TOWARD AN END TO CHILD MARRIAGE - Lessons from Research and Practice in Development and Humanitarian Sectors - Girls Not Brides

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TOWARD AN END TO CHILD MARRIAGE - Lessons from Research and Practice in Development and Humanitarian Sectors - Girls Not Brides
 Lessons from Research and Practice in
Development and Humanitarian Sectors
TOWARD AN END TO CHILD MARRIAGE - Lessons from Research and Practice in Development and Humanitarian Sectors - Girls Not Brides
 Lessons from Research and Practice in
Development and Humanitarian Sectors

                                 June 2018

                               Julie Freccero
                              Audrey Whiting

The Human Rights Center at the University of California, Berkeley, School of Law conducts research on war
crimes and other serious violations of international humanitarian law and human rights. Using evidence-
based methods and innovative technologies, we support efforts to hold perpetrators accountable and to protect
vulnerable populations. We also train students and advocates to document human rights violations and turn
this information into effective action.

The Health and Human Rights Program at the Human Rights Center promotes the health and protection of
marginalized populations affected by humanitarian crises. Through applied research and technical assistance,
we partner with local and international organizations to develop new tools, guidance, and interventions.

Human Rights Center, UC Berkeley School of Law, 396 Simon Hall, Berkeley, CA 94720
Telephone: 510.642.0965 | Email:, |                             @HRCBerkeley


Save the Children fights for children every single day. We stand side by side with children in the toughest
places to be a child. We do whatever it takes to make sure they survive, get protection when they’re in danger,
and have the chance to learn. Because every child should be able to make their mark on the world and build a
better future for us all.

Cover Photo: Rokaya,* 14, stands in the grounds of a temporary learning center for children who fled the conflict in Marawi city, the Philippines, run
by Save the Children. At this site, girls and young women face a heightened risk of early or forced marriage as well as other forms of gender-based
violence.*The child’s name was changed to protect her identity. Photo by Hanna Adcock / Save the Children.
Design and graphics: Nicole Hayward











       MAPPING / 25







       DEVELOPMENT / 56

       HUMANITARIAN / 60

       RESEARCH / 61


NOTES / 80

AMS       Awards Management System                    IDP    Internally Displaced Persons
ASRH 	Adolescent Sexual and Reproductive             INGO	International Non-governmental
          Health                                             Organization
CCT       Conditional Cash Transfer                   IPV    Intimate Partner Violence
CEDAW 	Convention on the Elimination of              IRC    International Rescue Committee
          All Forms of Discrimination Against         NGO    Non-governmental Organization
          Women                                       RCT    Randomized Control Trial
CEDPA	Centre for Development and                     RH     Reproductive Health
          Population Activities                       SC     Save the Children
CEFM      Child, Early, and Forced Marriage           SGBV   Sexual and Gender-based Violence
CM        Child Marriage                              SIDA	Swedish International Development
CRC       Convention on the Rights of the Child              Cooperation Agency
CSE       Comprehensive Sexuality Education           SRH/R	Sexual and Reproductive Health/
CSO       Civil Society Organization                         Rights
DRC       Democratic Republic of the Congo            STI    Sexually Transmitted Infection
FGM/C     Female Genital Mutilation/Cutting           UCT    Unconditional Cash Transfer
GBV       Gender-based Violence                       UN     United Nations
HIV/AIDS	Human Immunodeficiency Virus/               UNICEF United Nations Children’s Fund
          Acquired Immune Deficiency                  VSLA   Village Savings and Loan Association
          Syndrome                                    WASH   Water, Sanitation, and Hygiene
HRC       Human Rights Center
ICRW	International Center for Research on


DESPITE RECENT DECLINES            in the prevalence of       Methodology
child marriage globally, an estimated 12 million girls        The study methodology has three components:
are still married each year.1 Additionally, there has
been growing concern around reports of increasing             1.	LITERATURE REVIEW: A literature review was
child marriage rates among those affected by con-               conducted to identify the state of the global evi-
flict or natural disaster where underlying drivers              dence on child marriage prevention and response
such as gender inequality, social norms, and lack               interventions. In sum, 355 development and 27
of opportunities for girls are exacerbated, and new             humanitarian articles from both grey and aca-
drivers related to protection concerns and extreme              demic literature were evaluated for inclusion.
poverty arise. Consequently, girls who are married              Forty-three development and no humanitarian
young experience a violation of their human rights              articles met the inclusion criteria and were ex-
and suffer negative impacts on their education, eco-            tracted and evaluated for quality using adapted
nomic prospects, social lives, mental and physical              STROBE and CONSORT scales.2 Data was re-
health, and the health and nutrition of their chil-             viewed and findings relating to programs and
dren. Effective interventions are urgently needed to            initiatives for combatting child marriage were
address this critical issue.                                    identified and analyzed for common themes.
    The purpose of the following study is to gather
findings from efforts to prevent and respond to               2.	MAPPING EXERCISE: A mapping exercise of Save
child marriage in both development and human-                   the Children’s past and current programs to address
itarian contexts and determine what Save the                    child marriage was undertaken using internal and
Children and other organizations can do to improve              published documents from three sources: submis-
their response to this critical issue. The study adds           sions from Save the Children member and country
to existing research by synthesizing the most up-to-            offices, Save the Children’s Awards Management
date literature, bringing the voices of practitioners           System Database, and the program and project
and experts into the discussion, and examining the              Evaluation Repository database. Any evaluations
topic of child marriage interventions in a humani-              meeting inclusion criteria for the literature review
tarian context for the first time. In addition, through         were included in the literature review extraction and
a mapping and analysis of Save the Children’s pro-              analysis process. Program information from the 181
gramming, it assesses the organization’s approaches             resulting documents that met the inclusion criteria
against the available evidence.                                 was extracted to a standardized form for analysis.

    1         A literature           2           A mapping              3            Key informant
              review to                          exercise of Save                    interviews with 27
   Literature identify the          Mapping      the Children’s        Key           practitioners active
   Review     state of              Exercise     past and current      Informant     in child marriage
              the global                         programs to           Interviews    prevention and
              evidence on                        address child                       response in 21
              child marriage                     marriage using                      countries or regions
              prevention                         internal and                        across Africa, the
              and response                       published                           Middle East, South
              interventions                      documents from                      Asia, Europe, and
                                                 three sources                       North and South

3.	KEY INFORMANT INTERVIEWS: Key informant              and legal and advocacy. Empowerment approaches
  interviews were conducted with 27 practitioners        were the most frequently evaluated and consistently
  active in child marriage prevention and response       effective, but covered a broad range of activities that
  in 21 countries or regions across Africa, the Middle   were rarely evaluated independently to determine
  East, South Asia, Europe, and North and South          which components were most effective. Incentive/
  America. Interviews were conducted over Skype us-      asset transfer approaches had mixed results, but
  ing a semi-structured interview guide. Twenty-one      were more likely to be effective when focused on
  interviewees were from Save the Children, while six    younger adolescents and conditioned on or used
  practitioners were from other non-governmental         to promote educational outcomes (such as school
  organizations (NGOs). Transcripts were coded and       attendance). Community sensitization and engage-
  analyzed thematically to identify patterns in par-     ment approaches, while promising, were poorly
  ticipant responses.                                    represented and evaluated in the literature, but pro-
                                                         grams focusing on deeper community engagement
Findings                                                 were generally more successful than those that used
The literature review identified 43 experimental and     more light-touch sensitization approaches. Finally,
quasi-experimental evaluations of 30 distinct inter-     legal and advocacy approaches were found to be
ventions in development settings that had as their       the least represented in the literature, likely due to
primarily objective or a significant outcome im-         substantial challenges in evaluating such programs
pacts on child marriage outcomes including related       using experimental and quasi-experimental meth-
behavior, knowledge, and attitudes. Studies focused      ods. We identified two studies evaluating programs
primarily on African and South Asian contexts.           designed to address child marriage in humanitarian
Interventions were typically designed as single-com-     contexts, but neither fit the criteria for inclusion in
ponent or multi-component and targeted girls alone       the study.
or multiple levels of the social-ecological model,          The mapping of Save the Children’s program-
including families, communities, policy environ-         ming revealed that Save the Children has been ac-
ment, and society. Approaches to addressing child        tive in addressing child marriage since at least 2001
marriage included empowerment, incentive/asset           when the Ishraq program for out-of-school girls was
transfer, community sensitization and engagement,        instituted in Egypt. Since then, the organization has

                                     2   | Toward an End to Child Marriage
conducted over 52 projects, programs, and advocacy        Recommendations
initiatives in more than 41 countries. The majority of    The following recommendations are targeted at Save
programs are designed as multi-component, multi-          the Children and intended to help move the organi-
level interventions, and all four approaches identified   zation forward in addressing child marriage in de-
in the literature are recognized in Save the Children’s   velopment and humanitarian contexts. They are also
programming. However, empowerment and com-                intended to help other stakeholders, including re-
munity sensitization and engagement approaches are        searchers, policymakers, and practitioners, to more
the most frequently utilized, with legal and advocacy     effectively prevent and respond to child marriage.
efforts increasingly common. Incentive/asset trans-
fer approaches were used to address child marriage        Development
only twice by the organization.3 Program evaluations      Cross-thematic Recommendations
ranged from highly rigorous randomized controlled
                                                          1.		Adopt a gender equality lens when designing, im-
trials (RCTs) to quasi-experimental and qualitative
                                                               plementing, monitoring, and evaluating child
evaluations, and less-rigorous baseline-endline eval-
                                                               marriage programs and initiatives.
uations. Four past and current programs in human-
                                                          2.		Expand the geographic coverage of child mar-
itarian contexts were identified.
                                                               riage programming and advocacy to include
   Key informants discussed interventions or strate-
                                                               countries or regions with very high rates of
gies to address child marriage, outcomes or impacts
                                                               child marriage not currently covered by Save
(anecdotal or based on formal evaluation), imple-
                                                               the Children’s efforts.
mentation challenges, risk factors and intervention
                                                          3.		Target programs and advocacy to address the
adaptation strategies for humanitarian settings, in-
                                                               following under-reached populations: 1) girls
formation or guidance needs of practitioners, and
                                                               in urban contexts, 2) very marginalized girls, 3)
key programming gaps. A number of themes arose
                                                               faith-based and customary/traditional leaders,
from the interviews. On strategies and promising
                                                               4) men and boys, and 5) married girls.
practices, practitioners discussed the importance
                                                          4.		Consider addressing context-specific risk fac-
of multi-level, integrated interventions, mobilizing
                                                               tors at multiple social-ecological levels; how-
communities to change social norms, conducting
                                                               ever, these activities should complement efforts
formative research to inform intervention design,
                                                               to support, empower, and build the capacity of
and contextually sensitive framing of child marriage.
                                                               girls themselves.
They also identified implementation challenges and
                                                          5.		Contextualize empowerment approaches to
gaps, including the need for a holistic, coordinated
                                                               address local drivers of child marriage as well
strategy across sectors, the diverse and context-spe-
                                                               as the specific needs and interests of the girls
cific drivers of child marriage, the resource and time
intensive nature of social norms change, limited
                                                          6.		Use incentive/asset transfer approaches to build
legal frameworks and enforcement, and the diffi-
                                                               girls’ human capital by incentivizing educa-
culty of translating national level legal and policy
                                                               tional outcomes or combining them with com-
successes into meaningful change at the local level.
                                                               plementary approaches for long term impact.
Researchers identified certain groups—such as eth-
                                                          7.		Ensure community sensitization and engage-
nic minorities, faith-based leaders, men and boys,
                                                               ment approaches are long-term, participatory,
and married girls as needing greater inclusion in fu-
                                                               and engage a broad range of actors within a
ture efforts.
                                                               community who have been identified through
                                                               formative research.

                                      Toward an End to Child Marriage | 3
8.		Identify and engage key decision-makers and/or           8.		Increase the rigor of evaluations of child mar-
      people of influence within communities to serve              riage advocacy initiatives using creative, con-
      as champions for child marriage prevention and               text-appropriate methodologies.
9.		Design programs with the following consider-             Child Poverty
      ations in mind: 1) scalability and cost, 2) length,     1.		Measure the impact of child poverty program-
      3) formative research, 4) community input, and               ming on behavioral child marriage outcomes.
      5) rigorous evaluation.                                 2.		Consider the use of incentive/asset transfer pro-
10.	Develop a coordinated strategy at the organi-                 grams which incentivize educational outcomes
      zational level to address child marriage by es-              to reduce child marriage.
      tablishing joint objectives, outcomes, and in-          3.		Ensure that incentive/asset transfer programs
      dicators; unifying terminology; and clarifying               are well-evaluated and that impact is measured
      where the issue sits within Save the Children                by age.
      and how coordination within the organization            4.		Consider the use of age-appropriate employ-
      will take place.                                             ment and livelihood opportunities, as well as
11.		Develop a coordinated strategy at country lev-               training, to delay marriage among older adoles-
      els with all stakeholders within and outside of              cent girls.
      Save the Children active in addressing child
      marriage.                                               Child Protection
                                                              1.		Evaluate the impact of child protection inter-
Advocacy                                                           ventions on child marriage-related outcomes
1.		Place youth voices at the center of all advocacy ef-          using rigorous experimental and quasi-exper-
     forts, with a particular emphasis on girls’ voices.           imental methodologies or alternative rigorous
2.		Develop high-level partnerships and identify                  evaluation approaches.
     champions to expand political will and buy-in.           2.		Encourage other sectors to include child mar-
3.		Coordinate with well-established women’s rights               riage outcomes when evaluating interventions
     organizations to strengthen advocacy efforts and              to address drivers of child marriage in the local
     maximize impact.                                              context.
4.		Combine advocacy efforts with technical assis-           3.		Coordinate with other thematic areas to address
     tance to support governments in developing and                child marriage through approaches such as edu-
     implementing legislative and policy changes.                  cation, health, or livelihoods.
5.		Ensure advocacy efforts complement program-              4.		Provide assessment and measurement guidance
     ming directly benefitting girls where possible,               to other sectors to support the identification of
     that programs integrate advocacy components,                  contributing factors to child marriage.
     and that programming and advocacy are coor-
     dinated and work in synergy with each other.             Child Rights Governance
6.		Expand legal advocacy initiatives to include ed-         1.		Support opportunities for child-led advocacy
     ucational goals for adolescent girls.                         and accountability on child marriage, such as
7.		Assess the impact of advocacy achievements                    via child clubs and other forums for children
     on women and girls, rather than strictly focus-               to receive information about their rights, gain
     ing on whether legal or policy goals have been                advocacy skills, and lead activities in their com-
     achieved, to strengthen evaluation efforts.                   munities and countries.

                                        4   |   Toward an End to Child Marriage
2.		Build gender equality and child marriage into         4.		Measure the impact of nutrition programming
     child-friendly budget analysis and advocacy                on child marriage behaviors.
     work, to increase resourcing for child marriage       5.		Evaluate the impact of SRH programming, in-
     policies and programs.                                     cluding CSE, SRHR information, and youth-
3.		Integrate gender equality and child marriage               responsive SRH services, on behaviors, knowl-
     into efforts to protect and expand civil society           edge, and attitudes around child marriage.
     space from local to international levels, includ-     6.		Offer youth-responsive SRHR education pro-
     ing through working with girls’ and women’s                grams and services, as well as nutrition pro-
     groups.                                                    grams, to already-married girls.

Education                                                  Humanitarian
1.		Measure the impact of educational programming         1.		Conduct assessments to identify both pre-existing
     on behaviors, knowledge, and attitudes on child            drivers of child marriage, as well as new risk fac-
     marriage.                                                  tors related to crisis coping, such as economic
2.		Remove barriers to school participation and in-            and protection concerns, when developing child
     crease access to education for adolescent girls.           marriage interventions.
3.		Consider additional incentives to lower barriers      2.		Determine which forms of child marriage inter-
     to school attendance and increase the oppor-               vention are appropriate for various phases of an
     tunity cost for older adolescent girls to leave            emergency.
     school.                                               3.		Identify key entry points for mainstreaming
4.		Integrate comprehensive sexuality education                child marriage into existing humanitarian re-
     and/or child marriage, gender equality, and sex-           sponse efforts.
     ual and reproductive health and rights (SRHR)         4.		Pilot stand-alone child marriage programs and
     into standard education curriculum.                        integrate sector-specific approaches to address
5.		Remove barriers to education for already-mar-              child marriage in humanitarian settings. Build
     ried girls and pregnant and adolescent mothers.            in rigorous evaluations to develop evidence in
                                                                acute and protracted displacement settings.
Health and Nutrition                                       5.		Build child marriage prevention and response
1.		Determine whether food-insecurity is a driver of           capacity in fragile contexts whenever possible to
     child marriage and consider how nutrition pro-             ensure that the underlying drivers of child mar-
     grams may improve child marriage outcomes.                 riage are being addressed prior to acute crises.
2.		Determine whether lack of access to youth-            6.		Enable girls to return to school as quickly as
     responsive sexual and reproductive health                  possible following acute crisis.
     (SRH) services is a driver of child pregnancy,
     and thus child marriage, in a given context and       Research
     consider how such programs may improve child          1.		Expand research on child marriage drivers and
     marriage outcomes.                                         interventions to include settings that are poorly
3.		Integrate child marriage into comprehensive                represented in the literature, including child
     sexuality education (CSE), SRHR, and gender-               marriage in urban contexts, child marriage in
     based violence (GBV) education and awareness-              regions such as Latin America and Southeast
     raising activities for in- and out-of-school youth.        Asia, and child marriage in the context of gang
                                                                conflict in Central America.

                                       Toward an End to Child Marriage   | 5
2.		Conduct more rigorous impact evaluations of                 achievements on women and girls and 2) em-
     child marriage programming and advocacy                     ploying creative, context appropriate method-
     initiatives.                                                ologies to improve rigor of non-experimental
3.		Disaggregate evaluation data by age to better               methodologies when necessary.
     understand what works to prevent child mar-           10.	Evaluate the impact of other approaches such as
     riage among younger and older adolescents and               health, nutrition, and education on child mar-
     among different social, economic, and identity              riage as an outcome.
     groups.                                               11.		Build a formative research phase into piloting
4.		Lengthen evaluation time to capture individuals’            and evaluation efforts to tailor interventions to
     significant life events and social norm change.             the context-specific drivers and needs and pref-
5.		Evaluate each component of multi-component                  erences of the community.
     and multi-level programming individually as           12.		Prioritize research addressing support needs,
     well as together to determine which components              outreach strategies, and effective interventions
     are most successful at addressing child marriage.           for already-married girls to expand child mar-
6.		Consider cost, sustainability, and scalability when         riage response efforts.
     evaluating program impacts.                           13.		Build an evidence base in humanitarian settings
7.		Evaluate distinct components of empowerment                 that addresses the following topics: 1) why child
     programming separately to determine the im-                 marriage increases in some contexts, 2) decision-
     pact of each component on child marriage                    making factors of parents, 3) pre-existing and
     outcomes.                                                   crisis-specific drivers of child marriage, 4) sup-
8.		Improve evaluation of community sensitization               port needs of girls and their families, and 5) what
     and engagement to contribute significantly to               interventions work to address child marriage.
     organizational and global evidence on changing        14.		Engage youth in participatory research during
     social norms.                                               formative and pilot design phases to ensure that
9.		Improve evaluation of advocacy initiatives to               the needs and interests of young people are pri-
     contribute to organizational and global evi-                oritized and to improve buy-in.
     dence by 1) assessing the impact of advocacy

                                       6   | Toward an End to Child Marriage

CHILD MARRIAGE,       defined as formal or informal           as armed conflicts and natural disasters, and that
union before the age of 18,4 is a pervasive global phe-       where it does, adolescents under age 15 are often the
nomenon. According to the United Nations Children’s           most significantly impacted.10 In Jordan, for exam-
Fund (UNICEF), more than 650 million women alive              ple, UNICEF reported that rates of child marriage
today were married as children, and more than a               among displaced Syrian communities increased
third of those unions took place before those women           from 12% in 2011 to nearly 32% by the end of 2014.11
were 15. Currently, 12 million girls are married each         In Bangladesh, Human Rights Watch found that
year, 5 meaning globally one in six adolescent girls          families were hurrying to marry off their daughters
(aged 15–19) is married or in union.6 While some              before river erosion took away their homes.12
progress has been made with regards to decreas-                  Drivers of child marriage vary significantly across
ing the prevalence of child marriage, it is often not         regions and even within countries, but in nearly ev-
enough to offset population growth in regions such            ery context, child marriage is rooted in gender in-
as West and Central Africa where the practice is the          equality and discrimination. While statistics on
most common.7 In Niger, for example, where women              rates among boys are poor, current data shows that
have an average of 7.3 children each,8 prevalence of          girls are at nearly five times the risk compared with
child marriage is 76%. According to UNICEF, given             boys.13 Other drivers of child marriage include so-
the impact of population growth, at the current rate          cial and cultural norms and traditions with deeply
of decline, countries are not on track to reach the           entrenched beliefs around virginity and purity as
Sustainable Development Goal of ending child mar-             they relate to sex and pregnancy outside of mar-
riage by 2030, and an additional 150 million girls will       riage. Economic factors also play a significant role,
be married by that date.9                                     with girls from poor families nearly three times
   In addition, there has been increasing concern             more likely to marry before age 18 than those from
around child marriage in humanitarian contexts,               wealthy ones.14 Parents who are unable to adequately
where practitioners say a complex combination of              meet the financial needs of their families may see
factors leads parents to turn to early marriage as            marriage of a daughter as a way to lighten the finan-
a negative coping mechanism. While research in                cial burden, obtain a bride price, or keep dowries
this context is minimal thus far (several large-scale         more affordable. Finally, where education is inac-
prevalence studies are due for publication this year),        cessible or of low quality and where job prospects
one multi-country study found that early marriage             for girls are poor, girls may become brides simply
may increase markedly during some crises such                 because they have few alternatives.15

In humanitarian contexts such as armed conflict         emphasizing that child marriage, among other
or natural disaster, child marriage is driven by many      harmful practices, impairs “the recognition, enjoy-
of the same factors; however, these factors are often      ment and exercise of the human rights and funda-
severely aggravated by significant loss of resources,      mental freedoms of women and children.”21 Second,
crumbling infrastructure, breakdown of the rule of         child marriage has a serious impact on girls’ edu-
law, and uprooted social structures. Families report       cation and future economic prospects. Girls who
marrying off their daughters because there is not          marry before 18 years of age are less likely to stay
enough food to go around and few educational op-           in school and consequently, have 9% lower earn-
portunities or job prospects in displacement camps.        ings as adults.22 Young brides also face increased
In addition, protection concerns become primary,           social isolation and are at significantly higher risk
and parents arrange marriages hoping to protect            of physical and sexual violence at the hands of their
their daughters’ safety and honor in volatile situa-       partner than girls married after 18.23 Finally, child
tions where living quarters are often close and leav-      marriage is correlated with a number of serious
ing home unsafe.16                                         health consequences. Complications from preg-
   Unfortunately, girls who marry young face con-          nancy and childbirth are the number one reason
sequences that impact nearly every aspect of their         for the death of girls ages 15–19. In addition, babies
lives. First and foremost, child marriage is a violation   born to adolescent mothers are more likely to have
of children’s rights. While the Universal Declaration      low birth weight, and thus suffer from malnutri-
of Human Rights does not explicitly address child          tion and underdevelopment. This often perpetuates
marriage, Article 16(2) states that “Marriage shall        the cycle of poverty and early marriage for another
be entered into only with the free and full consent        generation.24
of the intending spouses.”17 The Convention on the             Effective interventions to prevent and respond
Elimination of All Forms of Discrimination Against         to child marriage and its consequences are sorely
Women (CEDAW) adds that any marriage of a                  needed. This report outlines the findings of a three-
child, which the Convention on the Rights of the           part study, conducted in collaboration with Save the
Child (CRC) defines as a person under the age of           Children, to determine what we know and what we
18,18 shall have no legal effect.19, 20                    still need to learn about preventing and responding
   Recently, committees for both CEDAW and CRC             to child marriage in both development and human-
reaffirmed 18 as the minimum age of marriage,              itarian contexts.

                                       8   | Toward an End to Child Marriage

Impetus                                                     the experiences of their practitioners have not yet
Save the Children is a global leader in addressing          been synthesized and analyzed to inform a clear
the health and protection needs of children in both         strategy to guide their work on this issue.
development and humanitarian contexts. Through                 Further, the global evidence addressing child
its member and country offices, Save the Children           marriage interventions is not available in an acces-
implements programs and advocacy initiatives to             sible format for practitioners and has several limita-
prevent and respond to child marriage. The Human            tions (Box 1). First, previous literature reviews ad-
Rights Center (HRC), at the University of California,       dressing child marriage interventions include only a
Berkeley, School of Law, through its Health and             small handful of studies due to strict inclusion crite-
Human Rights Program, conducts research to pro-             ria, often excluding grey literature or quasi-experi-
mote the health and protection of marginalized              mental studies that may offer useful information for
populations affected by humanitarian crisis. HRC            programming. Second, previous reviews also do not
undertook this research, in partnership with Save           include interventions in humanitarian contexts in
the Children, in order to provide the organization          addition to development contexts. Finally, research
with a synthesis of available evidence both within          and evaluations addressing child marriage inter-
and beyond the organization to inform Save the              ventions lack the perspectives of practitioners, their
Children’s strategy development and to strengthen           strategies, and challenges encountered in the field,
programming to address child marriage. In addi-             in order to ensure that we are building on lessons
tion, this research responds to key gaps in the evi-        learned from practice.
dence base more broadly and aims to provide orga-
nizations that address child marriage with accessible       Objectives
information to inform intervention design.                  This study has three main objectives:
   Although Save the Children implements a broad
                                                            1.	To provide a summary of the state of the evidence
range of child marriage prevention and response in-
                                                                regarding child marriage prevention and response
terventions around the world, the organization has
                                                                interventions, including promising practices and
not yet undertaken a comprehensive mapping of
                                                                evidence gaps;
their previous and current work on the issue of child
                                                            2.	To assess the nature, scope, and coverage of Save
marriage to ensure strategic coverage and coordina-
                                                                the Children’s current and recent child marriage
tion across member and country offices. In addition,
                                                                work within the past 10 years; and
lessons learned from their program evaluations and

3.	To identify strategies, implementation challenges,
                                                                  and the research priorities of practitioners within
Reviews and Reviews-of-Reviews on                                 Save the Children and beyond.
Interventions to Address Child Marriage
   Child Outcomes of Cash Transfer Programming                   Research findings are intended to inform Save
   by Anjini Mishra and Francesca Battistin (Save the
   Children, 2018)
                                                              the Children’s strategic focus, future programming,
                                                              research, and advocacy, further strengthening the
2.	The Global State of Evidence on Interventions to
    Prevent Child Marriage by Sophie Chae and Thoai           organization’s ability to prevent and respond to
    Ngo (Girl Center, 2017)                                   child marriage in development and humanitarian
3.	“Preventing Gender-Based Violence Victimization           settings.
    in Adolescent Girls in Lower-Income Countries:
    Systematic Review of Reviews,” Social Science &
    Medicine, by Kathryn Yount, Kathleen Krause, and
    Stephanie Miedema (2017)
4. “ Interventions to Prevent Child Marriage Among
    Young People in Low- and Middle-Income Countries:
    A Systematic Review of the Published and Gray
    Literature by Amanda Kalamar,” Journal of Adolescent
    Health, by Susan Lee-Rife, and Michelle Hindin (2016)
5.	“Interventions to Prevent or Reduce Violence Against
    Women and Girls: A Systematic Review of Reviews”
    by Diana J. Arango, Matthew Morton, Floriza Gennari,
    Sveinung Kiplesund, and Mary Ellsberg (The World
    Bank Group, 2014)
6.	“An Evidence Review of Gender-Integrated
    Interventions in Reproductive and Maternal-Child
    Health,” Journal of Health Communications, by
    Joan Kraft, Karin Wilkins, Guiliana Morales, Monique
    Widyono, and Susan Middlestadt (2014)
7.	“The Efficacy of Interventions to Reduce Adolescent
    Childbearing in Low- and Middle-Income Countries:
    A Systematic Review,” Studies in Family Planning, by
    Kate McQueston, Rachel Silverman, and Amanda
    Glassman (2013)
8.	“What Works to Prevent Child Marriage: A Review of
    the Evidence,” Studies in Family Planning, by Susan
    Lee-Rife, Anju Malhotra, Ann Warner, and Allison
    McGonagle Glinski (2012)
9.	Solutions to End Child Marriage: What the Evidence
   Shows by Anju Malhotra, Ann Warner, Allison
   McGonagle, and Susan Lee-Rife (ICRW, 2011)

                                         10   | Toward an End to Child Marriage

THE STUDY METHODOLOGY includes three com-                     professional networks were consulted to identify ad-
ponents: a review of the academic and grey liter-             ditional research or grey literature that had not been
ature addressing child marriage prevention and                found through the previous processes. The resulting
response interventions; a review of project and pro-          355 development and 27 humanitarian articles were
gram documents available in Save the Children’s               stored using RefWorks web-based reference manage-
global database; and key informant interviews with            ment software.
practitioners from Save the Children and other or-                All titles and abstracts resulting from the searches
ganizations involved in child marriage prevention             were screened according to the inclusion criteria
and response.                                                 provided in Table 1 below. Criteria for literature ad-
                                                              dressing interventions in humanitarian contexts were
Literature Review                                             expanded to include all years and humanitarian in-
Researchers identified peer-reviewed and grey liter-          dicators (such as armed conflict or natural disaster)
ature that evaluate interventions to prevent and re-          in addition to low- and middle-income country in-
spond to child marriage in development (i.e. low- and         dicators. The remaining 43 evaluations from develop-
middle-income country contexts) and humanitarian              ment contexts were subject to full-text review, quality
(i.e. armed conflict, natural disaster, or displace-          assessment, and data extraction. No evaluations for
ment) contexts. Relevant databases were combed us-            interventions in humanitarian contexts met inclusion
ing search terms appropriate to each database’s native        criteria. Extraction was conducted using predefined
controlled vocabulary. Searches were built by com-            criteria outlined in a comprehensive data extraction
bining terms that indicate a young person in a mar-           template (Appendix 2). In addition, researchers ap-
riage-like arrangement, with terms that indicate pre-         plied ranking criteria, adapted from the STROBE and
vention, intervention, reduction, or response in both         CONSORT standards for observational studies and
humanitarian and development settings (Appendix               randomized trials,25 to assess the quality and report-
1). In addition, websites for non-governmental orga-          ing of intervention and evaluation design (Appendix
nizations (NGOs), international non-governmental              3). Disagreements were recorded and resolved by fur-
organizations (INGOs), and governmental organiza-             ther discussion among the research team. Findings
tions known to be active in child marriage program-           from the included studies relating to programs and
ming were hand-searched for relevant publications.            initiatives for combatting child marriage in humani-
Searches were expanded by screening bibliographies            tarian and development settings were identified and
of published and grey literature matching eligibility         analyzed for patterns. Findings are outlined in the
criteria to identify new sources. Finally, experts and        following report.


DEVELOPMENT SETTINGS             Inclusion criteria                               Exclusion criteria

Publication type                 Peer-reviewed journals or grey literature from
                                 organizations known to be active in CEFM

Publication date                 2007–2017

Study type                       Intervention studies, clearly reported           Descriptive studies

Population                       Girls or boys
Mapping                                                      Once collected, program name, implementation
Researchers reviewed and synthesized Save the             dates, objectives, target population, intervention com-
Children’s internal and published documentation,          ponents, theory of change, and evaluation methods
focusing primarily on project and program evalu-          and outcomes were input into a standardized map-
ations and research on child marriage interventions       ping form for analysis. Any evaluations which met
across the movement since 2012. Documents were            the inclusion criteria for the literature review were
collected from a number of sources including:             put through the same data extraction, quality review,
                                                          and analysis process used for published literature.
1.	Submissions by Save the Children member and              There are a few notable limitations to the mapping
    country offices;                                      exercise. First, use of Save the Children’s Evaluation
2.	Save the Children’s Awards Management System          Repository is voluntary, which means member of-
    (AMS) Database; and                                   fices have not necessarily submitted all evaluations of
3.	Save the Children’s Evaluation Repository (a data-    child marriage-related programming to the reposi-
    base where members and country offices may vol-       tory. Second, not all grants or “awards” identified in
    untarily submit program or project evaluations).      the AMS Database were associated with strong pro-
                                                          gram documentation. Thus, not all programs related
    A request for program documents was circulated        to child marriage were well-understood. Third, par-
among Save the Children member offices, asking for        ticipation in the mapping exercise was not manda-
all relevant proposals, donor reports, and evalua-        tory. Though all member offices were encouraged to
tions with a child marriage component within the          submit documents and fill in documentation gaps,
past five years. The AMS search was conducted by ex-      some member offices were more actively engaged in
porting all grants or “awards” to Excel and applying      this process than others. Given these limitations, this
filters to identify active, closed, and approved awards   mapping exercise should not be considered exhaus-
relating to child marriage. Researchers then down-        tive or in any way representative of all of Save the
loaded logframes, final project reports, or evaluation    Children’s programming related to child marriage,
reports associated with each award. Together, these       especially in regards to non-current interventions.
resulted in 175 program documents. The Evaluation
Repository was searched for documents related to          Key Informant Interviews
child marriage, yielding a total of 89 documents. All     Researchers conducted key informant interviews
mid-term reviews, baseline studies, needs assessments,    with 27 practitioners currently engaged in child
or formative research documents were excluded, leav-      marriage prevention and response efforts. The ma-
ing 31 evaluation documents. Finally, transcripts from    jority of these interviews (21) were conducted with
key informant interviews were reviewed for project        Save the Children staff. Six practitioners at other in-
or program information relevant to mapping. (For          ternational and local NGOs implementing child mar-
key informant methodology, see below.) Documents          riage programming were also interviewed (Box 2).
from all sources which met inclusion criteria were           Researchers selected an initial set of key infor-
those related to interventions (including programs,       mants within Save the Children through purposive
tools and curricula, and campaigns) that sought to        sampling based on their work on child marriage
address child marriage as an explicit objective or        prevention and response programming, research,
those that measured child marriage indicators as an       or advocacy. Sampling aimed to include Save the
outcome in any year. In total, 206 Save the Children-     Children staff focusing on gender, child protec-
generated documents were collected and reviewed           tion, advocacy, and program development across
and 181 included in the final analysis.                   member, regional, and country offices. From these

                                      Toward an End to Child Marriage   | 13

             Key Informant Offices and Locations
             SC Member Offices           SC Country/Regional Offices                      Outside NGOs
             •   Canada                  • Asia             •   Nepal                     •   Arab Region
             •   International           • Bangladesh       •   Niger                     •   Bangladesh
             •   Netherlands             • Ethiopia         •   Sierra Leone              •   Ethiopia
             •   United Kingdom          •	Latin America   •   Somalia                   •   Lebanon
             •   United States              and Caribbean   •   South Sudan               •   Somalia
                                         • Malawi           •   West and Central Africa   •   South Sudan

interviews, snowball sampling was used to identify          interviews were not as directly involved as others in
additional key informants involved in direct imple-         child marriage program design or implementation.
mentation of child marriage programming within              Although these informants could provide general
Save the Children and other organizations, priori-          information about their programming and advo-
tizing those working in humanitarian contexts to            cacy, they were not able to speak about promising
address the significant gap in the literature on inter-     strategies, challenges, and research needs based on
ventions in these contexts.                                 direct experience. Third, interviews were conducted
   Researchers conducted all interviews by Skype            primarily with staff focusing on gender and child
using a semi-structured interview guide which was           protection, while only a few focused on advocacy.
developed based on research objectives and informed         Save the Children staff working in the areas of ed-
by key findings from the literature review. Interviews      ucation, poverty / livelihoods, and nutrition were
explored the following topic areas: nature of child         not interviewed, and therefore strategies to address
marriage, context-specific risk factors, nature of inter-   child marriage through these sectors were not fully
ventions or strategy, outcomes or impact (anecdotal         explored. Finally, the vast majority of interviews
or based on formal evaluation), implementation chal-        conducted were with practitioners from Save the
lenges, adaptation strategies for humanitarian set-         Children, and their perspectives reflect their experi-
tings, information or guidance needs of practitioners,      ences within this organization. Promising practices,
and key programming and research gaps. Researchers          challenges, and research priorities of practitioners
took detailed notes during interviews and followed          in other organizations were not fully explored and
up with thematic coding and analysis of those notes         may follow different trends. Given limited time and
to identify patterns in participant responses.              resource constraints, and the lack of literature ad-
   This qualitative research has several limita-            dressing child marriage interventions in these con-
tions. First, interviews were conducted in English          texts, individuals working in humanitarian settings
only. Second, some key informants in our initial            were prioritized.

                                       14   | Toward an End to Child Marriage
                                                                           THE LITERATURE

Development Literature
                                                                Fourteen countries are represented in the evalua-
Study Characteristics                                        tion literature, including Bangladesh, Burkina Faso,
Researchers identified, extracted, and analyzed a to-        Egypt, Ethiopia, India, Kenya, Malawi, Mexico,
tal of 43 experimental and quasi-experimental eval-          Pakistan, Senegal, Tanzania, Uganda, Zambia, and
uations to determine what is known about prom-               Zimbabwe (Figure 1). Program settings included 23
ising practices, programs, and evidence gaps to              rural, 2 urban, and 18 mixed rural, semi-urban, or
address child marriage in development contexts               urban settings. Program location settings were gen-
(see Appendices 4 and 5). Of these documents, 31             erally chosen (where reported) based on low liter-
were grey literature, including United Nations (UN)          acy rates, high poverty rates, and high prevalence of
reports, NGO reports, working papers, and dis-               child marriage.
sertations, and 12 were academic (peer-reviewed).               Of the programs included in the evaluation
Evaluations included 15 randomized controlled trials         studies, a majority of interventions (29) targeted
(RCTs), 23 quasi-experimental studies, and 5 natural         adolescent girls, with ten programs targeting both
experiments which evaluated 30 distinct projects or          adolescent girls and boys, and four targeting fami-
programs. Six studies evaluated programs imple-              lies of adolescents or the community more broadly.
mented by Save the Children.                                 Across studies, the term adolescent is used gener-
   Of those studies that met inclusion criteria, re-         ously, and where defined, may include children and
searchers determined that 24 were of high quality, 18        youth ranging in age from 10 through 24 years. Most
of medium quality, and 1 of low quality according to         programs targeted some broad span of ages within
modified STROBE and CONSORT scales.26 Medium                 this range (i.e. 12–19 years); however, five programs
and low-quality evaluations generally scored lower           specifically targeted younger adolescents (ages 10–
because the intervention was poorly described,               14 years), including Save the Children’s “CHOICES”
inclusion/exclusion criteria for participants was            curriculum and four school stipend programs for
poorly outlined, the sample size was not justified           girls beginning in grade 6 (roughly age 11). In addi-
on a statistical basis, no adjustment for confound-          tion, six studies aimed to respond to the needs of al-
ing was used, and limitations were not reported. We          ready married adolescent girls either exclusively or
retained all studies that met inclusion criteria for         in addition to preventing child marriage. For clarity,
learning, regardless of quality. However, only me-           these are separated from the remaining analysis, and
dium and high-quality studies were included in the           findings are examined in Box 3.
analysis of successful approaches.

Number of Studies




FIGURE 1:   Locations of child marriage program evaluations represented in this study.

   In general, studies sought to measure program-                    early pregnancy or contraceptive use. The remain-
matic impact on child marriage via behavior change,                  ing 18 interventions seek to reduce child marriage
change in knowledge and attitudes, or both. Of the                   as one of a range of objectives, including improving
evaluations measuring behavior change, indicators                    educational outcomes; improving economic oppor-
generally included age at first marriage or propor-                  tunity; decreasing SGBV; improving SRH outcomes;
tion of girls married between baseline and endline.                  changing gender norms, attitudes, and practices;
Of the evaluations that sought to measure change                     strengthening social networks; and improving life
in knowledge and attitudes, a wide range of indica-                  skills.
tors were evaluated for both girls and their parents                     Programs to address child marriage may be single-
or guardians, including knowledge of the legal age                   or multi-component by design. A single-component
of marriage and legal consequences for violations,                   intervention is one in which the program activities
perceptions regarding marriage before 18 years of                    are focused around addressing one primary driver
age, belief in girls’ right to choose both marriage age              of child marriage. For example, the Zomba cash
and partner, knowledge of advantages or benefits of                  transfer program sought to address child marriage
marrying after 18 years of age, and knowledge of a                   in Malawi by giving a cash transfer to families with
range of consequences of marrying before 18 years                    never-married daughters between the ages of 13–22
of age.                                                              years.27 Multi-component interventions, on the
                                                                     other hand, are those that seek to address multi-
Intervention Design                                                  ple drivers of child marriage using several different
The evaluation studies outline a number of differ-                   components as part of the same program. These may
ent intervention designs and approaches used to                      all be targeted directly towards girls, or they may ad-
prevent child marriage in development contexts.                      dress multiple levels of the social-ecological model
Interestingly, only five of the interventions aimed                  from a girl’s family, to her community, her policy
to address child marriage alone, while five inter-                   environment, and her society. The Empowerment
ventions combined child marriage objectives with                     and Livelihood for Adolescents (ELA) program by the
objectives around fertility decision-making such as                  NGO BRAC is one such program. It combines five

                                              16   |   Toward an End to Child Marriage
different components into one program, including 1)                    and 16 assess 13 distinct multi-component interven-
adolescent development centers, 2) life skills train-                  tions, 7 of which evaluated all components as a sin-
ing, 3) livelihoods training, 4) community participa-                  gle intervention and 9 of which evaluated compo-
tion, and 5) microfinance (Case Study 1).28 Overall,                   nents separately and against a control to determine
of the 37 evaluation studies included in this report,                  the impacts of individual components.
21 assess 14 distinct single-component interventions

  BOX 3

  Responding to Child Marriage
  The prevention of child marriage is a          also evaluated response components          ly being piloted by IRC in Lebanon to
  critical focus of child marriage interven-     (Appendix 5). Response programming          address the specific needs of married
  tions, yet the stark reality is that despite   in these studies addressed a broad array    adolescent girls in displacement set-
  efforts to the contrary, 12 million girls      of topics, including use of modern          tings. The program uses a 26-module
  are still married each year.29 While           contraceptives, use of SRH services,        life skills curriculum tailored to the local
  some of the challenges faced by young          pregnancy-related care seeking, egali-      context through participatory assess-
  brides are similar to those of their           tarian marital relations, and measures of   ments to cover topics such as self-es-
  unmarried peers, many, including those         autonomy and social support networks.       teem/self-worth, healthy relationship
  having to do with SRH, family planning,        Evaluations measured outcomes such          skills, financial management, family
  IPV, parenting, social isolation, educa-       as increased contraceptive use, delay       planning, and SGBV. With girls’ approval,
  tion, and livelihoods, are unique to this      and spacing of pregnancies, seeking         husbands and mothers-in-laws are en-
  population. For the nearly one in six          out RH services and pregnancy-relat-        gaged through one-on-one meetings
  adolescent girls (aged 15–19) married          ed care, absence of marital violence        to ensure girls are allowed to attend
  or in an informal union, it is critical that   and physical punishment of children,        sessions regularly.
  interventions and support are tailored         improved partner communication and
                                                                                                Generally speaking, Save the Chil-
  to meet their unique needs.30 Unfor-           knowledge of SRH, and improved eco-
                                                                                             dren is well-poised to contribute to
  tunately, many organizations are not           nomic outcomes.
                                                                                             addressing the needs of married girls
  focusing on supporting married girls
                                                    An example of an effective response      through new and existing program
  either because they do not feel it falls
                                                 project for married girls is TESFA (To-     models. As one key informant told us,
  under their mandate or because they
                                                 ward Economic and Sexual Reproduc-
  fear supporting married girls could be                                                     Response falls firmly under our man-
                                                 tive Health Outcomes for Adolescent
  viewed as condoning child marriage.                                                        date. We’re talking about anyone under
                                                 Girls), which worked with married girls
  Of those that do provide programming,                                                      the age of 18. . . . We also do a ton
                                                 in the Amhara region of Ethiopia to
  many include married and unmarried                                                         of work with adults. . . . This is really
                                                 achieve four primary aims: to 1) em-
  girls in the same cohorts, failing to                                                      relevant work through the themes we
                                                 power girls with information, skills, and
  address their distinct needs.                                                              have: livelihoods, life skills, post-
                                                 a support network, 2) provide essential
                                                                                             secondary education, through health
  There are so many organizations work-          health information and services, 3)
                                                                                             we’re doing work around SRH rights,
  ing on prevention of early marriage,           educate and rally parents and commu-
                                                                                             maternal health. . . . It’s really not a
  but not a lot are working at response to       nity members, and 4) provide financial
                                                                                             stretch for us, [it’s] just connecting the
  early marriage. . . . You cannot promote       and livelihoods training. Over the three
                                                                                             dots. That is something we haven’t
  awareness and prevention of early              years it ran, the program saw a signifi-
                                                                                             done as well as we could.
  marriage in a culture that does not            cant improvement among married girls
                                                                                             —PRACTITIONER, SAVE THE CHILDREN,
  want to stop early marriage. . . . I think     with regards to improved husband and
  it would be much more effective, when          wife communication, decreased SGBV,
  you’ve passed the point when you can           improved mental health, increased              As programming to address child
  do prevention, to do response. So our          investment in productive economic           marriage continues to develop, inter-
  job is to empower these girls, empower         assets, and improved knowledge and          ventions that respond to the needs
  these individuals in that specific cul-        use of SRH services, including family       of already married girls, in addition
  ture. —PRACTITIONER, NGO, LEBANON              planning.31                                 to those that prevent child marriage,
                                                                                             should receive increased attention and
     This review identified 10 articles eval-    In humanitarian contexts, key in-
  uating programming for married girls,       formants identified a program known
  including 4 prevention intervention         simply as the “early marriage tailored
  studies from the literature review that     package curriculum,” which is current-

                                             Toward an End to Child Marriage          | 17
An analysis of child marriage program evaluations     Intervention Approaches
over time shows that there has been a significant in-     Given the many drivers of child marriage, organi-
crease in rigorous evaluations of child marriage pro-     zations and governments take a broad range of ap-
gramming in the past 10 years. Programming prior          proaches to addressing the issue. However, across
to 2013 was typically single component by design;         interventions, there are four primary approaches
however, since 2013, there has also been a recog-         evaluated in the literature: 1) Empowerment, 2)
nizable increase in the number of multi-compo-            Incentive/asset transfer, 3) Community sensitization
nent programs, likely in response to the increasing       and engagement, and 4) Legal and advocacy.
acknowledgement of the complex range of drivers
that may promote child marriage in a given context.       Empowerment
Around the same time, evaluations of multi-com-           Social economist and women’s empowerment spe-
ponent programs began to separate components              cialist Naila Kabeer defines empowerment as, “The
for individual evaluation against a control to better     expansion in people’s ability to make strategic life
determine which program components were most              choices in a context where this ability was previ-
effective.                                                ously denied to them.”32 Thus, empowerment ap-
    Overall, program periods ranged in duration           proaches are those that seek to improve a child’s
from 1–16 years, with nearly half of all evaluated        agency, choice, and freedom of action with regards
programs falling between 1–2 years in length, and         to marriage and other aspects in his or her life.33
more than three quarters between 1–5. Given that          Given the broad definition, empowerment pro-
longer programs were all run by government en-            grams encompass a wide range of interventions.
tities, the high number of 1–5 year interventions         Common themes across programs are gender and
likely reflects the funding cycles to which NGOs          child-rights awareness, life skills education, health
and INGOs are subject, rather than ideal program          education (particularly SRH), financial literacy pro-
length. Likewise, intervention time—the amount of         grams, and livelihoods skill-building (Box 4). These
time a single participant might be engaged in the         hold a common theory of change that by improv-
program—ranged in length from 3 days to 5 years,          ing a girl’s knowledge, skills, self-confidence, and
with nearly three quarters of all interventions com-      self-awareness, she will have the tools necessary to
pleted in 24 months or less. There are no apparent        reduce her vulnerability to early marriage, improve
trends in length of programs or interventions over        her position within her home and community, and
time.                                                     expand her alternatives outside of the home.
    Interventions were generally introduced at the           Of the programs evaluated, 22 include empow-
level of the child, household/village, community,         erment interventions either as a sole component
region, or nation. Size or scope of the interven-         or in addition to other programmatic components.
tions were measured in different ways depending           Empowerment interventions are generally held in
on the target, while program scope was typically          designated youth-friendly spaces which have been
measured using number of villages/communities             called safe spaces, girls groups, help groups, devel-
reached, number of households reached, num-               opment clubs, or adolescent development centers
ber of girls reached, and number of girls and boys        in the literature. These spaces typically function as
reached. Programs’ scopes ranged from 100–460             meeting spaces for learning, recreation, and social
villages, 600–150,000 households, 860–40,000              activities, are often stocked with books, art sup-
youth or children, and 183–2 million girls more           plies, and recreation equipment (like balls or table
specifically.                                             games), and are generally managed by peer edu-
                                                          cators or older adolescent or youth leaders who

                                    18   |   Toward an End to Child Marriage
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