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

Summary

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

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

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

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

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

Child marriage prevention approaches

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

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

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

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

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

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

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

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