| Literature DB >> 35003910 |
Akanksha A Marphatia1,2, Naomi M Saville3, Dharma S Manandhar4, Mario Cortina-Borja2, Jonathan C K Wells2, Alice M Reid1.
Abstract
BACKGROUND: Women's early marriage (<18 years) is a critical global health issue affecting 650 million women worldwide. It is associated with a range of adverse maternal physical and mental health outcomes, including early childbearing, child undernutrition and morbidity. Poverty is widely asserted to be the key risk factor driving early marriage. However, most studies do not measure wealth in the natal household, but instead, use marital household wealth as a proxy for natal wealth. Further research is required to understand the key drivers of early marriage.Entities:
Keywords: Adolescence; Child marriage; Education; Natal household poverty; Nepal; Reproductive health; South Asia; Women’s early marriage
Year: 2021 PMID: 35003910 PMCID: PMC8684741 DOI: 10.7717/peerj.12324
Source DB: PubMed Journal: PeerJ ISSN: 2167-8359 Impact factor: 2.984
Figure 1Early marriage groups used in analysis.
Our first outcome variable, women’s ‘early marriage,’ uses four different age groupings, described as Scenarios A, B, C and D. To ensure comparability across these results, the same reference group, marrying at the minimum age cut-off of ≥18 years, is used irrespective of the age used to define early marriage. Each of the scenarios above the <15 years has the lower group nested within it, but excludes the higher group up to 18 years.
Description of sample.
| Traits measured in women’s natal household ( | ||
|---|---|---|
| Median | IQR | |
| Women’s age (y) | 21 | 4 |
| Women’s age at marriage (y) | 15 | 3 |
| Time since marriage (y) | 5 | 5 |
|
|
| |
| Trial intervention arm | ||
| Control | 429 | 17.6 |
| Women’s Group | 446 | 18.3 |
| Women’s Group with cash transfer | 793 | 32.6 |
| Women’s Group with food supplement | 764 | 31.4 |
| Women’s age at marriage (y) | ||
| <15 years | 666 | 27.4 |
| 15 years | 574 | 23.6 |
| 16 years | 356 | 14.6 |
| 17 years | 408 | 16.8 |
| ≥18 years | 428 | 17.6 |
| Women’s education level (y) | ||
| None | 1,610 | 66.2 |
| Primary (1–5 years) | 244 | 10.0 |
| Lower-secondary (6–8 years) | 196 | 8.1 |
| Secondary or higher (≥9 years) | 382 | 15.7 |
| Natal household asset score (quintiles) | ||
| 1: poorest | 525 | 21.6 |
| 2: 2nd poorest | 484 | 19.9 |
| 3: middle | 528 | 21.7 |
| 4: 2nd richest | 465 | 19.1 |
| 5: richest | 430 | 17.7 |
| Natal household agrarian land-holding | ||
| None | 951 | 39.1 |
| 0.01 to 0.5 hectares | 750 | 30.8 |
| 0.51 to 0.99 hectares | 344 | 14.1 |
| ≥1 hectare | 387 | 15.9 |
| Natal household access to big bazaar | ||
| <30 min | 798 | 32.8 |
| 30–59 min | 934 | 38.4 |
| 60–89 min | 472 | 19.4 |
| ≥90 min | 228 | 9.4 |
| Natal household caste affiliation | ||
| Disadvantaged: Dalit | 494 | 20.3 |
| Disadvantaged: Muslim | 468 | 19.2 |
| Middle: Janjati, Terai castes | 927 | 38.1 |
| Advantaged: Yadav, Brahmin | 543 | 22.3 |
Note:
IQR, interquartile range.
Figure 2Heat map of women’s educational attainment by natal household wealth.
Green shaded areas indicate low numbers and red shaded numbers the highest numbers.
Figure 3Association of women’s marriage age and their education level stratified by natal household asset score.
This figure uses the raw data to stratify the association of women’s marriage age with women’s education by natal household asset quintiles.
Hypothesis 1: Associations of natal household asset score with marrying early.
| Model 1: Marrying <15 years | Model 2: Marrying <16 years | Model 3: Marrying <17 years | Model 4: Marrying <18 years | |||||
|---|---|---|---|---|---|---|---|---|
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |||||
| Women’s age (y) | 1.02 [0.97–1.06] | 0.485 | 1.01 [0.97–1.05] | 0.556 | 0.99 [0.96–1.03] | 0.646 | 0.98 [0.95–1.01] | 0.178 |
| Asset score | ||||||||
| Poorest | 2.98 [1.90–4.67] | <0.001 | 2.44 [1.67–3.58] | <0.001 | 2.26 [1.58–3.24] | <0.001 | 1.93 [1.37–2.72] | <0.001 |
| 2nd poorest | 2.39 [1.53–3.71] | <0.001 | 1.68 [1.16–2.44] | 0.007 | 1.57 [1.11–2.23] | 0.002 | 1.41 [1.01–1.97] | 0.043 |
| Mid | 2.12 [1.35–3.31] | 0.001 | 1.83 [1.26–2.66] | 0.001 | 1.74 [1.23–2.47] | 0.001 | 1.52 [1.09–2.12] | 0.013 |
| 2nd richest | 2.34 [1.49–3.69] | <0.001 | 1.93 [1.31–2.83] | 0.001 | 1.90 [1.32–2.73] | <0.001 | 1.72 [1.22–2.43] | 0.002 |
| Richest (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Intercept | 0.52 [0.16–1.72] | 0.286 | 1.46 [0.53–3.97] | 0.462 | 3.11 [1.23–7.86] | 0.017 | 6.00 [2.54, 14.15] | <0.001 |
Notes:
Models include fixed and random effects estimates for geographic clusters and control for trial arm. Grey shading indicates statistically significant associations. As associations of trial arm with early marriage across the age groupings were not statistically significant, they are not reported in Tables. aOR, adjusted Odds Ratio. CI, 95% Confidence Interval.
n = 428 married ≥18 years vs n = 666 married <15 years.
n = 428 married ≥18 years vs n = 1,240 married <16 years.
n = 428 married ≥18 years vs n = 1,596 married <17 years.
n = 428 married ≥18 years vs n = 2,004 married <18 years.
Hypothesis 2: Broader socio-economic factors associated with women marrying early.
| Model 1: Marrying <15 years | Model 2: Marrying <16 years | Model 3: Marrying <17 years | Model 4: Marrying <18 years | |||||
|---|---|---|---|---|---|---|---|---|
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |||||
| Women’s age (y) | 0.99 [0.94–1.04] | 0.670 | 0.98 [0.94–1.02] | 0.401 | 0.96 [0.93–1.00] | 0.047 | 0.95 [0.91–0.98] | 0.003 |
| Asset score | ||||||||
| Poorest | 1.04 [0.58–1.85] | 0.902 | 0.90 [0.55–1.44] | 0.651 | 0.98 [0.63–1.53] | 0.933 | 0.92 [0.60–1.39] | 0.675 |
| 2nd poorest | 1.02 [0.59–1.74] | 0.949 | 0.74 [0.47–1.15] | 0.184 | 0.82 [0.55–1.23] | 0.338 | 0.79 [0.54–1.16] | 0.233 |
| Mid | 0.95 [0.56–1.63] | 0.863 | 0.91 [0.59–1.40] | 0.658 | 1.01 [0.68–1.50] | 0.948 | 0.94 [0.65–1.37] | 0.763 |
| 2nd richest | 1.61 [0.94–2.75] | 0.083 | 1.30 [0.84–2.02] | 0.233 | 1.48 [1.00–2.21] | 0.051 | 1.31 [0.90–1.89] | 0.157 |
| Richest (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Women’s education | ||||||||
| None | 18.43 [10.60–32.03] | <0.001 | 11.50 [7.66–17.28] | <0.001 | 8.00 [5.59–11.47] | <0.001 | 5.65 [4.07–7.84] | <0.001 |
| Primary (1–5 years) | 11.72 [6.06–22.68] | <0.001 | 7.21 [4.30–12.08] | <0.001 | 5.07 [3.18–8.08] | <0.001 | 3.81 [2.46–5.89] | <0.001 |
| Lower-secondary (6–8 years) | 5.23 [2.56–10.66] | <0.001 | 4.56 [2.64–7.88] | <0.001 | 3.96 [2.43–6.45] | <0.001 | 3.43 [2.18–5.41] | <0.001 |
| Secondary/higher (≥9) (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Agrarian land | ||||||||
| None | 1.05 [0.61–1.79] | 0.866 | 1.06 [0.68–1.65] | 0.793 | 0.95 [0.63–1.43] | 0.819 | 0.98 [0.67–1.44] | 0.927 |
| 0.01 to 0.5 hectares | 1.36 [0.81–2.26] | 0.242 | 1.42 [0.93–2.15] | 0.104 | 1.26 [0.85–1.85] | 0.246 | 1.32 [0.92–1.89] | 0.136 |
| 0.51 to 0.99 hectares | 0.96 [0.55–1.69] | 0.895 | 1.08 [0.68–1.70] | 0.746 | 1.09 [0.72–1.65] | 0.688 | 1.09 [0.74–1.60] | 0.671 |
| ≥1 hectare (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Access to big bazaar | ||||||||
| <30 min (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| 30–59 min | 1.09 [0.71–1.68] | 0.682 | 1.15 [0.80–1.64] | 0.443 | 1.03 [0.74–1.44] | 0.841 | 1.09 [0.80–1.48] | 0.605 |
| 60–89 min | 1.11 [0.66–1.87] | 0.702 | 1.17 [0.76–1.80] | 0.471 | 1.01 [0.68–1.51] | 0.954 | 1.01 [0.70–1.46] | 0.967 |
| ≥90 min | 1.32 [0.69–2.53] | 0.409 | 1.14 [0.65–2.01] | 0.650 | 0.90 [0.53–1.52] | 0.687 | 1.03 [0.63–1.68] | 0.912 |
| Caste | ||||||||
| Disadvantaged: Dalit | 0.98 [0.56–1.71] | 0.931 | 1.13 [0.71–1.78] | 0.616 | 1.19 [0.78–1.83] | 0.425 | 1.20 [0.80–1.79] | 0.376 |
| Disadvantaged: Muslim | 1.01 [0.59–1.71] | 0.984 | 0.99 [0.63–1.55] | 0.956 | 1.01 [0.67–1.55] | 0.946 | 1.03 [0.69–1.54] | 0.883 |
| Middle: Janjati, Terai castes | 0.99 [0.63–1.54] | 0.953 | 1.13 [0.78–1.62] | 0.517 | 1.13 [0.81–1.58] | 0.467 | 1.09 [0.80–1.49] | 0.576 |
| Advantaged: Yadav, Brahmin (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Intercept | 0.14 [0.03–0.59] | 0.007 | 0.55 [0.17–1.77] | 0.316 | 1.63 [0.57–4.72] | 0.363 | 4.01 [1.53–10.52] | 0.005 |
Notes:
Models include fixed and random effects estimates for geographic clusters and control for trial arm. Grey shading indicates statistically significant associations. aOR, adjusted Odds Ratio. CI, 95% Confidence Interval.
n = 428 married ≥18 years vs n = 666 married <15 years.
n = 428 married ≥18 years vs n = 1,240 married <16 years.
n = 428 married ≥18 years vs n = 1,596 married <17 years.
n = 428 married ≥18 years vs n = 2,004 married <18 years.
Hypothesis 3: Associations of natal household asset score and marrying early in uneducated women.
| Model 1: Marrying <15 years | Model 2: Marrying <16 years | Model 3: Marrying <17 years | Model 4: Marrying <18 years | |||||
|---|---|---|---|---|---|---|---|---|
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |||||
| Women’s age (y) | 1.00 [0.94–1.06] | 0.951 | 1.00 [0.95–1.05] | 0.923 | 0.98 [0.94–1.03] | 0.474 | 0.98 [0.93–1.02] | 0.316 |
| Asset score | ||||||||
| Poorest | 0.89 [0.46–1.72] | 0.733 | 0.87 [0.48–1.57] | 0.634 | 0.91 [0.52–1.61] | 0.756 | 0.82 [0.48–1.41] | 0.470 |
| 2nd poorest | 0.83 [0.43–1.62] | 0.590 | 0.69 (0.37–1.27] | 0.231 | 0.70 [0.39–1.25] | 0.228 | 0.67 [0.38–1.16] | 0.155 |
| Mid | 0.87 [0.44–1.71] | 0.679 | 0.83 [0.45–1.54] | 0.560 | 0.83 [0.46–1.50] | 0.544 | 0.75 [0.43–1.32] | 0.319 |
| 2nd richest | 1.71 [0.80–3.65] | 0.168 | 1.53 [0.76–3.11] | 0.235 | 1.48 [0.75–2.93] | 0.258 | 1.48 [0.77–2.84] | 0.241 |
| Richest (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Intercept | 3.28 [0.70–15.41] | 0.133 | 7.14 [1.74–29.26] | 0.006 | 12.28 [3.27–46.17] | <0.001 | 17.30 [4.98–60.07] | <0.001 |
Notes:
Models include fixed and random effects estimates for geographic clusters and control for trial arm. aOR, adjusted Odds Ratio. CI, 95% Confidence Interval.
n = 206 married ≥18 years vs n = 530 married <15 years.
n = 206 married ≥18 years vs n = 950 married <16 years.
n = 206 married ≥18 years vs n = 1,170 married <17 years.
n = 206 married ≥18 years vs n = 1,404 married <18 years.
Hypothesis 3: Broader socio-economic factors associated with women marrying early in uneducated women.
| Model 1: Marrying <15 years | Model 2: Marrying <16 years | Model 3: Marrying <17 years | Model 4: Marrying <18 years | |||||
|---|---|---|---|---|---|---|---|---|
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |||||
| Women’s age (y) | 1.00 [0.95–1.06] | 0.959 | 1.00 [0.95–1.05] | 0.995 | 0.98 [0.94–1.03] | 0.482 | 0.98 [0.93–1.02] | 0.338 |
| Asset score | ||||||||
| Poorest | 0.75 [0.36–1.57] | 0.449 | 0.78 [0.40–1.49] | 0.446 | 0.86 [0.46–1.61] | 0.639 | 0.78 [0.43–1.40] | 0.400 |
| 2nd poorest | 0.74 [0.37–1.50] | 0.402 | 0.63 [0.33–1.20] | 0.163 | 0.65 [0.35–1.20] | 0.172 | 0.62 [0.35–1.12] | 0.115 |
| Mid | 0.79 [0.39–1.59] | 0.503 | 0.77 [0.41–1.46] | 0.432 | 0.79 [0.43–1.45] | 0.439 | 0.72 [0.40–1.28] | 0.260 |
| 2nd richest | 1.56 [0.72–3.38] | 0.262 | 1.45 [0.71–2.96] | 0.311 | 1.41 [0.71–2.82] | 0.325 | 1.43 [0.74–2.77] | 0.287 |
| Richest (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Agrarian land | ||||||||
| None | 1.41 [0.72–2.78] | 0.315 | 1.24 [0.69–2.25] | 0.476 | 1.16 [0.65–2.06] | 0.609 | 1.26 [0.73–2.18] | 0.402 |
| 0.01 to 0.5 hectares | 1.59 [0.81–3.11] | 0.179 | 1.48 [0.82–2.68] | 0.196 | 1.46 [0.82–2.59] | 0.200 | 1.67 [0.97–2.89] | 0.066 |
| 0.51 to 0.99 hectares | 1.21 [0.55–2.67] | 0.634 | 1.18 [0.58–2.39] | 0.646 | 1.18 [0.60–2.31] | 0.638 | 1.32 [0.69–2.53] | 0.395 |
| ≥1 hectare (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Access to big bazaar | ||||||||
| <30 min (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| 30–59 min | 0.94 [0.56–1.57] | 0.810 | 0.91 [0.57–1.44] | 0.687 | 0.89 [0.57–1.38] | 0.597 | 0.92 [0.61–1.41] | 0.715 |
| 60–89 min | 1.10 [0.58–2.09] | 0.777 | 1.35 [0.76–2.43] | 0.308 | 1.19 [0.68–2.07] | 0.536 | 1.18 [0.70–2.00] | 0.536 |
| ≥90 min | 1.47 [0.67–3.22] | 0.331 | 1.29 [0.61–2.70] | 0.506 | 1.09 [0.54–2.20] | 0.803 | 1.10 [0.56–2.14] | 0.790 |
| Caste | ||||||||
| Disadvantaged: Dalit | 1.09 [0.54–2.20] | 0.800 | 1.03 [0.56–1.89] | 0.933 | 1.01 [0.56–1.82] | 0.973 | 1.07 [0.61–1.88] | 0.813 |
| Disadvantaged: Muslim | 0.96 [0.50–1.82] | 0.890 | 0.85 [0.48–1.51] | 0.576 | 0.87 [0.50–1.50] | 0.610 | 0.88 [0.52–1.49] | 0.642 |
| Middle: Janjati, Terai castes | 0.96 [0.53–1.74] | 0.904 | 1.00 [0.59–1.69] | 0.996 | 1.00 [0.60–1.66] | 0.996 | 0.96 [0.59–1.56] | 0.865 |
| Advantaged: Yadav, Brahmin (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Intercept | 2.27 [0.40–12.91] | 0.354 | 5.62 [1.16–27.28] | 0.032 | 10.94 [2.48–48.26] | 0.002 | 13.49 [3.31–55.02] | <0.001 |
Notes:
Models include fixed and random effects estimates for geographic clusters and control for trial arm. aOR, Adjusted Odds Ratio. CI, 95% Confidence Interval.
n = 206 married ≥18 years vs n = 530 married <15 years.
n = 206 married ≥18 years vs n = 950 married <16 years.
n = 206 married ≥18 years vs n = 1,170 married <17 years.
n = 206 married ≥18 years vs n = 1,404 married <18 years.
Hypothesis 4: Broader socio-economic factors associated with women being uneducated.
| Model 1: Natal household asset score | Model 2: Broader socio-economic factors | |||
|---|---|---|---|---|
| OR (95% CI) | aOR (95% CI) | |||
| Women’s age (y) | 1.16 [1.12–1.20] | <0.001 | 1.18 [1.14–1.23] | <0.001 |
| Asset score | 1.00 | 1.00 | ||
| Poorest | 11.84 [8.36–16.77] | <0.001 | 8.79 [5.97–12.95] | <0.001 |
| 2nd poorest | 4.01 [2.97–5.40] | <0.001 | 3.60 [2.59–5.01] | <0.001 |
| Mid | 3.18 [2.39–4.23] | <0.001 | 3.16 [2.31–4.34] | <0.001 |
| 2nd richest | 1.68 [1.27–2.22] | <0.001 | 1.68 [1.23–2.28] | <0.001 |
| Richest (ref) | 1.00 | |||
| Agrarian land | ||||
| None | 2.99 [2.15–4.18] | <0.001 | ||
| 0.01 to 0.5 hectares | 1.79 [1.33–2.42] | <0.001 | ||
| 0.51 to 0.99 hectares | 1.17 [0.84–1.63] | 0.351 | ||
| ≥1 hectare (ref) | 1.00 | |||
| Access to big bazaar | ||||
| <30 min (ref) | 1.00 | |||
| 30–59 min | 1.18 [0.90–1.55] | 0.220 | ||
| 60–89 min | 1.16 [0.83–1.60] | 0.387 | ||
| ≥90 min | 1.62 [1.05–2.51] | 0.031 | ||
| Caste | ||||
| Disadvantaged: Dalit | 1.66 [1.18–2.35] | 0.004 | ||
| Disadvantaged: Muslim | 7.12 [4.83–10.49] | <0.001 | ||
| Middle: Janjati, Terai castes | 0.99 [0.76–1.29] | 0.927 | ||
| Advantaged: Yadav, Brahmin (ref) | 1.00 | |||
| Intercept | 0.04 [0.02–0.09] | <0.001 | 0.01 [0.00–0.02] | <0.001 |
Notes:
Models include fixed and random effects estimates for geographic clusters and control for trial arm. Grey shading indicates statistically significant associations. aOR, Adjusted Odds Ratio. CI, 95% Confidence Interval.
n = 822 educated (≥1 year schooling) vs n = 1,610 uneducated.