case study of child marriage

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7 short child marriage stories

These child marriage stories show how and why Plan International is working to prevent early marriage and reveal the effect our work is having on girls’ lives.

Because I am a girl – I’ll take it from here

Our award-winning stop-motion film shows how education can transform girls’ lives. Education is one of the biggest factors in preventing child marriage. An educated girl is more likely to marry later, have fewer children, earn more money, invest in her children and become a force for change in society. 

It’s my life – girls say no to child marriage in Africa

In sub-Saharan Africa around 7 million girls live as child brides. Parents marry off their daughters due to poverty, tradition and gender inequality. See how children’s groups set up by Plan International are spreading the message about the value of educating girls and the negative aspects of early marriage. 

No mountain too high – ending child marriage in Nepal

15-year-old Maya was forced to drop out of school following her marriage. Plan International’s mobile outreach team helped her get back to school despite being unable to access Maya’s village by road.

13, and a bride

In Dosso, Niger, 13-year-old Mariama discovered that she was to be married in a few days’ time. In one of Plan International’s most watched child marriage stories, see how cultural and financial factors played a role in her mother’s decision to accept a dowry for her marriage and how Plan International works at multiple levels to educate communities about the consequences of child marriage.

Lamana’s story

Child marriage exposes girls to abuse, exploitation and early pregnancy. When Lamana was 15, this became her reality. See how Plan International worked alongside a local partner organisation to help her regain confidence, return to education and change her life.

12-year-old Thea’s wedding to 37-year-old Geir

Child marriage is most common in South Asia and West and Central Africa but how would people react to a child marriage taking place in Europe? Plan International Norway created a blog by 12-year-old Thea, who revealed she was marrying a 37-year-old man named Geir and the story soon went viral. This video shows what happened on the wedding day.

Wedding Busters: Child marriage free zones in Bangladesh 

66% of girls in Bangladesh are married under 18. See how Plan International works alongside a local children’s organisation to create ‘child marriage-free zones’ to stop early marriage.

Education, Emergencies, Protection from violence, Sexual and reproductive health and rights, child marriage, Child protection in emergencies, Gender-based violence

Related pages

From school leavers to star teachers , salma is determined to stay in school – no matter what.

Water helps a community to grow and thrive 

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Unchained At Last

UN-Arrange a Marriage … RE-Arrange a Life

United States’ Child Marriage Problem: Study Findings (April 2021)

Also see our article in the journal of adolescent health, view as pdf.

The United States has a child marriage problem – but a simple solution is available.

Nearly 300,000 minors, under age 18, were legally married in the U.S. between 2000 and 2018, this study found. A few were as young as 10, though nearly all were age 16 or 17. Most were girls wed to adult men an average of four years older.

Child marriage – or marriage before age 18 – is dangerous. Even at age 16 or 17, regardless of spousal age difference, child marriage:

1. Can easily be forced marriage, since minors have limited legal rights with which to escape an unwanted marriage (typically they are not even allowed to file for divorce);

2. Is a human rights abuse that produces devastating, lifelong repercussions for American girls, destroying their health, education, economic opportunities and quality of life; and

3. Undermines statutory rape laws, often covering up what would otherwise be considered a sex crime. Some 60,000 marriages since 2000 occurred at an age or spousal age difference that should have been considered a sex crime. 

Table of Contents

Methodology, implications, policy failures, policy recommendations, appendix a: acknowledgments, appendix b: methodology categories, appendix c: marriage age by state.

Unlike in countries where child marriage is illegal but persists anyway, the problem in the U.S. is the laws themselves. Most U.S. states still allow marriage before 18, and the four states* that banned it did so only in the last three years.

Federal law, too, allows and might even encourage child marriage. Immigration law does not specify a minimum age to petition for a foreign spouse or fiancé(e) or to be the beneficiary of a spousal or fiancé(e) visa, which allows for American girls to be trafficked for their citizenship and allows for children around the world to be trafficked to the U.S. under the guise of marriage. The U.S. approved nearly 9,000 petitions involving a minor between 2007 and 2017, and in 95% of them, the younger party was a girl. Further, the federal criminal code prohibits sex with a child age 12 to 15 but specifically exempts those who first marry the child. This incentivizes child marriage and implicitly endorses child rape.

Legislation to this effect harms no one except child rapists, costs nothing and protects children from a human rights abuse.

Unchained At Last first realized in 2015 that the U.S. has a child marriage problem. Unchained had been founded in 2011 by a forced marriage survivor with a mission of providing free legal and social services to help individuals in the U.S. to escape forced marriages – but more and more girls, under age 18, were reaching out to Unchained to plead for the same help.

At the time, child marriage was legal in all 50 U.S. states, a fact that seemed lost on policymakers and advocates. Yet there is almost nothing Unchained can do to help a girl who is not yet 18 to escape a forced marriage. Even a day before her 18th birthday, a girl in the U.S. typically cannot leave home, enter a domestic violence shelter or even file for divorce.

Unchained launched a national movement to end child marriage with an op-ed article in the New York Times titled “America’s Child-Marriage Problem” [1] . Since then, Unchained and its allies have formed a National Coalition to End Child Marriage and various state coalitions, worked with state and federal legislators on simple policy solutions and studied and raised awareness of child marriage in the U.S.

Still, many Americans remain unaware of the prevalence of child marriage in the U.S. [2], possibly because of significant data deficiencies. No central repository collects national marriage-age data in the U.S., and some states do not track this information or make it available.

This is the first study of the extent of child marriage in the U.S. that collected all available state data and used various estimation methods, based on high correlations identified between the available data and census data, to fill in the data gaps. (Unchained’s previous study of the extent of child marriage in the U.S. for the period 2000 to 2010 was based on available data from 38 states plus estimates for the other 12 states based only on state population [3]. PBS Frontline later extended that study to 2015 but did not attempt to fill in the many data gaps left by states that provided no data or only some data [4] ).

Unchained led the study, which was funded by the Bill & Melinda Gates Foundation. Unchained partnered with McGill University, Quest Research & Investigations, Quantitative Analysis and others. (See Appendix A for a full list of Unchained’s partners for this study.)

Unchained requested marriage-age data, based on marriage certificates, from all 50 states and the District of Columbia. Specifically, Unchained asked for de-identified data on the ages and genders of all people married in the state, along with their spouse’s age and gender, in each year since 2000.

Full Data (32 States)

Unchained retrieved marriage-certificate (or, in some states, marriage-license) data from 32 states that showed the age or age ranges of all individuals married each year between 2000 and 2018. For those states, Unchained analyzed the data to determine how many individuals married before age 18. (A few states provided data for 2019 and part of 2020 as well, but Unchained did not include those years in its national calculations.)

Note that Unchained counted children married, not child marriages. Thus, if a minor married another minor, Unchained counted that as two.

Some states provided data that conflicted with data they previously had provided to Unchained. For those states, Unchained used the newer data, on the assumption that the states had found and corrected errors.

Some states’ data included obvious gaps that mean Unchained’s findings are almost certainly an undercount. For example, Tennessee withheld all counts less than 10 (such as if nine 17-year-olds married 20-year-olds one year), potentially hiding thousands of additional child marriages, and Ohio randomly and irretrievably deleted data on children married before age 15 in most years. Additionally, some states’ data included nonsensical marriage ages, such as three-digit numbers, that Unchained excluded from its analysis.

Unchained confirmed all outliers in the data – that is, children listed as married before age 12 – by contacting the relevant state.

Partial Data (12 States + D.C.)

For 10 states and the District of Columbia, Unchained retrieved marriage-age data for some or most of the years 2000 to 2018. Since the number of children married in each state was highly correlated across years – the correlation ranged from .93 to .99 – Unchained used each of those states’ available data to estimate numbers for the missing years.

For two additional states (Nevada and Arizona), Unchained retrieved full marriage-age data from one county or a pair of counties that represented at least two-thirds of the state population.

No Data (6 States)

To estimate data for the remaining six states and the remaining sections of Nevada and Arizona, Unchained looked for correlations between available marriage-age data in other states and variables in the American Community Survey, the U.S. Census Bureau’s demographics survey program. Unchained identified a strong correlation of .88 with a combination of two ACS variables: already-married individuals age 15 to 17 (they self-reported as married, divorced, widowed or separated) and divorced or separated individuals age 18 to 24. (See Appendix B for a breakdown of which states fit into each methodology category.)

An estimated 297,033 children were married in the U.S. between 2000 and 2018. That number includes 232,474 based on actual data plus 64,559 based on estimates.

Child marriage occurred most frequently among 16- and 17-year olds. Some 96% of the children wed were age 16 or 17, though a few were as young as 10 [5].

10-Year-Olds: 5 (<1%) 11-Year-Olds: 1 (<1%) 12-Year-Olds: 14 (<1%) 13-Year-Olds: 78 (<1%) 14-Year-Olds: 1,223 (<1%) 15-Year-Olds: 8,199 (4%) 16-Year-Olds: 63,956 (29%) 17-Year-Olds: 148,944 (67%)

Child marriage is much more likely to impact girls than boys. Some 86% of the children who married were girls – and most were wed to adult men (age 18 or older) [6]. Further, when girls married, their average spousal age difference was four years, whereas when boys married, their average spousal age difference was less than half that: 1.5 years [7].

Child marriage often covers up child rape. Some 60,000 marriages since 2000 occurred at an age or spousal age difference that should have been considered a sex crime [8].

In about 88% of those marriages, the marriage license became a “get out of jail free” card for a would-be rapist under state law that specifically allowed within marriage what would otherwise be considered statutory rape.

In the other 12% of those marriages, the state sent a child home to be raped. The marriage was legal under state law, but sex within the marriage was a crime.

The 10 states with the highest per-capita rates of child marriage [9] are :

1. Nevada (0.671%) 2. Idaho (0.338%) 3. Arkansas (0.295%) 4. Kentucky (0.262%) 5. Oklahoma (0.229%) 6. Wyoming (0.227%) 7. Utah (0.208%) 8. Alabama (0.195%) 9. West Virginia (0.193%) 10. Mississippi (0.182%)

The national number of children married decreased almost every year but is unlikely to get to zero without legislative intervention.

Policymakers should be deeply concerned about child marriage – including at age 16 or 17 – for three main reasons:

1. Child marriage can easily be forced marriage.

  Minors, even highly mature 16- or 17-year-olds, do not have the legal rights they need to navigate a contract as serious as marriage.

Leaving home : Minors who leave home to escape from an abusive spouse or impending forced marriage are typically considered runaways under state law. Police might return them to their homes against their will; in some states, minors can be charged with a status offense for running away. Police might even arrest an advocate at Unchained who helped a minor leave home.

Entering a shelter : A minor who manages to run away from a forced marriage probably has nowhere to go, since Unchained has found that most domestic violence shelters do not accept unaccompanied minors. Youth shelters are not a solution: They typically notify parents their children are there, and house children only for about 21 days while they work on a reunification plan.

Retaining an attorney : Contracts with children, including retainer agreements with attorneys, usually are voidable under state law. Only the most generous attorneys would agree to represent a child.

Filing for divorce : Perhaps most shockingly, children typically are not allowed to initiate a legal proceeding – such as seeking a protective order or filing for divorce – unless they act through a guardian or other representative, under state law.

Some states have tried to close these legal traps by automatically emancipating minors upon their marriage. However, such emancipation arrives too late to prevent a child from being forced to marry; the child must undergo the trauma of the forced marriage before getting the limited legal rights that emancipation brings. And an emancipated minor’s rights are limited: Such a minor still might face difficulties leaving home, entering a shelter or taking other steps to escape an unwanted marriage. Further, automatic emancipation likely ends parents’ financial obligation to their child, regardless of the child’s financial situation. Unchained has seen such teens end up homeless after their marriage failed and their parents refused to allow them back home.

When children reach out to Unchained to ask for help escaping a forced marriage and learn about their limited options, many despair and turn to suicide attempts. Death seems like the only way out for them.

2. Child marriage is a human rights abuse that destroys American girls’ lives.

Marriage before 18, including at 16 or 17, is a human rights abuse, according to the U.S. State Department [10]. It produces devastating, lifelong repercussions for American girls, destroying their education [11], economic opportunities [12] and health [13]. It significantly increases a woman’s risk of experiencing domestic violence [14]. It almost always ends in divorce [15].

Much less is known about the impact of child marriage on American boys. Since most of the children who marry in the U.S. are girls, the research on the impacts of child marriage has been focused on girls.

3. Child marriage undermines statutory rape laws.

In most states and under federal law [16], sex with a child that would otherwise be considered rape – in some cases, felony rape – becomes legal within marriage. In those situations, the marriage license becomes a “get out of jail free” card for a child rapist.

In some states, statutory rape remains a crime within marriage. The marriage is legal, but sex within the marriage is rape. In those situations, the state that issues the marriage license sends a child home to be raped.

As this study showed, 60,000 marriages since 2000 occurred at an age or spousal age difference that should have been considered a sex crime – and 88% gave a rapist a “get out of jail free” card, while 12% sent a child home to be raped. Either way, the state made a mockery of its statutory rape laws.

Child marriage brings no benefit, other than to child rapists. A mature 17-year-old who is in love and wants to marry can wait a matter of months to marry without suffering any harm. A teen couple that gets pregnant can easily co-parent outside of marriage until they are both 18 (establishing paternity is a simple process in most states). A child who is in an abusive home deserves resources and options that do not involve entering a contractual sexual relationship.

Unlike in countries such as India, where child marriage is illegal but remains stubbornly widespread due to other factors, the problem in the U.S. is the laws themselves. The nearly 300,000 children wed in the U.S. between 2000 and 2018 all were married legally.

Each U.S. state sets its own marriage age. While most states set it at 18, legal loopholes in most states still allow children to marry, typically with nothing more than a parent’s signature on a form (parental “consent” that is often actually parental “coercion” [17] ) and/or a court’s approval (often a rubber stamp [18] ). Five states’ laws still specifically allow pregnant girls to marry,* a loophole that has been used to cover up rape and force girls to marry their rapist [19].

Federal law, too, allows and might even encourage child marriage. The Immigration and Nationality Act does not specify any minimum age to petition for a foreign spouse or fiancé(e) or to be the beneficiary of a spousal or fiancé(e) visa [22] . This creates a significant incentive to force a child to marry a foreign adult who wants a U.S. visa, and it invites the trafficking of children to the U.S. under the guise of marriage.

U.S. Citizenship and Immigration Services approved 8,868 petitions involving minors for spousal or fiancé(e) entry into the U.S. between 2007 and 2017. The younger party was a girl in 95% of the petitions [23] .

Additionally, the federal criminal code, which prohibits sex with a child age 12 to 15, specifically exempts those who first marry the child*** [24] . Refusing to punish child rapists who first marry the child encourages both child marriage and child rape.

Four states and two territories have passed legislation to end all marriage before 18, without exceptions: Delaware [25] , New Jersey [26] , Pennsylvania [27] and Minnesota [28] , as well as American Samoa [29] and U.S. Virgin Islands**** [30].  (Puerto Rico banned marriage before age 18 in 2020 [31]. However, the age of adulthood in Puerto Rico is 21, so Puerto Rico cannot end child marriage unless it sets the marriage age at 21 or lowers the age of adulthood to 18.)

But other states have rejected or watered down legislation to end child marriage, in some cases eliminating one loophole only to introduce a new one, and some states have not acted at all. Bills to eliminate child marriage currently are pending in 12 states, but some have stalled.

Federal legislation to set a minimum age of 18 to remove marriage-related immigration benefits, except Violence Against Women Act self-petitions, for those under 18, was introduced in 2019 but did not get enough support to move [32].

The U.S. is one of 193 countries that have pledged, under the United Nations Sustainable Development Goals (specifically, SDG 5.3) to end child marriage by year 2030 to help achieve gender equality [33]. The U.S. and the world will not be able to keep this promise if legislators do not act now.

Every U.S. state, territory and district must pass simple, commonsense legislation to eliminate any legal loophole that allows marriage before age 18 (or higher, in the three states where the age of adulthood is higher [34] ).

Unchained’s partners for this study included:

• Bill & Melinda Gates Foundation, whose generosity made the study possible through a one-year grant;
• McGill University, which conducted the data analyses regarding statutory rape and spousal-age differences;
• Quest Research & Investigations, which conducted most of the data collection and analysis on a “ low bono ” basis;
• Kroll, which conducted some initial data collection on a pro bono basis;
• Quantitative Analysis, which estimated the data where actual data was unavailable on a pro bono basis;
• J Strategies, which helped publicize the study findings;
• White & Case, which conducted the state-by-state legal research on which some the analysis was based on a pro bono basis;
• TrustLaw, which arranged the “match” between Unchained and White & Case;
• DLA Piper, which conducted legal research on a pro bono basis;
• Morgan Lewis, which conducted legal research on a pro bono basis; and
• DOSIDO Design, which created infographics to illustrate the study’s findings.

*Clark County, Nevada, data also was missing the year 2000. Unchained estimated for that year as it did for states whose data missed one or more years.

The youngest age* at which one may marry in each state [35]:

[1] Fraidy Reiss, America’s Child-Marriage Problem, New York Times (13 October 2015), https://www.nytimes.com/2015/10/14/opinion/americas-child-marriage-problem.html .

[2] David Lawson et al., What Does the American Public Know About Child Marriage?, PLoS ONE (23 September 2020), https://doi.org/10.1371/journal.pone.0238346 .

[3] Fraidy Reiss, Why Can 12-Year-Olds Still Get Married in the United States?, Washington Post (10 February 2017), https://www.washingtonpost.com/posteverything/wp/2017/02/10/why-does-the-united-states-still-let-12-year-old-girls-get-married .

[4] Anjali Tsui et al., Child Marriage in America, PBS Frontline (6 July 2017), http://apps.frontline.org/child-marriage-by-the-numbers .

[5] Numbers and percentages based on children wed for whom age data were available (actual data only, excluding estimates).

[6] Percentages are based on children wed for whom spousal age and gender data were available (actual data only, excluding estimates).

[7] Calculations of spousal age differences are based on McGill University’s analysis of Unchained’s data (actual data only, excluding estimates) in 43 states.

[8] McGill University’s analysis of Unchained’s data found 34,943 to 40,224 marriages since 2000 occurred at an age or with a spousal age difference that should have constituted a sex crime under the relevant state’s law. In some 80%, sex became legal within marriage; in the other 20%, sex within the marriage was a crime. Unchained added to the analysis the estimated 23,588 children married in California between 2000 and 2018, all of whom fit in the first category.

[9] Per-capita comparison is based on actual and estimated data.

[10] U.S. Department of State, et al., United States Global Strategy to Empower Adolescent Girls (March 2016), https://2009-2017.state.gov/documents/organization/254904.pdf .

[11] Vivian Hamilton, The Age of Marital Capacity: Reconsidering Recognition of Adolescent Marriage , William & Mary Law School Scholarship Repository (2012), http://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=2467&context=facpubs .

[12] Gordon Dahl, Early Teen Marriage and Future Poverty, The National Bureau of Economic Research (May 2005), http://www.nber.org/papers/w11328.pdf .

[13] Yann Le Strat, Caroline Dubertret, Bernard Le Foll, Child Marriage in the United States and Its Association With Mental Health in Women, Pediatrics: Official Journal of the American Academy of Pediatrics (24 August 2011), http://pediatrics.aappublications.org/content/pediatrics/early/2011/08/24/peds.2011-0961.full.pdf .

[14] World Policy Analysis Center, Fact Sheet (March 2015), https://www.worldpolicycenter.org/sites/default/files/WORLD_Fact_Sheet_Legal_Protection_Against_Child_Marriage_2015.pdf .

[15] Vivian Hamilton, The Age of Marital Capacity: Reconsidering Recognition of Adolescent Marriage , William & Mary Law School Scholarship Repository (2012), http://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=2467&context=facpubs .

[16] 18 U.S.C. § 2243 calls for up to 15 years in prison and/or a fine for someone who has sex with a child age 12 to 15, if the child is at least four years younger.

[17] In Unchained’s experience, even when a minor shows up sobbing at the clerk’s office while their parents force them to marry, the clerk is unwilling or unable to intervene.

[18] In Unchained’s experience, minors being forced to marry are too scared to tell the judge about it. Additionally, this study shows judges across the U.S. have approved marriages for children who are too young to consent to sex. Further indication that judges are not paying close attention is a report that showed Massachusetts probate judges approved 92% of child marriage petitions between 2010 and 2014. See Jim Morrison, Advocates Raise Concerns About Child Marriage in Mass. , Boston Globe (10 August 2016), https://www.bostonglobe.com/metro/2016/08/10/advocates-raise-concerns-about-child-marriage/sx4TQNbXp4gimy502yWB4L/story.html .

[19] The five states with a pregnancy exception to the marriage age are Arkansas (Arkansas Code Annotated § 9-11-103), Maryland (Maryland Family Law Code Ann. § 2-301), New Mexico (New Mexico Code § 40-1-6), North Carolina (North Carolina General Statutes § 51-2.1) and Oklahoma (Oklahoma Statutes Ann. § 43-3). For an example of how pregnancy loopholes have been used to cover up rape and force girls to marry their rapist, see: Nicholas Kristof, 11 Years Old, a Mom, and Pushed to Marry Her Rapist in Florida, New York Times (26 May 2017), https://www.nytimes.com/2017/05/26/opinion/sunday/it-was-forced-on-me-child-marriage-in-the-us.html . (CORRECTION: A previous version of this study said that four states as of April 2021 included a pregnancy exception to the marriage age, which excluded Arkansas. This was corrected as of April 2022.) * NOTE* After this study was completed, North Carolina changed its laws, reducing to four the number of states with a pregnancy exception to the marriage age: Arkansas, Maryland, New Mexico and Oklahoma.

[20] Puerto Rico banned marriage before age 18 in 2020 with PC1564. See https://sutra.oslpr.org/osl/esutra/MedidaReg.aspx?rid=124126 . However, the age of adulthood in Puerto Rico is 21, so Puerto Rico cannot end child marriage unless it sets the marriage age at 21 or lowers the age of adulthood to 18. *NOTE* After this study was completed, Rhode Island, New York, Massachusetts, Vermont, Connecticut, Michigan, Washington and Virginia ended child marriage. Now child marriage is legal in 38 states, and four states do not specify a minimum marriage age.

[21] The 10 states whose laws do not specify any minimum age for marriage are California, Massachusetts, Michigan, Mississippi, New Mexico, Oklahoma, Rhode Island, Washington, West Virginia and Wyoming. *NOTE* After this study was completed, Rhode Island, Massachusetts, Michigan and Washington, which previously did not specify a minimum age for marriage, ended child marriage. Additionally, Wyoming and West Virginia raised their age to 16 from 0. Currently, four states’ laws do not specify a minimum marriage age: California, Mississippi, New Mexico and Oklahoma.

[22] 8 U.S.C. § 1101.

[23] U.S. Senate Committee on Homeland Security and Governmental Affairs, How the U.S. Immigration System Encourages Child Marriages (11 January 2019), https://www.hsgac.senate.gov/imo/media/doc/Child%20Marriage%20staff%20report%201%209%202019%20EMBARGOED.pdf .

[24] 18 U.S.C. § 2243 calls for up to 15 years in prison and/or a fine for someone who has sex with a child age 12 to 15, if the child is at least four years younger. *NOTE* The Violence Against Women Reauthorization Act of 2022 — which President Biden signed into law in March 2022 — eliminated this marriage defense to statutory rape. However, another marriage defense to statutory rape remains in the federal code under 10 U.S.C. § 920b.

[25] HB337 (2018). https://legis.delaware.gov/BillDetail?LegislationId=26363 . 

[26] S427 (2018). https://www.njleg.state.nj.us/2018/Bills/AL18/42_.HTM . 

[27] HB360 (2020).  https://www.legis.state.pa.us/cfdocs/billInfo/billInfo.cfm?sYear=2019&sInd=0&body=H&type=B&bn=0360 . 

[28] HF745 (2020). https://www.revisor.mn.gov/bills/bill.php?f=HF745&y=2019&ssn=0&b=house .

[29] HB35-28 (2018). Not available online. 

[30] Bill No. 33-109 (2020). https://www.legvi.org/billtracking/Detail.aspx?docentry=27003 . 

[31] PC1564 (2020). https://sutra.oslpr.org/osl/esutra/MedidaReg.aspx?rid=124126 .

[32] S.742/H.R.1738: Protecting Children Through Eliminating Visa Loopholes Act (2019-2020). https://www.congress.gov/bill/116th-congress/senate-bill/742/text and https://www.congress.gov/bill/116th-congress/house-bill/1738/all-info .

[33] United Nations Sustainable Development Goal 5 is to “achieve gender equality and empower all women and girls.” One aspect of that, Goal 5.3, is to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.” https://sdgs.un.org/goals/goal5 .

[34] The age of adulthood is 19 in Alabama (Code of Alabama, Title 26, Chapter 1, § 26-1-1); 21 in Mississippi (Mississippi Code Ann. § 1-3-27); and 19 in Nebraska (Nebraska Code § 43-2101).

[35] Marriage age is based solely on statute, not on case law. *NOTE* After this study was completed, Rhode Island, New York, Massachusetts, Vermont, Connecticut, Michigan, Washington and Virginia ended child marriage. (The youngest marriage age allowed in those states is now 18.) Additionally, North Carolina and Alaska raised their marriage age to 16 from 14, Maryland raised its age to 17 from 15, Maine raised its age to 17 from 16, and Wyoming and West Virginia raised their age to 16 from 0.

© 2021 Unchained At Last

Legislative information on this page is accurate as of April 2021.

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Child grooms are often overlooked in the fight to stop child marriage

Photos and text by Stephanie Sinclair

Married at 15, Chakraman Shreshta Balami fulfilled his dying father's wish by getting married — at age 15. He had to give up his dream of becoming a doctor. Now the vice principal of Sri Bhavani government school, he campaigns against child marriage — but even his son was married as a teenager. Above, he poses with a grandchild. Stephanie Sinclair for NPR hide caption

Married at 15, Chakraman Shreshta Balami fulfilled his dying father's wish by getting married — at age 15. He had to give up his dream of becoming a doctor. Now the vice principal of Sri Bhavani government school, he campaigns against child marriage — but even his son was married as a teenager. Above, he poses with a grandchild.

The teenager dreamed of becoming a doctor. But that dream was derailed by child marriage. It's a familiar story – but in this case the details may surprise you.

The 15-year-old wasn't a child bride. He was a child groom.

Child marriage – defined by the United Nations as marriage under age 18 and considered a violation of human rights – disproportionally impacts girls. An estimated 650 million girls and women were married as children.

But there are also child grooms. In its first ever in-depth analysis of child grooms, published in 2019, UNICEF estimates 115 million boys and men around the world were married as children .

They too suffer because of young marriage. "Child grooms are forced to take on adult responsibilities for which they may not be ready," says UNICEF executive director Henrietta Fore . "Early marriage brings early fatherhood and with it added pressure to provide for a family, cutting short education and job opportunities."

Bishal and Sita, both 17, with their 18-month-old daughter Manisha, at his family's home in Kigati village in Nepal. A UNICEF study using data from 82 countries estimates that 115 million boys and men around the world married as children. Child marriage among boys is prevalent in a range of countries in sub-Saharan Africa, Latin America and the Caribbean, South Asia and East Asia and the Pacific. Stephanie Sinclair for NPR hide caption

In addition to perpetuating the cycle of poverty, child marriage has a powerful psychological impact. Based on what he's seen, Pashupati Mahat , technical director and senior clinical psychologist for the Center for Mental Health and Counselling – Nepal , says that boys forced into child marriage suffer higher rates of depression, loneliness and even suicide than do child brides.

"Young men force themselves to be adults, but they don't have the psychological resources to cope with all the demands," says Mahat. "There is more isolation, alienation and a lot of psychological pain within themselves. They are not skilled enough to provide the good affectionate, emotional support [and] use a punitive parenting style. They don't want to face the difficult emotions of the child because they never got the opportunity to deal with their own emotional difficulties when they were quite young."

A would-be doctor derailed

The teenager who wanted to be a doctor, Chakraman Balami, lives in Nepal, which ranks among the countries with the highest rates of marriages involving a child groom. That rate is estimated by UNICEF at 1 in 10. The highest rates are in Central African Republic (28%) and Nicaragua (19%).

The practice of child marriage persists in Nepal despite the fact that it's been illegal since 1963. Current law sets the minimum age of marriage at 20 for both men and women. However, it's rarely enforced.

Now an adult, Balami has become an activist against child marriage. And in 2022, his mission is still a challenge.

The cultural forces that lead to child marriage have not diminished. In Nepal as in many other countries, the practice is part of longstanding tradition. And families may see little advantage to keeping their youth in a classroom when they're so desperately needed elsewhere.

Students at the Sri Bhavani government school in Nepal. Economic pressures cause many families to pull their children out of school. Stephanie Sinclair for NPR hide caption

Students at the Sri Bhavani government school in Nepal. Economic pressures cause many families to pull their children out of school.

"In the village, the parents who want their kids to marry, they see only immediate benefits," explained Chakraman. "They see free labor, they see one more person able to take care of the household chores, food, field, agriculture." At the same time, they do not consider the harmful repercussions of child marriage.

The pandemic has made matters worse. UNICEF predicts that an additional 10 million girls are at risk of marriage over the next decade as a result of economic repercussions caused by COVID-19.

In Nepal, for example, where on-and-off lockdowns have decimated the ability of farmers to earn a living, parents are eager to marry off their children to have one less mouth to feed. Both girls and boys are affected .

Initial data from the pandemic period shows that boys as well as now facing a greater risk of marriage: In Balami's village of Kagati, 9 underage girls were married in 2020, compared to 7 the year before, and three teenage boys were wed, while there were no child grooms in 2019.

From top student to unwilling groom

Before he became a groom at age 15, Chakraman was a top student at his secondary school near Kathmandu with no interest in early marriage.

But when he was around 13, his father became critically ill. His dying wish? To see his son get married.

"I felt very bad," says Chakraman. "But I respected my parents. I listened to them. I wanted to fulfill their wishes." So in 1993, he reluctantly agreed to marry at age 15, shortly before his father's death. "People have a mindset, a belief system that if you arrange your son's marriage or if you see your son getting married, then your life will be fulfilled."

Barely an adult, Chakraman became a father at 18 — but the baby died just five days later, leaving the young couple heartbroken. The couple subsequently had two children. The funds he would have invested in his education went toward providing for the youngsters.

So his dream of medical school was not to be. "When somebody's dreams are taken away, you get emotionally hurt, you get affected," says Chakraman. "I have a lot of anger when I think of the life I never got to make for myself."

Married at just 15, Chakraman Shreshta Balami, vice principal of Sri Bhavani government school, encourages his students to remain in school — and not marry at a young age. Stephanie Sinclair for NPR hide caption

Married at just 15, Chakraman Shreshta Balami, vice principal of Sri Bhavani government school, encourages his students to remain in school — and not marry at a young age.

Child marriages traditionally take place in this area around the Mahalaxmi temple. Advocates are trying to stop the practice but face many obstacles — including fears among parents who push for teen marriage, worried that a daughter in a relationship could become pregnant while unwed. Stephanie Sinclair for NPR hide caption

Child marriages traditionally take place in this area around the Mahalaxmi temple. Advocates are trying to stop the practice but face many obstacles — including fears among parents who push for teen marriage, worried that a daughter in a relationship could become pregnant while unwed.

But he did persevere to complete his education over a span of 20 years. He recently earned a master's degree in Education Planning Management. These days, Chakraman is the vice principal of Shree Bhawani Primary and Secondary Schools.

While his own dreams of medical school have faded, he hasn't given up on those of his students. He encourages them to finish their studies before considering marriage. It's been a decades-long fight.

But the group's best arguments have a hard time overcoming long-held traditions, economic challenges and family pressures. Child marriage has continued into the next generation. Even Chakraman's own son and niece would ultimately marry before they reached adulthood.

Even in communities more amenable to delaying marriage, when adolescents begin romantic relationships, parents may push for child marriage as they worry about premarital pregnancy bringing shame to families.

Why it's so hard to stop child marriage in Nepal

Chakraman understands all too well how hard it is to stop this practice.

Not long after his own wedding, he and more than 40 of his male teenage friends – all of whom were married or engaged as children – formed the youth organization Mahalaxmi Janajagriti Yuba Pariwar, which translates to Mahalaxmi Awareness Youth Club. The volunteer group was named after the temple where these marriages take place and was aimed at preventing their neighbors and relatives from facing the same fate. "Whenever we heard about a child marriage, we would try to convince parents and family members to stop it. If they didn't listen, we went to the bride and groom," he explained. "If that still didn't work, [we would] smash all pots of alcohol they make at home for the wedding feast."

The plan backfired. Villagers viewed the activists as disobedient, blaming their rebellious behaviors on their education and consequent exposure to ideas outside the social norm. The backlash even led some families to briefly question sending their children to school at all. The youth group eventually turned to less extreme methods, focusing on peer support and training to achieve its goals.

Chakraman has also been unable to forestall child marriage in his own family. Along with several other teen couples, his niece Sumeena was married at age 13 on the festival of Shree Panchami, considered one of the most auspicious occasions for weddings in the Hindu religion. Chakraman reluctantly performed some of the wedding rites. Her groom, Prakash Balami, was 15. Almost immediately, Sumeena became pregnant.

Left: Prakash Balami, 15, is groomed by friends and family for his wedding ceremony in Kagati village, Kathmandu Valley, Nepal, on Jan. 23, 2007. Right: Prakash and his bride, Sumeena, 13. Stephanie Sinclair/VII Network hide caption

Left: Prakash Balami, 15, is groomed by friends and family for his wedding ceremony in Kagati village, Kathmandu Valley, Nepal, on Jan. 23, 2007. Right: Prakash and his bride, Sumeena, 13.

Prakash, 15, and Sumeena, 13, married in 2007. An estimated 115 million boys and men around the world were married as children, UNICEF stated in its first in-depth analysis of child grooms. Of these, 1 in 5, or 23 million, were married before the age of 15. Stephanie Sinclair/VII Network hide caption

Prakash, 15, and Sumeena, 13, married in 2007. An estimated 115 million boys and men around the world were married as children, UNICEF stated in its first in-depth analysis of child grooms. Of these, 1 in 5, or 23 million, were married before the age of 15.

"We suffered a lot," recalls Prakash, now 30. "She became dizzy, she was sick all the time.

"I was very young then – I was a child," he says. "I didn't know much about weddings or marriage."

Sumeena's underdeveloped pelvic bones made for a difficult and painful delivery that quickly became life-threatening to both her and the unborn child. She was rushed to the hospital for a cesarean section.

While Sumeena and their son, Mukesh, survived, the pregnancy abruptly ended her education. The young family's financial demands drove Prakash out of school shortly thereafter.

"After my son was born, my childhood was gone," he says. "I was very much interested in social work before I got married. I thought if someone had a problem, I could go help. I really like helping people, but that's all gone."

When his son reached school age, Prakash took a job in construction for two years in the sweltering, year-round heat of Qatar, planning to earn money to send home to his young family. But he says his earnings were withheld to ostensibly pay off the recruiter fees. He returned home empty-handed, unable to afford even a school uniform for his son.

"I thought I would earn a lot for my family, for my children," says Prakash. "That was my dream. But nothing turned out the way I thought it would."

Prakash Balami, 29, was forced into an arranged marriage at 15. He poses with his wife, Sumeena, 27, and their children, Paratichya and Mukesh, next to their home, which was destroyed in the 2015 earthquake in Kagati village. "After my son was born, my childhood was gone," he says. "I was very much interested in social work before I got married. I really like helping people, but that's all gone." Stephanie Sinclair for NPR hide caption

Prakash Balami, 29, was forced into an arranged marriage at 15. He poses with his wife, Sumeena, 27, and their children, Paratichya and Mukesh, next to their home, which was destroyed in the 2015 earthquake in Kagati village. "After my son was born, my childhood was gone," he says. "I was very much interested in social work before I got married. I really like helping people, but that's all gone."

Satellite TV and the internet add a complication

In an ironic twist, the modern age, with increased access to satellite television and internet on smart phones , has reinforced the practice of child marriage. In previously sheltered Nepali villages, South Indian movies blast melodramatic love stories nightly into homes, with young eyes watching. The result is a surge in teen romance – and in parental fear that their daughters will defame the family by having premarital relations.

"We fell in love in grade nine," explains Chakraman's son, Nirazan Balami. "But we were kind of forced to marry because her father came to know we were in a relationship. I was 17."

Smitten, the teenage Nirazan says the girl's father overheard him saying "love-related things a boyfriend says to a girlfriend." The father insisted the couple immediately become husband and wife.

In shock and overcome with stress, Nirazan tried to calm his nerves with alcohol. Then, he called his mother saying he wanted to get married.

"My mother told my father because I couldn't bear to tell him. When he came to know, he shouted at me, 'No, no, no! Not now! This is not the right decision!' "

Chakraman arrived in Kathmandu the following morning to take Sanjeeta back to her father's house. A few days later, Nirazan returned to the village to find his parents still distraught and angry. Sanjeeta had been calling him daily in response to her father's relentless pressure to marry Nirazan.

Nirazan Balami, 21, hold his 17-month-old son, Nir. He married at 17 under intense pressure from his wife's family. Stephanie Sinclair for NPR hide caption

Nirazan Balami, 21, hold his 17-month-old son, Nir. He married at 17 under intense pressure from his wife's family.

In an effort to placate Sanjeeta's father, Nirazan finally convinced his parents to let them get engaged.

His mother acquiesced and immediately began making arrangements for the wedding.

"That's how I got married," says Nirazan.

For a while, Nirazan was able to return to veterinary school. But the newlywed couple soon married. In 2017, they had a child, and, like his father, Nirizan's education came to a halt.

"I felt pressure to earn money because I had a family. I felt very depressed. I thought, I don't know, why should I live?"

Before long, Nirazan got a job as an excavator driver. He's held the job for several years – and still can't help but wonder what his life could have been like had he been allowed to continue his studies.

Economics could be a key to convincing parents not to marry off their children. High-ranked officials in the village, including former members of the youth club, say the pace of change will remain incremental at best until many parents see economic benefits of letting their children continue their education – both girls and boys, the pace of societal change will remain incremental at best.

Will things ever change?

Clearly, child marriage for boys will not end unless it ends for girls, says Anju Malhotra, a fellow at the United Nations University-International Institute for Global Health and a global leader in gender issues.

For this to happen, families have to realize that there's an economic benefit to keeping girls in school – a tough idea to embrace during a pandemic and when climate change is having an impact on harvests, she says.

And while there are clear career paths for sons, she says that families don't have enough awareness that the same should be true for daughters.

Sumeena, 13, is carried in a basket during her wedding to Prakash, 15, in 2007. Stephanie Sinclair/Stephanie Sinclair/VII hide caption

Sumeena, 13, is carried in a basket during her wedding to Prakash, 15, in 2007.

She says there also must be programs in villages to sensitize families on the importance of decoupling their reputation from their daughter's intimate decisions – and that those decisions should not be cause for immediate marriage.

Without these changes for girls, the boys will also be unable to break free from pressure for child marriage, says Malhotra.

Had they just postponed the wedding, Nirazan says he feels that his life and his wife's life would be much different today. He wishes he could have communicated that to his wife's parents.

"Now," he says, "we've both sacrificed our dreams."

In a career that's spanned over two decades, Pulitzer Prize-winning photographer Stephanie Sinclair has focused on gender and human rights issues, with special attention to the topic of child marriage. In 2014, she founded the charitable organization Too Young to Wed , whose mission is to empower girls and end child marriage globally.

• child grooms
• child marriage
• child brides

• Research article
• Open access
• Published: 14 December 2020

Early marriage and women’s empowerment: the case of child-brides in Amhara National Regional State, Ethiopia

• Mikyas Abera 1 ,
• Ansha Nega 2 ,
• Yifokire Tefera 2 &
• Abebaw Addis Gelagay 3  

BMC International Health and Human Rights volume  20 , Article number:  30 ( 2020 ) Cite this article

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Women, especially those who marry as children, experience various forms and degrees of exclusion and discrimination. Early marriage is a harmful traditional practice that continues to affect millions around the world. Though it has declined over the years, it is still pervasive in developing countries. In Ethiopia, Amhara National Regional State (or alternatively Amhara region) hosts the largest share of child-brides in the country. This study aimed at assessing the effects of early marriage on its survivors’ life conditions – specifically, empowerment and household decision-making – in western Amhara.

This study employed community-based cross-sectional study design. It adopted mixed method approach – survey, in-depth interview and focus group discussion (FGD) – to collect, analyse and interpret data on early marriage and its effects on household decision-making processes. The survey covered 1278 randomly selected respondents, and 14FGDs and 6 in-depth interviews were conducted. Statistical procedures – frequency distribution, Chi-square, logistic regression – were used to test, compare and establish associations between survey results on women empowerment for two groups of married women based on age at first marriage i.e., below 18 and at/after 18. Narratives and analytical descriptions were integrated to substantiate and/or explain observed quantitative results, or generate contextual themes.

This study reported that women married at/after 18 were more involved in household decision-making processes than child-brides. Child-brides were more likely to experience various forms of spousal abuse and violence in married life. The study results illustrated how individual-level changes, mainly driven by age at first marriage, interplay with structural factors to define the changing status and roles of married women in the household and community.

Age at first marriage significantly affected empowerment at household level, and women benefited significantly from delaying marriage. Increase in age did not automatically and unilaterally empowered women in marriage, however, since age entails a cultural definition of one’s position in society and its institutions. We recommend further research to focus on the nexus between the household and the social-structural forms that manifest at individual and community levels, and draw insights to promote women’s wellbeing and emancipation.

Peer Review reports

Early marriage is any marriage entered into before one reaches the legal age of 18 [ 1 , 2 , 3 ]. Though both boys and girls could marry early, the norm in many countries around the world is that more girls than boys marry young and someone older [ 3 ]. In Mauritania and Nigeria, for instance, “more than half of married girls aged 15-19 have husbands who are 10 or more years older than they are” [ 3 ].

Resilient and interlinked socioeconomic and normative factors (e.g. poverty, illiteracy, traditionalism, patriarchy, etc.) undermine women’s status, capabilities and choices, and ensure early marriage continues unabated in many developing countries [ 4 ]. As a harmful traditional practice, though it is more common in developing than developed countries, there are substantial variations between and within regions of the world and countries [ 3 , 5 , 6 , 7 ]. For instance, half of the world’s child-brides live in South Asia; and, while early marriage is still most common in Sub-Saharan Africa, between them, these two regions host the 10 countries with the highest rates of early marriage [ 3 , 5 , 8 ].

By early 2000s, 59% of Ethiopian girls were marrying before 18 [ 9 ]. Footnote 1 As in the rest of Sub-Saharan Africa, early marriage in Ethiopia is gendered with only 9% of men aged 25–49 been married by 18 [ 10 , 11 ]. Its effects are diverse and wide-ranging [ 3 , 4 ]. In its onset, early marriage effectively ends childhood by limiting its victims’ opportunities for schooling, skills acquisition, personal development and even mobility. It also increases the risks of early onset of sex, adolescent pregnancy and childbearing, etc. [ 12 , 13 ] whose negative outcomes are amplified by girls’ undeveloped physique and lack of or inadequate knowledge on healthy sexual and reproductive behaviours. Cumulatively, these effects of early marriage undermine girls’ and young women’s health, psychosocial wellbeing and overall quality of life [ 14 , 15 , 16 ].

Early marriage is not only a serious public health issue. It also exacerbates domestic violence [ 17 ] and undermines women’s status and decision-making powers [ 18 , 19 ]. It increases women’s risk of intimate partner sexual violence, for it is built on spousal age gap, power imbalance, social isolation and lack of female autonomy. Globally, some 30% of girls (aged 15–19) experience violence by partners [ 20 ]. Bangladeshi women married during their adolescence, for instance, are subject to increased domestic violence and loss of autonomy, which, nonetheless, improved with their educational attainment [ 21 ]. Child-brides, specifically, are twice as likely as adult-brides to experience domestic violence [ 22 ]. This is partly because child-brides are more likely to be uneducated, poor and adherents to traditional gender norms [ 3 , 23 , 24 , 25 , 26 ].

Child-brides are mostly isolated with restricted mobility and limited opportunities for independent living. Those who had been going to school would be coerced to discontinue when they marry, and those who have not been to school, the hope to do so dies on their wedding day. In Tach-Gaynt Woreda of Amhara region, for instance, 69% of young women marry early. Between 2009 and 2014, females represented 61% primary school dropouts in the Woreda; and, 34% of female school dropouts mentioned early marriage as the main reason. If child-brides want to start/continue schooling, a rare approval must come from husbands and/or families. In rural communities of Ethiopia, including Amhara region, the ‘good wife’ is primarily pictured in terms of what she accomplishes at home and for the husband, children and the elderly in the family and kinship.

Against the backdrop of mounting calls for legal and policy changes, Ethiopia introduced provisions [ 10 ] to redress gender inequalities and discrimination in its most recent Constitution (1995; Article 35:3) [ 27 ]; it has also revised its Family (2000) and Penal (2005) Codes to, among other things, raise the age of legal consent for women to 18 (from 15). Ethiopia’s latest Education and Training Policy [ 28 ] introduced provisions to reorient societal attitude towards and valuation of women in education, training and development. More profoundly, and partly due to international pressure, in 2013, Ethiopia spelled out its commitment to eradicate early marriage by 2025 in the National Strategy and Action Plan on Harmful Traditional Practices against Women [ 29 ]. These and other relevant documents informed governmental and nongovernmental interventions to remove barriers, including early marriage, to young women’s personal advancement and empowerment, and taking effect at individual, institutional, national and cultural levels.

Accordingly, age at first marriage has been increasing over the years in Ethiopia [ 9 ]; nonetheless, its reported scale and rate are suspect for two main reasons. First, the Ethiopian Demographic and Health Survey (EDHS) defines age at first marriage as the age at which partners begin living together under one roof [ 29 ], despite the fact that many early marriages in Ethiopia allow spouses to start living together only a few years later as in the cases of promissory or child marriages [ 4 ]. Second, systematic underreporting or omission is a high possibility, which would lower the magnitude of early marriage among girls than boys as the latter commonly delay marriage. Criminal prosecution under the Revised Family Code (Article 7) could also induce underreporting or deliberate omission of early marriages.

Though there needs to be caution in interpreting statistics on early marriage in Ethiopia, it has been amply documented that Ethiopian women’s low social status explains their limited rights and odds to assume duties, roles and authority on equal terms as their male counterparts [ 9 , 30 ]. Early marriage, one manifestation of this violence, is intimately linked with gender, poverty and illiteracy in rural Ethiopia [ 30 ]. Rural women tend to marry younger than those in urban areas, while patriarchy and the feminization of poverty, illiteracy and low educational attainment play crucial role in perpetuating the imbalance [ 9 , 30 ].

There are studies that document strong association between early marriage and poverty. UNICEF reports that one in three girls in low- to middle-income countries will marry before 18 [ 3 , 31 ]. Nonetheless, though many see a strong link between poverty and early marriage, the correlation is never monotonic. Family riches are not guarantee to avoid early marriage. With growing population and land shortages, girls from better-off families who stand to inherit valuable resources have become easy targets for sustained solicitations by those who desire to ‘marry-into’ wealth. Conversely, poor families generally resort to early marriage as a strategy to reduce economic vulnerability. In both scenarios, however, early marriage is seen as a mechanism to strengthen ties between families, evade the risk of daughters engage in premarital sex (and lose their virginity and/or become pregnant) or pass the culturally defined ‘desirable age’ for marriage (and become unmarriable).

The sociocultural consequences of becoming pregnant outside wedlock are harsh as they go against deep-rooted cultural norms that tie girls’ chastity and sexual purity before marriage to their family honor as well as their marriageability. Most parents fear delaying marriage makes sexual encounters imminent – consented or otherwise – that disgraces the family and tarnishes girls’ reputation and, subsequently, marriage prospects.

Within Ethiopia, girls in some regional states are more likely to marry early; and, Amhara region has the highest prevalence of early marriage with 50% of girls marrying at 15, and 80% marrying at 18 [ 32 , 33 ]. In 2014, 74% of women [ 20 , 21 , 22 , 23 , 24 ] in the region married before 18, significantly higher than the national average of 41% [ 2 ]. To put this in perspective, “a girl born in [Amhara region] is three times as likely as the girl born in Addis Ababa to marry early” [ 3 ].

Reports on improving inter-generational age at first marriage at national level puts the persistently high prevalence of early marriage in Amhara region in a curious light [ 34 ]. In the region, early marriage is deeply entrenched in religious and cultural norms where sex before marriage is a blow to a girl’s marriageability, for her worth lies in her sexual purity, her future role as a devout wife and mother, and her commitment to family honor [ 35 ]. Hence, despite proactive laws, institutional structures and project interventions, early marriage grew adept and continues to affect the lives of many under different guises.

Due to its myriad nature [ 36 , 37 ], on the other hand, eradicating early marriage requires simultaneously addressing its various dimensions and promoting girls’ empowerment through education, institutional support structures and community development programs. Informed by a mixed-methods approach, thus, this study aimed at informing such types of interventions at national and regional levels by identifying its association with women’s empowerment at three Zones (North Gondar, South Gondar and West Gojjam) of Amhara region – the regional State with “one the world’s highest rates of child marriage” (and the highest in Ethiopia) where “most unions take place without girls consent” [ 38 ]. The effects of early marriage go beyond the child-brides and their children, for they severely undermine national and global progress on a variety of Sustainable Development Goals, i.e., Agenda-2030. In light of this, this interdisciplinary study, falls within the current research priority agenda of promoting evidence-based policymaking and interventions [ 39 ] to mitigate early marriage as a resilient sociocultural problem – both from a human rights standpoint and meeting the Sustainable Development Goals targets.

Theoretically, systems theory, with its roots in Ludwig von Bertalanffy’s general systems theory, informs this study [ 40 , 41 , 42 ]. General systems theory argues that all entities – physical, biological, chemical, social, etc. – are complex, structured and dynamic systems, and they constitute sub-systems or units that interact with one another as well as the external environment. His theory advanced remarkably over the years with applications in biology [ 43 , 44 , 45 ], economics [ 46 , 47 , 48 ], psychiatry [ 49 , 50 ] and sociology [ 51 , 52 , 53 , 54 ], among others.

In the field of family studies, systems theory has been used to study family or marriage as an interactional system, whereby patterns in members’ behaviors reflect interdependencies and communications amongst each other and with their normative environment, primarily – rather than their idiosyncrasies. As such, it brings at least two advantages to the current study: firstly, it allows us to understand the norms that structure families, marital relations, individual choices and decisions; secondly, it helps us unravel the tensions between agency and structure i.e., how changes at individual, family and cultural levels feed on each other to make family or marriage a dynamic interactional system capable of recalibrating its functions, communications, etc. vis-à-vis subsystems other systems in its sociocultural milieu [ 55 , 56 ].

Using systems theory, hence, this study explores the effects of early marriage on child-brides interactional outcomes of a series of factors, including individuals’ personal convictions, the function of marriage (for instance, marriage in traditional societies is primarily a cultural arrangement that decent groups use to cement desirable alliances), normative definitions of sex, sexuality, etc. In other words, this study will treat early marriage as part of a broader, normative system where decisions or actions cannot be random but aim to create, maintain or re-create a state of equilibrium. Consensus, conflict, abuse or violence in a family, as Stratus puts it, can viewed as, primarily, products of the system than individual pathology [ 55 ]. Factors that perpetuate any of these scenarios in a family are embedded within the very fabric of the culture and norm that structure the family institution and relations among members i.e., individuals cannot randomly opt out of the norms of the system patterns without suffering consequences for their indiscretions or violations.

Description of the study area

The Amhara region is one of the 10 regional states and 2 city administrations that make-up the Federal Democratic Republic of Ethiopia. Footnote 2 The region has an estimated population of 21.13million, with 90.85% residing in rural areas. Agriculture is the mainstay of residents in rural areas, with tourism, services and commerce creating the majority of jobs for urbanites. In 2013, Net Enrolment Rate at primary level was 93%, with gender parity at 0.95 [ 57 ]. The national adult literacy rate was 41.5% in 2012 [ 58 ].

This study covered 7 administrative districts – five Woredas and two cities – located in three Zones – North Gondar, Footnote 3 South Gondar, West Gojjam – of northwestern Amhara region i.e., Chilga (Code.01), Gondar Zuria (Code.02), Libo-Kemkim (Code.05), Derra (Code.06) and Yèlma-èna-Dénsa (Code.07) Woredas , and cities of Gondar (Code.03) and Bahir Dar (Code.04). These districts are of varying sizes and they are subdivided into Kebeles – smallest administrative unit in the Ethiopian federal structure. The fieldwork was conducted between January and April 2017.

Study population

This study covered all women who had had their first marriage within 10-years prior to the fieldwork, irrespective of their current marital status, in western Amhara region. The 10-years timeline provided a reasonably representative group of married women who would furnish sufficient data to assess changes in the incidence, prevalence and multifaceted effects of early marriage on their life conditions.

Study design

This study employed a mixed method approach involving quantitative and qualitative methods. A cross-sectional study design with descriptive and analytical components enabled a comparative assessment of the effects of early marriage on women’s empowerment in the domestic sphere. Theoretically, system theory informs the discussion, analysis and interpretation of data i.e., by taking into account both individual (e.g., age) and ecological (e.g., cultural value, public policy) factors as they interact and affect actors’ behaviors (in this case, interpersonal interactions and decision-making) at household level.

Methods of the study

Survey, focus group discussions (FGDs) and in-depth interviews generated relevant data on married women. A representative sample of 1278 married women were surveyed to gathered data on the prevalence and outcomes of early marriage in western Amhara region. Qualitative methods – FGD and in-depth interview – were used to assess married women’s experiences, community perceptions and values on (early) marriage, appropriate age of marriage, and impact of early marriage and community change-actors, among others. Critical desk-review of relevant documents generated perspectives and insights to triangulate the results of primary data.

Sample size

Survey sample size was calculated using a single population formula, by assuming the proportion of early marriage in Ethiopia among married women whose age less than 24-years at 41% [ 2 ], with 95% confidence level and 4% margin of error: 581 . But after considering design effect for two-stage cluster sampling (*2) and non-response rate (*10%), the final survey sample size was determined at 1278 (=581*2 + (581*.10)).

To collect qualitative data, 2 types of FGDs were conducted in each of the 7 districts with, on average, 8 discussants: FGD 1 , with child-brides – a mixed length of age at first marriage i.e., 1–5 years and 6–10 years, and their residential place i.e., rural or urban; and, FGD 2 , with representatives of community leaders, elders, law enforcement officers, parents, school directors and governmental and non-governmental organizations working on children and girls. In total, 14 FGDs were conducted.

Sampling procedure

Probability and purposive sampling techniques were used, respectively, for survey, and FGD and in-depth interview. Firstly, 7 districts – 5 Woredas (Chilga, Gondar Zuria, Derra, Libo-Kemkim and Yèlma-èna-Dénsa) and 2 cities (Gondar and Bahir Dar) – of Amhara region were identified, for they host community intervention projects intended to curb early marriage. Secondly, 4 Kebeles from each district were selected and the sampling procedure accounted for differences among districts in their residential pattern (urban vs. rural) and availability of community intervention projects (beneficiaries vs. non-beneficiaries). Specifically, the sampling procedure followed a 3:1 urban: rural ratio for the two cities, and the reverse for the 5 Woredas . Finally, the 1278 survey sample was distributed to each Kebele based on its population size and the number of women in reproductive age (ages, 15-49). Using Kebele residents’ rosters as sampling frame, a random – and proportionate – sample of households were selected for the survey from each Kebele .

Data collection tools and procedure

All data collection tools (enumerator-administered questionnaire, and FGD and in-depth interview guides) were initially designed in English. They were translated into Amharic, and then back to English – forward-and-backward translation – to ensure their validity and consistency. The questionnaire was pilot-tested at Teda Kebele of North Gondar Zone, a Kebele excluded from the survey, to check for its validity, reliability and consistency. The pilot improved the questionnaire’s completeness, appropriateness, conciseness and relevance as well as the feasibility of the fieldwork.

Twenty-eight females were employed as survey enumerators from World Vision–Ethiopia’s roster of data collectors that documents trained, experienced, locally-resourceful youth for possible recruitment as enumerators, interviewers, guides, etc. in research projects. These enumerators and local guides underwent 2-days intensive training on research methods, data collection tools, interviewing skills, etc. including running mock-interview sessions. After the training, they administrated survey questionnaires by travelling from household to household. They, before asking survey questions, were required to explain the objective of the study, requested for informed consent to participate in the study and checked respondents’ profile for eligibility i.e., women married within 10 years during the fieldwork.

Two types of FGDs, 14 in total, were conducted: FGD 1 involved child-brides who were identified and invited by enumerators during the survey; and, discussants for FGD 2 were identified based on their knowledge of the problem of early marriage in the study area and approached via administrative channels. Finally, 6 in-depth interviews were conducted with child-brides, chosen purposively as their experiences vividly illustrate the effects of early marriage on women’s empowerment.

After inquiring about preferences and confirming with participants, FGDs and in-depth interviews were conducted in facilities and spaces convenient to all such as offices of World Vision–Ethiopia, Gender and Legal Affairs, and Youth Centers. These facilities and spaces were assessed beforehand for their cleanliness, calm, safety and accessibility as well as falling outside non-participants’ earshot and possible intrusions. On average, FGDs and in-depth interviews took, respectively, 60 and 40 min to complete. Authors conducted FGDs and interviewed child-brides.

Data management and analysis

For the survey, all filled and returned questionnaires were checked for completeness and consistency of responses. Once survey data collection was finalized, 3 experienced data encoders entered questionnaire data into Epi-Info and later transferred to SPSS [ 20 ] as data-sets for cleaning, organization and analysis. Descriptive and inferential statistics were employed to determine, among others: the prevalence of early marriage; the incidences and magnitude of bad outcomes of early marriage on women’s decision-making; and, community’s perception on early marriage and appropriate age of marriage. Binary logistic regression models were used determine the likely occurrence of different forms of disempowerment in two groups of women i.e., those married before 18 and those married at/after 18. A p -value of 0.05 was used as a cut-off point to determine statistical significance.

Regarding FGDs and in-depth interviews, all sessions, with the consent of participants, were digitally recorded. Audio-files were later transcribed, post-coded and categorized under core thematic areas. Thematic content analysis provided insights into the nature, community perception and drivers of early marriage and changes. Analytical descriptions and quotes from FGDs and in-depth interviews were used to triangulate, contextualize or explain survey results. Narrated texts, graphs and tables were used to present results according to the nature of the information derived.

In quoting directly from FGDs and in-depth interviews, codes were used to refer to the method, source and location (districts). Accordingly, FGD-R01, for instance, refers to an FGD conducted with representatives of relevant stakeholders (i.e., R) in Chilga Woreda of North Gondar Zone (i.e., 01). Similarly, Interview-S07 refers to an interview conducted with child-brides (i.e., S) in Yèlma-èna-Dénsa Woreda of West Gojjam Zone (i.e., 07).

Ethical considerations

Data for this article are taken from a larger study the authors conducted on behalf of E 4 Y Project , a project run by World Vision-Ethiopia and cleared for appropriate ethical standards at national and regional levels. On behalf of the authors, World Vision–Ethiopia supplied official letters to the respective regional and district administration offices and provide support and facilitation as required.

During the fieldwork, study participants and/or parents/legal guardians (when participants were under the age of 18) were informed about the study objectives and the scope of their involvement beforehand. Verbal consent was obtained from participants or parents/guardians prior to commencing survey, interviews or FGDs. Privacy and confidentiality were granted and maintained during the survey, discussions or interviews. Confidentiality of digital recordings and transcribed data were strictly protected and this was explained to all participants. During FGDs and in-depth interviews, special attention was given to when asking sensitive questions based on local contexts. Participants’ concerns and questions were addressed before they provided individual, informed consents. There was no financial incentive offered to study participants. Nonetheless, participants who had to travel from distant Kebeles for study’s purpose were provided with transport allowance.

The preliminary findings of the study were presented and validated in a national validation workshop held at Bahir Dar city (Ethiopia) and in attendance were representatives of the community (including study participants) and relevant governmental and non-governmental organizations working on early marriage. Workshop participants reflected on the process and results of the study. The authors addressed the comments and questions raised during the workshop, and they revised the study report submitted to World Vision-Ethiopia.

The results and findings of the study are organized and presented in two sub-sections: (a) the prevalence of early marriage; and (b) early marriage and household decision-making in Amhara region. Let us start with the prevalence of early marriage and its variation among districts of the region.

The prevalence of early marriage in Amhara region

The survey covered 1278 married-women respondents, while 112 [ 6 ] participants took part in 14 FGDs (interviews). Of the 1278 respondents, 444 (34.7%) were married before the age of 18 Fig.  1 . Nonetheless, as Fig.  2 reports, there was variation in the prevalence rate of early marriage among districts in the study area: Derra (54.5%) and Yèlma-èna-Dénsa (49.7%) Woredas registered the highest, and the cities of Gondar (16.7%) and Bahir Dar (25.1%) the lowest rates of early marriage. With the regional prevalence rate of 32%, the results indicated that urbanization is inversely related to the prevalence rate of early marriage.

Prevalence of early marriage in Western Amhara, Ethiopia (Survey, 2017)

Comparatively, early marriage was high among Orthodox Christians (38.8%) and rural residents (40.6%). Regarding schooling, the proportion of child-brides increased from ‘no formal schooling’ (48.3%) to ‘primary level’ (52.6%), before it declined at junior (39.7%) and senior (28%) high-school levels. These results underlined rural residents and primary grades as potent entry points for any effective intervention, for 53% of primary graders and 41% of rural residents ended up marrying before 18.

Respondents’ age at first marriage ranged from 5 to 35 (M = 18.75; SD = 3.44); and, the lowest ages to start living with spouses and make sexual debut among respondents were, respectively, 9 (M = 18.93; SD = 3.25) and 10 (M = 18.80; SD = 3.11).

Among respondents primarily engaged in farming, on the other hand, 67.1% experienced early marriage, which is not unexpected since the prevalence of early marriage is high in rural areas where agriculture is the main employer of labor. Similarly, 39.3% those who produce and sell local alcoholic beverages were married before 18 (Fig. 2 ). These and the results presented above indicate that early marriage has pertinent impacts on and associations with young women’s education, economic development and wellbeing.

Prevalence and profile of early marriage in Amhara National Regional State, Ethiopia (Survey, 2017)

Early marriage and household decision-making in Amhara region

In this section, the effects of early marriage on young women’s empowerment at household decision-making processes are presented under five sections: early marriage, marital interactions and dysfunctions; early marriage and spouse abuse; early marriage and household management; early marriage, social interactions and procreation; and early marriage and healthcare.

Early marriage, marital relations and dysfunction

As Table  1 shows, respondents’ current living arrangement with first husband – which, though imperfectly, serves as a proxy to history of family dysfunction – significantly varies by their age at first marriage (χ 2  = 34.296; α = .001). Family dysfunction refers to processes that undermine the intactness of the family institution and members’ ability to procreate, socialize children and support each other in life. These processes include, among others, conflict, abuse, role-strain, apathy, separation, divorce and desertion. In this study, when respondents did not share households with their first husbands at the time of the survey, it was taken to imply some form of family dysfunction i.e., conflict, abuse, separation, divorce, etc. Specifically, while 82.4% of the respondents married at/after 18 were living with their first husbands, only 68.2% of those married before 18 did. In other words, grim by-products of marriage such as separation, divorce, desertion (and possible remarriage) seems to be forced on women who had their first marriage before 18 – the legal age of consent under the Ethiopian Civil Code.

To put it in context, a logit model predicts girls married before 18 are more than twice as likely (= e 0.137 ) as women married at/after 18 not to be with their first husband (Logit: χ 2  = 31.431; α = .001; Wald = 31.388; ß  = .770; Constant = 772 ) . Significantly more respondents married before 18 also dissolved their first marriage and remarried (42 (9.5%)) than those married at/after 18 (21 (2.5%)). Specifically, girls married before 18 are twice as likely as women married at/after 18 to dissolve their first marriage, and either establish a new one or become widow or single (χ 2  = 45.380; α = .001). For FGD participants at Libo Kemkim, these experiences tend to make the lives of child-brides grimmer:

Most of them [child-brides] would not have strong foundation to build their marriage on and end up being divorcees. After divorce, they migrate to urban areas and, due to lack of opportunities for education or employment, become street children or, worse, prostitutes. They are ghastly populating this cruel occupation. Many also migrate to Arab countries as divorce implies loss of livelihood [FGD_R06].

Mostly in rural communities of western Amhara region, underage girls enter into marriage without a personal, informed choice. For marriage generally is the result of the decision of parents and/or close kin, and it is culturally desirable for girls to marry men much older than themselves. But as they drop out of school and become child-mothers, several child-brides resented their husbands, parents and others who brokered and/or enabled the loss of their childhood:

It is a challenge to raise a child and taking care of household chores while still being a child! If I were to give birth now, I will be physically mature to take care of my duties effectively. I would have more time for myself too. I think marrying and giving birth as children have stunted our development … We do not lead a decent living and we do not cloth or clean up well. This is the result of our parents’ decision to marry us early …. [Moreover,] our children did not get the best we could have provided in care and protection. For lack of knowledge, we neglected them and this would not have happened if we married after we matured well enough. We do not clean them as required. Despite all this, we managed to see them grow. We do not want to see them grow repeating what we passed through, though. We want them to go to school, mature physically and mentally, enjoy life before they assume the responsibility of running a household the way we did/do [FGD_S05].

Early marriage and spouse abuse

Higher rates of first marriage dissolution, separation or desertion were not the only outcomes more likely associated with early marriage in the study population. Child-brides who remained married to their first husbands were highly vulnerable to spousal abuse and violence. Chi-square test of association (χ 2  = 11.311; α = .01), for instance, found that child-brides were more likely to experience spousal verbal abuse (46.9%) than women married at/after 18 (36.9%). Specifically, women married at/after 18 are 33% (= e 0.119 ) less likely to experience spousal verbal abuse than child-brides (Logit: χ 2  = 11.247; α = .001; Wald = 11.261; ß  = -.440; Constant = .797 ) . In a patriarchal society where both women and men accept some type of spousal abuse as a normality in marriage, the results show that delaying marriage until or past 18 was associated with small but statistically significant decline in spousal verbal abuse (Table 2 ).

Similarly, compared to those married at/after the legal age of 18, child-brides were also more likely to experience spousal beating (χ 2  = 8.090; α = .01) and non-consensual sex or marital rape (χ 2  = 36.903; α = .001) by their first husbands compared to woman married at/after 18. Specifically, women married at/after 18 were 38% (= e 0.171 ) and 58% (= e 0.145 ) less likely to experience spousal beating (Logit: χ 2  = 7.845; α = .01; Wald = 7.986; ß  = -.483; Constant = .694 ) spousal non-consensual sex (Logit: χ 2  = 35.520; α = .001; Wald = 35.712; ß  = -.866; Constant = .808 ) , respectively, as compared to child-brides.

Early marriage and household management

Child-brides were also more subservient/subordinate to their husbands in the administration of family possession and/or money (χ 2  = 21.428; α = .001). While 45% of child-brides reported the main responsibility to administer family possessions and/or money rested in the husband, less than one-in-three women married at/after 18 reported similar scenarios. Furthermore, the percentage of respondents who share the responsibility of administering family resources with their husbands increased from 51.6 to 65% among those married before and at/after 18 respectively.

Similarly, child-brides’ decision-making roles in major family transactions and activities e.g., buy or sell land, livestock, groceries, children’s clothing, etc. were significantly lower than women married as adults (χ 2  = 33.702; α = .001).

As a norm, Ethiopian women have the responsibility of taking care of family members including children, the elderly, etc. As Table  3 shows, decisions on how and when married women dispense with this role disproportionately involves husbands. Only 14 and 19% of respondents married before and at/after 18, respectively, were the main decision makers on buying groceries (χ 2  = 14.608; α = .01); and, 2 and 3% of those married before and at/after 18, respectively, had made decisions on purchasing children’s clothing (χ 2  = 10.799; α = .02). On a related note, collaborative decision-making on both issues and respondent age-categories improved at the expense of husbands’ share. Nonetheless, married women had better decision-making powers in purchasing groceries (17%) than children’s clothing (3%).

Early marriage, social interactions and procreation

As Table  4 depicts, women married at/after 18 were more likely to visit their families as per their own terms (6.8% vs. 3.2%) or in consultation with their husbands (69.4% vs. 59.9%) than succumbing to husbands’ unilateral decision (10.0% vs. 18.7%) as compared to child-brides (χ 2  = 31.830; α = .001). But, for both group of women, the decision to visit families is more likely to be shared than unilateral – save for some variation for husband’s share.

The (non) use of contraceptives is another indicator of women’s decision-making power at household level, and the results in Table 4 underline that husbands retained disproportionate power in deciding whether or not wives will use contraceptives (χ 2  = 17.781; α = .001) or when they can have a child (χ 2  = 21.231; α = .001) when wives’ age at first marriage was below 18. The majority of married women in both groups made shared decisions together with their husbands on both issues; but, percentage differentials between the two groups show that those married at/after 18 negotiated decisions on when to have a child (66.8% vs. 54.8%), or use contraceptives (79.5% vs. 68.6%) more often than child-brides. Note here also that those who marry at/after 18 (84%) are more likely than those who marry before 18 (79%) to have ever used contraceptives.

Early marriage and healthcare

With regard to receiving medical care (Table  5 ), statistically significant difference existed on who made decisions when wives fell ill (χ 2  = 10.734; α = .02): most decisions were shared (55.7%) or made unilaterally by husbands (24.7%). Between the two groups, women married at/after 18 were almost twice as likely as child-brides to decide on their own to seek or receive medical services when they fell ill. On the other hand, there was no statistically significant difference between spouses on who made the decision to seek medical treatment when children were the once who fell ill. Parental decision-making powers did not differ much when it was the child’s, rather than the mother’s, wellbeing at stake.

There is no statistically significant difference on who decides on place of child delivery (Table 5 ) – i.e., whether at home or health stations – (χ 2  = 5.070; α = .17). When it comes to mothers’ availing antenatal care (ANC), nonetheless, women married at/after 18 were more likely to decide together with their husbands (48.7% vs. 44.7%), or on their own (11.4% vs. 9.0%), than accept husbands’ unilateral decision (2.4% vs. 5.4%) as compared to child-brides (χ 2  = 11.573; α = .009). This is, however, assuming both group of women have comparable – availability and accessibility – reproductive health facilities and services, gender-mix of health professionals (husbands prefer women health professionals to deliver their babies), etc.

Similarly, on how decisions on children’s immunization/vaccination were made at household level, there was weak statistical difference between the married women depending on their ages at first marriage. But observed differences show that child-brides were twice more likely to accept husbands’ unilateral decisions (3.8% vs. 2.0%), or less likely to share the role with their husbands (33.8% vs. 39.6%), as compared to women married at/after 18. However, cautious interpretation of this result must take into account the weak statistical association between age at first marriage and decision making on children’s immunization/vaccination (χ 2  = 7.035; α = .071).

Building on the survey results, this section explores further – using narratives and discourses generated through FGDs and in-depth interviews – the main findings on the effects of early marriage on women’s empowerment in western Amhara region. The discussion is embedded within systems theory and follows similar structure of presentation as the results section.

The survey results showed that one-third of married-women in western Amhara region were affected by early marriage; and, they experience various forms of marital and family disorganizations i.e., divorce, separation, martial abuse, etc. They mostly marry older men and soon afterwards drop out of school. Education is generally ‘unthinkable’ for child-brides, FGD participants at Libo Kemkim explain:

The immediate result of early marriage is dropping out of school, if they were [still] in school at the time of marriage. Husbands want their wives to quit schooling [and become stay-at-home wives] too. If child-brides stay in school, they become persistent truants or repeat grades. More than half of them repeat grades. They do not get the necessary support they need to stay in school and be successful. They are also very much depressed and isolated from the school community and their classmates (FGD_R06).

But as child-brides get older, many grew aware of their missed opportunities due to a life imposed on them. While their age-mates be and act as they are supposed to i.e., children, they toil and serve the will of an outmoded tradition. A 16 years old child-bride in Derra Woreda laments,

I loved going to school and did well too …. But when I reached Grade-7, my mother started complaining why I wanted to continue going to school instead of getting married. She used to name girls in my neighbourhood who married younger than I was at the time …. Now, I’m jealous of my former classmates who still go to school and progress through grades …. I sometimes cry alone (Interview_S 1 05).

Child-brides become more and more isolated and restricted to the household as years go by. A child-bride who married at 15 and dropped out of school at 6th grade says, “I don’t see my friends frequently. They visit during weekends, since they have school during weekdays. This makes me sad and angry. Seeing them going to school with books and in uniforms, I feel sad and I want to cry” (Interview_S 2 05).

Child-brides were also more likely to experience early sexual debut and pregnancy – and probably suffer from medical complications. Childbirth effectively ends their childhood as they become child-mothers: “My brothers used to tease me about the way I carried my son around. I did not know how to do it right. But they supported me a lot in raising him” (Interview_S07).

As the survey results revealed, child-brides were more likely to sustain verbal abuse (47%) than martial rape (28%) or beating (16%) by first husbands than adult-brides. These incidents remain mostly unreported to authorities, unless they result in serious injuries – and even these may be kept as a family matter and dealt with discretely. For they are taken for granted aspects of married life or a trait of masculinity as the experience of a child-bride who married a 22-year-old man when she was 15 attests. When asked if her husband ever verbally or physical abused her, she replies, with a dismissive chuckle in her voice, “Isn’t he a man?! Of course, he swears and insults me when things are not in order at home” (Interview_S 2 05).

As patriarchal culture normalizes spouse abuse and violence, men tend to regularly use it to settle disagreements with and/or assert their authority over their wives. Mostly against child-brides, due to age gap, husbands may feel justified, or even required, to use force to ensure conformity to patriarchal norms of marital relations. In fact, survey results underlined the importance of age at first marriage whereby such scenarios are significantly reduced among women married at/after 18 – their delayed marriage gave them the time and maturity to influence the mate selection process and martial relations.

Child-brides, compared to women married at/after 18, were also consistently powerless in making or negotiating decisions with their husbands on important household matters. At best, they shared decision-making powers with their husbands, which, considering their broad definition of ‘shared’ decision-making process, may not tell us much about their real-live experiences. Furthermore, their roles in household decision-making processes varied by the activity under consideration. For instance, they were better involved when the decision is about buying groceries than children’s clothing. This is not contrary to the prevailing patriarchal norms, however, as groceries are ‘must-have’ but children’s clothing could be optional depending on other priorities, and it is on such matters that men retain the authority.

On the other hand, child-brides and adult-brides were not different regarding decisions on when and how often they visited their families. But there is more to the process than what meets the eye; and, it is related to parental approval of the union – from initiation to formation and maintenance – which puts the husband at ease when it comes to his wife visiting her parents/families. In other words, it only implies the husband temporarily transferring the locus of control from his house to her parents’. Furthermore, marriage involves the transference of rights between domestic groups, and there is always a scope for a wife to visit and contribute labour or services to her parents/family in such occasions as childbirth, pre- and post-natal care, weddings, death, etc. Footnote 4 A husband cannot refuse his wife these socially sanctioned visits and roles without risking ridicule and contempt. But he can negotiate the length of her family visit, which exemplifies one of the few contexts where some level of negotiation (and empowering scenario) is built into marriage norms for married women.

The role of child-brides in decisions on conceiving, spacing and number of children, however, paints the usual picture of disempowerment, and it is primarily related to the cultural value that children have in the study community. As a norm, early marriage is actually marriage between families with procreation i.e., generational continuity in its core. In western Amhara, children are also seen as blessings, making the use of contraceptives immoral, sinful and threat to the foundation of traditional marriage. In the eyes of the community, children make a family complete; and oftentimes, contraceptive use is discouraged especially among young brides, which explains why this study found fewer child-brides ever using contraceptives. Hence, if and when husbands resist the use of contraceptives, they have the cultural leverage to back it up. However, those who married at/after 18 were better placed to negotiate the terms as their marriage was most likely shaped by their preference – with varying levels of parental and family involvement, of course.

Child-brides responded to these scenarios differently. Some resigned and accepted their fate, while others, like the child-bride at Bahir Dar city, revolted: “My mother married me off to a 22-years-old man when I was only 10. I moved to his parents’ house. My in-laws were very old and I had to take care of them. I did everything around the house as well …. It was killing me. One morning, I just got up and left, and came to Bahir Dar” (Interview_S04).

Parents and families almost unilaterally and ubiquitously arrange early marriage – and they draw on cultural values to justify their decisive roles. But, with early marriage being illegal, they must proceed discretely not to alert authorities – legal departments, police, the courts, education officers, teachers, etc. – and, primarily, the girl-child herself or her friends. A legal officer at Addis Zemen Woreda (South Gondar) explains:

As people become aware of the legal repercussions, many [parents] are also getting creative to evade the law and marry-off children. Now, they use social events like Mahèber , Zèkèr or birthdays as covers. This has made modern day early marriage practices largely clandestine and illusive. Detecting or reporting it is becoming difficult (FGD_R06).

With ramped-up campaigns against early marriage, girls and young women are becoming self-aware of its illegality of early marriage and their rights to education. Self-assertive girls have learned to evade this yoking institution by refusing their parents’ wishes or, when that does not work, threatening to contact authorities. This explains why many child-brides were kept in the dark about such arrangements, making their first encounter with their husbands-to-be disillusioning: “My father arranged everything. He told me who I will marry and where I will live afterwards. I never knew the person before and the first time I saw him was when we went for medical Footnote 5 …. They said he was 20 at the time but he looked much older to me” (Interview_S 1 05).

Child-brides may accept their parents’ decisions to marry early for various reasons: to fulfil a terminally-ill parents’ wish to see their children forming a family; to escape poverty or help parents benefit from bride-wealth ( tèlosh ); to enable a family forge desirable alliance with a respected family through marriage; etc. But growing older brings opportunities of self-awareness and maturity for most child-brides. Their exposure to the world outside induces changes in their views, attitudes and behaviours – changes that test their resolve to continue respecting parents’ life-changing decisions. Husbands and parents usually treat this change as a sign of moral corruption and respond with corrective measures, abuse or violence. This explains why most child-brides are more prone to various forms of family disorganization, abuse or disempowerment compared to adult-brides.

There is a common thread in these discussions i.e., age. In Ethiopia, as in most other societies, 18 is more than just a number. It is the age of legal emancipation, which comes with the right to decide on one’s own or give independent consent to contractual agreements including marriage. However, most communities in the study area – bar for the two cities of Gondar and Bahir Dar – define girls’ readiness for marriage well below 18 – with stark contradiction to the Family Law. The Law may see the child in a girl below 18. But for people around her, she could be at ‘the right age’ to become, or start her journey to become, a good-wife and/or a good-mother.

As future household heads, on the other hand, boys are allowed to grow older, develop their life-skills, and become experienced and mature. They enjoy greater scope for experimentation and financial independence before venturing to form family. Conversely, since early childhood, girls are taught to regard marriage, family and motherhood as the good-woman’s virtues. As soon as girls’ physical development ‘catch the eye,’ the norm is for her parents to identify a suitable marriage plan. This scenario is intimately related to the gendered socialization of boys and girls in patriarchal societies like Ethiopia. A secondary school principal at Yèlma-èna-Dénsa Woreda concurs:

The [rural] community sees boys and girls differently. It marries girls early as protection from risks [such as rape, abduction or adolescent pregnancy as they traverse great lengths to and from school]. Moreover, parents do not have faith in girls to be successful in education and lead a decent life on their own as boys. They think marriage is the best way for girls to have a fruitful adult life. For boys, parents usual wait for them to reach their potential in education, or learn to stand on their feet. This, however, does not happen for [most] girls (FGD_R07).

Whether parents arrange marriage for their daughters depends on a unique definition of ‘an appropriate mate,’ FGD participants at Chilga Woreda add:

What parents and the community take into account during arranging early marriage [for a girl] is whether the groom-to-be can provide for her. They don’t consider its bad health or other effects in her life …. [As a norm,] Parents [could also agree] to give their daughter’s hands in marriage if they are convinced that a boy [or his family] is economically well and promise to let her continue her education …. But this promise rarely materializes [FGD_R01].

But to ensure a child-bride keeps a good home, she is preferred (i.e., arranged) to marry someone older with the means to provide for her and the cultural wisdom to make important decisions on household and broader matters. The arrangement works well for boys who postpone marriage till they acquire the means to provide for a family and administer its affairs.

Consequently, in a patriarchal arrangement where power lies in the hands of men and the husbands are usually older, child-brides remain structurally fixed to subservient position in their own marriages and houses. With largely ineffective systems to prevent early marriage or ensure child-brides’ safety and rights in an unlawful arrangement, husbands can easily draw on the patriarchal culture to impose their decisions, whereby consulting or involving wives becomes an indulgence they do well without. Even with changes that undermine patriarchal rules on marital relations, as Kolb and Straus argue, “individuals socialized to operate in one system of family organization may have difficulty [in] operating under new standards” [ 59 ].

Conclusions

Informed by systems theory and using a mixed methods approach, this study compared child- and adult-brides in western Amhara region to assess their roles in household decision-making processes. It reported that child-brides are more likely to experience family and marital disorganizations – they had higher rates of both divorce and remarriage. They were also more likely to suffer from various types of abuse and violence while committed to subordinate roles in most household decision-making processes.

Systems theory teaches us that marital relations and household decision-making processes reflect the idiosyncrasies of members, the functional prerequisite of the household unit and the wider cultural milieu. As the study results revealed, women married at latter ages were able to influence household decision-making processes in ways that recognize their preferences and wellbeing. Age is not just a biological factor as it entails cultural definition of one’s scope of involvement and influence in household as well as wider sociocultural, economic and political affairs of the community. The interactions between individual and community factors seem to create better negotiation powers for women married as adults than those married as children.

Using systems theory, the discussion of results underlined the relevance of unravelling the interactions between individual, institutional and community factors to understand and/or change the power dynamics between spouses at household level. Furthermore, its findings imply that sectoral interventions will struggle to bring much-sought after emancipation of women in patriarchal institution and culture and abolish early marriage. The alignment between the study findings and the premises of system theory illustrate why child-brides faced resistance from their husbands, families and communities to be involved in household decision-making processes. There were reports about married women sustaining spousal abuse for wanting to have a say on what happens in the household. There were also women who did not want to do so since that was not how they were brought up and saw husbands’ unilateral decision-making powers as something natural.

In sum, the study results reveal that with increasing age comes physical, social and emotional maturity, and delaying marriage improved married women’s empowerment in household decision-making processes. But this change did not unfold unilaterally and in simple correlation with women’s age at first marriage since it bore the imprints of individual, institutional and cultural factors. There were instances of neglect, resistance or abuse as individuals, institutions and norms adjust to and accommodate women’s preferences and wills in marital relations and household management. We conclude by stating the obvious: if women do not have much decision-making power at the domestic sphere, which is traditionally defined as their domain, how would the gap be in the public sphere, which is traditionally out of their reach or influence? The authors believe this is one of the areas that further research could productively explore.

Following the political unrest of 2018, the North Gondar Zone has been subdivided into three zones with their own administrative structures – North, Central and West zones – in 2019. But this study was conducted in 2017 – before the restructuring – and covered Kebeles in the then North Gondar Zone.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Countries with higher prevalence of early marriage are Niger (82%), Bangladesh (75%), Chad (73%), Yemen (64%), Mali (63%), Nepal (63%), Mozambique (59%) and Ethiopia (57%)

The Federal Democratic Republic of Ethiopia had 9 regional states (Tigray, Afar, Amhara, Oromia, Somali, Benishangul-Gumuz, Southern Nations, Nationalities and Peoples, Gambela, and Harari) and 2 city administrations (Addis Ababa and Dire Dawa) until 2020. Currently, the Sidama region had broken-off with SNNP and has been recognized as a separate region, making the number of regional states 10.

Many Africans and Latin Americans practice a tradition for new moms called la cuarentena, a Hispanic word that to refer to a period of approximately 6 weeks, during which new mothers abstain from sex and solely dedicate their time and energy to breastfeeding and taking care of themselves and the baby. Members of the family participate to cook, clean and take care of other children, if there are any. What is different in the Ethiopian case is that pregnant women generally return to their parents’ house and stay there receiving all pre- and post-natal care by their family members. The length of the stay covers a week or days before birth and until the baby is baptized, for Christian folks.

Medical assessment of couples’ health status – mainly HIV/AIDS – is becoming increasingly a requirement to legalize marriage in Ethiopia.

Abbreviations

Central Statistical Authority (Ethiopia)

Demographic and Health Survey (Ethiopia)

Engaged, Educated, Empowered Ethiopian Youth

Focus Group Discussion

International Center for Research on Women

Ministry of Education (Ethiopia)

Ministry of Women, Children and Youth Affairs (Ethiopia)

Standard Deviation

Statistical Package for Social Sciences

Transitional Government of Ethiopia

United Nations Fund for Population (Activities)

United Nations High Commissioner for Refugees

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Acknowledgments

We would like to acknowledge the WV-E for providing the funding for the research based on which this manuscript is developed. Its staff were more than collaborative in providing editorial assistance and logistics support whenever required. We thank survey respondents, FGD participants and in-depth interviewees for taking their time and providing relevant information which enabled us to understand the nature of relations between early marriage and women empowerment in the study area. Last but not least, we are grateful for University of Gondar, where three of us had been working for over a decade at the time of the study, to enable and support our multidisciplinary research team.

We, the authors, would like to express our preference to be searchable through our own individual PubMed records and we include out names, institutional affiliation and country information as follows:

• Mikyas Abera, PhD. Assistant Professor, University of Gondar, Ethiopia

• Ansha Nega, Mrs. Assistant Professor, Addis Ababa University, Ethiopia

• Yifokire Tefera, Mr. Assistant Professor, Addis Ababa University, Ethiopia

• Abebaw Addis Gelagay, Mr. Assistant Professor, University of Gondar, Ethiopia

Funding for the research was provided by World Vision Ethiopia, whose staff provided editorial and logistics support during the data collection, analyses and write-up phases.

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School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

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MAN. MAN’s contributions to this manuscript involve collaboratively designing, conducting and coordinating the field research; checking for quality survey data entry; transcribing qualitative data; generate themes from qualitative data; running statistical analyses on SPSS and interpreting results; producing the first draft of this manuscript for comment and refinement by research team members. AN. AN’s contributions to this manuscript involve collaboratively designing and conducting the field research; transcribing qualitative data; running statistical analyses and interpreting results; and, enriching the first draft of the manuscript immensely with descriptive and illustrative additions. YT. YT’s contributions to this manuscript involve collaboratively designing and conducting the field research; transcribing qualitative data; running statistical analyses and interpreting results; and, enriching the first draft of the manuscript immensely with descriptive and illustrative additions. AAG. AAG’s contributions to this manuscript involve collaboratively designing and conducting the field research; transcribing qualitative data; running statistical analyses and interpreting results; and, enriching the first draft of the manuscript immensely with descriptive and illustrative additions as well as editorials. All authors have read and approved the final manuscript.

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1. Mikyas Abera . Dr. Mikyas Abera, PhD, is an Assistant Professor at the University of Gondar (UoG), Gondar (Ethiopia). He studied Sociology and Social Administration (BA; Addis Ababa University: 2003), Sociology (MA; Delhi School of Economics: 2007), and Sociology of Education (PhD; Addis Ababa University: 2015). His research interests are education, gender, rehabilitation, social inequality and science and technology. He helped UoG to launch undergraduate, graduate and postgraduate programs in Sociology between 2003 and 2017. He currently teaches and supervises students both at graduate and postgraduate levels, and engages in several research and community engagement projects.

2. Ansha Nega . Mrs. Nega, MSc, is Assistant Professor of Public Health at School of Public Health, Addis Ababa University (Ethiopia). She studied Occupational Health and Safety (BSc; University of Gondar) and Ergonomics (MSc; Loughborough University). Mrs. Nega worked for more than 13 years at UoG with varied responsibilities including teaching, research and community works. She has served as the Director for Community Based Rehabilitation program at University of Gondar; lead and co-lead various collaborative researches on disability, child labor, occupational safety, rehabilitation, and early marriage, among others. Currently, she is faculty at Addis Ababa University.

3. Yifokire Tefera . Mr. Yifokire Tefera, PhD Candidate at Addis Ababa University and adjunct staff and Assistant Professor of Public Health at UoG. Environmental Health Science (BSc; Jimma University, Ethiopia); Occupational Health and Safety (MSc; Loughborough University, UK). Mr. Tefera has served UoG for over 14 years under different capacities: teaching faculty, researcher, administrator and community worker. He has extensive experience in leading and/or coordinating collaborative international and national research projects. His research and community work interests lie on public health child labor, decent work, disability and development. Currently, Mr. Tefera pursues his PhD in Occupational Health and Safety at AAU, collaborative program between AAU and Bergen University, Norway.

4. Abebaw Addis Gelagay . Mr. Abebaw Addis Gelagay is an Assistant Professor of Reproductive and Child Health at UoG and have been serving University of Gondar since 2014 with roles in teaching, research, management and community work. He studied Nursing (Diploma; Addis Ababa University), Public Health (BSc; UoG), and MPH in Reproductive and Child Health (MPH; UoG). He has extensive experience in leading and/or coordinating collaborative international and national research projects. His research and community work interests lie, mainly, on general, reproductive and child health. Currently, Mr. Addis serves as Chair of Department of Reproductive Health, Institute of Public Health, UoG.

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Ethical approval for the research was attained at the level of the E 4 Y (Engaged, Educated, Empowered Ethiopian Youth) project – a project implemented by World Vision–Ethiopia in various regional States of Ethiopia. In addition, the study proposal, tools, funding source, etc. were submitted to and approved by the Institute of Public Health’s Institutional Review Board (IRB) of the University of Gondar, Ethiopia to meet scientific and ethical standards. The IRB cleared the study not to have any health, social, personal harm to participants, their communities and the environment. Study participants as well as parents and/or legal guardians – for those under the legal age of 18 – were requested to provide verbal or signed consent for participation beforehand. The IRB approved oral consent for parents and/or legal guardians as well as participants considering many reside in remote villages with very low literacy level. However, whenever possible, written consent was collected from study participants and such was approved.

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Abera, M., Nega, A., Tefera, Y. et al. Early marriage and women’s empowerment: the case of child-brides in Amhara National Regional State, Ethiopia. BMC Int Health Hum Rights 20 , 30 (2020). https://doi.org/10.1186/s12914-020-00249-5

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Social Determinants of Child Marriage in Rural India

Rajeev seth.

1 Bal Umang Drishya Sanstha (BUDS), New Delhi, India

Vijayluxmi Bose

Yawar qaiyum, riti chandrashekhar, shubhangi kansal, indra taneja, tulika seth.

2 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India

Background:

Child marriage represents a grave violence against children and deprives them of their rights to health, education, and a livelihood. Because child marriage should be recognized as a social and medical emergency, the social determinants of child marriage in India need to be mapped. The aim of this qualitative case study was to document social determinants of child marriage identified by the authors while providing community mobile health services in rural Mewat District, India.

Case Report:

We present qualitative participatory medical histories and assessments of two clinical cases: an adolescent who is waiting to get married and a young woman who was married as an adolescent but developed multiple health complications after her husband abandoned her.

Conclusion:

Patriarchy, coercion, social customs, and norms were identified as major social determinants. The two cases demonstrate that social norms influence intergenerational norms and lead to uninformed decision-making and child marriage. In low- and middle-income countries, medical professionals should urgently address child marriage as a major public health problem. Primary care physicians and medical professionals should implement preventive measures and provide anticipatory guidance to prevent child marriage.

INTRODUCTION

Child marriage represents a grave violation of the United Nations Convention on the Rights of the Child. 1 Worldwide, more than 60 million women are estimated to be married before they reach the age of 18 years, and more than one-third of these women live in South Asia. 2 , 3 Despite the Prohibition of Child Marriage Act of 2006 that established marriage of females under 18 years and of males under 21 years as a cognizable offence, child marriage remains widespread in India. 4 Evidence suggests that approximately 30% of all women aged 20-24 years are married before they attain legal age. 5 The 2011 Indian census estimated that 17 million children in the age group of 10-19 years are married. 5 A United Nations International Children’s Emergency Fund (UNICEF) study on reducing child marriage identifies the trajectory of associated adverse consequences: curtailment of freedom of choices and opportunities, early marriage, and early child-bearing. 5 The study also partially attributes domestic violence and harmful health outcomes such as high infant, child, and maternal mortality rates to child marriage.

Children who marry early are subject to a growing problem of violence and abuse. They experience trauma, early life toxic stress, and related adverse childhood experiences. According to the Adverse Childhood Experiences study, a major American epidemiological research project, a powerful relationship has been established between maltreatment and violence in childhood and adverse health effects in adult life. 6 , 7 Development of high-risk health behaviors such as smoking, alcohol and drug abuse, and severe obesity are correlated with depression, heart disease, cancer, chronic lung disease, and shortened lifespan. 6 Underage marriage puts children at risk of long-term adverse health effects that may not manifest until adulthood. 8 A study published in Lancet reported that medical practitioners in Andhra Pradesh (a state in South India) saw adolescents who came in for checkups but lacked information, indicative of the low priority accorded to girls’ health. 9

Although child marriage is a major public health problem, its social determinants in different regions have not yet been mapped. Social determinants of health are the conditions in which people are born, grow, work, live, and age. 10

Bal Umang Drishya Sanstha (BUDS) 11 is an Indian-registered nonprofit organization that operates according to the Three Principles (3Ps): prevention of disease, prompt treatment, and promotion of health. BUDS facilitates access to healthcare in the marginalized rural community in the Mewat District in the state of Haryana, India, via a fully equipped mobile health van. 12

Of the 644 districts in the 29 states in India, Mewat is currently ranked the lowest among the districts. In its composite ranking of all five development sectors—health and nutrition, education, agriculture and water resources, financial inclusion and skill development, and basic infrastructure—the National Institution for Transforming India, Government of India, placed Mewat at the bottom. 13 Mewat District household- and facility-level data revealed that the majority of adolescents suffer from high levels of malnutrition, anemia, and sexual and reproductive health issues. The percentage of married women who wed before they are 18 years of age in rural Mewat is 16.9%. 14 Only 9% of married women in rural Mewat have had more than 10 years of schooling. 14 Most of the families in Mewat have many children. Children either do not go to school or drop out of school after the primary level. They also get married at ages well below the legal age of marriage. 4 This family life cycle repeats generation after generation.

The BUDS van provides healthcare access to many adolescents and young women who are undernourished and anemic, as well as to infants who are low birth weight and children suffering from various early-onset childhood illnesses who are brought to the clinic by adolescent mothers.

The aim of this case study was to identify the social determinants related to child marriage that were elicited from two patients seen by the authors as they provided community mobile health services in rural Mewat, India. These case studies will be used to develop a public health strategy to help prevent child marriage in this community.

Knowing that direct questions get evasive answers, women in the region are conditioned to give socially desirable responses, and quantitative data need to be supplemented by qualitative responses reflective of social norms, the authors designed a qualitative participative case study approach to test whether one-on-one interviews would lead to greater disclosure. Because the BUDS team is accepted by the villagers, we conducted a participative, exploratory case analysis to gain a better understanding of the social determinants of child marriage.

Consent forms were translated into Hindi (the local language) and signed by the case study respondents. Consonant with the norms of the society, a woman was present throughout the interview because the interviewer (R.S.) is a US-trained male pediatrician from Delhi who volunteers with the BUDS mobile health van in underserved villages in Mewat District. Rapport building was facilitated by a senior woman social worker and female pediatrician from the BUDS team.

In conjunction with the BUDS team, the author visited two family homes to observe first-hand the social determinants related to child marriage. The names of the respondents have been changed to protect their identities.

CASE STUDY 1

Salma is a 14-year-old girl who lives with her family in Ghasera village, Mewat District, Haryana, India. The family is large, and the father, an itinerant seller of clothes, is the only wage earner. Salma has two sisters aged 12 and 7 years and three brothers who are approximately 10, 5, and 3 years old. Salma’s 12-year-old sister attends a government school. None of the other children is in school.

During the prior 6 months, the family faced several health challenges, including respiratory and gastrointestinal infections, scabies, and eye and dental problems. They accessed the BUDS mobile health van facility twice to receive treatment.

Salma approached the primary care physician in the health van with symptoms of common cold and fatigue. While diagnosing her upper respiratory tract infection and anemia, the doctor asked Salma why she wasn’t in school. Salma stated that she had dropped out of school after standard five (10 years of age) because her mother became ill with pulmonary tuberculosis. 15 The disease is currently in remission, but the mother’s left lung is fibrotic and nonfunctional. Salma’s mother has a history of frequent admissions to the National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, when she has an attack of asthmatic bronchitis.

When asked how she feels about early marriage, Salma said she has no views. She knows that early marriage is the custom in her community; girls get married as soon as they attain puberty. Salma said that the practice of marrying daughters at the age of 15-16 years is a “very common social norm in this village.” If girls do not marry early, they are subject to taunts; people in the community suspect them of having illicit affairs or of having some kind of disability. The parents of adolescent unmarried girls are also criticized, and the community accuses them of being negligent or not having enough money to marry off their daughters.

Although Salma’s reason for not continuing her education was her mother’s ill health, her peers frequently either did not go to school or dropped out because the “environment is not conducive.” Gender-based violence seems to be a threat for most young girls in the community. Adolescent girls cover their heads and faces in public and in the presence of males. They are not encouraged to leave home unescorted. The authors asked whether molestation had occurred. Salma and her mother were emphatic in their denial. Salma mentioned that the “media reportage and portrayal of gender violence” also add to the latent fears of the community.

CASE STUDY 2

Sahuni is 25 years old. Her house is well built and has three rooms and a toilet, indicating that the family is not very poor. The family has approximately one-half acre of land that provides food year-round. In addition to the parents, the household consists of five other siblings. One of the boys born to this family died early, possibly of blood cancer. The family members said that they had visited the BUDS mobile health van three times.

Sahuni and her 23-year-old sister participated in the interview; their mother provided intermittent comments. Like some of her peers, Sahuni received Quran-based religious education in a madrasa (a local center for Islamic religious studies); however, none of the other children in the family has ever set foot inside a school. From a medical perspective, Sahuni, her mother, and her sister looked tired and weak and showed signs of anemia and malnourishment. Sahuni’s estimated weight is <35 kg. The mother’s grueling daily routine and lack of proper nutrition likely contribute to her pallor and weakness. A homemaker, her day begins at 5:00 am. Following ablutions, she reads the Quran and begins her daily chores. After her husband leaves for work, she sews to augment the family income. She is worried about Sahuni’s sister’s marriage because the family is too poor to afford a dowry (which usually consists of a motorcycle).

Sahuni’s medical condition—complaints of headache, body ache, depression, and fatigue—likely results from her poor physical and mental health status. Gradually, as rapport was built, including a visit to the health van parked nearby, Sahuni told her story. She was married at age 15 or 16 years to a man who worked as a driver. Sahuni had 8 successive miscarriages with heavy bleeding in her attempts to provide her husband with children. All attempts failed. After she was hospitalized for a blood transfusion, Sahuni’s husband abandoned her at her maternal home. She described the cycle of poverty, ignorance, and illiteracy that is the lot of young women in her community and the threat of gender violence that drives jawanladkis (sexually mature adolescent girls) to be married at an early age.

Sahuni has no views of her own about being married early. During a revisit to question further, the authors were given an answer that they had heard repeatedly in the community: “ Izzat ka sawal hai ” (it is a question of honor). Sahuni conformed to what her parents had asked her to do. Now she has nowhere to go and nothing to do. “Society makes it more of an issue than our parents,” she said.

Sahuni has no aspirations. Unschooled and confined to the house, she hopes that her husband will give her a new set of clothes for Eid (a major Muslim festival that was just a few days away when the interview was conducted) as he has given his sisters. Despite having cultivable land and a pukka (cemented) house, the woman of the house and her adolescent children are neglected, resulting in a chronic cycle of disease that could be corrected by medication/supplementation and a good diet.

Child marriage is associated with major health complications in teenage mothers and their children. Most underage mothers are at risk of reproductive health challenges, impaired mental health, malnutrition, anemia, vaccine-preventable infectious diseases, and exposure to sexually transmitted diseases. The children of underage mothers are at increased risk of prematurity, intrauterine growth retardation, being small for gestational age, birth asphyxia, perinatal complications, and even death. 9 Teenage mothers risk hypertensive disorder, eclampsia, preeclampsia, and postpartum hemorrhage.

The onset of menarche indicates to the elders and community that a girl is of marriageable age, irrespective of her chronological age. Ladki jawan ho gayi hai means that the girl has become sexually mature. According to the two interviewees, the threat to family honour and adherence to social customs are determinants of early/child marriage. These factors may influence decision-making at the family level; however, at the community and societal level, social norms may be used to camouflage the actual causes such as structural inequalities and patriarchy. 16 Some sexual reproductive factors—such as the onset of menarche—contribute to the gating of women; Salma said that adolescent girls never leave the house unaccompanied. Therefore, gender norms play out in the overemphasis of the connection between girls’ virginity and chastity and family honor. 16 Child marriage is used as a strategy to preserve such customs and traditions that are an extension of the normative conditioning that adolescents are subject to from infancy. 2 , 17 As a number of studies in India have shown, these societal threats coerce adolescents to conform to norms. 16 , 17 Consequently, the control of the patriarchy, endorsed by community support, is perpetuated from one generation to the next.

These social, cultural, and patriarchal mindsets and gender norms discourage girls aged 10-12 years (or more) from going to school. Most young children are educated in the Urdu language at madrasas and are not sent to formal schools at all. Children who receive minimal education become home-bound, and the lack of livelihood opportunities perpetuates poverty in the family. Lack of knowledge about government programs also adds to disempowerment and isolation of families within communities ( Table ). 18 These are the drivers behind low knowledge among adolescents about the negative health outcomes of early marriage (eg, multiple miscarriages, infections, anemia). The BUDS team found that social norms and neglect influence structural norms that contribute to the collective community experiences and uninformed decision-making. Illiteracy, lack of mobility, and early marriage influence the macroenvironment (disempowerment of women, apathy, inability to earn) that in turn strengthens social norms and neglect of adolescents ( Figure ).

BUDS, Bal Umang Drishya Sanstha; HIV, human immunodeficiency virus.

Resources are available; the villages in Mewat District have mainstream schools in the vicinity, a primary health center, and a district hospital. The low access to these facilities may be explained by adolescent girls conforming to prevalent social norms, vested interest groups, and gender prescriptions and by inefficient implementation of the Prohibition of Child Marriage Act. 5

The persistence of child marriage is a social and medical emergency, and its symptoms may already be overburdening India’s already-overburdened health systems. 5 Incorporating child rights and protection training into the medical school curriculum and continuing medical education of physicians is an urgent need. Physicians need to be aware of and involved with cases of child marriage because of its effects on two generations of children: the underage parent and her infant.

In rural and marginalized social environments, the roles of physicians should not be confined to clinical activities alone, but they should also provide comprehensive health services, prevention, and anticipatory guidance. Primary care physicians and healthcare providers are often the first point of contact outside of the family with abused and neglected children. They may come across various forms of exploitation, including child marriage, in their practices. Trained primary care physicians—pediatricians in particular—should be taught to engage with issues of violence and child marriage. Medical providers should ask questions about potential areas of child neglect, such as lack of education and poor nutrition. They should probe for the underlying etiology in all children with functional symptoms such as chronic fatigue. Practitioners who work in hospitals can order behavioral, counseling, or mental health/psychiatric consultations. This approach involves shifting from the diagnostic-prescriptive mode and into the realm of participative inquiry.

Globally, progress in understanding and preventing violence against children from birth 0-18 years is advancing rapidly. In 2016, the World Health Organization released INSPIRE, a package of seven evidence-based strategies to prevent violence against children. 19 INSPIRE is an essential tool to help achieve Sustainable Development Goal (SDG) Target 16.2 (End abuse, exploitation, trafficking, and all forms of violence and torture against children) and also for achieving SDGs 1, 3, 4, 5, 10, 11, and 16 that target poverty, health, education, gender equality, reduced inequalities, safe environment, and justice. 20 Some of the well-known strategies to prevent child marriage include (1) empowering girls with information, skills, and support; (2) educating and mobilizing parents and community members to restrict harmful gender and social norms; (3) enhancing the accessibility and quality of formal schooling; (4) providing economic support and incentives for girls; and (5) fostering an enabling legal and policy framework. Implementation of preventive programs faces challenges such as lack of convergence of various sectors, engagement of medical and multidisciplinary professionals, government policies, and gaps in implementation of the law. 2

Nongovernmental organizations (NGOs) and medical professional societies such as Indian Child Abuse, Neglect and Child Labour, the Indian Academy of Pediatrics, and the Federation of Obstetric and Gynaecological Societies of India have huge numbers of pediatrician and gynecologist members who can be trained in identifying child abuse, neglect, and exploitation.

Physicians can be trained in the principles of trauma-informed care and in how to take a proper history, as well as how to properly document and record all cases. They should be able to work effectively with multidisciplinary child protection professionals such as forensic and law enforcement agencies, the National Commission for Protection of Child Rights, child welfare committees, the CHILDLINE India Foundation (1098 tele helpline), child rights activists, and NGOs. Primary care physicians can give adolescents access to therapeutic treatment and justice. Clinical evidence, data, and strategic interventions by large numbers of practitioners can lead to social and policy change.

The social determinants of child marriage identified in these case studies are indicative of a patriarchal system that prevents women from obtaining an education, earning a livelihood, and becoming productive citizens. Child marriage is a violation of the basic rights of the child and a major public health problem. The need is urgent to provide an enabling environment for all adolescents, including those who have never been to school or who have dropped out of school. Preventive measures and anticipatory guidance to prevent child neglect, abuse, and child marriage should become a part of routine medical management. Social pediatrics, community medicine twinned with social/mixed methods research outcomes, and documentation of good practices are powerful enablers. Proactive and sustained evidence-based advocacy with government, civil societies, and professional societies can bring about changes in the macroenvironment, help ensure that laws are enforced, and eventually help adolescents find their rightful place in society. Physicians have an important role as influencers of public health policy and as advocates in the community for prevention of child marriage.

ACKNOWLEDGMENTS

The authors have no financial or proprietary interest in the subject matter of this article.

This article meets the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties Maintenance of Certification competencies for Patient Care, Medical Knowledge, Interpersonal and Communication Skills, and Systems-Based Practice.

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The power of education to end child marriage

Child marriage is a violation of human rights that limits girls in reaching their full potential. This harmful practice is closely associated with deprivations in education, health, access to resources and empowerment. Chief among these deprivations is the exit from schooling that typically accompanies the marriage of a child. In many countries, marriage and schooling are viewed as incompatible, and decisions about removing a girl from school and marrying her off at a young age are often made at the same time. These decisions are influenced by the perceived value of education and the availability of employment opportunities for educated girls. Better quality and higher education may make the returns on investment in girls more readily apparent and justifiable to both parents and society. Access to quality education and decent work are also critical to breaking the cycle of poverty and the intergenerational transmission of child marriage, since girls from more educated and wealthier households are less likely to marry in childhood. As the world rallies to accelerate progress against child marriage, understanding what drives change in how people think about the practice – and act – is key to its elimination.

This publication uses data to illustrate how child marriage and schooling are related, showing the likelihood of child marriage among populations with different levels of education, as well as the educational status of girls who are child brides today.

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Towards ending child marriage.

Child Marriage - Overview

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Child marriage publication catalogue 2020-2021.

Investing in data and generating and disseminating evidence on what works to prevent child marriage is essential to developing smart, effective policies and programmes that lead to large-scale change.

This publications catalogue compiles 119 research and evidence pieces published in 2020 and 2021 by the United Nations Population Fund (UNFPA) and United Nations Children’s Fund (UNICEF) headquarters and regional and country offices, as well as by our partners around the world. The catalogue serves as a global good for sharing knowledge, identifying gaps in research and helping to connect child marriage experts to each other.

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