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

Abstract

Background Child marriage, defined as marriage before 18 years of age, is a violation of human rights and a marker of gender inequality. Growing attention to this issue on the global development agenda also reflects concerns that it may negatively impact health. We conducted a systematic review to synthesize existing research on the consequences of child marriage on health and to assess the risk of bias in this body of literature. Methods and findings We searched databases focused on biomedicine and global health for studies that estimated the effect of marrying before the age of 18 on any physical or mental health outcome or health behaviour. We identified 58 eligible articles, nearly all of which relied on cross-sectional data sources from sub-Saharan Africa or South Asia. The most studied health outcomes were indicators of fertility and fertility control, maternal health care, and intimate partner violence. All studies were at serious to critical risk of bias. Research consistently found that women who marry before the age of 18 begin having children at earlier ages and give birth to a larger number of children when compared to those who marry at 18 or later, but whether these outcomes were desired was not considered. Across studies, women who married as children were also consistently less likely to give birth in health care facilities or with assistance from skilled providers. Studies also uniformly concluded that child marriage increases the likelihood of experiencing physical violence from an intimate partner. However, research in many other domains, including use of contraception, unwanted pregnancy, and sexual violence came to divergent conclusions and challenge some common narratives regarding child marriage. Conclusions There are many reasons to be concerned about child marriage. However, evidence that child marriage causes the health outcomes described in this review is severely limited. There is more heterogeneity in the results of these studies than is often recognized. For these reasons, greater caution is warranted when discussing the potential impact of child marriage on health. We provide suggestions for avoiding common biases and improving the strength of the evidence on this subject. Trial registration The protocol of this systematic review was registered with PROSPERO (CRD42020182652) in May 2020.

Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia

“…Poor of access to sexual reproductive health and rights services (SRHR) continue to be one of the leading contributors to the burden of SRHR related problems such as sexual assault, rape, and early pregnancies among adolescents [ 1 ]. In sub–Saharan Africa, adolescent girls and young women remain as one of the sub-population most susceptible to unplanned pregnancies, early marriages, sexual violence, and HIV infections [ 2 , 3 ]. For example, in Zambia adolescents and young people currently constitute more than half of the total population and yet, they also face many health and SRHR related problems which impact their lives and in the long run impacting on the overall health status of the country [ 4 ].…”

Child Marriage in South Asia: A Systematic Review

“…This forced alliance is rooted in harmful pre-existing traditional norms and practices passed down through generations with debilitating effects on the girl child, their families, and society at large [ 3 ]. This harmful practice significantly undermines the best interests of the girl child at the individual, societal and national levels [ 4 ]. Besides being a human rights issue, child marriage has dire reproductive and sexual health consequences for girls, impeding their overall development and wellbeing [ 4 ].…”

“…This harmful practice significantly undermines the best interests of the girl child at the individual, societal and national levels [ 4 ]. Besides being a human rights issue, child marriage has dire reproductive and sexual health consequences for girls, impeding their overall development and wellbeing [ 4 ].…”

“…Previous studies conducted in countries outside South Asia have reported some individual-level factors as being associated with child marriage, including place of residence (mostly rural) [ 7 , 8 , 9 ], low education level [ 7 , 8 , 9 ], poverty [ 7 , 8 ], culture [ 3 ], lack of exposure to mass media [ 7 , 8 ], low decision-making capacity [ 10 , 11 ], and religion [ 7 , 12 ]. Besides these associated factors, several other factors have also been reported to result from child marriage such as increased school dropouts [ 12 ], increased marital violence [ 10 , 13 ], increased maternal morbidity and mortality [ 14 , 15 ], increased risk of unintended pregnancies [ 16 ], decreased utilization of antenatal care and postnatal care services [ 17 , 18 ], decreased institutional delivery in health care facilities [ 17 , 19 ], and decreased deliveries assisted by skilled birth attendants [ 4 , 17 , 19 ]. However, no study has collectively and systematically analyzed the most consistent factors across the entire South Asia region to guide region- and country-specific interventions, which could lead to a decline in child marriage within each South Asian country and across the region.…”

Reasons for early marriage of women in Zahedan, Iran: a qualitative study

“…Marriage at a young age can also increase physical and sexual problems [36] and even sexual violence and forced sex [14,37]. In addition, early pregnancy and preterm delivery, increased mortality of pregnant adolescents during labor, increased HIV and other sexually transmitted infections, higher neonatal mortality and anemia, exaggerated risk of preeclampsia and postpartum hemorrhage, and complicated and prolonged labor are among other consequences of early marriage [38][39][40][41][42][43].…”