Girl Child Marriage, Health, and Well-Being in Sub-Saharan Africa: A Mixed Methods Investigation

Abstract

Nearly 650 million girls and women alive today have experienced girl child marriage, a formal union before age 18. Yet gaps exist in understanding its health consequences for women and children in African contexts. The objective of this multi-study dissertation was to use a mixed methods research approach to improve our understanding of the complex relationships between girl child marriage and the health and well-being of women and their children in sub-Saharan Africa. Aim 1 estimates associations between girl child marriage and women’s undernutrition in sub-Saharan Africa. Using household data from Demographic and Health Surveys (DHS), representing 35 African countries (N=249,269 women), this study revealed that girl child marriage was associated with increased odds of early motherhood and being in the poorest versus wealthiest quintile as well as decreased odds of completing secondary school, controlling for contextual factors. Despite these relationships, girl child marriage was associated with reduced odds of being underweight (body mass index less than 18.5). Aim 2 estimates associations between girl child marriage and children’s development and stunting to examine intergenerational impacts. Using household data from UNICEF Multiple Indicator Clusters Survey (MICS) for 16 African countries (N=37,558 child-mother pairs), this study showed increased odds being off-track for development (measured using the Early Childhood Development Index) and stunted (height-for-age z score less than -2) among children born to women who married before age 18, compared to those whose mothers married as adults. Adjusted models revealed that contextual factors, maternal education, and wealth explained these associations. Aim 3 qualitatively explores how women married as children in Conakry, Guinea see their marriages as related to their health and their children’s health. Rooted in grounded theory, this study used data from in-depth interviews, brief ethnographic interviews, observation, and participant observation (N=19 women). Open coding was used to identify key themes. In the context of their child marriages, women perceived health disadvantages, categorized under four themes. Women also perceived health advantages in their marriages, categorized under five themes. Further analysis identified three factors influenced women’s perceptions. In combination with a theoretical chapter that deconstructs the term “girl child marriage,” research findings provide evidence to guide population policies designed to ensure that women and children can achieve their developmental potential.