Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt.

ABSTRACT

BACKGROUND: Egypt has made progress in delaying age at marriage, but child marriage continues to be practiced in many places across the country. This study investigates the impacts of child marriage on the health and wellbeing of girls residing in urban Egypt using a multi-method approach. METHODS: The quantitative component leveraged data from the 2014 Egypt Demographic and Health Survey and focused on (1) reproductive health, (2) maternal health and (3) social outcomes among a subsample of ever-married urban women ages 20-24 (N = 1041). Simple and multivariable logistic regressions were used to estimate prevalence odds ratios and 95% confidence intervals for associations between child marriage and the three sets of outcomes. The qualitative component drew from 11 focus groups, 23 in-depth interviews, and 13 key informant interviews conducted in three urban sites in Egypt. The data was thematically analyzed using a combination of inductive and deductive coding. RESULTS: The prevalence of marriage under age 18 was 13.22%. Child marriage was significantly associated with ever use of contraception (Adjusted Odds Ratio (AOR) 2.95 95% CI 1.67-5.19), multiple births (AOR 12.93 95% CI 5.45-30.72), rapid repeat childbirth (AOR 2.20 95% CI 1.34-3.63), and pregnancy termination (AOR 1.89 95% CI 1.11-3.23). Many of these associations disappeared after adjusting for marriage duration. Girls married under age 18 had larger spousal age gaps (AOR 2.06; 95% CI 1.24-3.41) and higher odds of FGM (AOR 2.14; 95% CI 1.11-4.13). They were significantly more likely to report receiving no ANC care (AOR 0.39; 95% CI 0.19-0.80), and less likely to deliver through C-section (AOR 0.53; 95% CI 0.34-0.83). Consequences emerging from the qualitative data centered around five themes (1) Access to and use of sexual and reproductive health services; (2) exposure to FGM; (3) marriage and birth registration; (4) marital relations; and (5) relationship with in-laws. CONCLUSION: Findings provide important insights into the practice of child marriage in urban areas in Egypt and illustrate a range of adverse consequences associated with the practice.

Child marriage has been shown to lead to a host of negative health and social consequences. In this study, we explored the prevalence and consequences of child marriage in urban areas in Egypt, where there has been little research done on the topic. We analyzed quantitative data collected as part of the Egypt Demographic and Health survey as well as qualitative data collected as part of a bigger study on child marriage in humanitarian studies. In the quantitative analysis, we focused on three sets of outcomes: reproductive health outcomes, social outcomes and maternal health outcomes. In the qualitative analysis, we analyzed focus group discussions, in-depth interviews and key informant interviews and came up with themes around consequences of child marriage. The analysis revealed that child marriage is associated with multiple adverse consequences. However, many of the reproductive health consequences identified were due to the longer duration of these marriages, and thus disappeared when marriage duration was taken into account. From the social outcomes, we found that child marriage was associated with female genital mutilation and larger spousal age gaps, and from the maternal health outcomes, we found that child marriage was associated with not receiving antenatal care and not delivering via C-section. The qualitative data highlighted a range of consequences focusing on access to sexual and reproductive health services, exposure to FGM, marriage and birth registration, and relationships with husbands and in-laws.