Updated research gaps on ending child marriage and supporting married girls for 2020-2030.

Over the past 25 years, tremendous progress has been made in increasing the evidence on child marriage and putting it to good use to reduce the prevalence of child marriage and provide support to married girls. However, there is still much to be done to achieve the Sustainable Development Goal target 5.3 of ending child marriage by 2030, and to meet the needs of the 12 million girls who are still married before age 18 each year. To guide and stimulate future efforts, the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, the World Health Organization, the UNICEF-UNFPA Global Programme to End Child Marriage, and Girls Not Brides: The Global Partnership to End Child Marriage convened an expert group meeting in 2019 to: (1) review the progress made in building the evidence base on child marriage since the publication of research priorities in this area in 2015, (2) identify an updated set of research priorities for the next ten years, and (3) discuss how best to support research coordination, translation, and uptake. This article provides a summary of the progress made in this area since 2015 and lists an updated set of research gaps and their rationale in four key areas: (1) prevalence, trends, determinants, and correlates of child marriage; (2) consequences of child marriage; (3) intervention effectiveness studies to prevent child marriage and support married girls; and (4) implementation research studies to prevent child marriage and support married girls. It also highlights a number of calls-to-action around research coordination and knowledge translation to support the emerging and evolving needs of the field.

RéSUMé: Au cours des 25 dernières années, d'énormes progrès ont été réalisés pour mettre à jour les données concernant le mariage des enfants et les mettre à profit pour réduire la prévalence du mariage des enfants et apporter un soutien aux filles mariées. Cependant, il reste encore beaucoup à faire pour atteindre la cible 5.3 de l'Objectif de Développement Durable consistant à mettre fin au mariage des enfants d'ici 2030 et pour répondre aux besoins des 12 millions de filles qui sont encore mariées avant l'âge de 18 ans chaque année. Guider et stimuler les efforts futurs, tel est le Programme Spécial de Recherche de la Banque Mondiale PNUD-FNUAP-UNICEF-OMS, du Développement et la Formation à la Recherche en Reproduction Humaine, de l'Organisation Mondiale de la Santé, du Programme Mondial UNICEF-FNUAP pour mettre fin au mariage des enfants et «  Des filles pas des Mariées  ¼ : le Partenariat Mondial pour mettre fin au mariage des enfants a convoqué une réunion de groupe d'experts en 2019 pour : 1. passer en revue les progrès accomplis dans la constitution de la base de données factuelles sur le mariage des enfants depuis la publication des priorités de la recherche dans ce domaine en 2015, 2. identifier un ensemble actualisé de priorités de recherche pour les dix prochaines années, et 3. discuter de la meilleure façon de soutenir la coordination, la traduction et la compréhension de la recherche. Cet article résume les progrès réalisés dans ce domaine depuis 2015 et répertorie sous forme de mise à jour un ensemble de lacunes dans la recherche et leur justification dans quatre domaines clés: 1) prévalence, tendances, déterminants et corrélatifs du mariage des enfants; 2) conséquences du mariage des enfants; 3) études ayant trait à l'efficacité des interventions pour prévenir le mariage des enfants et soutenir les filles mariées; et 4) études de recherche sur la mise en œuvre pour prévenir le mariage des enfants et soutenir les filles mariées. Il met également en évidence un certain nombre d'appels à l'action autour de la coordination de la recherche et de l'application des connaissances pour répondre aux besoins émergents et à l'évolution de ce domaine.

RESUMEN: En los últimos 25 años se ha avanzado enormemente y existe ahora más evidencia sobre el matrimonio infantil, y sobre como se debe poner la evidencia en práctica para reducir la prevalencia del matrimonio infantil y proporcionar apoyo a las niñas casadas. Sin embargo, aún queda mucho por hacer para alcanzar la meta 5.3 de los Objetivos de Desarrollo Sostenible de poner fin al matrimonio infantil para 2030, y para satisfacer las necesidades de los 12 millones de niñas que cada año se casan antes de los 18 años. Para orientar y estimular los esfuerzos futuros, el Programa Especial de Investigación, Desarrollo y Formación de Investigadores en Reproducción Humana del PNUD-FNUAP-UNICEF-OMS-Banco Mundial, la Organización Mundial de la Salud, el Programa Mundial para la Eliminación del Matrimonio Infantil de UNICEF-FNUAP y Girls Not Brides: La Alianza Mundial para Acabar con el Matrimonio Infantil convocó una reunión de un grupo de expertos en 2019 para: 1. Revisar los progresos realizados en la construcción de la base de evidencias sobre el matrimonio infantil desde la publicación de las prioridades de investigación en este ámbito en 2015, 2. Identificar un conjunto actualizado de prioridades de investigación para los próximos diez años, y 3. Debatir la mejor manera de apoyar la coordinación, la traducción y la aceptación de la investigación.Este artículo ofrece un resumen de los progresos realizados en este ámbito desde 2015 y enumera un conjunto actualizado de lagunas de investigación y su justificación en cuatro áreas clave: 1) prevalencia, tendencias, determinantes y correlaciones del matrimonio infantil; 2) consecuencias del matrimonio infantil; 3) estudios de eficacia de las intervenciones para prevenir el matrimonio infantil y apoyar a las niñas casadas; y 4) estudios de implementación para prevenir el matrimonio infantil y apoyar a las niñas casadas. También destaca una serie de llamados a la acción en torno a la coordinación de la investigación y la traducción de conocimientos para apoyar las necesidades emergentes y en evolución del campo.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development.

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Risk factors for childhood violence and polyvictimization: A cross-country analysis from three regions.

Understanding risk factors is important to ending childhood violence and meeting Sustainable Development Goal 16.2. To date, no study has examined patterns of risk factors across countries comprehensively for different types of childhood violence, and there is a dearth of evidence of polyvictimization in lower- and middle-income settings. We analyse risk factors of childhood emotional (EV), physical (PV), sexual violence (SV) and polyvictimization for children aged 13-17 from nationally-representative Violence Against Children Surveys across six countries. We examine risk factors at the community-, household-, and individual- levels for each violence type, stratified by gender using multivariable logistic regression models. Across countries, school enrolment increased violence risk among females and males (three countries), but was protective against violence among females (one country), and among males (three countries). Among females, increasing age was associated with increased risk of SV (five countries) and polyvictimization (three countries); among males this relationship was less salient. Non-residence with a biological father emerged as a risk factor for SV among girls. Few or inconsistent associations were found with other factors, including number of household members, wealth, and urban residence. These results underscore on the one hand, the need for country-specific research on risk factors to inform prevention strategies, as well as increased investment in data collection to provide a more complete and robust basis for evidence generation. High levels of polyvictimization highlight overlapping vulnerabilities children face, and may provide insights for policymakers and practitioners in designing strategies to protect children at greatest risk of abuse.

Sexual violence among adolescent girls and young women in Malawi: a cluster-randomized controlled implementation trial of empowerment self-defense training.

BACKGROUND: Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi. METHODS: The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278). RESULTS: Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p < 0.001). Significant increases in self-defense knowledge were observed solely among intervention students (RR 3.33, 95% CI 2.76, 4.02; interaction effect p < 0.001). Significant changes in sexual violence prevalence and knowledge were observed for both primary and secondary students. Favorable reductions were also observed in sexual violence incident rate among students overall (interaction effect p = 0.01). CONCLUSIONS: This intervention reduced sexual violence victimization in both primary and secondary school settings. Results support the effectiveness of ESD to address sexual violence, and approach the elimination of violence against women and girls set forth with Sustainable Development Goal #5. Implementation within the education system can enable sustainability and reach. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201702002028911 . Registered 09 February 2017. Retrospectively registered.

Adverse Childhood Experiences and HIV Sexual Risk-Taking Behaviors Among Young Adults in Malawi.

Adverse childhood experiences (ACEs) exhibit a dose-response association with poor health outcomes in adulthood, including HIV. In this analysis, we explored the relationship between ACEs and HIV sexual risk-taking behaviors among young adults in Malawi. We analyzed responses from sexually active 19- to 24-year-old males and females ( n = 610) participating in the Malawi Violence Against Children Survey. We tested the association between respondents' exposure to six ACEs (having experienced emotional, physical, or sexual violence; witnessing intimate partner violence or an attack in the community; one or both parents died) and infrequent condom use in the past year and multiple sexual partners in the past year. We used logistic regression to test the association between ACEs and these sexual risk-taking behaviors. A majority (82%) of respondents reported at least 1 ACE, and 29% reported 3+ ACEs. We found positive unadjusted associations between the number of ACEs (1-2 and 3+ vs. none) and both outcomes. In adjusted models, we found positive associations between the number of ACEs and infrequent condom use (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: [1.0, 7.8]; aOR: 3.7, CI: [1.3, 11.1]). Among young adults in Malawi, exposure to ACEs is positively associated, in a dose-response fashion, with engaging in some sexual risk-taking behaviors. HIV prevention efforts in Malawi may benefit from prioritizing programs and policies aimed at preventing and responding to violence against children.

Violent experiences in childhood are associated with men's perpetration of intimate partner violence as a young adult: a multistage cluster survey in Malawi.

PURPOSE: To examine the association between exposures to violence in childhood, including exposure to multiple forms of violence, with young men's perpetration of intimate partner violence (IPV) in Malawi. METHODS: We analyzed data from 450 ever-partnered 18- to 24-year-old men interviewed in the Malawi Violence Against Children and Young Woman Survey, a nationally representative, multistage cluster survey conducted in 2013. We estimated the weighted prevalence for perpetration of physical and/or sexual IPV and retrospective reporting of experiences of violence in childhood and examined the associations between childhood experiences of violence and perpetration of IPV using logistic regression. RESULTS: Among young men in Malawi, lifetime prevalence for perpetration of sexual IPV (24%) was higher than for perpetration of physical IPV (9%). In logistic regression analyses, the adjusted odds ratios for perpetration of sexual IPV increased in a statistically significant gradient fashion, from 1.2 to 1.4 to 3.7 to 4.3 for young men with exposures to one, two, three, and four or more forms of violence in childhood, respectively. CONCLUSIONS: Among young men in Malawi, exposure to violence in childhood is associated with an increased odds of perpetrating IPV, highlighting the need for programs and policies aimed at interrupting the intergenerational transmission of violence.