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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Child marriage and associated outcomes in northern Ghana: a cross-sectional study

Authors: Richard de Groot, Maxwell Yiryele Kuunyem, Tia Palermo, on behalf of the Ghana LEAP 1000 evaluation team

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Child marriage is a human rights violation disproportionately affecting girls in lower- and middle-income countries and has serious public health implications. In Ghana, one in five girls marry before their 18th birthday and one in 20 girls is married before her 15th birthday. This paper uses a unique dataset from Northern Ghana to examine the association between child marriage and adverse outcomes for women among a uniquely vulnerable population.

Methods

Baseline data from on ongoing impact evaluation of a government-run cash transfer programme was used. The sample consisted of 1349 ever-married women aged 20–29 years from 2497 households in the Northern and Upper East regions of Ghana. We estimated a series of ordinary least squares (OLS) and logistic regression models to examine associations of child marriage with health, fertility, contraception, child mortality, social support, stress and agency outcomes among women, controlling for individual characteristics and household-level factors.

Results

Child marriage in this sample was associated with increased odds of poorer health, as measured by difficulties in daily activities (OR = 2.08; CI 1.28–3.38 among women 20–24 years and OR = 1.58; CI 1.19–2.12 among women 20–29 years), increased odds of child mortality among first-born children (OR = 2.03; CI 1.09–3.77 among women 20–24 years) and lower odds of believing that one’s life is determined by their own actions (OR = 0.42; CI 0.25–0.72 among women 20–24 years and OR = 0.54; CI 0.39–0.75 among women 20–29 years). Conversely, child marriage was associated with lower levels of reported stress (regression coefficient = − 1.18; CI -1.84–-0.51 among women 20–29 years).

Conclusions

Child marriage is common in Northern Ghana and is associated with poor health, increased child mortality, and low agency among women in this sample of extremely poor households. While not much is known about effective measures to combat child marriage in the context of Ghana, programmes that address key drivers of early marriage such as economic insecurity and school enrolment at the secondary level, should be examined with respect to their effectiveness at reducing early marriage.
Trial registration: Registered in the Registry for International Development Impact Evaluations (RIDIE) on 01 July 2015, with number RIDIE-STUDY-ID-55942496d53af.
Footnotes
1
Maternal disorders in the Global Burden of Disease report include: maternal haemorrhage; maternal sepsis and other maternal infections; maternal hypertensive disorders; maternal obstructed labour and uterine rupture; maternal abortion, miscarriage and ectopic pregnancy; indirect maternal deaths; late maternal deaths; maternal deaths aggravated by HIV/AIDS; and, other maternal disorders.
 
2
All figures in this paragraph are based on authors’ calculations from the Ghana Multiple Indicator Cluster Surveys and Ghana Demographic and Health Surveys.
 
3
We define adolescents as those between 10 and 19 years of age [47].
 
4
The total sample size for the evaluation was established at 2500 households. Hence, the response rate to the survey was nearly universal.
 
5
The LEAP programme uses a proxy means test (PMT) with a sharp threshold to determine if households meet the poverty criterion. The PMT takes into account household demographic characteristics, assets and housing conditions. The evaluation is a ‘regression discontinuity design’. As such, about 50% of the sample consists of households just below the threshold with the other 50% of households scoring above the poverty threshold. For more information about the study design and the sampling, see [27].
 
6
We also considered disability, but the share of women who reported a disability in our sample is very low (1%) and the estimates are therefore unreliable.
 
7
We only consider first-born children here because child brides start bearing children earlier, and hence have more children at the time of the survey and thus higher chance that at least one of their children has died.
 
8
Since our sample is not a random sample of the population, this does not necessarily mean that the rate of child marriage has been increasing.
 
9
We display our findings graphically, for ease of reading. Full regression output is available from the authors upon request.
 
10
The confidence interval for unmet need for contraception is large, due to the low number of women with an unmet need (approximately 3%). This low value is not uncommon, as the DHS value of a similar indicator is 2.0% for women 20 to 24 years old and 5.0% for women 25 to 29 years old [16].
 
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Metadata
Title
Child marriage and associated outcomes in northern Ghana: a cross-sectional study
Authors
Richard de Groot
Maxwell Yiryele Kuunyem
Tia Palermo
on behalf of the Ghana LEAP 1000 evaluation team
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5166-6

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