Globally, around 650 million girls and women married before their 18th birthday. According to recent data, Sub-Saharan Africa accounts for the largest share of child, early, and forced marriage and unions (CEFMU), with 35 percent, followed by South Asia, with 30 percent. But as research expands, new geographies are coming into focus, including Latin America and the Caribbean, where one in four girls under the age of 18 are married.
Despite the evidence emerging from new settings, research still tends to focus on a limited subset of countries. Although the prevalence of CEFMU is greater in low- and middle-income countries, child marriage also occurs in high-income countries: for example, between 2000 and 2015, more than 200,000 minors, of whom 87 percent were girls and 13 percent were boys, were married in the United States.
Scholars and activists agree that the proportion of girls getting married early in many countries across the globe is very high compared to their male counterparts. However, analyses of CEFMU tend to focus solely on age to describe and explain this phenomenon. The underlying assumption is that once girls reach the age of 18, they are at reduced risk of violence and nonconsensual marriage. This ignores other important factors that place girls at risk, such as poverty, gender inequalities, including harmful gender norms, traditional understandings of femininities and girlhood, and gender-based violence.
The role child marriage plays in controlling female bodies, specifically young girls, and regulating their sexuality continues to be under-addressed in the discourse around gender equality and CEFMU. The aim of this special edition of the Journal of Adolescent Health is to present recent research on the diverse manifestations of child marriage around the world. This means going beyond geographies on which rich evidence already exists in order to amplify diverse voices and highlight the intersections between this practice and other manifestations of gender inequality and oppression.
The collection of studies in this supplement takes this wholistic approach, so well captured in the commentary by Kimball and Dwivedi: “Our intention was never simply to work toward stopping child marriage, but to approach it via its root causes and to develop more holistic, transformational processes” for responding to the practice.
Elena Camilletti, Zahrah Nesbitt-Ahmed
Sarah Bott, Ana P Ruiz-Celis, Jennifer Adams Mendoza, Alessandra Guedes
This study aimed to determine how many Latin American and Caribbean (LAC) countries had national data on co-occurring IPV and violent discipline in the same household, how estimates compared and whether violent discipline was significantly associated with IPV. Nine countries had eligible datasets. Co-occurring physical punishment with past year IPV ranged from 1.7% (Nicaragua) to 17.5% (Bolivia); and with IPV ever from 6.0% (Nicaragua) to 21.2% (Haiti). In almost all countries, children in IPV affected households experienced significantly higher levels and ORs of physical punishment and verbal aggression, whether IPV occurred during or before the past year. Significant adjusted ORs of physical punishment ranged from 1.52 (95% CI 1.11 to 2.10) in Jamaica to 3.63 (95% CI 3.26 to 4.05) in Mexico for past year IPV; and from 1.50 (95% CI 1.23 to 1.83) in Nicaragua to 2.52 (95% CI 2.30 to 2.77) in Mexico for IPV before past year. IPV is a significant risk factor for violent discipline, but few national surveys in LAC measure both. Co-occurrence merits greater attention from policymakers and researchers.
Maria Carolina Alban Conto, Spogmai Akseer, Thomas Dreesen, Akito Kamei, Suguru Mizunoya, Annika Rigole
Htet Thiha Zaw, Suguru Mizunoya, Dominic Richardson, Despina Karamperidou, Hiroyuki Hattori, Monika Oledzka-Nielsen
Jennifer Waidler, Franziska Gassmann, Bruno Martorano
Amber Peterman, Amiya Bhatia, Alessandra Guedes, Camilla Fabbri, Ilan Cerna-Turoff, Ellen Turner, Michelle Lokot, Ajwang Warria, Sumnima Tuladhar, Clare Tanton, Louise Knight, Shelley Lees, Beniamino Cislaghi, Jaqueline Bhabha, Karen Devries
UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition.
This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work.
From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods.
UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.
Essa Chanie Mussa, Frank Otchere, Vincenzo Vinci, Abduljelil Reshad, Tia Palermo
Community-Based Health Insurance (CBHI) has received increasing attention in low and middle-income countries as a pathway toward universal health coverage. In 2011, the government of Ethiopia piloted CBHI and subsequently integrated CBHI with its flagship social protection programme, the Productive Safety Net Program (PSNP). We examined enrolment decisions by PSNP households, including, understanding of the programme, reasons for non-coverage, and factors associated with enrolment.
Current CBHI enrolment is higher among public works (PW) households (70.1 %) than Permanent Direct Support (PDS) clients (50.3 %). The most common reason for not enrolling in both PW and PDS households is cost. Results further show that the following characteristics are positively associated with CBHI enrolment: the number of children and working-age adults in the household, older household head, female household head, married household head, having been food insecure in the previous 12 months, heads having experienced illness in the past month, and increasing household wealth status.
While demographic factors are important in households’ decisions to enrol in CBHI, various mechanisms could be used to increase enrolment among vulnerable households such as PDS clients. In this regard, while better communication about CBHI could increase enrolment for some households, other poor and vulnerable households will need fee waivers to induce enrolment.