Scope, range and effectiveness of interventions to address social norms to prevent and delay child marriage and empower adolescent girls: a systematic review.

OBJECTIVES: Harmful gender and social norms prescribe divergent opportunities for girls and boys and drive child marriage. This systematic review examines the scope, range and effectiveness of interventions to change social norms and delay child marriage. DESIGN: We systematically assess the contributions made by interventions that work to shift norms to prevent child marriage or to limit its harmful consequences. Our analysis classifies each study's quality in evaluation and implementation design regarding shifting norms. DATA SOURCES: We conducted a search of electronic databases (PubMed, PsycINFO, Embase, CINAHL Plus, Popline, Web of Science and Cochrane Library) and grey literature (targeted hand-searches of 15 key organisations and Google Scholar). ELIGIBILITY CRITERIA: Included interventions sought to change norms related to child marriage, were evaluated in experimental or quasi-experimental evaluations, collected data on age at marriage and norms/attitudes, and were published in English from January 2000 to September 2021. DATA EXTRACTION AND SYNTHESIS: We used a standardised form to extract data from all eligible studies, and double-screened to validate coding and reporting. We classified the studies by low, medium and high quality for evaluation and risk of bias, and separately by the extent to which they addressed social norms. RESULTS: Our assessment of the 12 eligible studies identified revealed little evidence of a systematic relationship between social norms related to marriage and changes in child marriage behaviours. We found stronger evidence of programme effect on child marriage outcomes than on social norms, though only a minority of studies found an effect for either. Studies that appeared effective in changing child marriage norms varied greatly in scale and extent of programming, and few attempted to identify the appropriate reference groups for measuring social norms. CONCLUSION: The studies evaluated by our review provide only weak evidence on the impact of interventions on norms, and on the link between shifts in norms and marriage behaviour.

Systematic scoping review of interventions to prevent and respond to child marriage across Africa: progress, gaps and priorities.

OBJECTIVES: Despite the high prevalence of child marriage in Africa, little is known about the current state of the evidence on interventions to prevent and respond to child marriage in the region. The objectives of this systematic scoping review are to describe the breadth of existing evidence on child marriage prevention and response interventions, analyze where these interventions have been implemented, and identify research gaps and priorities for moving forward. METHODS: The inclusion criteria incorporated publications that: (1) focused on Africa, (2) described interventions to address child marriage, (3) were published 2000-2021 and (4) were published as peer-reviewed articles or reports in English. We searched seven databases (PubMed, PsychINFO, Embase, Cinahl Plus, Popline, Web of Science and Cochrane Library), hand-searched the websites of 15 organisations and used Google Scholar to identify research published in 2021. Two authors independently screened titles and abstracts followed by full-text reviews and data extraction for included studies. RESULTS: Our analysis of the 132 intervention studies identified highlights important disparities by intervention type, sub-region, and intervention activities, focus populations and impact. The greatest number of intervention studies focused on Eastern Africa. Health and empowerment approaches were most represented, followed by education and laws and policies. Norms or livelihoods approaches were least represented. CONCLUSION: Our review finds few high-quality impact evaluations, most of which assess cash transfer programmes. There is a need to strengthen evaluative evidence on other intervention approaches including empowerment and norms change interventions, in particular. Given the linguistic and cultural diversity of the continent, more country-specific studies and research published in languages other than English are needed, particularly in high-prevalence Middle African countries.

Mapping the Field of Child Marriage: Evidence, Gaps, and Future Directions From a Large-Scale Systematic Scoping Review, 2000-2019.

The 2030 Agenda for Sustainable Development explicitly calls for an end to child, early, and forced marriages, a harmful practice that has been experienced by 650 million girls and women globally. The COVID-19 pandemic threatens to halt progress toward this goal and highlights the need to assess research progress and link emerging knowledge with efforts to prevent and respond to child marriage. We conducted a systematic search of publications focused on child marriage covering four languages (English, Spanish, Portuguese, and French), encompassing a 20-year period (1 January 2000-31 December 2019) and including peer-reviewed and gray literature across all major geographic regions of the world. Our review identified and analyzed 1,068 publications from an initial number of 4,081 abstracts screened, finding that studies on the prevalence, determinants, and consequences of child marriage represented a majority of the total publications. Including publications in Spanish and Portuguese yielded results from Latin America and the Caribbean, Mozambique, and Europe, and including publications in French yielded results from West Africa and the Maghreb, in addition to English language publications covering both these and other parts of the word. Our review of the evolution and distribution of research over time and space calls for a greater focus of research on interventions preventing child marriage and responding to the needs of individuals married as children, a multilinguistic approach to knowledge exchange, and for research to be conducted in neglected high-prevalence settings.

What Do We Know After Decades of Research About Parenting and IPV? A Systematic Scoping Review Integrating Findings.

This systematic scoping literature review synthesizes scholarship about intimate partner violence (IPV) and parenting into a conceptual model. We integrate findings from across 136 studies. To be included, studies had to consider how IPV influenced one's parenting and/or how parents responded to the violence they encountered in terms of their practices related to their children. Studies had to be peer-reviewed, empirical articles, done using quantitative, qualitative, or mixed methods, and published in English. There were no limits on the dates or locations of studies. Using these predetermined criteria, authors screened over 6,000 articles, finally selecting 136 studies to be coded and analyzed. Results demonstrate IPV undermines maternal well-being and parenting practices. Our findings also highlight multiple ways that mothers struggle to realize the complex tasks of parenting within IPV, including through emotional coping, action-based coping, and social support. By systematically bringing together and analyzing existing data on the topic, this study helps build the knowledge base around how women facing IPV plan for physical and psychological safety of themselves and their children. Our synthesis of the literature helps expand theoretical frameworks, and stregthen prevention practices and policies so they reflect both the suffering and the resilience of mothers who grapple with IPV. Our review draws attention to the need to focus interventions on promoting the mental health and parenting self-efficacy of mothers who suffer from the direct effects of IPV and its attacks on their mental health and parental role.

Detailed study protocol for systematic scoping review of research on child marriage, 2000-2019.

INTRODUCTION: The global development agenda reflects greater attention to ending child marriage and supporting adolescent girls than ever before. Limited understandings of the evidence base on child marriage, however, make it challenging to assess gaps in the literature and inform policy and programming to respond to the needs of adolescent girls. The goal of this project is to systematically identify, evaluate and synthesise the global evidence on child marriage. METHODS AND ANALYSIS: We will include articles with a thematic focus on child marriage from all geographic settings, two decades of research (2000-2019) and in four languages (English, Spanish, French and Portuguese). We will search 18 electronic academic databases (7 in English and 4 each in French, Spanish and Portuguese, with 1 overlapping database) and for the grey literature, conduct targeted hand-searches of organisations engaged in work to prevent child marriage. The databases for studies in English are PubMed, PsychINFO, Embase, CINAHL Plus, Popline, Web of Science and Cochrane Library; for studies in French, the databases will be DialNet, Directory of Open Access Journals, Science Direct and Biblioteca CCG-IBT database; in Spanish, DialNet, La Biblioteca Científica Electrónica en Línea, Red Iberoamericana de Innovación y Conocimiento Científico and Jstor and in Portuguese, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Biblioteca Virtual em Saúde, Biblioteca Científica Eletrônica On-line and Biblioteca Digital Brasileira de Teses e Dissertações. We will also review reference lists of select articles and seek input from key authors, field practitioners and participants in international convenings. We will collect and analyse data on publication characteristics, including type of document, institutional affiliation, publication year, language, focus country and region, study objective, specific focus, research method, key findings and recommendations of the material offered for future work. The database searches for publications in English were conducted in January 2020 and we plan to complete the searches in French, Spanish and Portuguese in early 2021. ETHICS AND DISSEMINATION: As a systematic review of already-published data, this study does not raise ethical or safety concerns. The authors plan to publish the results of the scoping review in a relevant international journal as well as present the results widely following publication. Building on this foundational work, the authors plan to conduct analyses that make use of the rich data. REGISTRATION DETAILS: The study design adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Our protocol was registered with Open Science Framework on 14 January 2020 (https://osf.io/awh8v).

Time trends and determinants of breastfeeding practices among adolescents and young women in Nigeria, 2003-2018.

INTRODUCTION: Optimal breastfeeding practices have far-reaching health and economic benefits. Evidence suggests disparities in breastfeeding practices by maternal age-groups, with younger mothers often having lower rates of breastfeeding initiation, continuation and exclusivity compared with older mothers. There is limited knowledge of trends and factors associated with breastfeeding practices, particularly among adolescent and younger mothers in Nigeria. We examine key breastfeeding practices in Nigeria over a 15-year period, comparing adolescent mothers to young women. METHODS: We used four Nigeria Demographic and Health Surveys collected between 2003 and 2018. We constructed six key breastfeeding indicators to cover the time period of breastfeeding from initiation to child age 24 months in women of three maternal age groups at the time of birth: young adolescents (<18 years), older adolescents (18-19.9 years) and young women (20-24.9 years). We used logistic regression to examine the association between maternal age group and select breastfeeding behaviours on the 2018 survey. RESULTS: Analysis showed an increase in optimal breastfeeding practices across the four surveys and among all maternal age groups examined. Adolescent mothers had consistently lower prevalence for three of the six key breastfeeding indicators: early initiation of breastfeeding, exclusive breastfeeding <6 months and no prelacteal feed. Compared with young women, adolescent mothers had a higher prevalence of continued breastfeeding at 1 and 2 years. In multivariate analysis, we found that maternal age group was not associated with early breastfeeding initiation or with exclusive breastfeeding <6 months. However, several sociodemographic (ethnicity, region of residence) and healthcare-related (mode of delivery, antenatal care, postnatal breastfeeding counselling) factors were strongly associated with these two practices. CONCLUSIONS: In Nigeria, there is need to better support breastfeeding and nutritional practices in adolescents and young women focusing on ethnic groups (Hausa, Fulani, Kanuri/Beriberi) and geographic regions (South East) that are lagging behind.

Using three indicators to understand the parity-specific contribution of adolescent childbearing to all births.

INTRODUCTION: A strong focus on sexual and reproductive health of female adolescents is a key to achieving sustainable development goals, due to the large size of the current cohort in low-income and middle-income countries (LMICs) and adolescents' biological and social vulnerability. Several indicators of fertility among adolescents are in wide use, but the contribution of adolescent births to all births is poorly understood. We propose and calculate a package of three indicators capturing the contribution of adolescent births to all births, stratified by parity (first and second/higher). METHODS: We used Demographic and Health Survey data for 30 LMICs and vital registration for two high-income countries (to calculate levels and trends across a range of countries) for three time periods: 1990-1999, 2000-2009 and 2010-2015. The three indicators were calculated overall and by age thresholds (<16, <18 and <20 years) and exact ages, for each country and time point. Patterns of changes in indicators for the three cumulative thresholds over time are described. RESULTS: In the 30 LMICs, the percentage of all live births occurring to adolescents varied across countries, with a median of 18% for adolescents <20 years. Three countries (Jordan, Indonesia and Rwanda) had levels below 10%; Bangladesh had the highest at 33%. The contribution of adolescent first-order births to all first-order births was high; a median of 49%. Even among second-order and higher-order births, the contribution of adolescent childbearing was appreciable (median of 6%). Over the period under examination, the proportion of adolescent births among all live births declined in the majority of the LMICs. CONCLUSION: These three indicators add to our understanding of the scale of adolescent childbearing and can be used in conjunction with population estimates to assess the absolute need for age-appropriate and parity-appropriate reproductive, maternal and newborn healthcare and to monitor progress in improving young people's health.