Health Science Journal

Keywords

Female; Child; Early marriage; Ethiopia

Introduction

Child marriage, also known as early marriage, is defined as “any marriage carried out below the age of 18 years, before the girl is physically, physiologically, and psychologically ready to shoulder the responsibilities of marriage and childbearing. It therefore has major consequences for public health, national security, social development, human rights, economic development and gender equality [1].

These days, the devastating impact of female child marriage continues to be ignored in the developing world. Millions of child brides, some only just past puberty, are denied access to health, education and economic opportunities. The majority of them are burdened with the roles and responsibilities of wives and mothers without adequate support, resources or capabilities. Girls are either seen as an economic burden or valued as capital for their exchange value in terms of goods, money or livestock that is for economic and social reasons, controlling girls’ sexuality which is directly linked to family honor and status for strong social pressure on families to either conform or face ridicule, disapproval or family shame for traditional practices [2].

In the world 10 million girls under the age of 18 marry each year that is around 833,333 a month 192,307 a week 27,397 a day 19 every minute or, around one girl every three seconds [3]. Among these 40 percent and 49 percent of girls were in Central and West Africa respectively. More over 27 per cent were in East Africa and 20 percent in Northern and Southern Africa [4].

The Convention on the Elimination of all forms of discrimination against Women as the current estimates show that approximately 82 million girls in the world between 10–17 years will be married before they reach 18 years of the 331 million girls aged 10–19 in developing countries (excluding China), 163 million will be married before they are 20 [5].

In Ethiopia, female child early marriage is seen as a way to improve the economic status of the family, to strengthen ties between families, to ensure that girls are virgins when they marry, and to avoid the possibility of a girl reaching an age where she is no longer desirable as a wife (“Qoma Qerech”). The practice of female child early marriage is now (for a while) understood to have very harmful effects on the health, psychological, physiological and socio-economic well-being of young girls (as well as for the newborns). However, this knowledge is not broadly shared across most of the population [6].

Ethiopia has one of the highest rates of female child early marriage in the world, with one in two girls marrying before her 18th birthday and one in five girls marrying before the age of 15. However, prevalence rates vary greatly by region and are often higher than national figures, such as in the Amhara region in northern Ethiopia, where almost 50 percent of girls are married by age 15 [3].

Female child early marriage is a public health concern that violates international human rights laws and seriously compromises the development and health of individuals, households, community and countries. Female child marriage has a direct effect on realizing at least six of the MDGs such as causes for poverty, denies to access education, against gender equality and empowerment, increase child mortality and maternal health problems. It has also a risk factor in the spread of HIV and other STIs and erodes the health and well-being of girls and the overall welfare of communities [4].

Among the factors for female child early marriage are socio – cultural, religious, economic security and dependency are some that contribute for the practices of female early child marriage: In many communities, child marriage is a long-standing tradition, since a delayed’ marriage would not be acceptable in the eyes of the community. Getting a daughter married early may be seen as a means of ensuring her and families safety, sexual abstinence and virginity are also considered important values that if not protected will affect the family honor. Moreover, in families where parents cannot provide daughters’ a safe space to live, child marriage is considered to be a protection from risks such as abuse than giving prioritizes for education. In the orthodox religion for deacon to become a priest he should have to marry the virgin girl. According to the orthodox religion ethics the age of marriage is (13 – 15 for girls). Religious leaders further argue that even ‘Eve’ married Adam at the age of 15 years; religious people said that it will be difficult to get virgin if the girls are left to get older, because virginity could be loosed without engaging in sexual intercourse such as heavy work and carrying heavy load they believe that virginity can only be assured at early age [7].

The Amhara region of Ethiopia is extremely impoverished; it is served by few roads, children rarely get more than a few years of education and those who do go to school often walk many miles. It also has one of the highest rates of child marriage worldwide eighty percent of girls in Amhara are married by the time they are eighteen, half by the age of fifteen; and the most common age for a girl to marry is twelve. Child marriage is rooted in religious and cultural traditions based around protecting a girl’s honor, since sex before marriage is seen as an extremely shameful act. A girl’s worth is therefore based on her virginity and her role of being a wife and mother [8].

All relevant laws of Ethiopia, including Article 7 of Ethiopia’s revised family code of 2000 established a legal minimum age at marriage of 18 years for boys and girls as well as much of the education on early marriage prevention clearly indicate that the legal minimum age for marriage is 18 years for both girls and boys. However, a study done in Amhara region shows clearly that the general public’s definition of early marriage for girls uses a much lower cut-off than the legal definition indicating the age cut-off for defining early marriage for female adolescents considered marriages occurring before age 15.3. Moreover, rural respondents reported slightly lower age cut-offs for defining early marriage for girls than urban respondents. Sixty six percent of caretakers knew that the legal minimum age at marriage was 18. Among rural caretakers the proportion who knew that this age was 18 years was 69 percent. The most commonly recognized consequences of early marriage by care takers were increased poverty (54 percent), more obstructed labor (47 percent), high obstetric fistula (30 percent), higher maternal mortality (22 percent), and less education for girls (21 percent) [9].

A survey conducted in Ethiopia shows that among women married before age 15, 82% resided in rural areas and among respondents married before age 15, 97% had mothers with no education and 91% had fathers with no education. In this survey, Mothers and fathers were the main decision makers in arranging these marriages, and the younger the bride, the more pronounced their influence was. Among women married before age 15, some 81% said that their mother had been a primary arranger or supporter of the marriage. In this study the strongest reason for early marriage is the desire or need to maintain the family’s good name and social standing. For some families, the desire to get ‘macha’ (money paid to the girl’s family by the boy’s family upon agreement to marriage) is an incentive to arrange a marriage and family believe that for girls beyond the of age 15 will not get husband because she cannot be managed easily by her husband (she will be stronger than the boy physically and mentally [10].

Early marriage in Amhara region is still high regardless of tremendous efforts attempted by government agencies different non-governmental organizations. Showing the magnitude and contributing factors for early marriage exploring form the practicing community will have a very important contribution for intervention. The findings of this study will help as an input for the policy makers and planners in the area as well as the regional government to respond to the practicing devastating problem; early marriage at all levels of governmental and non- governmental sectors. Furthermore, it will help also as an initiative for further investigation and intervention in the area regarding early marriage for those who will be interested in studying its consequences and related issues.

Methods

Study design

Community-based cross sectional design was carried out.

Study areas and period

The study was conducted in Sinane district Northwest, Ethiopia from June to August, 2014.

Populations

Source population

The source population was all community members in Sinan district who practiced marriage in the last five years prior to the study.

Study population

The study populations was community members in selected kebekes of Sinan district who practiced marriage in the last five years prior to the study

Sample size determination

The sample size was determined using single population proportion formula:

n = (z α /2)2 p (1-p)/d2

n= (1.96)2 (0.448) (1- 0.44)/0.052

where: n= sample size

P= proportion of early marriage in Amahra region (44.8 %) [11].

d: margin of error = (5%)

α: level of confidence = 95%

Considering 10% non –response rate and design effect of 2 for using multistage sampling technique, the final sample size is 837.

Sampling techniques and procedures

Stratified multistage sampling technique was used to select the study participants. First, four out of 17 rural kebeles and 1 out of two urban kebeles were selected by simple random sampling techniques, and households from each kebele were selected by systematic random sampling technique. The sample size for each kebele was allocated proportionally to the size of households. In case, when eligible were absent in the selected household, the next household was considered for interview.

Eligibility criteria

Inclusion criteria: All community members in the study area who practiced marriage in the last five years prior to the study.

Exclusion criteria: Those seriously ill and unable to respond.

Variables of the study

Dependent variable: Female child Marriage

Independent variables

Age, Sex, Education, Families/guardians knowledge regarding early marriage, Religiosity, Social pressure/reasons, Family income/Economic reasons, Parents perceptions regarding early marriage.

Data collection

Data were collected using semi-structured questionnaires adapted by reviewing literatures and suited to the local situation. The questionnaire was prepared first in English and was translated to Amharic (local) version and the local version was used to collect the data.

The data were collected by trained health extension workers and was supervised by 3 supervisors. During data collection, if there were more than one eligible parent / care takers in households, one parent/ care taker was selected randomly.

Data quality control

In order to maintain quality of data, data collectors and supervisors ware trained and questionnaire guide was prepared. Pre-test was done on 5% of the total sample and based on the findings of the pre-test the questions were modified. At every night of data collection day the collected data were checked for completeness and consistency by the principal investigator and supervisors and were communicated to data collectors.

Data management and analysis

The collected data were cleaned and fed to Epi Data version 3.1 and analysis was done by using SPSS version 20 statistical software. Odds ratios and 95% confidence intervals with p-value less than 0.05 as statistical significant were used for data presentation.

Operational definitions

Female child early marriage: is used to refer to girl child making formal union with partner below the age of 18 years.

Knowledge: parent’s knowledge of the minimum legal age of marriage; awareness on child marriage practices and the related reproductive health consequence or not.

Ethical consideration

Ethical clearance was obtained from Ethical review committee of Debre Markos University College of medicine health science. Moreover, data collectors and supervisor were communicated through official letter written from the University and sinane woreda women, Children and youth Affairs, (WCYA) and Woreda administration. Confidentiality of the participants’ response was maintained throughout the research work. Participants were also informed that they will had full right to discontinue or refuse to participate in the study. Each respondent was informed about the objective of the study and its contribution to the society.

Results

Demographic and socio-economic characteristics

A total of 802 participants responded for the interviews making the response rate 95.7 %. Majority (74.6%) of the respondents were fathers and 151 (18.8%) of household heads were mothers. All of respondents were Amhara Ethnically and almost all (99.8 %) were orthodox Christians regarding religion (Table 1).

Table 1: Socio-Demographic characteristics of study participants, in Sinan District, 2014

Variable		Frequency	%
Age of respondents	<= 40	163	20.3
	41 – 50	344	42.9
	51 – 60	223	27.8
	>60	72	9.0
Head of household	Father	651	81.2
	Mother	151	18.8
Residence	Urban	45	5.6
	Rural	757	94.4
Marital status of respondents	Married	661	82.4
	Divorced	60	7.5
	Widowed	81	10.1
Educational status of respondents	No education	515	64.2
	Can read and write	246	30.7
	Primary and above	41	5.1
Household livelihood	Farmer	770	96.0
	Daily laborer	10	1.3
	Merchant	22	2.7
Monthly income of family	<= 450	207	25.8
	451 – 650	211	26.3
	651 – 800	194	24.2
	>800	190	23.7

Table 2 below shows the bivariate and multivariate associations of background characteristics of parents with early marriage practice within the last five years in the study area. The odds of early marriage practice was 12.2(95% C.I: 5.79, 26.23) times higher among rural residents compared to urbanites. Families with monthly income of ranging 451 -650 were 2.5 times more likely to practice early marriage compared to those having monthly income of more than eight hundred (95% CI: 1.2, 4.97). Parents who perceive ideal marital age as less than 18 were 3 (95% CI: 1.47, 7.69) times higher in practicing early marriage compared to those who had perception of ideal marital age as eighteen and above. In the other hand, parents who do not have any idea about the ideal marital age of girls were less likely to practice early marriage (AOR= 0.024, 95% C.I: 0.01, 0.06) than those who perceive ideal marital age as less than eighteen.

Table 2: Association of background characteristics of parents with early marriage practice within the last 5 years in Sinan District, 2014

Variables	Early marriage		OR (95% C.I)		P- value
	Yes	No	COR	AOR
Residence
Urban	11	34	1.00	1.00
Rural	604	153	12.2(5.79, 26.23)	7(3.4, 15.6)*	<0.001
Age of respondents
<= 40	140	23	1.00	1.00
41 – 50	261	83	0.52(0.30, 0.88)	0.6(0.33, 0.19)*	0.149
51 – 60	170	53	0.53(0.3, 0.93)	0.7(0.34, 1.48)
>60	44	28	0.26(0.13, 0.52)	0.3(0.11, 0.86)*
Marital status of respondent
Married	512	149	1.4(0.79, 2.35)	1.1(0.28, 4.1)
Divorced	45	15	1.2(0.52, 2.72)	0.6(0.18, 1.7)	0.571
Widowed	58	23	1.00	1.00
Educational status of respondent
No education	395	120	1.00	1.00
Can read and write	193	53	1.11(0.76, 1.62)	0.9(0.48, 1.51)	0.861
Primary and above	27	14	0.6(0.28, 1.22)	0.96(0.33, 2.86)
Educational status of partner
No education	497	132	1.00	1.00
Can read and write	52	28	0.49(0.29, 0.84)	0.6(0.31, 1.29)	0.136
Primary and above	8	4	0.5(0.14, 2.13)	5(0.58, 49)
Head of household
Father	503	148	1.00	1.00
Mother	112	39	0.84(0.55, 1.3)	0.9(0.27, 2.9)	0.844
Family monthly income
<= 450	178	29	3.6(2.13, 6.03)	1.7(0.8, 3.5)
451 – 650	172	39	2.6(1.59, 4.17)	2.5(1.2, 4.97)*	0.051
651 – 800	145	49	1.7(1.09, 2.74)	1.14(0.58,2.3)
>800	120	70	1.00	1.00
Perceived ideal marital age
<18	201	5	1.00	1.00
>= 18	217	30	0.2(0.06, 0.5)	0.3(0.13, 0.68)*	<0.001
Do not know	197	152	0.03(0.01, 0.08)	0.024(0.01, 0.06)*
Relative wealth of cohabiting family
Much better	120	58	1.01(0.53, (1.92)	1.4(0.7, 2.8)
Better	190	55	1.7(0.9, 3.17)	1.4(0.7, 2.7)	0.643
No difference	260	52	2.4(1.3, 4.59)	0.9(0.38, 2.4)
lower	45	22	1.00	1.00
Knowledge of legal marital age
Know legal marital age	270	159	1.00	1.00
Do not know	345	28	7.3(4.62, 11.45)	12(6.5, 23)*	<0.001
Know someone who was accused of early marriage
Yes	198	126	1.00	1.00
No	417	61	4.4(3.02, 6.27)	4(2.45, 6.75)*	<0.001

Regarding legal marital age, those who did not know the legal marital age were 12 times more likely to practice early marriage compared to parents who know the legal marital age (95% C.I: 6.5, 23). Parents who knew individuals who were accused of early marriage crimes were less likely to practice early marriage compared to their counter parts (AOR= 0.25, 95% C.I: 0.15, 0.41)

Discussion

The odds of early marriage practice was 12.2(95% C.I: 5.79, 26.23) times higher among rural residents compared to urbanites. This finding is in line with a previous study in Ethiopia which showed, the odds that rural residence was associated with a threefold elevation in the odds of marriage at ages 15–17 than urban residents.

Families with monthly income of ranging 451 -650 were 2.5 times more likely to practice early marriage compared to those having monthly income of more than eight hundred (95% CI: 1.2, 4.97). These findings were in line with findings from Ugandan DHS which revealed that women who live in urban areas and those in the highest wealth quintile marry about two years later than those living in rural areas and those in the remaining four wealth quintiles [12]. The latter is also in agreement with a finding of a survey from Dare salaam which showed that parents and guardians living in poverty were often tempted to marry off their young daughters to obtain bride price which they believe will relieve them from economic hardship

Parents who perceive ideal marital age as less than 18 were 3 (95% CI: 1.47, 7.69) times higher in practicing early marriage compared to those who had perception of ideal marital age as eighteen and above. This finding is in line with finding from a study in West Gojjam zone which showed that participants who believed that the girl’s ideal marital age as 15 and below were more likely to practice early marriage than those who believe it as 20 and above. This might be due to that those who practiced early marriage thought as they are doing right.

Regarding legal marital age, those who did not know the legal marital age were 12 times more likely to practice early marriage compared to parents who know the legal marital age (95% C.I: 6.5, 23). This might be due to that those who know the minimum legal marital age may fear to practice early marriage, because they know that early marriage is crime.

Parents who knew individuals who were accused of early marriage crimes were less likely to practice early marriage compared to their counter parts (AOR = 0.25, 95% C.I: 0.15, 0.41). This might be due to that those who have seen others accused, may understand the consequence of early marriage crime.

Conclusion and Recommendation

Variables like residence, family monthly income, perceived ideal marital age, knowledge of legal marital age and knowing someone who was accused of early marriage crime were independent determinants of early marriage practice. Awareness has to be developed in the community regarding the legal marital age and about the consequences of early marriage. Since the majority of the population resides in rural areas and their female early marriage practice is high, emphasis has to be given to the rural dwellers.

Authors’ contribution

All the authors participated in the proposal drafting, data collection, analysis and result writing. The second author; Getiye Dejenu Kibret also prepared the manuscript in addition.

Competing interests

The authors declare that they have no competing interests.

Acknowledgement

We would like to thank Debremarkos University and Gamby College of Medical Sciences for their support; we would like to extend our gratitude to all the study participants.

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