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Effect of child marriage on girls' school dropout in Nepal: Analysis of data from the Multiple Indicator Cluster Survey 2014.

ABSTRACT: School dropout and child marriage are interrelated outcomes that have an enormous impact on adolescent girls. However, the literature reveals gaps in the empirical evidence on the link between child marriage and the dropout of girls from school. This study identifies the 'tipping point' school grades in Nepal when the risk of dropout due to marriage is highest, measures the effect of child marriage on girls' school dropout rates, and assesses associated risk factors. Weighted percentages were calculated to examine the grades at highest risk and the distribution of reasons for discontinuing school. Using the Nepal Multiple Indicator Cluster Survey (MICS) 2014 data, we estimated the effect of marriage on school attendance and dropout among girls aged 15-17 by constructing logistic regression models. A multivariate logistic regression model was used to assess risk factors of school dropout due to child marriage. It was found that early marriage is the most common reason given for leaving school. Overall, the risk of school dropout due to marriage heightens after girls complete the fifth or sixth grade. The risk of girls' dropping out peaks in the seventh and eighth grades and remains noteworthy in the ninth and tenth grades. Married girls in Nepal are 10 times more likely to drop out than their unmarried peers. Little or no education of the household head, belonging to the Kirat religion, and membership of a traditionally disadvantaged social class each elevate the risk of school dropout due to early marriage. The findings underscore the need to delay girl's marriage so as to reduce girls' school dropout in Nepal. School-based programmes aimed at preventing child marriage should target girls from the fifth grade because they are at increased risk of dropping out, as well as prioritizing girls from disadvantaged groups.

SUBMITTER: Sekine K

PROVIDER: S-EPMC5519022 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Effect of child marriage on girls' school dropout in Nepal: Analysis of data from the Multiple Indicator Cluster Survey 2014.

Sekine Kazutaka K Hodgkin Marian Ellen ME

PloS one 20170720 7

School dropout and child marriage are interrelated outcomes that have an enormous impact on adolescent girls. However, the literature reveals gaps in the empirical evidence on the link between child marriage and the dropout of girls from school. This study identifies the 'tipping point' school grades in Nepal when the risk of dropout due to marriage is highest, measures the effect of child marriage on girls' school dropout rates, and assesses associated risk factors. Weighted percentages were ca ...[more]

PMID: 28727793

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Project description:BackgroundSecondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girls in rural settings of southern India.Methods80 of 121 villages in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (control = 40; intervention = 40). All 12-13 year-old SC/ST girls in final year of primary school (standard 7th) were enrolled and followed for 3 years (2014-2017) until the end of secondary school (standard 10th). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data.Results92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result.ConclusionsSamata intervention had no overall impact, however, it added value in one of the two implementation districts- increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain at-risk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India "leaves no-one behind" and achieves its gender, health and education Sustainable Development Goal aspirations.Trial registrationClinicalTrials.gov registration number NCT01996241.

Project description:BackgroundDespite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences.MethodsA cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15-49 and at least one adolescent female aged 10-19. In addition to calculating the proportion of girls married under age 18, we used survival methods - namely Kaplan Meier graphs and Cox proportional hazard models - to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls.ResultsA total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15-19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11-0.18), and 11% were ever married under age 18 (95% CI 8-15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls - particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94-22.40), and early childbearing was common (60%; 95% CI 45.56-72.89).ConclusionsThis research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.

Project description:BackgroundLow caste adolescent girls living in rural northern Karnataka are at increased risk of school drop-out, child marriage, and entry into sex-work, which enhances their vulnerability to HIV, early pregnancy and adverse maternal and child health outcomes. This protocol describes the evaluation of Samata, a comprehensive, multi-level intervention designed to address these structural drivers of HIV risk and vulnerability.Methods/designThe Samata study is a cluster randomised controlled trial that will be conducted in eighty village clusters (40 intervention; 40 control) in Bijapur and Bagalkot districts in northern Karnataka. The intervention seeks to reach low caste girls and their families; adolescent boys; village communities; high school teachers and school governing committees; and local government officials. All low caste (scheduled caste/tribe) adolescent girls attending 7th standard (final year of primary school) will be recruited into the study in two consecutive waves, one year apart. Girls (n = 2100), their families (n = 2100) and school teachers (n = 650) will be interviewed at baseline and at endline. The study is designed to assess the impact of the intervention on four primary outcomes: the proportion of low caste girls who (i) enter into secondary school; (ii) complete secondary school; (iii) marry before age 15; and (iv) engage in sex before age 15. Observers assessing the outcomes will be blinded to group assignment. The primary outcome will be an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at follow-up. We will also conduct survival analyses for the following secondary outcomes: marriage, sexual debut, pregnancy and entry into sex work. Complementary monitoring and evaluation, qualitative and economic research will be used to explore and describe intervention implementation, the pathways through which change occurs, and the cost-effectiveness of the intervention.DiscussionThis is an innovative trial of a comprehensive intervention to improve the quality of life and reduce HIV vulnerability among marginalised girls in northern Karnataka. The findings will be of interest to programme implementers, policy makers and evaluation researchers working in the development, education, and sexual and reproductive health fields.Trial registrationClinicalTrials.Gov NCT01996241 . 16th November 2013.

Project description:BackgroundChild marriage is a violation of children's rights and it exposes them to social isolation and psychological damages. These negative effects are not limited to them and expands to the family and society as well. The present research aimed at determining the knowledge and viewpoint of adolescent girls regarding child marriage, its causes and consequences in the city of Tabriz-Iran, in 2020-2021.MethodsThis cross-sectional study was carried out on 300 adolescent girls who had records in the health centers in the city of Tabriz. The data were collected using the sociodemographic characteristics questionnaire, questionnaire of knowledge, and view of adolescent girls regarding child marriage, and its causes and consequences. The multivariate logistic regression model with adjusting the sociodemographic characteristics was used to determine the relationship between the viewpoint of adolescent girls about child marriage and their knowledge in this regard.ResultsThe mean (SD) knowledge about child marriage was 6.70 (3.09) (score range: 0-11). The majority of the girls (85.4%) were against marriage before the age of 18 and only 16 girls (5.1%) of them agreed with marriage before the age of 18. Investigating the viewpoint of adolescent girls regarding the causes of child marriage revealed that the important issue leading to reduction of child marriage can be "intellectual, emotional, social, and economic maturity of girls plus their physical puberty (92.4% agree), increase in the girls' education (79% agree) and increasing girls' awareness regarding the consequences of early marriage in schools and media (69.6% agree). Illiteracy or lack of education of parents (64% agree), meeting the emotional needs (59.3% agree), family problems and conflicts (59.6% agree), and lack of exhilaration in daily life, especially in the rural regions and suburbs (58.3% agree) were among the reasons of increase of child marriage. The most important consequence of child marriage from the viewpoint of the girls is deprivation from the chance of education. The results of multivariate logistic regression model by adjusting the possible confounding variables, showed that girls who believed the appropriate age for marriage is under 20 were almost 13 times more likely to agree with child marriage than girls who believed the appropriate age for marriage is over 20 years (aOR = 13.82; 95% Cl 2.61-71.16 p = 0.002) and girls who opposed their parents' decision to marry under the age of 18 were less likely to agree with the child marriage than girls who did not oppose their decision (aOR = 0.09; 95% Cl 0.01-0.63 p = 0.016).ConclusionsThe results revealed a good level of knowledge and negative attitude to child marriage among the girls. The girls who disagreed with child marriage were more knowledgeable than the girls who agreed with child marriage. Thus, the increase of the level of knowledge of girls and their families regarding the consequences of early marriage and developing the culture for correcting the cultural beliefs and wrong social beliefs to prevent child marriage can decrease this damage to a great extent.

Project description:Background: Rohingya girls living in the refugee camps in Bangladesh are disproportionately vulnerable to child marriages and teenage pregnancies. This study examines the factors affecting child marriage and contraceptive use among Rohingya girls who have experienced child marriages. Methods: We collected and analysed quantitative and qualitative data from adolescent Rohingya girls (age 10-19 years) who experienced child marriages. The quantitative data (n=96) came from a cross-sectional survey, and the qualitative data (n=18) from in-depth interviews conducted in the world's largest refugee camp located in Cox's Bazar, Bangladesh. We also interviewed service providers (n=9) of reproductive healthcare services to gain their perspectives regarding contraceptive use among these young girls. We used descriptive statistics to characterise the girls' demographic profiles, ages at their first marriages, and contraceptive use. Thematic analysis was used for the qualitative data to identify key factors influencing child marriage and contraceptive use among these girls. Findings: On average, the adolescent female participants had been 15.7 years old when they were first married. Over 80% had given birth during the two years before the survey or were pregnant during time of the data collection. The main factors that influenced child marriage were found to be perceptions regarding the physical and mental maturity for marriage, social norms, insecurity, family honour, preferences for younger brides and the relaxed enforcement of the minimum legal age for marriage. A third (34%) of the girls said they were using contraceptives on the week when the study was conducted. The desire for children, religious beliefs, misapprehension about contraception and long waiting periods in facility-based health services and current service provision were the main factors influencing contraceptive use. Depo Provera injections and pills were the dominant methods of contraception. Contraceptive use during the period between marriage and the first childbirth is rare. Interpretation: Girl child marriage is common in Rohingya camps. Contraceptive use is rare among newly married girls before they give birth for the first time. The involvement of female and male Rohingya volunteers for outreach services can be catalytic in promoting contraceptive use. Funding: La Trobe Asia, La Trobe University, Melbourne, Australia. Bengali translation of the abstract in Appendix 1.

Project description:ObjectivesWe analysed predictors of health insurance enrolment in Nepal, measured wealth-related inequality and decomposed inequality into its contributing factors.DesignCross-sectional study.SettingWe used nationally representative data based on Nepal Multiple Indicator Cluster Survey 2019. Out of 10 958 households included in this study, 6.95% households were enroled in at least one health insurance scheme.Primary outcomemeasures health insurance (of any type) enrolment.ResultsHouseholds were more likely to have health insurance membership when household head have higher secondary education or above compared with households without formal education (adjusted OR 1.87; 95% CI: 1.32 to 2.64)). Households with mass media exposure were nearly three times more likely to get enroled into the schemes compared with their counterparts (adjusted OR 2.96; 95% CI 2.03 to 4.31). Hindus had greater odds of being enroled (adjusted OR 1.82; 95% CI 1.20 to 2.77) compared with non-Hindus. Dalits were less likely to get enroled compared with Brahmin, Chhetri and Madhesi (adjusted OR 0.66; 95% CI 0.47 to 0.94). Households from province 2, Bagmati and Sudurpaschim were less likely to have membership compared with households from province 1. Households from Richer and Richest wealth quintiles were more than two times more likely to have health insurance membership compared with households from the poorest wealth quintile. A positive concentration index 0.25 (95% CI 0.21 to 0.30; p<0.001) indicated disproportionately higher health insurance enrolment among wealthy households.ConclusionsEducation of household head, exposure to mass media, religious and ethnic background, geographical location (province) and wealth status were key predictors of health insurance enrolment in Nepal. There was a significant wealth-related inequality in health insurance affiliation. The study recommends regular monitoring of inequality in health insurance enrolment across demographic and socioeconomic groups to ensure progress towards Universal Health Coverage.

Project description:BackgroundInequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality.MethodsMost recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality.ResultsThe socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%).ConclusionsTo reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).

Dataset Information

Effect of child marriage on girls' school dropout in Nepal: Analysis of data from the Multiple Indicator Cluster Survey 2014.

Publications

Effect of child marriage on girls' school dropout in Nepal: Analysis of data from the Multiple Indicator Cluster Survey 2014.

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