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Purpose: Considering the high levels of female genital mutilation (FGM) in Sierra Leone with over 83% of girls and young women aged 15-24 years having undergone the practice, the study explores the potential influence of FGM on sexual behaviors of adolescent girls and young women (AGYW) in Sierra Leone., Methods: Cross-sectional data from the 2019 Demographic Health Survey were utilized to examine the association between FGM and three sexual behaviors; sexual debut before 18 years, child marriage and adolescent motherhood. To model this association, a generalized estimation equation technique was employed, while controlling for socio-demographic characteristics. Additionally, the study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure with a specified false discovery rate of 0.05. Finally, percentage predicted probabilities of occurrence of the sexual risk behaviors in the presence of FGM were also calculated., Results: Of the 5524 AGYW, 76% had undergone FGM. FGM was associated with all three sexual risk behaviors. Sexual debut before 18 years had the highest predicted probability increase (+18.00 ppt, 95% CI: 14.41 to -21.59), followed by adolescent motherhood (+13.38 ppt, 95% CI: 10.16-16.60) and child marriage (+12.61 ppt; 95% CI: 10.22-15.01). Education was found to be protective against all three sexual risk behaviors., Discussion: The findings of this study demonstrate that FGM remains a prevalent practice in Sierra Leone, even among the younger generation. This practice is strongly associated with sexual behaviors that pose a significant risk to the health outcomes of AGYW. Investments in education by removing barriers to access for AGYW could lead to multiple gains., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Fragile states are countries characterized by poverty, conflict, political instability, insecurity, and disaster. In such settings, there are high levels of disability and women and girls are disproportionately impacted by violence. Despite the 2030 Sustainable Development Goal's call for both the elimination of violence against women and girls and disability-disaggregated data, few studies have investigated how disability may be associated with girl child marriage (GCM) and how these two factors impact intimate partner violence (IPV). This study sought to assess the prevalence and associations of disability with GCM and IPV among currently married/cohabiting women (aged 20-24 years) in fragile states., Methods: A secondary data analysis of pooled nationally representative data from four Demographic and Health Surveys were analyzed using multivariable regressions to examine the associations between disability, GCM, and IPV (N = 3,119). The association between disability and GCM was further analyzed by multinomial regressions. These weighted analyses accounted for complex survey designs., Results: Overall, 54.4% of GCM occurred among women with disabilities. Disabled women were more likely to report GCM compared to women without disabilities (adjusted odds ratio = 1.62, 95% confidence interval = 1.16-2.28). Among disabled women with a history of GCM, 41.3% experienced past-year IPV. Disabled women with a history of GCM were more likely to report past-year IPV compared to nondisabled women and no GCM (adjusted odds ratio = 1.78, confidence interval = 1.21-2.62)., Discussion: GCM and IPV (e.g., past-year, lifetime) among disabled girls may be pervasive in fragile states, underscoring the need for additional research examining the mechanisms driving these observations and to inform inclusive programming and policy., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Ethiopia has registered remarkable achievements in reaching global development goals, including reducing child marriage. Policymakers are keen to understand which investments have contributed to this. We evaluated the association between Ethiopia's Health Extension Program (HEP) and 12 adolescent health and wellbeing outcomes., Methods: We used Young Lives Ethiopia cohort data between 2002 and 2013. We evaluated associations between household support from HEP at age 15 and 12 adolescent outcomes spread across health, gender-based violence, education, and employment at age 19 using the inverse probability of treatment weighting propensity score approach, stratifying by sex. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP versus no exposure., Results: Of 775 adolescents with complete follow-up, 46% were female. Sixty-six percent of adolescents reported support from HEP, with higher rates of support in poorer, less educated, and rural households, particularly in Tigray Province. In boys, HEP was positively associated with education enrolment (APD: +20 percentage points [ppts], 95% confidence interval [CI]: +9 ppts, +31 ppts) and literacy (AMD: +6 ppts, 95% CI: +0.2, +11), and negatively associated with >4 hours in income-generating activities per day (APD: -19 ppts, 95% CI: -30 ppts, -9 ppts). In girls, HEP was positively associated with no child marriage (APD: +16 ppts, 95% CI: +4 ppts, +27 ppts), no adolescent pregnancy (APD: +17 ppts, 95% CI: +6 ppts, +28 ppts), education enrolment (APD: +27 ppts, 95% CI: +15 ppts, +39 ppts), literacy (AMD: +5 ppts, 95% CI: +0.2, +11), and numeracy (AMD: +8 ppts, 95% CI: +3; +13)., Discussion: Policies promoting HEP are likely to have supported improvements in multiple areas of adolescents' lives in Ethiopia., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: In many U.S. states, children can legally marry at an earlier age than they can legally consent to sex, leading to situations in which sex between spouses may be a criminal act. Some states exempt sex between married persons from their definition of statutory rape, which may create perverse incentives for child marriage. We estimated the number of child marriages that violated statutory rape laws across the United States since January 1, 2000., Methods: We created a longitudinal database of statutory rape laws in place from 2000 to 2020 in each state. Using data from marriage certificates filed in 44 states and Washington, DC, we compared the age of married spouses with the text of state-specific statutory rape laws in place at the time the marriages occurred., Results: Child marriages violated statutory rape laws in 14 states. The proportion of child marriages that violated statutory rape laws varied from 1% to over 50%. In 33 states, some or all statutory rape laws exempted sex between married couples from the definition of crimes. In these states, the proportion of child marriages that would have been crimes, without these exemptions, varied from less than 1% to over 80%., Conclusions: Our results highlight the blurred legal and conceptual boundaries between child marriage and sexual violence. The simultaneous legality of child marriage and marital exemptions to statutory rape laws provide legal loopholes for sexual acts with children that would otherwise be considered crimes. Marital exemptions to statutory rape laws may also incentivize a substantial portion of child marriages., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Relatively little is known about the factors associated with child, early, and forced marriage (CEFM) for boys. This brief explores potential economic, social, and demographic drivers of CEFM for boys, highlighting the role of gendered social norms., Methods: Forty-two indicators related to CEFM were drawn from a combination of Demographic and Health Survey and publicly available national-level data and associations with CEFM presented in scatterplots with a linear regression line., Results: CEFM for boys is consistently associated with economic factors related to "readiness to marry," including overall labor force participation, the proportion of boys who are not in school, and youth unemployment., Conclusions: Patriarchal norms regulating sexual and reproductive behavior influence CEFM for boys through pressures to marry as soon as economic independence is achieved. This perpetuates cycles of poverty and locks boys into unfavorable life course pathways., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The 2030 Agenda for Sustainable Development explicitly calls for an end to child, early, and forced marriages, a harmful practice that has been experienced by 650 million girls and women globally. The COVID-19 pandemic threatens to halt progress toward this goal and highlights the need to assess research progress and link emerging knowledge with efforts to prevent and respond to child marriage. We conducted a systematic search of publications focused on child marriage covering four languages (English, Spanish, Portuguese, and French), encompassing a 20-year period (1 January 2000-31 December 2019) and including peer-reviewed and gray literature across all major geographic regions of the world. Our review identified and analyzed 1,068 publications from an initial number of 4,081 abstracts screened, finding that studies on the prevalence, determinants, and consequences of child marriage represented a majority of the total publications. Including publications in Spanish and Portuguese yielded results from Latin America and the Caribbean, Mozambique, and Europe, and including publications in French yielded results from West Africa and the Maghreb, in addition to English language publications covering both these and other parts of the word. Our review of the evolution and distribution of research over time and space calls for a greater focus of research on interventions preventing child marriage and responding to the needs of individuals married as children, a multilinguistic approach to knowledge exchange, and for research to be conducted in neglected high-prevalence settings., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: Research on child marriage has increased in volume but remains scarce in humanitarian settings. This study aimed to investigate rates, correlates, and consequences of child marriage among Syrian refugees in South Lebanon., Methods: A sample of 1,593 female adolescents and 893 adults was selected using a multistage stratified cluster survey design. We quantified the cumulative incidence of child marriage among age cohorts of female refugees and identified risk factors associated with child marriage using survival methods. We also presented sexual and reproductive health measures among child brides., Results: We found evidence that child marriage was widely practiced among adolescent girls, with Kaplan-Meier curves showing that 32.56% of girls aged 10-19 transitioned to marriage by age 17. Although high, this was lower than rates among women aged 25-29 (p < .005), indicating that child marriage was already widely practiced in prewar Syria. Our Cox models indicated that several factors, which mirror drivers of child marriage in stable settings, are associated with hazard of child marriage in this context. We additionally found important sexual and reproductive health gaps among child brides, such as low levels of knowledge of the dangers of early childbearing and closely spaced births as well as high rates of early and multiple births., Conclusions: Child marriage is a pervasive practice among Syrian refugees residing in this setting. Our results suggest that a confluence of factors at different levels of the social ecology increase refugee girls' vulnerability to child marriage. They also demonstrate the pressing need for interventions that target refugee child brides., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Although there is a growing evidence base on the drivers of child marriage, comparatively little is known about the experiences of married girls in refugee settings and how their development trajectories diverge from those of their nonmarried peers, particularly in the context of the COVID-19 pandemic. Drawing on cross-national panel data from Bangladesh and Jordan, this article explores diversity in child marriage experiences in contexts affected by forced displacement, highlighting how married girls' well-being differs from that of their unmarried peers, and how COVID-19 has reinforced these differences., Methods: We analyzed longitudinal survey data-collected pre- and post-COVID-19-from the Gender and Adolescence: Global Evidence study with 293 ever-married and 1,102 never-married adolescent girls. Multivariate regression analysis assessed the well-being of married and unmarried girls across contexts and refugee status, both prior to and during the COVID-19 pandemic. These quantitative data are complemented by in-depth qualitative data from adolescents (n = 112), and key informant interviews with service providers and community leaders (n = 62)., Results: Our findings highlight that married girls in contexts affected by displacement are disadvantaged in multiple ways, but that the patterning of disadvantage varies across contexts, and that marriage can also have protective effects in certain contexts. The COVID-19 pandemic has, however, served to exacerbate existing inequalities in all contexts., Discussion: Although child marriage prevention efforts remain critical, there is also an urgent need for programming that targets married girls in refugee and host communities to mitigate negative outcomes among this vulnerable group., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Although the average age of marriage has increased in many countries in the Middle East in recent years, child marriage is thought to become more common among certain populations in Jordan, notably the refugees. This study explores the perspectives of Jordanian and Syrian adolescents on child marriage in relation to the Syrian conflict as members of refugee populations and host communities., Methods: This study used data from in-depth interviews with 64 Jordanian and Syrian adolescents between the ages of 15 and 19 years. Interviews consisted of a narrative, flexible dialog in which participants discussed their life histories using the creation of a visual timeline as a tool. Data analysis was iterative, inductive, and based on the grounded theory approach. Themes were identified through ongoing interaction with the data., Results: Three major themes emerged from the data relating to child marriage: (1) the influence of intermingling between Syrian and Jordanian communities, (2) vulnerability and control interact to fuel increases in child marriage in displacement, and (3) finding agency by rejecting child marriage., Conclusions: The Syrian conflict has changed practices relating to child marriage, fostering a renewed reliance on child marriage in light of increasing instability, leaving both Jordanian and Syrian adolescents increasingly vulnerable. Many adolescents reject the practice, thus offering an opportunity for social change., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study is to broaden understanding of how premarital conception in adolescence contributes to child marriage and early union in selected countries in Southeast Asia and the Pacific., Methods: Data were drawn from the latest Demographic and Health Surveys and Multiple Indicator Cluster Surveys from seven countries in Southeast Asia and Papua New Guinea, to examine patterns and trends of premarital conception and its potential contribution to early union and child marriage., Results: Among ever-married/in union women aged 20-24 years, who gave birth under 18 years, between 9% and 36% of pregnancies were conceived premaritally. Of these adolescent mothers, who conceived premaritally, 57%-92% were married by the time of birth. Data indicate a trend of increasing premarital conception in six of the selected countries., Discussion: Findings suggest that adolescent pregnancy is a significant driver of child marriage/early union in seven countries in Southeast Asia and Papua New Guinea., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Despite international commitments and increases in education and economic opportunities for girls and young women, child marriage persists and, in some contexts, reductions have stagnated. In order to accelerate and sustain progress, a better understanding of the social norms that continue to support the practice is required., Methods: This qualitative study used 20 in-depth interviews with adolescent girls and another 10 with boys, a total of 16 focus group discussions with girls, boys, and parents of adolescent girls, and 8 key informant interviews with community leaders, to identify and understand the expectations that support the practice of child marriage, in communities in northern Bangladesh., Results: Expectations that girls will restrict their mobility, limit their engagement with male peers, and take extremely limited decision-making roles in their marriage reinforce the practice of child marriage. Girls, and their families, that are considered at risk of or are perceived to have violated these norms face immense pressure for early marriage to mitigate damage to both their own and their families' reputations., Discussion: Social norms that are primarily engineered to control girls' sexuality continue to underpin the practice of child marriage in Bangladesh. Efforts to reduce child marriage such as through increased education or economic opportunities must also address these norms if substantial reductions are to be achieved and sustained in the long-term., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This study explores links among marianismo, girls' mobility and sexuality, and child marriage among adolescent girls in rural areas of Honduras., Methods: We analyze quantitative and qualitative data collected in 2008-2016 for a longitudinal cohort study of rural Honduran adolescent girls. These data include interviews (n = 10 married before age 18) and surveys (n = 563; 155 married early). We also use qualitative data from focus groups in 2016 that included students, parents, teachers, and community members (n = 120)., Results: We find that girls who scored higher on a scale of traditional gender norms were more likely to marry early. Furthermore, our qualitative findings indicate that girls experienced control over their mobility and their sexuality because of rigid gender norms prevalent in their communities. The control girls experience clashes with undergoing psychosocial changes that are associated with increased desire for autonomy and intimacy as well as increased awareness of their sexuality. In some cases, girls believed that marriage was better than staying in their restrictive households, and/or they viewed marriage as the only way to have a romantic relationship., Discussion: Rigid gender norms that promote excessive regulation of girls' behavior and sexuality influence girls' decision-making processes to enter child marriage. Educational initiatives that challenge sexist gender norms and explain and normalize attraction and intimacy during adolescence should be a central component of child marriage prevention programming for adolescents, parents, and community members., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: In developing countries, approximately one in three girls marry before the age of 18; however, early marriage is not a homogenous experience. Cohabitation can be either a precursor or an alternative to marriage, yet studies and programs often conflate marriage types. The purpose of this study is to understand the underlying factors and stability of cohabiting and formal child marriage unions among adolescent girls., Methods: This mixed-methods study draws on four rounds of quantitative data collected annually between 2013 and 2016 as part of a longitudinal study among girls 10-19 years old in Zambia. In-depth interviews were conducted in 2017 with 32 girls, divided by formal unions and informal unions, randomly selected from the quantitative sample. Multivariate logistic models were estimated to test key associations and Cox regression models used to estimate the hazard of separation/divorce by a certain age., Results: Qualitative findings highlighted that informal unions did not typically have approval of the couples' parents and frequently ended in separation. As compared to formal unions, having both families' approval was associated with 69% lower odds of cohabiting (odds ratio = 0.31, p < .001), while forced entry into union due to pregnancy was associated with 61% greater odds of cohabiting (OR = 1.61, p < .05). Being in a cohabiting union was associated with a 43% greater hazard of union dissolution (hazard ratio = 1.43, p < .05)., Discussion: There are key differences between formal marriages and cohabitation among adolescent girls and young women that should be considered when addressing early marriage in research and programs., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: School attainment has increased and gender gaps narrowed in many settings without commensurate declines in child marriage and with persistent gender gaps in work. This paper investigates whether child marriage changes young people's ability to translate education into paid work in rural Malawi., Methods: Using data from a longitudinal study of adolescents in rural Malawi followed through young adulthood, individual-level fixed-effects regressions that account for time-invariant factors were used to investigate differences in child marriage status on the extent to which grade attainment, reading, and numeracy skills lead to higher participation in paid work and reduce participation in unpaid work. Gender differences in these relationships were explored., Results: Prevalence of child marriage is high for young women (53% vs. 6% for men), and participation in paid work low (7% vs. 42% for men). Attainment of six grades among young married women and nine grades among young married men was associated with paid work irrespective of child marriage. Reading with comprehension in two languages was associated with paid work for young men married as adults (coefficient = .27, p ≤ .01). Numeracy was associated with paid work among unmarried young women (coefficient = .04, p ≤ .01). Negative associations between grade attainment and unpaid work were found for young women married at ages 16-17 and unmarried, while positive associations were found for young unmarried men., Conclusions: The relationship between education and work among young people in Malawi is compromised by related challenges of poor learning and continued high levels of child and young adult marriage., (Copyright © 2021 Society for Adolescent Health and Medicine. All rights reserved.)

Purpose: The purpose of the study was to examine associations of gender role beliefs with marital safety as well as social and digital connectivity among married adolescent girls in India., Methods: We analyzed cross-sectional survey data from married adolescent girls from rural Bihar and Uttar Pradesh, India in 2015-2016 (N = 4,893). Gender role belief items assessed participants' beliefs regarding appropriateness of female marital choice and economic decision-making, male childcare responsibility, and marital violence. The outcomes were time with friends (social connection), freedom of movement, mobile phone ownership and internet access (digital connection), and safety from marital violence (marital safety). Adjusted regression models examined associations between gender role beliefs and outcomes, caste/religion beliefs related to segregation, and demographics., Results: Beliefs supportive of female marital choice (adjusted odds ratio [AOR] 1.38, 95% confidence interval [CI] 1.00-1.88, p = .048) and female economic decision-making (AOR 1.43, 95% CI 1.03-1.99, p = .03) were associated with social connection. Beliefs supportive of female marital choice (AOR 1.88, 95% CI 1.31-2.71, p = .001), female economic decision-making (AOR 1.67, 95% CI 1.03-2.72, p = .04), and male childcare responsibilities (AOR 1.42, 95% CI 1.05-1.94, p = .03) were associated with freedom of movement. Belief supporting female marital choice was associated with mobile phone ownership (AOR 1.23, 95% CI 1.01-1.50, p = .04), and belief supporting male childcare responsibility was associated with internet access (AOR 1.76, 95% CI 1.11-2.77, p = .02). Beliefs supportive of female marital choice (AOR .73, 95% CI .59-.89, p = .003), male childcare responsibility (AOR 1.26, 95% CI 1.03-1.54, p = .02), and unacceptability of marital violence (AOR 1.72, 95% CI 1.38-2.15, p < .001) were associated with safety from marital violence., Conclusions: Progressive gender role beliefs regarding female choice, control, and safety in marriage are associated with greater connectivity and safety for married adolescent girls in India. Future studies that can longitudinally assess these associations are warranted., (Copyright © 2021. Published by Elsevier Inc.)

Purpose: The child marriage field lacks a simplified framework that connects an understanding of the drivers of child marriage for girls to decisions about the design of interventions to delay marriage within different contexts and support married girls., Methods: We reviewed existing child marriage frameworks and conducted consultations with experts working on child marriage. We then developed a simplified conceptual framework describing the key drivers of child marriage for girls. We explored how these drivers play out and interact using qualitative data from three settings where child marriage is common: Bangladesh, Malawi, and Niger., Results: The final conceptual framework lays out five core drivers of child marriage for girls, which vary and interact across contexts. Social norms and poverty are shown as core drivers that underlie lack of agency, lack of opportunity, and pregnancy/fear of pregnancy. These drivers reflect community, household, and individual-level factors. The case studies highlight the important relationships between these drivers, and the way they interact within each context. We use these examples to explore how policymakers and practitioners might identify the most appropriate interventions to address child marriage across different settings., Conclusions: We offer this framework as a starting point to guide more targeted interventions and policies that address the complex combination of child marriage drivers within each setting. By adapting this framework to different settings, those designing and implementing child marriage prevention interventions can identify the key drivers in each setting, understand how those drivers interact, and more effectively target effective interventions., (Copyright © 2021. Published by Elsevier Inc.)

Purpose: The study projects the potential impact of COVID-19 on child marriage in the five countries in which the burden of child marriage is the largest: Bangladesh, Brazil, Ethiopia, India, and Nigeria., Methods: The projected impact of the pandemic on child marriage is based on a Markov model. A review of empirical and theoretical literature informed construction and parameter estimates of five pathways through which we expect an elevated marriage hazard: death of a parent, interruption of education, pregnancy risk, household income shocks, and reduced access to programs and services. Models are produced for an unmitigated scenario and a mitigated scenario in which effective interventions are applied to reduce the impact., Results: The total number of excess child marriages in these five countries could range from 3.5 million to 4.9 million in the unmitigated scenario and from 1.8 million to 2.7 million in the mitigated scenario. The elevated risk compared with the baseline projection would continue until 2035., Conclusions: These projections represent the impact in five countries that account for 50% of child marriages globally, implying that if similar patterns hold, we might expect the number of excess child marriages due to the pandemic to reach 7 million to 10 million globally. These estimates are necessarily subject to high levels of uncertainty because of limited evidence on the impacts in relation to child marriage and for parameter estimates. It will likely take years to understand the full impact of the pandemic. Despite these limitations, the potential for harm is unquestionably large., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This comparative study explores the connections between potential drivers of child marriage among girls at the individual, household, and community levels. It provides insight into the multilevel influences on child marriage with the goal of informing policies and programs aimed at eliminating the practice., Methods: We conducted a secondary analysis of baseline data from the Building Evidence to Delay Child Marriage Project, a large study undertaken in Burkina Faso and Tanzania. For each country, using data on adolescent girls and parents, we ran a series of nested logistic regression models to identify factors associated with having ever been married among girls aged 15-17 years., Results: Findings indicate that child marriage among girls is shaped by a combination of factors at multiple levels and that the weight of influencing factors varies by context. At the household level, parental relationships were influential in both countries, although in different ways. The influence of the community varied considerably between countries, holding more importance in Burkina Faso than in Tanzania. In Burkina Faso, the importance of schooling and existence of alternative pathways for girls beyond marriage appears crucial to reducing child marriage. Other factors strongly associated with child marriage include girls' agency, the timing of girls' sexual initiation, and community norms, specifically views on child marriage among fathers. In Tanzania, early sexual initiation among girls was common and strongly associated with marriage during childhood; parents' fear of premarital sex and pregnancy also emerged as a significant factor., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Despite many programs aiming to delay girls' marriage and pregnancy over the last 2 decades, there is no consensus yet concerning the effectiveness of different approaches and the contexts in which they are implemented. We focus on different social contexts within Bangladesh and Zambia and investigate how literacy, poverty, and community characteristics impact the effectiveness of interventions., Methods: We utilize data sets from two randomized controlled trials conducted by the Population Council in Bangladesh and Zambia. Within each respective country, we estimate the impacts of the interventions on marriage and pregnancy among adolescent girls using the analysis of covariance estimator by different social contexts based on community-level variables., Results: In Bangladesh, providing academic skill training had a significant impact on discouraging child marriage in the villages where girls' paid-work participation rate was relatively high, whereas in low paid-work participation villages, providing gender-awareness skill training had an impact. In Zambia, providing empowerment intervention and safe spaces had a significant impact on delaying pregnancy especially for illiterate girls in the communities where premarital sex was relatively common., Conclusions: In Bangladesh, where girls' paid-work participation is limited, premarital sex is uncommon, and marriage is subject to collective decision-making; the effectiveness of a program may depend on girls' agency and the availability of acceptable working opportunities. In Zambia where premarital sex is common, pregnancy may precede marriage, and marriage entails the nature of individual decision-making; empowering the most vulnerable girls seems to be more effective in delaying marriage/pregnancy., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This review assesses evaluations published from 2000 to 2019 to shed light on what approaches work, especially at scale and sustainably, to prevent child marriage in low- and middle-income countries., Methods: We conducted a search of electronic databases and gray literature and evaluated the methodological quality and risk of bias of included studies., Results: A total of 30 studies met the inclusion criteria. Interventions that support girls' schooling through cash or in-kind transfers show the clearest pattern of success in preventing child marriage, with 8 of 10 medium-high quality studies showing positive results. Although limited in number, five studies on favorable job markets and targeted life skills and livelihoods training show consistent positive results. Comparatively, asset or cash transfers conditional on delaying marriage show success only among two of four evaluations, and the three studies on unconditional cash transfers for poverty mitigation show no effect. Findings also show a low success rate for multicomponent interventions with positive results in only one of eight medium-high quality studies. Further, single component interventions were much more likely to be at scale and sustainable than multicomponent interventions., Conclusions: These results indicate that enhancement of girls' own human capital and opportunities is the most compelling pathway to delaying marriage. In contrast, low rates of success, scale-up, and sustainability of multicomponent programs requires reconsideration of this approach., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: Parental influence over early marriage of girls is well-documented in qualitative research, but little quantitative work in this area has been conducted. This study assesses the effects of the parent-child relationship in early adolescence (aged 12 years) on early marriage of girls., Methods: We analyzed survey data from a multicountry prospective cohort of girls (n = 1,648) followed over four rounds from age 8 to 19 years (2002-2013), as part of the Young Lives study in India, Ethiopia, Vietnam, and Peru. Multinomial logistic regression models assessed the effects of parent-child communication and parent-child relationship quality, as reported when girls were aged 12 years on child and early marriage (married <16 years, married 16-17 years, married 18-19 years, unmarried). Covariates were wealth, rural/urban residence, maternal education, parents' value of education, early menarche, and country., Results: One in five girls (18.04%) reported marriage before 18 years of age, and 8.1% reported marrying before 16 years (8.3% and 13.7% in India and Ethiopia). Multinomial regression found that girls reporting good parent-child communication and high parent-child relationship quality at age 12 years were significantly less likely to marry before age 16 years (moderate relationship quality, adjusted relative risk ratio: .23, 95% confidence interval: .07-.72; high relationship quality, adjusted relative risk ratio: .34, 95% confidence interval: .11-.99)., Conclusion: Parent-child relationship quality and communication in early adolescence are protective against very early marriage of girls cross-nationally, although communication may facilitate marriage soon on completion of school. Primary prevention interventions targeting child marriage may benefit from components focused on improving the parent-child relationship., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This study sets out to identify effective interventions to reduce child marriage, estimate their economic benefits achieved through enhanced productivity, and undertake a benefit-cost analysis of the interventions., Methods: We model the effects of a set of identified child marriage and education interventions for 31 low- and middle-income countries, 1 focusing on the reduction in child marriage rates and increasing secondary school attendance and completions. These lead to higher productivity, which generates increased gross domestic product per capita. The comparison of these benefits with the costs of the interventions generates benefit-cost ratios., Results: Both types of interventions have significant effects on marriage rates for girls aged 15-17 years, which fall from 13.2% in 2015 to 5.2% in 2050. Both interventions lead to sharp increases in school attendance and secondary completion, which is 19.3% points higher by 2030. The productivity improvement is 22.7% by 2030. The average benefit-cost ratio for the 31 countries is 7.4 (standard deviation of 1.0) at a 3% discount rate., Conclusions: The results indicate that there are substantial economic gains to reducing child marriage by specific child marriage and education interventions., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Given the importance of developing appropriate measures for assessing social norm change, this article documents the process, results, and lessons learned from a baseline survey measuring social norms related to child marriage in Phalombe and Thyolo districts in Southern Malawi., Methods: A quantitative questionnaire was administered to a representative sample of all adults (age ≥18 years) who self-identified as a decision-maker for at least one girl between the ages of 10 and 17 years, for a total sample size of 1,492 respondents. Measures of empirical expectations, normative expectations, and sanctions related to child marriage were modeled after previously developed measures and social norm theory., Results: Using an established social norm diagnostic process, this study found that, despite Southern Malawi having the lowest median age of first marriage in the country, child marriage may not be a strong social norm in the intervention communities. Specifically, although 89.3% of respondents expressed the empirical expectation that "Most girls in this community marry before the age of 18," agreement with the normative expectation that "Most people in this community expect girls to marry before the age of 18" was just 53.2% overall and fear of sanctions was just 36.4%., Conclusions: Taken together, the presence of prudential reasons for child marriage and the weak evidence of normative expectations and sanctions indicate that child marriage may not be a social norm in these communities although it may be indirectly perpetuated by other norms related to adolescent sexuality and access to contraception., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Child marriage is the norm in Bangladesh, leading to lifelong negative consequences. Evidence on sustainable child marriage programs is scant. Our study aimed to evaluate the impact of three community-based skills-building programs to delay child marriage among adolescent girls in rural Bangladesh., Methods: The study used a cluster randomized controlled trial design with four arms-ARM1 offered educational support, ARM2 promoted gender rights awareness, ARM3 offered livelihoods training, and ARM4 was a control area. All adolescent girls were offered 144 hours of skills training in village centers over 18 months. Among 11,609 baseline survey respondents, 91% were successfully included in the endline analysis. Program impact was assessed using discrete time hazard models., Results: The program reduced child marriages (<18) significantly in all arms relative to control-(adjusted hazard ratio [AHR]: .75; 95% confidence interval [CI]: .60-.92) for the education arm, (AHR: .72; 95% CI: .59-.88) for the gender arm, and (AHR: .70; 95% CI: .56-.87) for the livelihoods arm. Program participants were younger and more likely to be in school and faced lower risk of marriage relative to nonparticipants. In the gender and livelihoods arm, nonparticipants had lower risk of child marriage relative to the control group significant at the 10% level., Conclusions: The study demonstrates it is possible to reduce the prevalence of child marriage in a relatively short period of time by working with communities to implement holistic programs to build skills among girls. The program had similarly large impact and did not depend on the type of skills offered., (Copyright © 2018. Published by Elsevier Inc.)

The goal of this project was to systematically review and compile evidence on interventions in low- and middle-income countries, which targeted three adverse health-related outcomes for young people (ages 10-24): (1) early pregnancy and repeat pregnancy; (2) child marriage; and (3) sexually transmitted infections including human immunodeficiency virus. We searched the gray and published literature to identify interventions and developed a scoring system to assess whether these interventions and their evaluations were of high quality. The three review articles in this volume focus on behavioral outcomes and provide a summary of interventions and evaluations that were both successful and unsuccessful in their impact on the targeted outcomes. This commentary provides the details of the methodology that are common across all three review articles., (Copyright © 2016. Published by Elsevier Inc.)

Child marriage, defined as marriage before the age of 18 years, is a human rights violation that can have lasting adverse educational and economic impacts. The objective of this review was to identify high-quality interventions and evaluations to decease child marriage in low- and middle-income countries. PubMed, Embase, PsycInfo, CINAHL Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was used, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Eleven high-quality interventions and evaluations were abstracted. Six found positive results in decreasing the proportion married or increasing age at marriage, one had both positive and negative findings, and four had no statistical impact on the proportion married or age at marriage. There is wide range of high-quality, impactful interventions included in this review which can inform researchers, donors, and policy makers about where to make strategic investments to eradicate marriage, a current target of the Sustainable Development Goals. Despite the cultural factors that promote child marriage, the diversity of interventions can allow decision makers to tailor interventions to the cultural context of the target population., (Copyright © 2016. Published by Elsevier Inc.)

Purpose: In light of the global pervasiveness of child marriage and given that improving maternal health care use is an effective strategy in reducing maternal and child morbidity and mortality, the available empirical evidence on the association of child marriage with maternal health care utilization seems woefully inadequate. Furthermore, existing studies have not considered the interaction of type of place of residence and parity with child marriage, which can give added insight to program managers., Methods: Demographic Health Survey data for seven countries are used to estimate logistic regression models including interactions of age at marriage with area of residence and birth order. Adjusted predicted probabilities at representative values and marginal effects are computed for each outcome., Results: The results show a negative association between child marriage and maternal health care use in most study countries, and this association is more negative in rural areas and with higher orders of parity. However, the association between age at marriage and maternal health care use is not straightforward but depends on parity and area of residence and varies across countries. The marginal effects in use of delivery care services between women married at age 14 years or younger and those married at age 18 years or older are more than 10% and highly significant in Bangladesh, Burkina Faso, and Nepal., Conclusions: The study's findings call for the formulation of country-and age at marriage-specific recommendations to improve maternal and child health outcomes., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Child marriage (before 18 years) is widely prevalent in Pakistan, and disproportionately affects young girls in rural, low-income, and poorly educated households. Our study aims to determine the associations between child marriage and controlling behaviors (CB) and spousal violence by husbands against adolescent and young women in Pakistan beyond those attributed to social vulnerabilities., Methods: We analyzed data from the Pakistan Demographic and Health Survey, 2012-2013, of currently married women aged 15-24 years who had participated in the domestic violence module (n = 589, 22.5% [589/2,615] of the subsample aged 15-24 years) to identify differences in CB and spousal violence experiences between early (<18 years) and adult (≥18 years) ages at marriage. Associations between child marriage and CB and spousal violence by husband were assessed by calculating adjusted odds ratios (AOR) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, and rural residence), spousal age gap, and husband's education., Results: Overall, 47.8% of currently married women aged 15-24 years in Pakistan were married before the age of 18 years. About one third of women aged 15-24 years in Pakistan reported experiencing CB (31.8%) and spousal violence (31.1%) by their husbands. Compared with adult marriage, child marriage was significantly associated with CB (AOR = 1.50; 95% confidence interval [CI], 1.042-2.157), any form of spousal violence (physical or emotional) (AOR = 2.03; 95% CI, 1.392-2.969), emotional violence (AOR = 1.86; 95% CI, 1.254-2.767), and physical violence (AOR = 2.44; 95% CI, 1.582-3.760), including severe physical violence (AOR = 2.57; 95% CI, 1.122-5.872)., Conclusions: Effective interventions are needed to prevent child marriages and raise awareness about their negative consequences, with special reference to spousal violence., (Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)