ASRHR in Ethiopia: reviewing progress over the last 20 years and looking ahead to the next 10 years.

Over the last two decades, improvements in Ethiopia's socio-economic context, the prioritization of health and development in the national agenda, and ambitious national health and development policies and programmes have contributed to improvements in the living standards and well-being of the population as a whole including adolescents. Improvements have occurred in a number of health outcomes, for example reduction in levels of harmful practices i.e., in child marriage and female genital mutilation/cutting (FGM/C), reduction in adolescent childbearing, increase in positive health behaviours, for example adolescent contraceptive use, and maternal health care service use. However, this progress has been uneven. As we look to the next 10 years, Ethiopia must build on the progress made, and move ahead understanding and overcoming challenges and making full use of opportunities by (i) recommitting to strong political support for ASRHR policies and programmes and to sustaining this support in the next stage of policy and strategy development (ii) strengthening investment in and financing of interventions to meet the SRH needs of adolescents (iii) ensuring laws and policies are appropriately communicated, applied and monitored (iv) ensuring strategies are evidence-based and extend the availability of age-disaggregated data on SRHR, and that implementation of these strategies is managed well (v) enabling meaningful youth engagement by institutionalizing adolescent participation as an essential element of all programmes intended to benefit adolescents, and (vi) consolidating gains in the area of SRH while strategically broadening other areas without diluting the ASRHR focus.

Key drivers of fertility levels and differentials in India, at the national, state and population subgroup levels, 2015-2016: An application of Bongaarts' proximate determinants model.

OBJECTIVES: The transition to small family size is at an advanced phase in India, with a national TFR of 2.2 in 2015-16. This paper examines the roles of four key determinants of fertility-marriage, contraception, abortion and postpartum infecundability-for India, all 29 states and population subgroups. METHODS: Data from the most recent available national survey, the National Family Health Survey, conducted in 2015-16, were used. The Bongaarts proximate determinants model was used to quantify the roles of the four key factors that largely determine fertility. Methodological contributions of this analysis are: adaptations of the model to the Indian context; measurement of the role of abortion; and provision of estimates for sub-groups nationally and by state: age, education, residence, wealth status and caste. RESULTS: Nationally, marriage is the most important determinant of the reduction in fertility from the biological maximum, contributing 36%, followed by contraception and abortion, contributing 24% and 23% respectively, and post-partum infecundability contributed 16%. This national pattern of contributions characterizes most states and subgroups. Abortion makes a larger contribution than contraception among young women and better educated women. Findings suggest that sterility and infertility play a greater than average role in Southern states; marriage practices in some Northeastern states; and male migration for less-educated women. The absence of stronger relationships between the key proximate fertility determinants and geography or socio-economic status suggests that as family size declined, the role of these determinants is increasingly homogenous. CONCLUSIONS: Findings argue for improvements across all states and subgroups, in provision of contraceptive care and safe abortion services, given the importance of these mechanisms for implementing fertility preferences. In-depth studies are needed to identify policy and program needs that depend on the barriers and vulnerabilities that exist in specific areas and population groups.

Banned by the law, practiced by the society: The study of factors associated with dowry payments among adolescent girls in Uttar Pradesh and Bihar, India.

BACKGROUND: Despite the prohibition by the law in 1961, dowry is widely prevalent in India. Dowry stems from the early concept of 'Stridhana,' in which gifts were given to the bride by her family to secure some personal wealth for her when she married. However, with the transition of time, the practice of dowry is becoming more common, and the demand for a higher dowry becomes a burden to the bride's family. Therefore, this study aimed to determine the factors associated with the practice of dowry in Bihar and Uttar Pradesh. METHODS: We utilized information from 5206 married adolescent girls from the Understanding the lives of adolescents and young adults (UDAYA) project survey conducted in two Indian states, namely, Uttar Pradesh and Bihar. Dowry was the outcome variable of this study. Univariate, bivariate, and multivariate logistic regression analyses were performed to explore the factors associated with dowry payment during the marriage. RESULTS: The study reveals that dowry is still prevalent in the state of Uttar Pradesh and Bihar. Also, the proportion of dowry varies by adolescent's age at marriage, spousal education, and household socioeconomic status. The likelihood of paid dowry was 48 percent significantly less likely (OR: 0.52; CI: 0.44-0.61) among adolescents who knew their husbands before marriage compared to those who do not know their husbands before marriage. Adolescents with age at marriage more than equal to legal age had higher odds to pay dowry (OR: 1.60; CI: 1.14-2.14) than their counterparts. Adolescents with mother's who had ten and above years of education, the likelihood of dowry was 33 percent less likely (OR: 0.67; CI: 0.45-0.98) than their counterparts. Adolescents belonging to the richest households (OR: 1.48; CI: 1.13-1.93) were more likely to make dowry payments than adolescents belonging to poor households. CONCLUSION: Limitation of the dowry prohibition act is one of the causes of continued practices of dowry, but major causes are deeply rooted in the social and cultural customs, which cannot be changed only using laws. Our study suggests that only the socio-economic development of women will not protect her from the dowry system, however higher dowry payment is more likely among women from better socio-economic class.

COVID-19 and the surge of child marriages: A phenomenon in Nusa Tenggara Barat, Indonesia.

BACKGROUND: Worldwide, there has been a massive increase in child marriages following the COVID-19 crisis. In Indonesia, too, this figure has risen with Indonesia ranked amongst ten countries with the highest rates of child marriage in the world. One of the Indonesian provinces with a high incidence of child marriage cases is in Nusa Tenggara Barat (NTB). OBJECTIVE: This study aims to examine what is causing the rate of child marriages to increase since the outbreak of COVID-19 in NTB. PARTICIPANTS AND SETTING: Using snowball sampling techniques, the researcher selected 23 study participants, including ten parents (seven mothers and three fathers) with children who were married underage and 13 adolescents aged 14 to 17 years old (ten females and three males) who were married between March and December 2020. They came from two different regencies of NTB: Lombok Barat and Lombok Utara. METHODS: This study employed qualitative phenomenology as the method of inquiry. Data was obtained through semi-structured in-depth interviews and analyzed in a two-stage coding model. The results of the analysis were asserted on phenomenological themes. RESULTS: The data reveals that teenagers get married because: 1) they believe that marriage is an escape-from schoolwork, house chores, and the stress and boredom of studying and staying at home during the pandemic; 2) the customary law- some local customs encourage or permit child marriage; 3) there is a lack of understanding of the impact and long term implications of underage marriage; 4) economic problems- financial problems trigger parents to marry their children at a young age; and 5) the influence of the surrounding environment and peers, which encourages early marriage. CONCLUSIONS: The findings suggest a number of recommendations for the prevention of child marriage: 1) socializing the prevention of child marriage; 2) offering alternative activities and support systems for adolescents to overcome frustration and pressure due to online learning and staying at home; 3) changing society's view that marrying children solves adolescent promiscuity, prevents pregnancy, and addresses the issue of non-marital pregnancy.

Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa.

BACKGROUND: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. METHODS: We analyzed national household surveys from 37 countries in SSA, conducted during 1990-2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15-24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban-rural residence and educational status (primary or less versus secondary or higher education). RESULTS: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000-2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10-14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban-rural and wealth-related inequalities remained stagnant or widened during 2000-2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. CONCLUSION: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

Early Marriage among young girls in Eastern Ethiopia: trend during 2008-2018.

Early marriage practices undermine girls' autonomy and seriously affect their physical and mental wellbeing. Monitoring the trends and understanding the drivers is essential in intervening against early marriage. However, many studies on early marriage in Ethiopia are cross-sectional, focusing only on the magnitude at a single point in time. Hence, we extracted data of girls of 10-17 years from Kersa Health and Demographic Surveillance System (Kersa HDSS) database for the period of 2008-2018 in order to examine the trends of early marriage. In this data note we provide the details of a research database of 24,452 girls in the age group of 10-17 years. The extracted data include date of marriage and the girls' socio-demographic variables. Other variables considered to be potentially associated with timing of marriage were also extracted. The purpose of this publication is to describe the dataset for external researchers who may be interested in making use of it as a secondary use of their routinely collected data. This dataset is available at    https://doi.org/10.6084/m9.figshare.15034812.

The herbivore's dilemma: Trends in and factors associated with heterosexual relationship status and interest in romantic relationships among young adults in Japan-Analysis of national surveys, 1987-2015.

BACKGROUND: It has been suggested that an increasing proportion of young adults in Japan have lost interest in romantic relationships, a phenomenon termed "herbivorization". We assessed trends in heterosexual relationship status and self-reported interest in heterosexual romantic relationships in nationally representative data. METHODS: We used data from seven rounds of the National Fertility Survey (1987-2015) and included adults aged 18-39 years (18-34 years in the 1987 survey; sample size 11,683-17,675). Current heterosexual relationship status (married; unmarried but in a relationship; single) was estimated by sex, age group and survey year, with singles further categorized into those reporting interest vs. no interest in heterosexual romantic relationships. Information about same-sex relationships were not available. RESULTS: Between 1992 and 2015, the age-standardized proportion of 18-39-year-old Japanese adults who were single had increased steadily, from 27.4 to 40.7% among women and from 40.3 to 50.8% among men. This increase was largely driven by decreases in the proportion of married women aged 25-39 years and men aged 30-39 years, while those in a relationship had increased only slightly for women and remained stable for men. By 2015, the proportion of single women was 30.2% in those aged 30-34 years and 24.4% in those aged 35-39 years. The corresponding numbers for men were 39.3% and 32.4%. Around half of the singles (21.4% of all women and 25.1% of all men aged 18-39 years) reported that they had no interest in heterosexual romantic relationships. Single women and men who reported no interest in romantic relationships had lower income and educational levels and were less likely to have regular employment compared to those who reported such an interest. CONCLUSIONS: In this analysis of heterosexual relationships in nationally representative data from Japan, singlehood among young adults had steadily increased over the last three decades. In 2015 around one in four women and one in three men in their thirties were unmarried and not in a heterosexual relationship. Half of the singles reported no interest in romantic relationships and these women and men had lower income and educational levels and were less likely to have regular employment.

Defining and deconstructing girl child marriage and applications to global public health.

An estimated 650 million girls and women alive today married before their 18th birthday. Referred to as girl child marriage, the formal or informal union of the girl-child before age 18, the practice is increasingly recognized as a key roadblock to global health, development, and gender equality. Although more research than ever has focused on girl child marriage, an important gap remains in deconstructing the construct. Through an extensive review of primary and secondary sources, including legal documents, peer-reviewed articles, books, and grey literature across disciplines, we explore what the term "girl child marriage" means and why it more accurately captures current global efforts than other terms like early, teenage, or adolescent marriage. To do this, we dive into different framings on marriage, children, and gender. We find that there has been historical change in the understanding of girl child marriage in published literature since the late 1800s, and that it is a political, sociocultural, and value-laden term that serves a purpose in different contexts at different moments in time. The lack of harmonized terminology, particularly in the global public health, prevents alignment amongst different stakeholders in understanding what the problem is in order to determine how to measure it and create solutions on how to address it. Our intent is to encourage more intentional use of language in global public health research.

What does the American public know about child marriage?

Global efforts to eradicate 'child marriage' (<18 years) increasingly target governments, the private sector and the general public as agents of change. However, understanding of child marriage may be subject to popular misconceptions, particularly because of ambiguity in the age threshold implied by the term 'child', and because awareness campaigns routinely emphasize extreme scenarios of very young girls forcibly married to much older men. Here, we ascertain public knowledge of child marriage via an online survey. Half of those surveyed mistakenly believed that the cut-off for child marriage is younger than the threshold of 18 years, and nearly three-quarters incorrectly believed that most child marriages occur at 15 years or below (it primarily occurs in later adolescence). Most participants also incorrectly believed that child marriage is illegal throughout the USA (it's illegal in only 4/50 states), substantially overestimated its global prevalence, and mistakenly believed that it primarily takes place among Muslim-majority world regions. Our results highlight important popular misconceptions of child marriage that may ultimately undermine global health goals and perpetuate harmful stereotypes. Organizations seeking to empower women by reducing child marriage should be cautious of these misunderstandings, and wary of the potential for their own activities to seed misinformation.

Chinese trends in adolescent marriage and fertility between 1990 and 2015: a systematic synthesis of national and subnational population data.

BACKGROUND: Early marriage and fertility are major social determinants of health and wellbeing. Rapid shifts in the past three decades, including a rise in sexual activity in unmarried adolescents, a large population of young migrant workers, and a high proportion of males relative to females, have the potential to alter patterns of reproductive health in Chinese adolescents and young women. We aimed to establish long-term trends of marriage and fertility for girls and women aged 15-24 years in China. METHODS: We did a longitudinal study in which we extracted aggregated data for marriage and childbearing status for Chinese girls and women aged 15-24 years from the Chinese National Population Census (in 1990, 2000, and 2010) and the Chinese 1% National Population Sample Survey (in 1995, 2005, and 2015). The census included all individuals with Chinese nationality who resided in China when the survey was done. For the 1% sample survey, communities or villages were randomly selected and all residents with Chinese nationality in the selected communities or villages were included. In all censuses and sample surveys, forms that included information on basic demographic characteristics, education, marriage, and fertility were completed and verified by the census enumerators at the household residence, based on responses provided by the householder or another adult in the household. We calculated the ever-married rate and age-specific fertility rate (ASFR) for all included individuals. We built multivariate random-effects generalised least squares regression models on panel data to test whether marriage or fertility rate was associated with education level, sex ratio, and the proportion of the population who are an ethnic minority in a province. FINDINGS: The ever-married rate for those aged 15-19 years decreased from 4·7% in 1990 to 1·2% (95% CI 1·2-1·3) in 2000, but rebounded to 2·4% (2·4-2·5) in 2015. The ASFR for this age group decreased from 22·0 births per 1000 individuals in 1990 to 6·0 (5·9-6·0) births per 1000 in 2000, and rebounded to 9·2 (8·9-9·4) births per 1000 in 2015. The rebound was found in most provinces. In women aged 20-24 years, the ever-married rate generally declined from 58·6% in 1990 to 25·5% (95% CI 25·4-25·6) in 2015, and the ASFR decreased from 198·8 births per 1000 in 1990 to 55·0 (54·5-55·5) births per 1000 in 2015. In 2015, the ever-married rate and ASFR for girls and women in rural areas aged 15-19 years were three-times higher than those of their urban counterparts (3·8% [95% CI 3·7-3·9] vs 1·1% [1·1-1·1] for the ever-married rate and 15·4 [14·9-15·9] vs 4·1 [3·9-4·3] births per 1000 for the ASFR). There were large disparities in ever-married rate across individuals of different education levels, with increases in the ever-married rate of 15-19-year-olds not attending senior high school between 2000 and 2010. Those aged 15-19 years were more likely to be married or give birth in the western provinces. Education held a protective association against adolescent childbearing, whereas a high ratio of males to females and a high proportion of ethnic minorities were associated with greater risk. INTERPRETATION: Although China's total fertility rate remains far less than replacement, after a period of steady decline, there has been a rebound in adolescent marriage and childbearing in the past decade. A range of adolescent-targeted strategies will be needed across provinces, including scaling up comprehensive sex education, ensuring that girls continue in school, and providing adequate reproductive health services, which specifically meet the needs for modern contraception in sexually active unmarried girls. FUNDING: Humanities and Social Sciences Planning Fund Project, Sports and Health Special Project of Education and Scientific Research, and China Scholarship Council.

Young Adulthood Relationships in an Era of Uncertainty: A Case for Cohabitation.

The young adulthood years are demographically dense. Dr. Ronald Rindfuss made this claim when he was Population Association of America (PAA) president in 1991 (Rindfuss 1991), and this conclusion holds today. I offer both an update of his work by including Millennials and a new view on young adulthood by focusing on an increasingly common experience: cohabitation. I believe we need to move away from our marriage-centric lens of young adulthood and embrace the complexity that cohabitation offers. The cohabitation boom is continuing with no evidence of a slowdown. Young adults are experiencing complex relationship biographies, and social science research is struggling to keep pace. Increasingly, there is a decoupling of cohabitation and marriage, suggesting new ways of framing our understanding of relationships in young adulthood. As a field, we can do better to ensure that our theories, methods, and data collections better reflect the new relationship reality faced by young adults.

Timing of vape use among adolescents: Differences by family structure.

BACKGROUND: The prevalence of adolescent e-cigarette (vape) use has increased significantly over the past several years. Given the risks associated with vape use, it is important to identify predictors of adolescent vape use onset. PURPOSE: The primary aim was to examine the time to vape use among adolescents, as a function of parental marital status and living arrangements. METHODS: A sample of 863 adolescents (Mage = 12.73, SD = 0.70; 52% girls; 61% non-Hispanic White) from public middle schools in the Northeast United States were asked about whether they vaped over the course of three years (fall 2016-spring 2019). Cox proportional hazards (PH) regression models were conducted to examine associations between parental divorce and the timing of vape use, gender differences in the association, and potential differences in the association as a function of living arrangements. RESULTS: Findings indicated that adolescents with divorced parents at Time 1 vaped earlier, and were 51% more likely to vape than adolescents with married parents. There were no gender differences, or differences in timing among those with divorced parents as a function of living with a step-parent. CONCLUSION: These findings highlight the importance of identifying familial risk factors associated with early vape use in adolescents.

Marriage Decline in Korea: Changing Composition of the Domestic Marriage Market and Growth in International Marriage.

Explanations for the substantial decline in rates of marriage in East Asian countries often emphasize the role of rapid educational expansion for women in reducing the desirability of marriages characterized by a strong gender-based division of labor. Focusing on South Korea, we consider a very different scenario in which changing educational composition of the marriage market reduces the demographic feasibility of such marriages. Analyses of 1% microsamples of the 1990 and 2010 Korean censuses show that changes in the availability of potential spouses accounted for part of the decline in marriage rates over a period of 20 years (1985-1989 to 2005-2009) for highly educated women and less-educated men. We also show that growth in international marriages played a role in preventing an even more dramatic decline in marriage among low-educated men. These findings support the general relevance of marriage market mismatches in gender-inegalitarian societies and highlight the declining feasibility of marriage for low-educated men in such contexts. Findings also hint at important implications for inequality in a society such as Korea, where marriage remains a symbol of social success and is closely related to women's economic well-being and men's health and subjective well-being.

Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: analysis of the 2006-2016 period.

BACKGROUND: Uganda's fertility was almost unchanging until the year 2006 when some reductions became visible. Compared to age at first marriage and contraceptive use, age at sexual debut and family size preferences are rarely examined in studies of fertility decline. In this study, we analyzed the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to change in fertility in Uganda between 2006 and 2016. METHODS: Using data from the 2006 and 2016 Uganda Demographic and Health Survey (UDHS), we applied a nonlinear multivariate decomposition technique to quantify the contribution of age at first marriage, age at first sex, family size preference and contraceptive use to the change in fertility observed during the 2006-2016 period. RESULTS: The findings indicate that 37 and 63% of the change in fertility observed between 2006 and 2016 was respectively associated with changing characteristics and changing fertility behavior of the women. Changes in proportion of women by; age at first marriage, age at first sex, family size preferences and contraceptive use were respectively associated with 20.6, 10.5 and 8.4% and 8.2% of the change in fertility but only fertility behavior resulting from age at first sex was significantly related to the change in fertility with a contribution of 43.5%. CONCLUSIONS: The study quantified the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to the change in fertility observed between 2006 and 2016. We highlight that of the four factors, only age at sexual debut made a significant contribution on the two components of the decomposition. There is need to address the low age at first sex, accessibility, demand for family planning services and youth-friendly family planning services to young unmarried women such that they can achieve their desired fertility. The contribution of other factors such as education attainment by women and place of residence and their relationship with changes in fertility calls for addressing if further reduction in fertility is to be realised.

Extramarital relationships in the Vietnamese migrant community in Laos: reasserting patriarchal ideologies and double standards.

Undocumented migration from Central Vietnam to Laos stretches Vietnamese families and generates marital tensions and social anxieties around the extramarital relationships that migrant husbands establish with vo hau (second wives), an emic term that encompasses mistresses and more stable partners. This paper sheds light on these processes via an ethnographic study on how migration from Central Vietnam to Savannakhet - a town located in Central Laos bordering Thailand - shapes family formation, marital relationships and double standards in gender and sexuality. It argues that husbands and first and second wives manage these issues by preserving family integrity, negotiating extramarital relationships and retreating from marriage. These strategies are shaped by and constitutive of normative double standards that families refer to, reinforce and in some cases transcend to make sense of the marital challenges and disruptions caused by dislocation, translocality and the intrusion of second wives in their marriages. Overall, the study emphasises that families remain committed to a domestic division of labour and to the institutions of marriage and family, albeit with some adjustments. This argument resonates with broader discussions about migration, gender and sexuality in Vietnam.

Semi-arranged marriages and dowry ambivalence: Tensions in the changing landscape of marriage formation in South Asia.

Marriage is a point of change in young people's lives, especially in parts of the world that place high value on it, such as in South Asian countries including Nepal. However, marriage practices are changing, with a move towards more love marriage; this is likely to have important implications on women's status and agency, household and couple dynamics, and mental and physical health. The aim of this paper is to describe how changing marriage formation patterns and traditional practices such as co-residence and dowry are intersecting and impacting relationships post-marriage. In-depth qualitative interviews took place with 20 intact triads of newly married women, their husbands and their mothers-in-law, in one district of Nepal in 2017. Many marriages remain arranged; however, couples often talk or meet before marriage and feel that they are able to build a foundation of love before marrying. Access to technology facilitates this practice, although some couples are reluctant to admit their communication, suggesting stigma about this practice. Husbands have growing ambivalence about dowry, leading to confusion and negatively impacting on relationships post-marriage. A clash of traditional and modern ideas and practices is occurring in Nepal, influencing newly married women's household status and relationship quality, and potentially impacting women's health.

Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes.

BACKGROUND: While the determinants and impacts of child marriage among girls have been well documented, little research exists on the practice among boys. This paper explores the sociodemographic profile of men who married by age 18 and assesses whether they are more or less advantaged than their peers in terms of their sexual and reproductive health outcomes. METHODS: This analysis used the most recent data from nationally representative household surveys for the 15 countries with the highest prevalence of marriage by age 18 among men aged 20-24 at the time of the survey. The prevalence of child marriage was then explored for the full cohort of men aged 20-49 through descriptive statistics and bivariate analysis. Available reproductive health indicators were explored, comparing men who married during childhood and men who married in adulthood. For the youngest and oldest cohorts, the total number of children fathered and the total ideal number of children were compared based on whether men married by age 18. RESULTS: For this subset of countries, the prevalence of child marriage among men aged 20-24 ranges from 8.4 to 27.9%. The practice appears most common among respondents living in the poorest households and in rural areas, and with no education or only primary schooling. Men who married as children appear less likely to have comprehensive knowledge of HIV than their peers who married in adulthood. Little difference among men who married by age 18 and those who married in adulthood was observed regarding knowledge or use of modern methods of contraception. In almost all countries with data, the odds of having fathered three or more children among men aged 20-29 are higher for those who married as children compared to their peers. In four countries, the odds of exceeding one's ideal family size among men aged 40-49 also appear higher among those who married during childhood compared to men who married at older ages. CONCLUSION: These results highlight the need for further research to identify drivers of the practice and short- and long-term outcomes for men who married during childhood, specifically concerning fatherhood, fertility preferences, and completed family size.