the study.

Author information

Authors and affiliations.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada

Suiqiong Fan & Alissa Koski

Institute for Health and Social Policy, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada

Alissa Koski

You can also search for this author in PubMed   Google Scholar

Contributions

SF and AK were responsible for the study conception and design. SF conducted database searches. SF and AK screened eligible studies and extracted data from included studies. SF and AK conducted the analysis, interpreted the results, and collaboratively wrote the manuscript. SF prepared the tables and figures. AK supervised the study. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Alissa Koski .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1., additional file 2., additional file 3., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Fan, S., Koski, A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health 22 , 309 (2022). https://doi.org/10.1186/s12889-022-12707-x

Download citation

Received : 16 September 2021

Accepted : 31 January 2022

Published : 14 February 2022

DOI : https://doi.org/10.1186/s12889-022-12707-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Child marriage
  • Social determinants of health
  • Systematic review

BMC Public Health

ISSN: 1471-2458

review related literature of early marriage

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Biomed Res Int

Logo of bmri

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

Setognal birara aychiluhm.

1 Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia

Ayenew Kassie Tesema

2 Department of Health Education and Behavioral Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Abay Woday Tadesse

Associated data.

The data used for this analysis is available from the Demographic and Health Survey (DHS) website ( http://www.measuredhs.com ).

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.

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.

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.

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.

1. Introduction

Early marriage refers to “any marriage happens under the age of 18 years, where the girl is not ready for the marriage and childbirth” [ 1 – 3 ]. Over 700 million women were married before being 18 years old in the world [ 2 ]. Similarly, in Ethiopia, four in ten young women were married or get into union before the age of 18 and six million girls get married before the age of 15 [ 4 ]. Moreover, according to the Ethiopian Demographic and Health Survey 2000, 2005, and 2011 reports, more than two-thirds of married women reported that they were married before the age of 18 years [ 5 – 7 ]. Though the prevalence rate of early marriage varies from region to region in the country, eighty percent of girls in Amhara region got married before the age of eighteen which is higher than the national prevalence [ 8 ].

Early marriage has various consequences on the health and social outcomes of women and their children. These include increased risk of depression and suicidality; compromised sexual, reproductive, and maternal health [ 9 – 14 ]; greater risk of intimate partner violence [ 11 , 13 , 15 ]; decreased physical and social mobility; and decreased autonomy in decision-making within and outside the household [ 10 , 16 , 17 ]. Besides, early marriage also compromises girls' ability to attend a school that leads to school withdrawals [ 10 , 16 , 18 – 21 ]. Thus, it is a public health concern that violates international human rights laws and it seriously affects the development and health status of women and children [ 12 , 17 , 18 , 20 – 27 ].

Studies conducted across the globe had identified various contributing factors of early marriage. These include family income, family size, educational level of the father and the respondent, young women who faced first sexual intercourse before 16, residence, wealth status, perceived ideal marital age, and media exposure [ 22 , 28 – 33 ].

Different policies, strategies, and programs have been tried in the past decades to address the early marriage problems at global, and regional levels [ 1 , 3 ]. Similarly, the revised Family Law of Ethiopia (FLoE) sets the legal age for marriage to be at 18 years and above [ 34 ]. However, the prevalence of early marriage in Amhara region is still consistently high [ 8 , 35 , 36 ]. There are some studies concerning early marriage undertaken in Amhara region in different settings [ 22 , 29 , 35 ]. However, most of these studies were limited in scope (that is the sample size and geographic area) and analyzed using single-level analysis, which does not consider the community-level factors. Moreover, using a single-level logistic regression analysis technique to analyze data that has a hierarchical structure nature (that is women nested within communities) violates the independence assumptions of regression [ 37 , 38 ]. Hence, to address these limitations and to further estimate the significant effect of individual and community-level factors in the field of public health, this study used multilevel logistic regression analysis.

Therefore, the purpose of this study was to determine the prevalence and determinants (both individual and community-level factors) that are associated with early marriage in Amhara regional state, Ethiopia.

2. Methods and Materials

2.1. study area and data source.

Amhara Regional State, one of Ethiopia's largest but most disadvantaged regions, is situated in the northwest and northcentral part of the country. The Amhara people (numbering approximately 20 million) comprise one of the nine ethnic divisions (regions) of Ethiopia and are predominantly (more than 85%) engaged in agriculture. The region is characterized by high levels of food insecurity due to recurrent drought and deforestation and low educational attainment (that is more than 60% of women over the age of 15 have never been to school) [ 5 ]. In this region, child marriage is rooted in religious and cultural traditions based around preventing a girl's honor, since sex before marriage is seen as an extremely shameful act. Therefore, a girl's worth is based on her virginity and her role of being a wife and a mother [ 39 ]. There was a large age difference between couples: nearly 75% of ever-married females were married to older men, and among these, the age difference was ten years or more in half of the cases. This age differential affects the level of communication, mutual understanding, and the balance of influence within the family [ 40 ]. Maintaining a family's dignity, social bonding, and desire to earn additional income “macha” (i.e., men's family pay money for the girl's family) are thought to be some of the main reasons to practice early marriage in the region [ 41 ].

The data for this study were retrieved from the DHS program official database website ( http://dhsprogram.com ), which was conducted in 9 regions and 2 city administrations of Ethiopia from January 18, 2016, to June 27, 2016 [ 10 ]. To conduct the 2016 EDHS, a two-stage stratified cluster sampling technique has been employed. In the first stage, enumeration areas were selected. In the second stage, 28 households per enumeration area were selected with an equal probability of systematic selection per enumeration area. A total of 645 EAs (202 in urban areas and 443 in rural areas) were selected with probability proportional to EA size. All women of reproductive age group were included in the first stage. All women aging 15-49 years who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed [ 36 ]. For this study, 2887 (weighted) women of the reproductive age group in Amhara regional state were used for our analysis.

2.2. Study Variables

2.2.1. dependent variable.

Early child marriage is defined as a formal marriage or informal union before 18 years old [ 42 ]. It was categorized in such a way that 0 is marriage at age of 18 and above and 1 is marriage experienced before the 18th birthday.

2.2.2. Independent Variables

The following are the independent variables:

  • Individual-related factors: who decide age at first marriage, women's education level, husband's education level, husband's occupation, wealth index, respondent's work status, religion, ethnicity, and exposure to any mass media
  • Community-related factors: residence site and cluster

2.3. Data Analysis

2.3.1. deceptive statistics.

The analysis was performed in R version 3.5.2 statistical software and STATA 15 statistical package. Based on the recommendation of EDHS, proportions and frequencies were estimated after applying sample weights to the data to adjust for disproportionate sampling and nonresponses, since the allocation of the sample in the EDHS to different regions and urban and rural areas were nonproportional. A detailed explanation of the weighting procedure can be found in the 2016 EDHS report [ 36 ]. Categorization was done for continuous variables using information obtained from different literatures, and recategorization was done for categorical variables accordingly to make it suitable for analysis.

2.3.2. Multivariable Multilevel Analysis

To account the clustering effects (that is, women are nested within clusters) of 2016 EDHS data, a multivariable multilevel logistic regression analysis was applied to determine the effects of each predictor of early marriage. The basic data structure of the two-level logistic regression is a collection of N groups (cluster) and within-group j ( j = 1, 2, 3, ⋯ N ), a random sample of nj of level-one units (individual women).

The response variable is denoted by the following: Yij = 1, if marriage happened under 18 years of age, and Yij = 0, if marriage happened 18 and above years of age.

In data with a nested structure like that of EDHS, the individual observations have some degree of correlation within a cluster because of common characteristics they share. Thus, when the correlation with the higher level is ignored and only the individual-level variables are considered, it might lead to a violation of the independence assumption between observations. This results in biased parameter estimates and will generally lead to underestimation of the standard errors and produce spurious significant results and accordingly to incorrect conclusions on effect sizes. In contrast, modeling group-to-group variation simultaneously with individual-to-individual variation in analysis has several advantages. It allows us to focus on the importance of both communities' and individuals' effects on individuals' health outcomes. By using the clustering information, it enables us to obtain statistically efficient estimates of regression coefficients [ 43 ]. Thus, to get the mixed effect (fixed effect for both the individual and community-level predictors and a random effect for the between cluster-variation), a multilevel analysis was applied for this analysis. Variables that were statistically significant at the bivariable multilevel logistic regression analysis were considered candidates for multivariable multilevel logistic regression analysis.

Finally, multivariable multilevel logistic regression analysis was performed to estimate the Adjusted Odds Ratios and to estimate the extent of random variations between communities.

2.3.3. Model Building and Comparison

Four models containing variables of interest were fitted using R statistical database version 3.5.2.

Model I (empty model) was fitted without explanatory variables to test random variability in the intercept and to estimate the intraclass correlation coefficient (ICC) and Proportion Change in Variance (PCV). Model II examined the effects of individual-level characteristics, Model III examined the effect of community-level variables, and Model IV (full model) examined the effects of both individual and community-level characteristics simultaneously.

2.3.4. Parameter Estimation Technique

In the multivariable multilevel models, the measures of association (fixed-effects) estimate the associations between the probability of early marriage and independent variables (individual and community-related) expressed as Adjusted Odds Ratio (AOR) with their 95% Confidence Intervals (CIs). The measures of variation (random-effects) were reported as intracluster correlation coefficient (ICC) which is the percentage variance explained by the higher level (community-level variables), and proportional change in variance (PCV) shows the change in the community-level variance between the empty model and the successive models [ 37 , 44 ].

2.3.5. Model Fitness

Akaike Information Criterion (AIC) was used to choose a model that best explains the data and the model with a low AIC value was taken. The AIC value for each subsequent model was compared and the model with the lowest AIC value was considered to be the best fit model [ 38 , 45 , 46 ]. Among the models considered, the full model has the smallest AIC value; therefore, the full model best fits the data. AOR with 95% Confidence Interval in the multivariable model was used to select variables that have a statistically significant association with early marriage.

3.1. Socioeconomic and Demographic Characteristics of Respondents

Out of the total respondents, 2400 (83.12%) women were living in a rural site, 1938 (67.10%) of respondents were not attended formal education, and 356 (80.8%) of the respondents did not have media exposure towards early marriage (see Table 1 ).

Sociodemographic characteristics of married reproductive-age women, Amhara regional state, Ethiopia, 2016.

Other+: Catholics and protestants; Other++: Argoba and Kimant; Other+++: EDHS 2016 other category.

3.2. Prevalence of Early Marriage

According to this study, overall 2098 (73% [95% CI: 71.38%, 74.62%]) were married before the age of 18 years in Amhara regional state. Of women who live in rural sites, 77.42% got married earlier 18 years of age and the rest were married 18 and above. Out of 2405 married women whose marriage was decided by their parents, 1,886 (78.44%) got married before the age of 18 years. The prevalence of early marriage in those who had no formal education was 1,529 (78.87%) (See Table 2 ).

Cross-tabulation of early marriage with independent variables in Amhara regional state, Ethiopia, 2016.

3.3. Multilevel Logistic Regression

3.3.1. result of empty multilevel logistic regression model.

From the null model, variance of the random factor was 0.49 with 95% Confidence Interval of (0.32, 0.74), showing heterogeneous areas. Since the variance estimate is greater than zero, it indicates that there are enumeration (cluster) area differences in early marriage status among married reproductive age women in Amhara regional state, and thus, multilevel analysis should be considered an appropriate approach for further analysis.

The intraenumeration area correlation coefficient (ICC) indicated that 13% of the total variability in early marriage status is due to differences across cluster areas, with the remaining unexplained 87% attributable to individual differences. The Proportion Change in Variance (PCV) indicated that 10% of the variation in early marriage status across communities was explained by both individual and community-level factors included in the full model (see Table 3 ).

Community-level variance of two-level mixed-effect logit models predicting early marriage, Amhara regional state, Ethiopia, 2016.

3.3.2. Result of Multilevel Multivariable Logistic Regression Model (Full Model)

In the two-level mixed effect multivariable logistic regression model where both the individual and community-level factors were fitted simultaneously and when all the other independent variables are controlled, the odds of being married below the age of 18 in rural area is 4.33 more likely than living in an urban area (AOR = 4.33; CI: 2.17, 8.64).

After adjusting other covariates, the odds of being married below the age of 18 in the poorer and poorest level were 1.38 and 2.37 more likely to be early married compared to those women in the richest level (AOR = 1.38 and CI: 1.16, 4.83; AOR = 2.37 and CI: 2.19, 7.83), respectively.

Keeping other covariates constant, those women with no education were 2.51 more likely to be married below the age of 18 years than those who have higher education level (AOR = 2.51; CI: 0.71, 6.75) and those women with primary education level were 2.31 more likely to be married below the age 18 years compared to those with higher education level (AOR = 2.31; CI: 1.68, 8.53).

Regarding responsibility on who decides on age at first marriage, those women who have to decide by parents were 3.44 times more likely to have marriage below the 18 years than those who decide by themselves (AOR = 3.44; CI: 2.20, 5.39) (see Table 4 ).

Multilevel multivariable logistic regression of the individual and community-related variables associated with early marriage, Amhara regional state, Ethiopia, 2016.

ref: reference; ∗ statistically significant variables at 95% Confidence Interval; Other+++: EDHS 2016 other category.

4. Discussion

Previous studies were limited in scope and analyzed without considering the community-level related factors. This study is intended to determine the prevalence and determinants of early marriage among married reproductive age women in Amhara regional state using multilevel analysis.

This study revealed the prevalence of early marriage in Amhara regional state was 73% [95% CI: 71.38%,74.62%]. This prevalence is higher than a study conducted in Injibara, Ethiopia (44.8%) [ 29 ]. Moreover, the finding is also higher than those in studies conducted in Sudan (45.9%), India (22.6%), Sub-Saharan Africa (55%), and Roma of Serbia (50.4%) [ 28 – 31 , 47 ].

In developing nations, there are geospatial variations in cultural practices and beliefs that strongly influence the acceptance and practices of early marriage [ 27 , 48 , 49 ]. Similarly, in Ethiopia, the existence of variations in sociocultural norms, values, and traditions encourages early marriage in Amhara region compared to other parts of the country [ 33 ]. Hence, this high prevalence could be attributed to conformity to social norms, seeking social status, ensuring virginity, material benefit (macha), and security for the future [ 35 , 50 , 51 ].

However, this prevalence is lower than the study conducted in east Gojjam, Ethiopia (87%) [ 35 ], and a study conducted in Bangladesh (78.2%). This discrepancy might be due to the small sample size in the previous studies compared to the current study.

In this study, the odds of early marriage among rural women were 4-folds higher compared to that among urban women. This finding is similar to the findings of studies conducted in Sudan, Bangladesh, and Serbia [ 52 – 54 ]. This could be explained by women who live in rural areas who may not know about the health, education, and economic impact of early marriage [ 55 , 56 ]. Besides, they do not know where to go when their parents and/or their guardians violate their human rights declared by the national family law [ 55 – 57 ]. Consequently, women who resided in a rural part of the region are more prone to early marriage compared to women resided urban areas of the region.

The study revealed that women with no education level were 2.5 more likely to be married before the age of 18 compared to women who attended a higher education level. Similarly, the odds of early marriage among women who attended only primary education level was 2-folds higher compared to women who attended higher education level. These findings are similar to two studies conducted in Ethiopia that showed the educational level of women was found to be a significant predictor for early marriage [ 34 , 58 ]. Moreover, other studies conducted in Malawi and Western Uganda also revealed that women's education level was the independent predictor for early marriage [ 27 , 59 ]. This could be justified by the higher education level of women enabling them to be aware of their rights and empowering them to make their decision when to get marriage [ 2 , 34 , 60 ].

In this study, the odds of early marriage among women with the poorest household wealth index were 2.4 times higher compared to those among women with the richest household wealth index. This result is consistent with two studies conducted in Ethiopia and a study done in India [ 50 , 58 , 61 ]. This might be justified by the poorest families preferring early marriage to generate more income in the form of “macha” (i.e., male's family pay money and cattle for female's family) [ 35 ]. This is also supported by another study conducted in Ethiopia that revealed low economic status is one of the predisposing factors for early marriage [ 34 , 55 , 62 ]. Therefore, parents with low household income are still practicing early marriage as one of the alternative sources of income to relieve their economic problems. Consequently, women from the poorest families are prone to early marriage compared to women from the richest families.

Religious and cultural practices that defined puberty as the age of maturation consider a girl ready for marriage when she reaches puberty [ 63 , 64 ] that deprives her decision-making autonomy. Similarly, in this study, the odds of early marriage among women whose age of the first marriage was decided by their parents was 3-folds higher compared to that among those whose age of first marriage was decided by themselves. This finding is similar to studies conducted in different settings [ 41 , 65 , 66 ]. In Ethiopia, particularly in Amhara region, there are deep-rooted harmful sociocultural practices in the community, whose females have no autonomy to choose their husband and to make decisions when to get married [ 34 , 39 , 67 ]. As a result, females are enforced to get married early without their involvement and consent.

5. Conclusion

The overall prevalence of early marriage among married reproductive age women in Amhara regional state is still high compared to the national prevalence.

After adjusting for covariates, women living in a rural part of the region, never attended formal education, being in the poorest and poorer household wealth status, and who never been part of decision-making when to get married were the independent predictors of early marriage in Amhara regional state.

Therefore, the regional government should give due attention to access to education and encourage women's decision-making power upon the age of marriage especially those residing in rural parts of the region. Moreover, the regional government should encourage women to participate in small-scale entrepreneurship to maximize their economic status. Additional community-based interventional studies are recommended to be carried out in the nearby future.

6. Strengths and Limitations of the Study

This study was based on the recent demographic health survey with a nationally representative large sample size. Furthermore, this study used multilevel logistic regression modeling to control the hierarchical nature of the EDHS data. Despite the above strengths, the study might have recall bias since the participants were asked the events that took place 5 years or more preceding the survey.

Acknowledgments

The authors acknowledge the ICF International for granting access to the use of the 2016 Ethiopian Demographic and Health Survey (EDHS) data for this study.

Abbreviations

Data availability, ethical approval.

The accessed data were used for this registered research only. The data were treated as confidential and no effort was made to identify any household or individual respondent.

Conflicts of Interest

The authors declare that they have no conflict interests.

Authors' Contributions

SB had initiated the research, wrote the research proposal, carried out the data analysis, interpreted the results, and drafted the manuscript. AK and AW are involved in designing the study, revising the proposal, and guiding the statistical analysis and write-up of the manuscript. All authors read and approved the final manuscript.

  • Skip to main content [s]
  • Infonet (For Students and Staff)
  •    
  • Research Priority Areas
  • Research Degrees
  • Library Research Resources

A Literature Review on Early Marriage

-

Children being married has been the site of renewed interest and activism since the 1990s (Moschetti 2005). This literature review seeks to address what is known, internationally, about the reasons and outcomes of early marriage (See Section 1 for definitions of terms used here) and why there is a need for legal change in the UK (and elsewhere).It does not address in depth the UK statistics on child marriages because it has proven impossible to get accurate, up-to-date information on the numbers of early marriages (aged 16-18) conducted in the UK, the prevalence of customary marriages involving children in the UK and the numbers of people arriving in the UK who have taken part in a legal or customary early marriage. This is a significant gap in our understanding of this issue given the lifetime impact of child marriage (See Section 4).

University Staff: Request a correction | Repository Editors: Update this record

  • About the Repository
  • Repository Policies
  • Open Access Policies
  • Statistics Overview
  • Accessibility

Skip navigation links

University Of Gloucestershire

Bookmark and Share

Find Us On Social Media:

Social Media Icons

Other University Web Sites

  • Staffnet (Staff Only)
  • © UoG 2008-18
  • Privacy and Cookies
  • Comments concerning this page to Webmaster
  • Publications

Literature review on effects of interventions to reduce the prevalence of child marriage

Download this publication

Child marriage prevention approaches

This paper presents the current status of research on child marriage and focuses on intervention studies and reviews of evaluations and programs with reduction of child marriage as a core objective. The main research question is: What is the evidence of the effect of approaches to prevent child marriage in low- and middle-income countries? The paper is divided into three main sections. Firstly, we present data on prevalence and trends of child marriage in low- and middle-income countries, focusing on Africa. Then, the main findings of the literature on the causes and drivers of child marriage; reviews of studies on child marriage prevention programs. Finally, we address what the literature says about the effect and impact of the most common approaches and strategies to prevent child marriage and reduce its prevalence. Each section has a sub-chapter on Ethiopia, which has been a focus country for Norway’s contribution to end harmful practices.

According to data from Demographic and Health Surveys (DHS), the overall prevalence of women in Africa aged 20–24 who experienced child marriage was 54.0% with results ranging from 16.5% in Rwanda to 81.7% in Niger. Four patterns of levels of child marriage have been identified across sub-Saharan Africa: some countries show little sign of change; earlier declines have stalled in some countries; others show a recent decline; and some show evidence of slow but steady reductions over time. In Ethiopia, the overall prevalence of child marriage declined from about 60% to about 40% between 2005 and 2015.

Child marriage (CM), defined as marriage before the age of 18, is a complex problem with many intersecting root causes and drivers including poverty, conflict and shocks, lack of access to education, lack of opportunities, barriers to rights and health. Gender inequality and systematic discrimination of girls and women is an underlying factor to the practice. Poverty is a major driver and cause of CM and it has been reported from many countries that girls from poor families get married because their parents cannot afford to send them to school or support them financially. Sending girls to school has direct and indirect costs and girls who have ended or dropped out of-school have an increased chance of child marriage.

The practice of child marriage is often closely linked to ideas about proper behavior for girls and how to preserve the honor of both the girl and her family. Arranging marriage for girls serves to prevent them from initiating relationships on their own and risk a socially disapproved premarital pregnancy. Religious beliefs are commonly assumed to have an important role in the persistence of child marriage, but no religion prescribes child marriage and studies have found substantial heterogeneity within the adherents of any particular faith as to how the practice of child marriage is considered.

Studies from Latin-America and parts of Africa have found that it is most common that girls first get pregnant and then marry a man of their own choice. Historically at a global level, child marriage has mostly preceded pregnancy.

We identified one scoping review and four systematic reviews published on the topic between 2007 and 2018. The reviews reached somewhat different conclusions. Three of the four systematic reviews found that girl empowerment approaches were most common and had the highest success rates. Such empowerment programs can include a vast array of activities, often including variations of life skills or vocational training and the reviews found that many using this approach achieved reducing child marriage rates and increasing age at marriage. However, the review that retained the least number of studies concluded that economic approaches, such as incentives and cash transfers, have been most effective. Programs that reported success were commonly community-based and engaged parents and other family members in activities, and had longer duration of participation and greater regularity of attendance.

Findings concerning the effectiveness of economic approaches are inconsistent and different reviews have reached different conclusions: one review found them the most effective, others least effective. One review found that economic approaches had the highest failure rate when used as the sole approach, but then found that interventions coupling it with another approach had a higher success rate. Successful economic programs have, in many cases, been part of efforts to help girls continue school or been conditioned on attendance or educational outcomes. Several studies indicate that the gains of cash support fade quickly when programs stop. Other studies, however, suggest that economic incentives and support may be more effective when combined with interventions addressing norms and/or building girls’ skills.

A very popular approach among NGOs is to encourage community mobilization and build community awareness about the harmful consequences of the practice, with the aim to establish an understanding of the need to abandon or change the practice. The evidence of its effectiveness is quite limited due to a lack of studies that use rigorous methods and measure the impact on behavior. Community engagement approaches typically aim to create long-term social norms change, but there is limited evidence about how best to incorporate a norms-focus into programs for adolescent health and how to demonstrate effectiveness of norms change interventions.

Studies suggest that improving girls’ educational and economic opportunities offer young women acceptable alternatives to early marriage. Interventions that are capable of increasing enrollment and keeping girls in school have showed promising results in reducing child marriage. However, most of the evidence comes from programs that include an economic component and there is less information from programs that focus on reducing non-economic barriers and improving teaching and infrastructures.

Legal and advocacy approaches are common, but poorly de­scribed and evaluated in the literature. In most cases, legal reforms have had little or no effect as an isolated measure due to weak implementation and absence of enforcement.

Although many organizations work to reduce both female genital mutilation and child marriage where both are prevalent, no study has been able to measure the effect of a program on both practices. Both practices occur in many of the same places and among the same subgroups. Both FGM and early/child marriage are thought to protect girls from social and economic risks, and they are driven by poverty and lack of economic opportunity for girls in the areas where they are practiced. In some contexts, cut women have been found to face higher odds of early/child marriage than uncut women.

Multi-level and multicomponent programs have become more common, but child marriage prevention research suggests that single component programs are successful more frequently, while multi-component interventions more often have had mixed results.

The results of the different approaches vary across settings and no approach stands out as equally successful across different settings. Several reviews indicate that empowerment and life skills approaches have had the highest success rates. One review concluded that economic interventions which often aim at helping girls to continue school, have most frequently demonstrated positive impact. Findings suggest that for ‘empowerment of girls’ programs duration, intensity and level of adherence are critical factors to obtain significant impact. It also seems to be important to involve parents and community leaders in designing programs that target adolescents and to include components that target adults.

  • Global Health
  • Child marriage

review related literature of early marriage

Sexual violence in Sudan: From denial to recognition

Samia Nihar

review related literature of early marriage

Candidates’ experience of violence in the Norwegian parliamentary election of 2021

Jana Belschner, Ragnhild Muriaas, Vibeke Wang

review related literature of early marriage

Zimbabwes sivilsamfunn kveles mens vi vender blikket bort

Siri Gloppen

review related literature of early marriage

​Feminist policy in Ukraine’s recovery and post-conflict reconstruction: ​A gender perspective in anti-corruption efforts

Sabrina White, Sara Bandali, Monica Kirya

Book cover

Handbook of Labor, Human Resources and Population Economics pp 1–26 Cite as

The Economics of Early Marriage: Causes, Consequences, and Policy Solutions

  • Zaki Wahhaj 2  
  • Living reference work entry
  • First Online: 16 February 2022

127 Accesses

1 Altmetric

There is growing consensus among researchers, policymakers, and other stakeholders that the practice of female early marriage has adverse consequences for the women who experience them, their families, and the wider population. While it is evident that the practice of female early marriage is entwined with longstanding customs and traditions, there is also good reason to believe that economic factors are important drivers behind current behavior and underpin a range of solutions being explored by policymakers. This chapter provides an economic perspective on the issue. It examines the literature for theories and evidence relating to the economic causes and consequences of female early marriage and the efficacy of alternative policies, and highlights current knowledge gaps.

This is a preview of subscription content, log in via an institution .

Adams A, Andrew A (2019) Preferences and beliefs in the marriage market for young brides. IFS working papers, no. W19/05

Google Scholar  

Aldashev G, Wahhaj Z (2019) Marriage timing and forward contracts in marriage markets. Working papers ECARES 2019–20. ULB – Universite Libre de Bruxelles

Amin S, Asadullah MN, Hossain S, Wahhaj Z (2017) Can conditional transfers eradicate child marriage. Economic and Political Weekly, 52(6), 11 February

Amirapu A, Asadullah MN, Wahhaj Z (2020) Can Child Marriage Law Change Attitudes and Behaviour? Experimental Evidence from an Information Intervention in Bangladesh. EDI Working Paper Series

Amin S, Saha JS, Ahmed JA (2018) Skills-building programs to reduce child marriage in Bangladesh: a randomized controlled trial. J Adolesc Health 63(3):293–300

Article   Google Scholar  

Asadullah MN, Wahhaj Z (2019) Early marriage, social networks and the transmission of norms. Economica 86(344):801–831

Baird S, McIntosh C, Ozler B (2011) Cash or condition? Evidence from a cash transfer experiment. Q J Econ 126(4):1709–1753

Baird S, McIntosh C, Ozler B (2019) When the money runs out: do cash transfers have sustained effects on human capital accumulation? J Dev Econ 140:169–185

Bandiera O, Buehren N, Burgess R, Goldstein M, Gulesci S, Rasul I, Sulaiman M (2020a) Women’s empowerment in action: evidence from a randomized control trial in Africa. Am Econ J Appl Econ 12(1):210–259

Bandiera O, Buehren N, Goldstein M, Rasul I, Smurra A (2020b) Do school closures during an epidemic have persistent effects? Evidence from Sierra Leone in the time of Ebola. Working paper. http://www.homepages.ucl.ac.uk/-uctpimr/research/ELA_SL.pdf

Becker GS (1960) “An economic analysis of fertility.” Demographic and economic change in developed countries. Princeton University Press, Princeton

Becker GS (1973) A theory of marriage: Part I. J Polit Econ 81(4):813–846

Belles-Obrero C, Lombardi M (2020) Will you marry me, later? Age-of-marriage laws and child marriage in Mexico. J Hum Resour:1219–10621R2

Bergstrom TC, Bagnoli M (1993) Courtship as a waiting game. J Polit Econ 101(1):185–202

Buchmann N, Field E, Glennerster R, Nazneen S, Pimkina S, Sen I (2018) Power vs money: alternative approaches to reducing child marriage in Bangladesh, a randomized control trial. Unpublished manuscript

Buchmann N, Field EM, Glennerster R, Nazneen S, Wang XY (2021) A signal to end child marriage: theory and experimental evidence from Bangladesh. National Bureau of Economic Research, working paper 29052

Chari AV, Heath R, Maertens A, Fatima F (2017) The causal effect of maternal age at marriage on child wellbeing: evidence from India. J Dev Econ 127:42–55

Coles MG, Francesconi M (2011) On the emergence of toyboys: the timing of marriage with aging and uncertain careers. Int Econ Rev 52(3):825–853

Corno L, Hildebrandt N, Voena A (2020) Age of marriage, weather shocks, and the direction of marriage payments. Econometrica 88(3):879–915

Dube L (1997) Women and kinship: comparative perspectives on gender in South and South-East Asia. United Nations University Press Ltd., Tokyo

Field E, Ambrus A (2008) Early marriage, age of menarche and female schooling attainment in Bangladesh. J Polit Econ 116(5):881–930

Field E, Glennerster R, Buchmann N, Murphy K (2016) Cost-benefit analysis of strategies to reduce child marriage in Bangladesh. Copenhagen Consensus Center

Garcia-Hombrados J (2017) Child marriage and infant mortality: evidence from Ethiopia. Department of Economics, University of Sussex Business School Working Paper Series

Girls Not Brides (2020) COVID-19 and child, early and forced marriage: an agenda for action

Goody J (1990) The oriental, the ancient and the primitive: systems of marriage and the family in the pre-industrial societies of Eurasia. Cambridge University Press

Book   Google Scholar  

Heath R, Mobarak AM (2015) Manufacturing growth and the lives of Bangladeshi women. J Dev Econ 115:1–15

Hicks J, Hicks DL (2019) Lucky late bloomers? Consequences of delayed marriage for women in rural Western Kenya. Available at SSRN: https://doi.org/10.2139/ssrn.2622189

Jensen R (2012) Do labor market opportunities affect young women’s work and family decisions? Experimental evidence from India. Q J Econ 127(2):753–792

Jensen R, Thornton R (2003) Early female marriage in the developing world. Gend Dev 11(2):9–19

Jones GW (2017) Changing marriage patterns in Asia. In: Routledge handbook of Asian demography. Routledge, pp 351–369

Chapter   Google Scholar  

Leeson PT, Suarez PA (2017) Child brides. J Econ Behav Org 144:40–61

Malhotra A, Elnakib S (2021) 20 years of the evidence base on what works to prevent child marriage: a systematic review. J Adolesc Health

Muchomba FM (2021) Parents’ assets and child marriage: Are mother’s assets more protective than father’s assets? World Development, 138

Ortner SB (1978) The virgin and the state. Fem Stud 4(3):19–35

Pew Research Center (2016) Many countries allow child marriage. Pew Research Center Report. Available at: http://www.pewresearch.org/fact-tank/2016/09/12/manycountries-allow-child-marriage/

Raj A, McDougal L, Rusch ML (2012) Changes in prevalence of girl child marriage in South Asia. JAMA 307(19): 2027–2029

Roychowdhury P, Dhamija G (2021) The causal impact of women’s age of marriage on domestic violence in India. Fem Econ 27(3):188–220

Save the Children (2020) The global girlhood report: how COVID-19 is putting progress in peril, save the children, London

Sekhri S, Debnath S (2014) Intergenerational consequences of early age marriages of girls: effect on children’s human capital. J Dev Stud 50(12):1670–1686

Sunder N (2019) Marriage age, social status, and intergenerational effects in Uganda. Demography 56(6):2123–2146

Trinh TA, Zhang Q (2020) Adverse shocks, household expenditure and child marriage: evidence from India and Vietnam. Empir Econ. https://doi.org/10.1007/s00181-020-01907-2

UNFPA (2012) Marrying too young: end child marriage. United Nations Population Fund, New York

UNFPA (2019) State of world population 2019: unfinished Business. United Nations Population Fund, New York

UNFPA (2020) State of world population 2020: against my will. United Nations Population Fund, New York

UNICEF (2018) Child marriage: latest trends and future prospects. United Nations Children's Fund, New York

Wahhaj Z (2018) An economic model of early marriage. J Econ Behav Org 152:147–176

Wodon Q, Male C, Nayihouba A, Onagoruwa A, Savadogo A, Yedan A, Edmeades J, Kes A, John N, Murithi L, Steinhaus M, Petroni S (2017) Economic impacts of child marriage: global synthesis report. The World Bank and International Center for Research on Women, Washington, DC

World Bank (2018) Piercing together the poverty puzzle. IRBD/World Bank, Washington, DC

Download references

Acknowledgment

Responsible Section Editor: M Niaz Asadullah.

The article has benefitted from valuable comments of the editor and anonymous referees. There is no conflict of interest.

Author information

Authors and affiliations.

School of Economics, University of Kent, Canterbury, Kent, UK

Zaki Wahhaj

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Zaki Wahhaj .

Editor information

Editors and affiliations.

UNU-MERIT & Princeton University, Maastricht, The Netherlands

Klaus F. Zimmermann

Section Editor information

Faculty Of Economics And Administration, University of Malaya, Kuala Lumpur, Malaysia

M. Niaz Asadullah

Centre on Skills, Knowledge & Organisational Performance, University of Oxford, Oxford, UK

Dept of Economics, University of Reading, Reading, UK

School of Education, Environment and Development (SEED),, University of Manchester, Manchester, UK

IZA Institute of Labor Economics, Bonn, Germany

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Cite this entry.

Wahhaj, Z. (2022). The Economics of Early Marriage: Causes, Consequences, and Policy Solutions. In: Zimmermann, K.F. (eds) Handbook of Labor, Human Resources and Population Economics. Springer, Cham. https://doi.org/10.1007/978-3-319-57365-6_67-1

Download citation

DOI : https://doi.org/10.1007/978-3-319-57365-6_67-1

Received : 30 August 2021

Accepted : 03 January 2022

Published : 16 February 2022

Publisher Name : Springer, Cham

Print ISBN : 978-3-319-57365-6

Online ISBN : 978-3-319-57365-6

eBook Packages : Springer Reference Economics and Finance Reference Module Humanities and Social Sciences Reference Module Business, Economics and Social Sciences

  • Publish with us

Policies and ethics

  • Find a journal
  • Track your research

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

  • We're Hiring!
  • Help Center

paper cover thumbnail

IMPACT OF EARLY MARRIAGE ON EDUCATION ATTAINMENT OF ADOLESCENT GIRLS A LITERATURE REVIEW

Profile image of Ashesh Acharya

According to the Human Development Report 2013, despite the rapid rise of the South, many countries are still underdeveloped and are far behind in terms of growth be it economic, political or social . Change is slower, and Nepal too, falls amongst one of the least developed countries. Women are more susceptible to various kinds of discrimination, inequalities as a result of structure of society. The Human Development Report 2014 points out that women are more vulnerable to wide range of hazards due to their position in society. .

Related Papers

Vilma Seeberg

This study proposes an elaboration of the human development capability approach by theorizing empowerment capabilities as an essential aspect of the education of excluded village girls. Seeking to explain Chinese village girls’ demand for schooling, the article identifies intangible and instrumental capabilities that have often been overlooked and their indirect influence on social changes in gender roles, in the fertility and domestic transitions, accelerated educational attainment and urbanization. The linkage between village habitus and, one, the poor quality of basic and junior high education, and, two, the high cost of senior high school presented the greatest limitation, which cemented the urban-rural gap and inequality in urban employment. Policy to expand and regulate vocational secondary schools and non-formal skills education would counter the alarming increase in systemic rural-urban inequalities that disproportionately affect village girls and women, and would release pent up aspirations and agency of excluded village girls.

review related literature of early marriage

Anita Ghimire , Fiona Samuels

Rohini Pande

International Journal of Educational Development

Susan Kiragu

Within a conceptual framework of Sen's capability approach, the paper explores aspects of girls’ retention in Kajiado schools, Kenya. Drawing on a qualitative study involving in-depth interviews with 24 girls in four schools, the paper discusses the ‘unfreedoms’ the girls experience in relation to environmental, infrastructural and economic constraints, as well as the personal unfreedoms they experience in relation to their gender. The study found that despite these constraints, girls’ retention was linked to their zeal for education and to the part played by key people, supporting and encouraging them and sometimes acting as catalysts for change.

Marit Tjomsland , Henni Aasen

Anita Ghimire

The paper analyses communication strategies for addressing discriminatory social norms in marriage and education for adolescent girls in Nepal

Tribhuvan University, CERID

Madhusudan Subedi

Ragnar Anderson

Aldisonadamara Aldisonadamara

Childhood, adolescence and early adulthood remain for many girls and young women a period of deprivation, danger and vulnerability, resulting in a significant lack of agency and critical development deficits. In many cases, overlapping and intersecting experiences of deprivation, foregone human development opportunities and abuse or exploitation serve to perpetuate and intensify poverty for girls and women over the life-course. Girls’ vulnerabilities in relation to poverty dynamics are different to those of boys and to those of adult women. This is in part because of their relative powerlessness and the particularities of their life stage. What happens at this critical time in their lives can reinforce their poverty status and that of their offspring, or influence their movement into or out of poverty. Poverty research has historically focused on material manifestations of poverty (measured by income and basic human development indicators such as educational enrolment and nutritional status). However, the role that social risks and vulnerabilities play in perpetuating chronic poverty and propelling people into poverty has gained recognition over the past decade. Accordingly, in this report we focus on social institutions – the collection of formal and informal laws, norms and practices that have an effect on human capabilities by either limiting or enabling individual and collective agency. These social institutions, we suggest, have far greater influence on developmental outcomes than is generally appreciated. Social institutions are part of the wider culture that informs multiple aspects of our behaviour and our societies. They play a key role in determining girls’ and young women’s life opportunities and capabilities, by either limiting or enabling individual and collective agency. Social institutions are not inherently good or bad, but when they result in processes that lead to inequality, discrimination and exclusion, they generate a myriad of development deficits and physical and psychological trauma. These barriers to human development can lead to and perpetuate chronic poverty and vulnerability over the course of childhood and adulthood, and potentially inter-generationally. In this report, we identify five critical social institutions, broadening and modifying the Social Institutions and Gender Index of the Organisation for Economic Co-operation and Development (OECD). Within this set of institutions, we pay particular attention to how gender intertwines with other forces of exclusion (class, caste, ethnicity, urban/rural locality, disability, etc). We also highlight the importance of local context, which matters both in the analysis of constraints and in the identification of solutions. Our key modifications to the SIGI are as follows: first, we extend the SIGI range to cover girls rather than just women. Second, we consider a broader definition of well-being beyond the economic, one which captures a range of capabilities and outcomes as well as the complexities of supporting girls and women to both avoid and exit chronic poverty. Third, we give our own labels to the institutions, and also modify some of the component variables, in order to better capture the range of norms and practices that underpin them. Below is a brief overview of each of the characteristics of the five institutions we cover.

RELATED PAPERS

Rumana Hashem

Siobhan Crowley

Fiona Samuels , Anita Ghimire

Samjhana Bhujel

Pramod Regmi

Pierre Pratley

Kathmandu University …

Saraswati Raju

Aftab Ahmed

Kelly Dickson

Journal of Adolescent Research

Dev Acharya

Ayesha Khan

Deanna Bergdorf

Anita Ghimire , Sumeera Shrestha

Hassan Abdallah

Rachel Arinii Judhistari

Christina Kwauk

Population Welfare Deptt Khyber Pakhtunkhwa

Brigitte Rohwerder

Susheela Singh

Michael Fitzgerald

Hari Bhattarai

ether habib

International Review of Education

Cristine Smith

Sushan Acharya

CharmingGirl Lama

Putting Children First: new frontiers in the fight against child poverty in Africa.

Elizabeth Ngutuku

Sajeda Amin

luis flores

Journal of Youth Studies

Chai Podhisita

Akanksha Marphatia

emmanuel njile

RELATED TOPICS

  •   We're Hiring!
  •   Help Center
  • Find new research papers in:
  • Health Sciences
  • Earth Sciences
  • Cognitive Science
  • Mathematics
  • Computer Science
  • Academia ©2024

IMAGES

  1. Early Marriage Critique Essay

    review related literature of early marriage

  2. literature review article examples Sample of research literature review

    review related literature of early marriage

  3. review of related literature in research process

    review related literature of early marriage

  4. review related literature of early marriage

    review related literature of early marriage

  5. (PDF) Marriage Preparation Programs: A Literature Review

    review related literature of early marriage

  6. Review of Related Literature and Studies

    review related literature of early marriage

VIDEO

  1. Review of Related Literature and Studies Part 1

  2. Review of Related Literature : Meaning (RM_Class_20_Bengali_Lecture)

  3. THE SEVEN IMPORTANCES OF LITERATURE REVIEW

  4. 3_session2 Importance of literature review, types of literature review, Reference management tool

  5. Reviews of Related Literature : Research Topic

  6. love marriage vs arrange marriage Debate

COMMENTS

  1. Literature Review: Implications of Early Marriage on Human Development

    This study aims to conduct a literature review on the implications of early marriage on human development. The method used in this study is the SLR (Systematic Literature Review)...

  2. PDF A Literature Review on Early Marriage

    This literature review seeks to address what is known, internationally, about the reasons and outcomes of early marriage (See Section 1 for definitions of terms used here) and why there is a need for legal change in the UK (and elsewhere).

  3. Prevalence and factors associated with child marriage, a systematic review

    The prevalence of child marriage among married women was explored from January 2000 to March 2022 in five databases, including Scopus, PubMed, Web of science, Poplin and Google Scholar to review the related gray literature. According to Haddaway , most gray literature appears in the first 200 citations provided by Google Scholar. Haddaway ...

  4. The health consequences of child marriage: a systematic review of the

    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 ...

  5. Economic Impacts of Child Marriage: A Review of the Literature

    View PDF. Child marriage is a widespread violation of human rights. It is an impediment to social and economic development, and it is rooted in gender inequality. The low value placed on girls and women perpetuates the act and acceptability of child marriage in societies where the practice is common. Child marriage is defined as any legal or ...

  6. [Pdf] Literature Review: the Infuencing Factors of Early Marriage in

    LITERATURE REVIEW: THE INFUENCING FACTORS OF EARLY MARRIAGE IN ADOLESCENTS Sri Handayani, Firmina Theresia Kora, +1 author Amin Dwi Rahayu Published in JURNAL KESEHATAN SAMODRA ILMU 30 November 2022 Sociology TLDR

  7. Early Marriage and Its Determinants among Married Reproductive Age

    1. Introduction. Early marriage refers to "any marriage happens under the age of 18 years, where the girl is not ready for the marriage and childbirth" [1-3].Over 700 million women were married before being 18 years old in the world [].Similarly, in Ethiopia, four in ten young women were married or get into union before the age of 18 and six million girls get married before the age of 15 [].

  8. Literature Review: the Infuencing Factors of Early Marriage in Adolescents

    LITERATURE REVIEW: THE INFUENCING FACTORS OF EARLY MARRIAGE IN ADOLESCENTS November 2022 JURNAL KESEHATAN SAMODRA ILMU 13 (02):70-79 Authors: Sri Handayani Firmina Theresia Kora Rika Monika...

  9. PDF The Economics of Early Marriage: Causes, Consequences, and ...

    compared to other existing reviews of the literature on female early marriage. 2 Z. Wahhaj. In addition, in reviewing the empirical literature on the consequences of early marriage and policy- related questions, the chapter focuses on studies that address ... take place after marriage. A review of traditional marriage practices around the 4 Z ...

  10. Interventions to Prevent Child Marriage Among Young ...

    This review of the literature finds six high-quality interventions and evaluations that reduced child marriage, using a range of implementation strategies and in a variety of settings. ... and one found a decrease in early marriage in younger girls but an increase among older girls. These six represent a range of high-quality intervention ...

  11. Full article: Global and Regional Trends in Child Marriage

    Child marriage remains highly prevalent today and it has substantial negative development impacts in the areas of education, labor force participation, health, violence, and empowerment (see the review article by Parsons et al., 2015, in this issue; see also Brown 2012 and Klugman et al. 2014).

  12. Married Too Young? The Behavioral Ecology of 'Child Marriage'

    For girls and women, marriage under 18 years is commonplace in many low-income nations today and was culturally widespread historically. Global health campaigns refer to marriage below this threshold as 'child marriage' and increasingly aim for its universal eradication, citing its apparent negative wellbeing consequences. Here, we outline and evaluate four alternative hypotheses for the ...

  13. Determinant factors of early marriage in developing countries: a

    This literature review aims to examine the determinants of early marriage in developing countries. Materials and Methods. This study is a literature review using three databases, namely Science ...

  14. PDF A Literature Review of Factors Influencing Early Marriage Decisions in

    1. INTRODUCTION Marriage generally occurs in the age range of 20 to 30 years or can be categorized as early adulthood [1]. Marriage in Indonesia is regulated in Law Number 16 of 2019 which states that the age of individuals who can marry is 19 years for women and men [2].

  15. A Literature Review on Early Marriage

    This literature review seeks to address what is known, internationally, about the reasons and outcomes of early marriage (See Section 1 for definitions of terms used here) and why there is a need for legal change in the UK (and elsewhere).It does not address in depth the UK statistics on child marriages because it has proven impossible to get ac...

  16. [PDF] A Literature Review of Factors Influencing Early Marriage

    DOI: 10.2991/assehr.k.220404.223 Corpus ID: 248623083; A Literature Review of Factors Influencing Early Marriage Decisions in Indonesia @article{Nabila2022ALR, title={A Literature Review of Factors Influencing Early Marriage Decisions in Indonesia}, author={Rizkia Nabila and Roswiyani Roswiyani and Heryanti Satyadi}, journal={Proceedings of the 3rd Tarumanagara International Conference on the ...

  17. PDF LITERATURE REVIEW ON EARLY CHILD MARRIAGE

    LITERATURE REVIEW ON : ERY CD MRRE the prevalence of child marriage in Bangladesh is around 59% (BDHS 2014). This desk review is structured in the following sequence: 1. the concept of early child marriage along with the current prevalence and recent trends in Bangladesh as well as in South Asian and other developing countries 2.

  18. Literature review on effects of interventions to reduce the prevalence

    Joar Svanemyr (2020) Bergen: Chr. Michelsen Institute (CMI Report R 2020:02) Pdf Contents Share Summary This paper presents the current status of research on child marriage and focuses on intervention studies and reviews of evaluations and programs with reduction of child marriage as a core objective.

  19. The Economics of Early Marriage: Causes, Consequences, and ...

    This chapter provides an economic perspective on the issue. It examines the literature for theories and evidence relating to the economic causes and consequences of female early marriage and the efficacy of alternative policies, and highlights current knowledge gaps. Download reference work entry PDF.

  20. The Impact of Early Marriage Practices: A Study of Two Indigenous

    Jovanie Espesor of early marriage among the two groups. More specifically, the study answered the following questions: See Full PDF Download PDF Related Papers International Journal of Humanities and Social Science Child Protect: Response to Poverty Alleviation in the Philippine Indigenous Community Noemi Cabaddu Download Free PDF View PDF

  21. Impact of Early Marriage on Education Attainment of Adolescent Girls a

    Early marriage is defined as a type of marriage where either one or both spouses are under 18 (Wong, 2011) . Early marriages are high in places where poverty is prevalent and where birth and death rates are high. In places of higher levels of conflict and lower levels of development early marriage is observed to be higher.

  22. PDF Perceptions of Early Marriage

    Chapter II:Review of Literature ..... 10 Definition of Early Marriage ..... 10 Issues and Differences Related to Early Marriages ..... 10 Factors Related to Early Marriage in the Hmong Population and ... related to early marriage it is important to consider the Hmong's marital traditions and family unit.

  23. Literature Review: the Infuencing Factors of Early Marriage in

    Methods: The study used literature review strategy. Results: From the results of the literature review, it was obtained twelve journals related to factors that affect the early marriage in adolescents. There are nineteen factors that influence early marriage, namely: education, knowledge, socio-cultural, parents, social norms, economy, gender ...