Pourtaheri et al.

BMC Women’s Health (2023) 23:531 BMC Women’s Health

https://doi.org/10.1186/s12905-023-02634-3

RESEARCH Open Access

Prevalence and factors associated with child

marriage, a systematic review
Asma Pourtaheri1†, Seyedeh Belin Tavakoly Sany2†, Monavvar Afzal Aghaee3, Hamideh Ahangari1 and
Nooshin Peyman1*

Abstract
Background Girl child marriage is increasingly recognized as a critical barrier to global public health and gender dis-
crimination. There are still more gaps in the global rate of child marriage and the underlying factors. Thus, the present
systematic review aimed to explore the prevalence of child marriage and the underlying factors.
Methods A comprehensive search was conducted for all English-language studies that measured the prevalence
of child marriage and its correlates from 2000 to March 2022, indexed in PubMed, Scopus, Web of Science, Poplin,
and Google Scholar databases. Child marriage is defined as marriage under the age of 18. In the present study, Joanna
Briggs’ quality assessment checklist was used for data collection. Two independent reviewers reviewed all the articles.
Results In total, 34 eligible prevalence articles and 14 trend articles were included in the study with data from 127,945
participants. The prevalence of child marriage ranged between 1.8% to 90.85%. In most studies, the trend of child
marriage was decreasing. The most important individual factors include the respondent’s education and occupation,
interpersonal factors such as the education and occupation of parents and husband, family size and type. Community
factors include socioeconomic status, region, residence, ethnicity, and religion at the social level.
Conclusion Despite a central focus of research and policies on interventions that decrease child marriage, this phe-
nomenon is still prevalent in many places. Therefore, further specific interventions are required to improve education,
reduce poverty and inequality. This may help achieve the 2030 Sustainable Development Goals.
Keywords Marriage age, Prevalence, Child, Systematic review

Background
The United Nations Children’s Fund (UNICEF) defined
Child Marriage (CM) as marriage occurring at the age
younger than 18 years [1]. Nearly 15 million girls under
the age of 18 marry around the world annually [2]. A total
†
Asma Pourtaheri and Seyedeh Belin Tavakoly Sany contributed as the first number of 750 million women get married during child-
author.
hood nowadays, and this number will be as large by 2030
*Correspondence: unless a significant change is introduced, [3].
Nooshin Peyman
[email protected] CM is a major health and child rights issue in many low-
1
Department of Health Promotion and Education, School of Health, and middle-income countries [4–6]. Human rights experts
Mashhad University of Medical Sciences, Mashhad, Iran argue the practice violates children’s human rights and
2
Department of Health, Safety and Environment management (HSE),
School of Health, Mashhad University of Medical Sciences, Mashhad, Iran threatens their health and development [7]. Much human
3
Department of Epidemiology and Biostatistics, School of Health, rights evidence, over the past few years, has dealt with
Mashhad University of Medical Sciences, Mashhad, Iran child marriage, such as the UN Convention on Consent to

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 2 of 15

Marriage, Minimum Age of Marriage and Registration of economic background, low exposure to mass media and
Marriages (1962) [8], Convention on the Elimination of All religion as the underlying factors of child marriage [34].
Forms of Discrimination against Women (1979) [9], Con- A combination of child marriage with political, economic
vention on the Rights of the Child (1989) [10]. According and religious matters has led to inaccurate statistics in many
to the Convention on the Rights of the Child, one criterion countries, which challenges preventive policies. Compre-
for international development is the percentage of women hensive information helps understand the prevalence rate of
population married before the age of 18 (10). In addition, child marriage in different contexts and provides a perspec-
the percentage of women married before the age of 18 is tive for policymakers to develop appropriate intervention
included in the annual report on the achievement of the strategies. In addition, recognition of the main influential
UN Sustainable Development Goals [11]. factors underlying child marriage could contribute to sys-
The growing focus on CM as a global development issue tematic interventions against these factors. Therefore, the
also appears to reflect growing concern over its poten- objectives of the present study were: 1) to systematically
tial impact on the population health. United Nations review the prevalence of child marriage in different parts of
Children’s Fund (UNICEF), the World Bank, the United the world 2) to represent trends in child marriage over time
Nations Population Fund (UNFPA) consider the potential 3) to recognize the factors that affect child marriage.
adverse effects on health a great concern [12, 13].
Girls who marry under the age of 18 come to have chil-
dren at an early age [3, 14]. Studies have shown that they Methods
Design of study
have less control over their fertility. For example, they have
less access to contraception, have more unwanted preg- In the present review, the Preferred Reporting Project for
nancies, have higher chances of terminating pregnancies, Systematic Review (PRISMA) was used along with the
and have shorter intervals between childbirths [15, 16]. As PICO framework to explore the prevalence of child mar-
a result, they are at a higher risk of obstetric complications, riage and the underlying factors [35]. Review techniques
known as the leading cause of mortality among adolescents were used to address the following research questions.
in low- and middle-income countries [17, 18]. Girls mar-
ried early are more likely to experience domestic violence 1. What is the global prevalence of child marriage?
[19, 20]. The risk of sexually transmitted diseases (STD) 2. What are the trends in child marriage in different
increases in this population [21, 22]. Also, early marriage parts of the world?
affects girls’ psychological well-being [23, 24]. 3. What factors account for child marriage?
Several studies have explored the correlates of child
marriage. Child marriage is common among poor fami-
lies because there is little motivation or resource to invest Information sources and search strategy
in future [25]. The loss of educational opportunities, The prevalence of child marriage among married women
unemployment are related to poverty [26] and natural was explored from January 2000 to March 2022 in five data-
vulnerabilities also reduce economic functioning, thus bases, including Scopus, PubMed, Web of science, Poplin
negatively affecting poor households [27]. Social, reli- and Google Scholar to review the related gray literature.
gious, cultural and traditional beliefs and norms play a According to Haddaway [36], most gray literature
major role in the continuation of early marriage [28]. appears in the first 200 citations provided by Google
An essential step to achieve the fifth goal of the Sustain- Scholar. Haddaway suggests that the reviewers focus
able Development Goals 2030 (SDGs), concerning the on the first 200–300 records. As suggested, the first 300
elimination of all forms of violence against women, entails records were retained and sorted by relevance.
the preventative interventions for child marriage. How- The search terms included Medical Subject Headings
ever, this act of elimination by 2030 will require a substan- (Mesh), free words, and selected keywords. The keywords
tial acceleration, equivalent to a 23% reduction [29]. included "early marriage", "teenage marriage", “prevalence”,
Despite the growing literature on strategies and meth- “Incidences”, "Incidence Proportion", "Cumulative Incidence",
ods to reduce child marriage [30–32], there is no sys- "Incidence Rate". The main components were combined by
tematic review on the prevalence of child marriage and Boolean operators (AND, OR) in the search strategy.
the underlying factors. In a systematic review, Zaman Here is an instance of search strategy in PubMed:
reported that about 1% of 15- 19-year-old population in (((((("early marriage"[Title/Abstract]) OR ("spouse
Canada were in common-law unions or married in 2016 child"[Title/Abstract])) OR ("teenage marriage"[Title/
and there was no national estimation of the frequency Abstract])) OR ("adolescent marriage"[Title/Abstract]))
of child marriage [33]. In a review of rural residence, OR ("child bride"[Title/Abstract])) OR ("forced
Nasser Subramanee introduced low education level, poor marriage"[Title/Abstract])).
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 3 of 15

AND extracted according to the purpose of study: (1) authors/

publish year, country of origin, type of participants, total
((((((((Prevalence[Title/Abstract]) OR (Incidences[Title/
papulation, sample size, girls married (number of ado-
Abstract])) OR ("Incidence Proportion"[Title/Abstract]))
lescents who got married under the age of 18), marriage
OR ((Proportion[Title/Abstract] AND Incidence[Title/
age range, prevalence of child marriage (2), and factors
Abstract]))) OR ("Cumulative Incidence"[Title/Abstract]))
underlying child marriage. The results of all studies were
OR ((Incidence[Title/Abstract] AND Cumulative[Title/
collected according to the purpose of study and research
Abstract]))) OR ("Incidence Rate"[Title/Abstract])) OR
question. A total number of 28 eligible articles and
((Rate[Title/Abstract] AND Incidence[Title/Abstract]))).
14-trend articles were included in the study. In addition,
Finally, we came across additional studies through a 6 studies were added by searching in the reference list of
manual search of references. articles. Finally, 34 scientific papers and 14 trend articles
were included.
Selection process: inclusion and exclusion criteria
The PICO-SD guidelines were followed, including Risk of bias assessment
patients, interventions, comparisons, outcomes, and Joanna Briggs’ Quality Assessment Checklist was used
study design to extend the criteria. The inclusion criteria for Cross-sectional Analytical Studies [37]. This checklist
were married women under the age of 18, and a report of contains eight questions. Two questions were not used
the prevalence of child marriage. As part of our supple- in the present study, as they were objective in type. They
mentary information, the details of inclusion and exclu- explored whether standard criteria were used to measure
sion criteria are summarized in Table S1. the condition, and whether the outcome behavior was
Letters to the editor, intervention studies, qualitative measured in a valid and reliable way. Thus, the quality of
studies, reviews, case reports, meeting summary reports, the studies was evaluated with 6 questions.
and studies that did not report the sample size were
excluded. According to the UNICEF, child marriage is Extraction of the prevalence of child marriage
defined as marriage under the age of 18. In 28 of the overall 34 articles, the prevalence of child
marriage was stated directly [38–65], and it was consid-
Identification and selection of studies ered as the prevalence rate. However, in five articles, the
All potentially relevant studies in each database were prevalence was not mentioned directly [66–70]. Thus, the
imported into electronic reference management software prevalence was estimated as the proportion of the girls
(EndNote X8.8) and spreadsheets (Excel 2016). Arti- married under 18 years to the total population.
cle selection for the present review was done in several
steps by two independent researchers. In the first step, Evaluation of trend studies
duplicate studies were eliminated. In the second step, the The Average Annual Rate of Reduction (AARR) was
title and abstract of each study were screened accord- computed using the following equation to check relative
ing to some predefined inclusion and exclusion criteria. trends:
The articles that did not meet the inclusion criteria were
1
removed. To determine eligibility, the full text, methods, AARR(%) =
and results sections were read. In the present review, years between survey
only the articles that were totally agreed to be included prevalence at second survey
× In
by both reviewers were included. When there was a disa- prevalence at first survey
greement about the eligibility of an article, it was resolved × 100
by referring to the third researcher. (1)
AARR in Eq. (1) represents the average relative decline
Data extraction in child marriage each year.
Two independent authors (A.P and B.T) extracted data SDG target 5.3 refers to the "Elimination of early child-
from studies through parallel processes. hood and forced marriage" by 2030.
Through discussion or consultation with the third and To assess whether countries are on track to achieve this
fourth reviewers, any doubts and disagreements between goal, the prevalence of EM in 2030 was anticipated for
the authors (M.A and N.P) regarding the data extraction each country using the following equation:
were resolved.
For the independent double data extraction, a pre- 2030 prevalence(%) =prevalence at second surevey
designed table was used to suit systematic reviews × (1 − (0.01 × AARR))n
and extract the following information. The data were (2)
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 4 of 15

The AARR for each country is calculated using A study reported the phenomenon of child marriage
formula (1), and n represents the number of years among Syrian refugees. This study was excluded due to
between a country’s most recent survey and 2030 [71]. the high rate of child marriage in this population and the
potential bias in results [86].
The sample size ranged between 300 [44] and 22 807
Analysis [72]. The studies included were published between
Extensive data on the prevalence of child marriage needed 2005 and 2021, but they were mostly published in
to summarize the studies descriptively and evaluate them 2019–2021 (n = 15, 44.11%). In total, the data were col-
qualitatively. Therefore, no meta-analysis was done. It was lected from 14 countries. In terms of geographic dis-
very intuitive and practical to combine the results into tribution, 15(44.11%) of the included articles had been
categories of related factors, such as education, socioeco- conducted in South and Southeast Asia [38, 39, 44,
nomic status, and parental conditions. These categories 45, 48, 50, 51, 57–61, 69, 70, 72], 16 in Africa (47.05%)
emerged from the data and were not predetermined. [40, 41, 43, 47, 52–56, 62–68], and three in the East-
ern Mediterranean (8.82%) [42, 46, 49]. Two countries,
Results Bangladesh (n = 7) [38, 39, 45, 48, 50, 61, 69] and Ethi-
Search outcome: study design opia (n = 8) [43, 53–55, 62, 63, 65, 68] accounted for
The systematic review included 32 prevalence articles approximately half of the studies included in the pre-
[38–50, 52–70, 72], two theses [40, 51] with data from sent review.
127,945 participants, Of these participants, 82,147 were Overall, the majority of studies (n = 33, %97.05) were
married under the age of 18 and there were also14 trends conducted in low- and middle-income countries [87].
articles [71, 73–85] (Fig. 1, Table 1). All included studies followed a cross-sectional design.

Fig. 1 PRISMA flow chart diagram describing selection of studies for systematic review on Prevalence and factors relating of child marriage
Table 1 Summary characteristics of cross sectional studies included in the systematic review
a b c
Author/year Country Income Type of participant Total population Girls married Marriage Age range Prevalence of
child marriage
(%)

1 Rahman 2005 [38] Bangladesh Lower-middle Adolescents aged 3362 2256 16.2 ± 1.9 67.1
10–19 years
2 Raj/ 2009 [72] India Lower-middle Married—aged 20–24 years 22 807 7730 < 18 44.5
3 Nasrin/ 2012 [39] Bangladesh Lower-middle Married women 609 510 < 18 83.7
4 Adams/ 2013 [40] Nigeria Lower-middle Adolescents 10–19 years 397 17 16.1 ± 2.3 11
and parents
Pourtaheri et al. BMC Women’s Health

5 A Ali 2014 [41] Sudan Low Ever married women 1700 781 15.4 45.9
aged ≤ 35 year
6 Al Ridhwany 2014 [42] Iraq Upper-Middle Married women in child- 1302 204 18.5 ± 4.2 15.7
bearing age having at least
two living children
(2023) 23:531

7 Asrese 2014 [43] Ethiopia Low-Income Currently married or ever 476 395 < 18 83
married
8 Dharan. 2014 [44] Nepal Lower-Middle Women aged 15 to 45 years 300 208 < 18 69.3
9 Sumon 2014 [45] Bangladesh Lower-Middle Married aged 600 538 15–19 89.7
less than 50 year
10 Ghrayeb/ 2015 [46] Palestinian - Rural married women 500 207 < 18 41.4
11 Envuladu 2016 [47] Nigeria Lower-Middle Secondary School Girls 4013 74 < 18 1.8
Within The Ages Of
10-25 years
12 Islam 2016 [48] Bangladesh Lower-Middle Ever-married women aged 17,808 13,837 < 18 77.7
12–49 years
13 Hamed/ 2017 [49] Egypt Lower-Middle Ever-married women aged 1064 640 17.86 ± 3.27 60.15
20–60 years
14 Mpilambo, 2017 [66] Congo Low Young women aged 3481 2238 16.7 64.29
15–24 years
15 Rahman 2017 [50] Bangladesh Lower-Middle Married women aged 15 16,830 12,740 < 18 75.04
to 49 years
16 Groot 2018 [67] Ghana Lower-Middle Ever-married women aged 1943 509 < 18 26.19
20–29 years
17 Pham 2018 [51] Viet Nam Lower-Middle Girls from young 424 55 < 18 12.8
18 Basazinewu/2018 [55] Ethiopia Low women’s of 15–50 years 350 318 < 17 90.85
19 Rumble 2018 [70] Indonesia Lower-Middle women aged 20 to 24 6578 938 15.82 ± 0.05 14.27
20 Ahonsi 2019 [52] Ghana Lower-Middle women aged 20–24(GDHS) 1613 334 17.7 20.68
21 Bezie/ 2019 [53] Ethiopia Low married women aged 373 167 17 ± 3.2 44.80
15–49 years
22 Gashaw 2019 [54] Ethiopia Low married women age 9262 5942 < 18 64.2
15–49 year
Page 5 of 15
Table 1 (continued)
a b c
Pourtaheri et al. BMC Women’s Health

Author/year Country Income Type of participant Total population Girls married Marriage Age range Prevalence of
child marriage
(%)

23 Kalum 2019 [56] Congo Low women of childbearing age 5304 1227 12–18 23.1
24 Alem/ 2020 [68] Ethiopia Low all women aged from 15– 11,646 7322 < 18 62.87
49 years
(2023) 23:531

25 Chowdhury 2020 [69] Bangladesh Lower-Middle - 8,699 7,046 < 18 80.99

26 Manandhar/ 2020 [60] Nepal Lower-Middle Married women age 358 187 17.2 52.2
less than 50 years
27 Talukder 2020 [61] Bangladesh Lower-Middle married women aged 15–49 17,883 10,551 59
28 Tekile/2020 [62] Ethiopia Low all female community 1120 544 15 48.57
members
29 Berliana 2021 [57] Indonesia Lower-Middle reproductive women aged 7207 1009 15–19 14
15– 49 years
30 Hasanah 2021 [58] Indonesia Lower-Middle married women 1687 909 < 18 53.9
31 Roy 2021 [59] Bengal Lower-Middle married women 15–49 years 357 230 < 18 64.42
32 Aychiluhm/2021 [63] Ethiopia Low All women aging 2887 2098 < 18 73
15–49 years
33 Bengesai/2021 [64] Zimbabwe Lower-Middle Ever-married women aged 2380 821 24.2 ± 2.7 36.8
between 20–29 years
34 Masresha 2021 [65] Ethiopia Low adolescent women 597 232 17.62 ± 1.36 38.9
between the ages of 15
to 19
a
This information was followed linked; https://​datat​opics.​world​bank.​org/​world-​devel​opment-​indic​ators/​the-​world-​by-​income-​and-​region.​html
b
Total papulation that was examined in these studies
c
Total girls that got married under 18 year
Page 6 of 15
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 7 of 15

About 47% (n = 16) of studies relied on data from the Related factors to child marriage
National Survey and the Demographic Health Survey The factors that influence individuals at a personal level
(DHS) [48, 50–52, 54, 57, 58, 61–64, 66–69, 72]. can contribute to a girl being more likely to marry at a
young age. Interpersonal factors that increase the likeli-
Risk of bias assessment hood of a girl getting married at a young age are influ-
Four studies met the inclusion criteria. Only one study enced by her relationships with family members, peers,
used a valid and reliable method to measure exposure. and teachers. The level of presumption has an impact on
Sixteen studies identified confounders. Eleven described a girl’s immediate social circle, which consists of her fam-
details of the setting and subjects. Strategies to control ily members, peers, and schoolmates. These individuals
the confounders were adopted in 26 studies. play a role in shaping her behavior and overall experi-
Appropriate statistical analyses and valid ways to meas- ences. The influences at the community level refer to the
ure outcomes were used in 26 studies. More details of the factors that raise the risk level based on the community
quality assessment of articles are shown in Table S2. and social surroundings, particularly schools and neigh-
borhoods. Societal level influences refer to broader fac-
tors that have an impact on child marriage. These factors
Prevalence of child marriage
include religious or cultural beliefs, and societal norms
Most articles (n = 31,91.17) aimed to show the preva-
that contribute to or maintain disparities between differ-
lence and determinants of child marriage, and two
ent groups of people.
(5.88%) focused on knowledge about and attitudes
We categorized the factors related to child marriage
towards child marriage [38, 40]. In the present sys-
based on the Social Ecological Level, which consists
tematic review, there was considerable variation in the
of four levels that influence a child’s life: the individual,
prevalence of child marriage. Different estimates of
interpersonal, community, and societal levels. The fac-
the prevalence of child marriage were reported in the
tors that influence individuals at a personal level can
same country at the same time. Instances are Bezie [53]
contribute to a girl being more likely to marry at a young
and Gashaw [54] from Ethiopia (2019), Berliana [57]
age. The interpersonal level influences are factors that
and Hasanah [58] from Indonesia (2021). The reported
increase the risk of a girl getting married early because
prevalence of child marriage ranged from 12.8% [51] to
of her relationships with family members, peers, and
89.7% [45] in Asia 1.84% [47] to 90.85% [55] in Africa
teachers. The level of presumption influences a girl’s clos-
and 15.7% [42] to 60.15% [88] in the Mediterranean.
est social circle, which includes family members, peers,
and school partners who shape her behaviors and experi-
ences. The influences at the community level refer to the
Trends in child marriage
factors that raise the risk level based on the community
Fourteen trend papers were found among national and social surroundings, particularly schools and neigh-
studies [71, 73–82, 84, 85]. More than 78.50% (n = 11)
borhoods. Societal level influences refer to broader fac-
of the articles reported child marriage trends in Asia
tors that have an impact on child marriage. These factors
[71, 73, 74, 76–82, 85]. Two articles were conducted in
include religious or cultural beliefs, societal norms that
Africa (14.28%) [83, 84] and one in the United States
contribute to or maintain disparities between different
(7.14%) [75].
groups of people [89].
The trend of child marriage has been declining in
Individual factors related to child marriage include
most studies (n = 12, 85.71%), with an exception of
the low education of respondents [38–45, 48–50, 52–54,
Iran, where the prevalence of child marriage increased
56–63, 65, 66, 68–70, 72], unemployment of respond-
from 10.27 to 11.21 in 2006–2016 (AARR = 0.87)
ents [38, 45, 48, 54, 66], limited knowledge about the
[80] and China, where the prevalence of child mar-
complexities of marriage, pregnancy, and marriage laws
riage increased from 2.41 to 2.85 in 2000–2010 [38, 43, 49, 62, 65], and engaging in sexual activity before
(AARR = 1.67) [85]. The highest decrease was observed the age of 17 [64, 66]. Interpersonal factors related to
in India in 2016–2006 (AARR = -3.63) [71] and the child marriage include the husband’s low education
lowest decrease was in West Africa in 2014–2006 [39, 41, 42, 44, 45, 48, 50, 53, 54, 61, 64, 68–70, 72], the
(AARR = -0.58) [83]. husband’s occupation as a worker or farmer [44, 50],
The prevalence of child marriage in 2030 was esti- low parental education [41, 42, 47, 53, 59, 65], parents
mated using a formula based on the prevalence working as farmers [47, 56] or low-skilled jobs [41, 42],
reported in the study. Bangladesh is predicted to have having a family size of more than 5 [41, 47, 49, 50, 70],
the highest number of child marriage followed by the and belonging to a nuclear [45], or extended [42] fam-
United States [75] (Table 2).
ily type., decision-making by parents [38, 44, 63, 68],
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 8 of 15

Table 2 Studies of child marriage trends included in systematic reviews

a
Author Continent Country Year Duration Time Prevalence Of CM (%) AARR​ Prevalence
Of CM 2030
(%)

Moor/2009 [73] Asia India 1992–2006 14 50–45 -0.74 35.1

Marshan/2013 [74] Asia Indonesia 2001–2010 9 18.2–13.5 -3.31 10.26
Marashi/2017 [75] American United States 1992–2013 21 1.1–0.8 -1.49 0,64
Modak/2018 [76] Asia India 2011–2016 5 31.88 -26.8 -3.47 22.78
Biswas/2019 [77] Asia Bangladesh 2004–2014 10 69–52 -2.82 42.12
MacQuarrie/2019 [78] Asia Bangladesh 1993–2011 18 41–20 -3.58 11.4
India 1998–2016 18 64–45 -1.76 37.35
Indonesia 1991–2012 21 50–37 -1.41 29.6
Nepal 1996–2016 20 75–55 -1.55 44
Wahyudi/2019 [79] Asia Indonesia 2000–2014 14 2.65–1.96 -2.14 1.41
Kumar/2020 [81] Asia India 1993–2011 18 87–77 -0.61 63.91
Paul/2020 [82] Asia India 1992–2016 24 54.2–26.8 -2.88 16.34
Azimi/2020 [80] Asia Iran 2006–2016 10 10.27–11.21 0.87 9.64
Scott/2021 [71] Asia Bangladesh 2007–2014 7 77–69 -1.55 64.17
Nepal 2005–2016 11 63–52 -1.72 46.28
India 2006–2016 10 59–41 -3.63 29.93
Pakistan 2008–2018 10 50–37 -3.01 25.67
Fatusi/2021 [83] African West Africa 2006–2014 8 43.5 -41.5 -0.58 39.84
Sagalova/2021 [84] African West And Central Africa 1990–2010 20 37.3–24.9 -2.02 16.43
Fan/2022 [85] Asia China 2000–2010 10 2.41–2.85 1.67 2.30
a
Average Annual Rate of Reduction

consanguineous marriage (marrying close relative) [42, countries marked by the highest rate of early marriage
49], Community factors related to child marriage include in the world, with one in two girls married before the
low socio-economic status [39, 44, 48–54, 56–59, 61–63, age of 18 and one in five married before the age of 15. It
66, 70, 72], rural residence [41–43, 48–52, 54, 57, 62–64, can be due to the acts of discriminating girls by parents,
66, 69, 70, 72]. region (regional division in a country) adhering to the traditions and norms of society, leav-
[47, 48, 50–52, 54, 61, 66, 68, 72], Kurdish, Arab [42], ing natural gifts behind after marriage, forming a social
Dalit [44], Gurma [52], Sundanese [58], Foreign/Non- bond (kinship), maintaining virginity and preventing
Congolese and Cuvette central ethnicity [66], Addition- sex before marriage, purchasing dowry (for financial
ally, the lack of access to media is also a significant factor benefits) [55].
[43, 45, 54, 57, 65, 66, 70] and Societal factors related to In 2016, Nigeria had the lowest prevalence of child
child marriage include Islam [39, 47, 50, 52, 54, 69], Hin- marriage (%1.8) [47]. This study measured the preva-
duism [60, 72], Orthodox [54] religions, and no religions lence of child marriage among high school girls. Overall,
[52]. Factors associated with child marriage are shown in female students are less likely to marry, and those who
Tables 3 and 4. get married lose the opportunity to continue education
because of the house chores and child care-taking tasks.
The trend of child marriage in India has declined signif-
Discussion icantly (AARR -0.61 to -3.63). The improvement in wom-
Child marriage adversely affects children and society in en’s education and the wealth of married couples during
many ways. The development of interventions depends the past decade can be a major reason. The furtherance
on access to comprehensive information on the preva- of women’s education in India reduced child marriage by
lence of child marriage and its geographic distribution. 38% [71].
Thus, the purpose of the present study was to measure However, the trend of child marriage seems to be
the prevalence of child marriage, the associated factors, increasing in Niger, Nigeria and Côte d’Ivoire. Living in
and the trend of child marriage. rural areas, low education and poverty were the fore-
Ethiopia was found to have the highest rate of child most factors affecting child marriage in these regions.
marriage in 2018 (%90.85) [55]. Ethiopia is among the In addition, in these countries, planning to reduce child
Table 3 A summary of factor associated with child marriage in the article
Articles Education of Socio-economic Residence Husband’s Religion Region Ethnicity Access to Parental Respondent’s
Respondents status education Media education Job

1 * *
2 * * * * * *
3 * * * *
4 *
5 * * * *
Pourtaheri et al. BMC Women’s Health

6 * * * * *
7 * * *
8 * * * *
9 * * * *
10
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20 * * * * * *
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23 * *
24 * * *
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26 * *
27 * * * * *
28 * * *
29 * * * *
30 * * *
31 * * *
32 * * *
33 * * *
34 * * *
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Table 3 (continued)
Articles Knowledge Family size Parent’s Family Type Parental decision Consanguineous Age of first sex Husband job Others
occupation making marriage

1 * *
2
3
4
5 * *
Pourtaheri et al. BMC Women’s Health

6 * * * *
7 *
8 * *
9 *
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14 * *
15 * *
16
17 *
18
19 *
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22
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24 *
25 *
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27
28 *
29
30
31
32 *
33 * *
34 *
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Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 11 of 15

Table 4 Determinants of child marriage in the social ecological framework

Summary of Findings Determinants Social Ecological Level

Girls with lower levels of education are more vulnerable to early marriage Education of Respondents Individual level
Girls who do not work are often married at a young age Respondent’s Job
Participants’ awareness and literacy levels regarding the consequences of early marriage, Knowledge
pregnancy, and the legal age are related to early marriage. Awareness of these factors can be
associated with a reduction in early marriage
Girls who have their first sexual experience before the age of 17 are more likely to marry Age of first sex
at a young age
Men with low levels of education are more likely to marry underage girls Husband’s education Relationship level
Men who worked as farmers and laborers were more likely to marry young girls compared Husband job
to men in other occupations
Parents with low education often see their daughters marrying at a young age Parental education
Child marriage was more common among parents who were farmers or had jobs that required Parent’s occupation
little skill
Child marriage is more common in large families with more than four children Family size
Child marriage is more common in nuclear and extended families Family type
Young girls often lack the authority to make decisions regarding their own marriage, as it is typi- Parental decision making
cally determined by their families
Younger girls are more likely to marry their relatives Consanguineous marriage
Low socio-economic status encompasses factors such as family income, social class, wealth Socio-economic status Community level
index, and overall socio-economic status. If a family has a low socio-economic status, the likeli-
hood of early marriage increases
Girls marry more frequently in rural areas Residence
The division of regions in a country can affect child marriage, for example, the north and south. Region
Child marriage is more prevalent in underdeveloped regions
Child marriage is more common among Kurdish, Arab, Gurma, Agew, Sundanese, Foreign/Non- Ethnicity
Congolese, and Cuvette Central ethnicities
Girls who lack access to media are more likely to marry at a young age compared to girls who Access to Media
have access to media
Child marriage is most prevalent among Muslims. This practice is also observed among Hindus, Religion Societal level
Orthodox, Protestant and non-religion

marriage seems to be scarce and these countries fail to the right decision about their lives [41, 57, 63, 66, 88, 90].
apply an accurate evaluation mechanism [83]. They spend time studying [47, 54] and have the oppor-
In two studies in Iran and China, the trend of child tunity to land a job to delay marriage [49, 59]. Educa-
marriage was increasing. In Iran, the trend has decreased tion not only prevents girls from getting pregnant and
in the age group of 10–14 years, but has increased in the sick, but also improves their social and economic status,
age group of 15–19. It should be interpreted with cau- allowing them to live in cities [45]. Educated girls can
tion because distinguishing age groups can overestimate contribute to the health and well-being of their families,
the prevalence of child marriage. However, changes in and they tend to marry men of their own age [60]. Una-
demographic policies should not be ignored [80]. Child vailability of education for any reason including insur-
marriage is more prevalent in China’s western prov- gency and armed conflict increases the likelihood of child
inces (Yunnan, Xinjiang, Qinghai, Ningxia, Tibet, and marriage [66]. In parts of Ethiopia, social norms are so
Guizhou). The population of women, autonomous ethnic strong that awareness fails to prevent child marriage. Vir-
minorities and poverty is the most important underlying ginity assurance, access to resources and safe future are
reason [85]. the most important norms in this country to encourage
child marriage [43, 63].
Related factors Age of starting sex was associated with early marriage.
A girl’s education was the major individual factor asso- Increased libido in young people around the world can
ciated with child marriage. Education promotes girls’ possibly explain this issue [64, 66].
awareness of all aspects of reproductive health and the Education also plays an important role among the
negative outcomes of pregnancy [53, 58, 62, 70, 90]. Edu- interpersonal factors associated with child marriage.
cated girls are better aware of their rights and can make Low education also affects parents’ understanding of
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 12 of 15

the nature and purpose of marriage, economic factors, and beliefs in people, poverty, natural disasters, dif-
environmental factors, personal desires, religious fac- ferences in urbanization, and religion. Differences in
tors, early marriage culture, and adolescents’ perception socioeconomic development across regions have led to
of free sex [58]. Farmer parents usually have low educa- growth in education [47], and increased access to the
tion and socio-economic status, which can be a reason internet, media and information [50, 51]. Girls in devel-
for their daughters’ early marriage [47, 56]. Husband’s oped and urban places of residence tend to delay mar-
education is also effective in child marriage. Girls who riage as most of them have higher education and more
marry early mostly have uneducated husbands. Gener- job opportunities than peers in less developed places
ally, men tend to marry women who are less educated [48, 50, 51, 57]. In rural areas, women may not ade-
(than themselves), and as a result, average-educated men quately perceive the impact of marriage on their health,
choose women with an average or below-average level of education, economy, and even their rights [63]. What’s
education, which eventually leads to early marriage [50]. more, the socio-economic status and traditional norms
Increasing men’s awareness of the adverse effects of early differ across geographical regions, which can encourage
marriage can reduce the rate of marrying girls under 18 child marriage [50].
years [61]. Husband’s occupation also affects children’s Ethnicity affects child marriage through cultural
marriage due to the education level. Manual workers and norms and education level. In Arab nations, cultural
farmers marry children because of their low education norms promote child marriage [42]. Parents’ decision
level [50]. Family size and type can also affect child mar- to marry children under the influence of traditions is
riage. Child marriage has been reported in large families another factor affecting child marriage. In Nepal, where
[51, 53], and nuclear families [45] both, so it is difficult to the Sundanese have the highest number of child mar-
establish the relationship between family type and child riages, the traditional customs and cultural factors
marriage. Yet, there is evidence to support the finding of these ethnic groups make parents responsible for
that households of more than 5 are associated with child deciding on the right man to marry; thus, girls do not
marriage [41, 47]. have the right to make independent decisions [58].
At the community level, various factors were found to be At the societal level, religion was the sole factor associ-
related to child marriage, with one of them being socioec- ated with child marriage. Child marriage is more preva-
onomic status.. In societies with a low socio-economic sta- lent in certain religions, such as Islam [39, 47, 50, 69]
tus such as India [72], Bangladesh [39, 48, 50, 61], Ghana and Hinduism [60, 72]. There is no clear answer to how
[52], Ethiopia [53, 54, 62], and Indonesia [57, 70], early religion affects child marriage. The classic interaction of
marriage reduces financial burden, increases income and religion and culture [91] and the absence of a legal age
improves economic conditions. Adolescents from poor for marriage [92] can increase the rate of child marriage.
families do not have jobs, and parents with low income Instances of sociocultural norms [68] are the priority of
cannot afford the living expenses of young girls. In these marrying a family’s eldest son in Bangladesh [50], virgin-
conditions, girls are considered as a burden, and with mar- ity of girls in Ghana [52] and Ethiopia [68], the desire for
riage, the family’s economic pressure is lowered. In fact, in normative structures such as kinship and extended family
these families, child marriage has been considered an eco- [54], family desire to maintain a good name [93, 94], stig-
nomic strategy [38, 50, 52–54, 59, 70]. matizing single girls [95] and limited right of decision-
Sometimes, girls’ stubbornness, curiosity or materialis- making [96]. As a result of this rigid marriage tradition, it
tic desires lead to marriage [52]. In Ethiopia (2021) new forces young women to marry at a young age.
brides provide income for their families mainly through
"macha" (money and livestock paid by the groom’s fam- Limitations of study
ily). In poor families, the loss of educational opportuni- There are several limitations in the present study. The
ties [57, 59], and low parental awareness of the adverse first point to consider is that the search was for English-
effects of early marriage increase child marriage [50]. language articles only. Thus, if an article was published
Poverty is exacerbated in areas prone to natural disas- in other languages, it was not retrieved in the present
ters, making it difficult for the poor to pay their dowries. review. Second, there is a risk of generalizing the pre-
In these circumstances, parents’ concern for girls’ safety sent findings because most articles are from low-income
increases [48]. Regional as well as religious differences countries. Third, the extensive data made it hard to per-
can also account for the rate of early marriage [90]. form a meta-analysis; thus, it was decided to review the
Research evidence shows that the place/region of studies qualitatively. Fourth, the present search origi-
residence also affects child marriage as it sets the stage nally aimed to find the prevalence of child marriage.
for education, awareness, job opportunities, required However, a review of the data led to the emergence of
amenities, access to mass media, formation of norms factors associated with child marriage. There were no
Pourtaheri et al. BMC Women’s Health (2023) 23:531 Page 13 of 15

effective factors in the search process, so many studies Availability of data and materials
All data related to this study are reported in this document.
that investigated effective factors were missed, yet this
study can be a good guide for future researchers.
Declarations
Conclusion Ethics approval and consent to participate
The present study showed that the prevalence of child Ethics approval was received from the ethics committee of deputy of research
and technology, Mashhad University of Medical Sciences (IR.MUMS.FHMPM.
marriage is high in many regions of Africa and South REC.1401.126).
Asia. Although interventions to reduce child marriage
are underway and the trend of child marriage is decreas- Consent for publication
Not applicable.
ing, further acceleration is needed to achieve the 2030
development goals. Also, the present study identified the Competing interests
most important factors associated with child marriage, The authors declare no competing interests.
including low education, poor socio-economic status,
rural residence, less developed nature of the place of resi- Received: 22 October 2022 Accepted: 4 September 2023
dence, religions such as Islam, Hinduism and Christian-
ity, a lack of access to media, and decision-making on
marriage by parents. These factors are interconnected
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