research paper on child marriage in india

• UNFPA in India
• Country Representative
• UNFPA Asia & the Pacific
• UNFPA Global
• Sexual & reproductive health
• Young people
• Human rights & gender equality
• Population matters
• Campaigns & programmes

Publications

Child Marriage in India: Key Insights from the NFHS-5 (2019-21)

Number of pages

UNFPA India

Technical Reports and Document

Publication date

25 July 2022

Child marriage is closely associated with poverty and is likely to increase girls’ vulnerabilities. Girls who marry young are often socially isolated and cut-off from family, friends and other support systems. They may face an increased risk of limited opportunities for education and decent work. In spite of the Prohibition of Child Marriage Act (2006), the practice of child marriage remains pervasive due to factors spread across the socio-ecological spectrum, including structural inequalities and regressive social norms.

The objective of this analysis is to study and trace the trends in the practice of child marriage in India. The review is based on the latest data and evidence and will examine socio-economic determinants to understand the specific role of these factors, which perpetuate this harmful practice.

31 December 2024

Public Health Care Utilization by Elderly in India: An Analysis of Major Determinants from LASI Data

06 September 2024

A Life-Cycle of Change: The People Behind Taalim-i-Naubalighan

22 August 2024

From Family to Frontline: Empowering Survivors of Gender-based Violence

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

The PMC website is updating on October 15, 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.18(4); Winter 2018

Social Determinants of Child Marriage in Rural India

Rajeev seth.

1 Bal Umang Drishya Sanstha (BUDS), New Delhi, India

Vijayluxmi Bose

Yawar qaiyum, riti chandrashekhar, shubhangi kansal, indra taneja, tulika seth.

2 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India

Background:

Child marriage represents a grave violence against children and deprives them of their rights to health, education, and a livelihood. Because child marriage should be recognized as a social and medical emergency, the social determinants of child marriage in India need to be mapped. The aim of this qualitative case study was to document social determinants of child marriage identified by the authors while providing community mobile health services in rural Mewat District, India.

Case Report:

We present qualitative participatory medical histories and assessments of two clinical cases: an adolescent who is waiting to get married and a young woman who was married as an adolescent but developed multiple health complications after her husband abandoned her.

Conclusion:

Patriarchy, coercion, social customs, and norms were identified as major social determinants. The two cases demonstrate that social norms influence intergenerational norms and lead to uninformed decision-making and child marriage. In low- and middle-income countries, medical professionals should urgently address child marriage as a major public health problem. Primary care physicians and medical professionals should implement preventive measures and provide anticipatory guidance to prevent child marriage.

INTRODUCTION

Child marriage represents a grave violation of the United Nations Convention on the Rights of the Child. 1 Worldwide, more than 60 million women are estimated to be married before they reach the age of 18 years, and more than one-third of these women live in South Asia. 2 , 3 Despite the Prohibition of Child Marriage Act of 2006 that established marriage of females under 18 years and of males under 21 years as a cognizable offence, child marriage remains widespread in India. 4 Evidence suggests that approximately 30% of all women aged 20-24 years are married before they attain legal age. 5 The 2011 Indian census estimated that 17 million children in the age group of 10-19 years are married. 5 A United Nations International Children’s Emergency Fund (UNICEF) study on reducing child marriage identifies the trajectory of associated adverse consequences: curtailment of freedom of choices and opportunities, early marriage, and early child-bearing. 5 The study also partially attributes domestic violence and harmful health outcomes such as high infant, child, and maternal mortality rates to child marriage.

Children who marry early are subject to a growing problem of violence and abuse. They experience trauma, early life toxic stress, and related adverse childhood experiences. According to the Adverse Childhood Experiences study, a major American epidemiological research project, a powerful relationship has been established between maltreatment and violence in childhood and adverse health effects in adult life. 6 , 7 Development of high-risk health behaviors such as smoking, alcohol and drug abuse, and severe obesity are correlated with depression, heart disease, cancer, chronic lung disease, and shortened lifespan. 6 Underage marriage puts children at risk of long-term adverse health effects that may not manifest until adulthood. 8 A study published in Lancet reported that medical practitioners in Andhra Pradesh (a state in South India) saw adolescents who came in for checkups but lacked information, indicative of the low priority accorded to girls’ health. 9

Although child marriage is a major public health problem, its social determinants in different regions have not yet been mapped. Social determinants of health are the conditions in which people are born, grow, work, live, and age. 10

Bal Umang Drishya Sanstha (BUDS) 11 is an Indian-registered nonprofit organization that operates according to the Three Principles (3Ps): prevention of disease, prompt treatment, and promotion of health. BUDS facilitates access to healthcare in the marginalized rural community in the Mewat District in the state of Haryana, India, via a fully equipped mobile health van. 12

Of the 644 districts in the 29 states in India, Mewat is currently ranked the lowest among the districts. In its composite ranking of all five development sectors—health and nutrition, education, agriculture and water resources, financial inclusion and skill development, and basic infrastructure—the National Institution for Transforming India, Government of India, placed Mewat at the bottom. 13 Mewat District household- and facility-level data revealed that the majority of adolescents suffer from high levels of malnutrition, anemia, and sexual and reproductive health issues. The percentage of married women who wed before they are 18 years of age in rural Mewat is 16.9%. 14 Only 9% of married women in rural Mewat have had more than 10 years of schooling. 14 Most of the families in Mewat have many children. Children either do not go to school or drop out of school after the primary level. They also get married at ages well below the legal age of marriage. 4 This family life cycle repeats generation after generation.

The BUDS van provides healthcare access to many adolescents and young women who are undernourished and anemic, as well as to infants who are low birth weight and children suffering from various early-onset childhood illnesses who are brought to the clinic by adolescent mothers.

The aim of this case study was to identify the social determinants related to child marriage that were elicited from two patients seen by the authors as they provided community mobile health services in rural Mewat, India. These case studies will be used to develop a public health strategy to help prevent child marriage in this community.

Knowing that direct questions get evasive answers, women in the region are conditioned to give socially desirable responses, and quantitative data need to be supplemented by qualitative responses reflective of social norms, the authors designed a qualitative participative case study approach to test whether one-on-one interviews would lead to greater disclosure. Because the BUDS team is accepted by the villagers, we conducted a participative, exploratory case analysis to gain a better understanding of the social determinants of child marriage.

Consent forms were translated into Hindi (the local language) and signed by the case study respondents. Consonant with the norms of the society, a woman was present throughout the interview because the interviewer (R.S.) is a US-trained male pediatrician from Delhi who volunteers with the BUDS mobile health van in underserved villages in Mewat District. Rapport building was facilitated by a senior woman social worker and female pediatrician from the BUDS team.

In conjunction with the BUDS team, the author visited two family homes to observe first-hand the social determinants related to child marriage. The names of the respondents have been changed to protect their identities.

CASE STUDY 1

Salma is a 14-year-old girl who lives with her family in Ghasera village, Mewat District, Haryana, India. The family is large, and the father, an itinerant seller of clothes, is the only wage earner. Salma has two sisters aged 12 and 7 years and three brothers who are approximately 10, 5, and 3 years old. Salma’s 12-year-old sister attends a government school. None of the other children is in school.

During the prior 6 months, the family faced several health challenges, including respiratory and gastrointestinal infections, scabies, and eye and dental problems. They accessed the BUDS mobile health van facility twice to receive treatment.

Salma approached the primary care physician in the health van with symptoms of common cold and fatigue. While diagnosing her upper respiratory tract infection and anemia, the doctor asked Salma why she wasn’t in school. Salma stated that she had dropped out of school after standard five (10 years of age) because her mother became ill with pulmonary tuberculosis. 15 The disease is currently in remission, but the mother’s left lung is fibrotic and nonfunctional. Salma’s mother has a history of frequent admissions to the National Institute of Tuberculosis and Respiratory Diseases, Mehrauli, New Delhi, when she has an attack of asthmatic bronchitis.

When asked how she feels about early marriage, Salma said she has no views. She knows that early marriage is the custom in her community; girls get married as soon as they attain puberty. Salma said that the practice of marrying daughters at the age of 15-16 years is a “very common social norm in this village.” If girls do not marry early, they are subject to taunts; people in the community suspect them of having illicit affairs or of having some kind of disability. The parents of adolescent unmarried girls are also criticized, and the community accuses them of being negligent or not having enough money to marry off their daughters.

Although Salma’s reason for not continuing her education was her mother’s ill health, her peers frequently either did not go to school or dropped out because the “environment is not conducive.” Gender-based violence seems to be a threat for most young girls in the community. Adolescent girls cover their heads and faces in public and in the presence of males. They are not encouraged to leave home unescorted. The authors asked whether molestation had occurred. Salma and her mother were emphatic in their denial. Salma mentioned that the “media reportage and portrayal of gender violence” also add to the latent fears of the community.

CASE STUDY 2

Sahuni is 25 years old. Her house is well built and has three rooms and a toilet, indicating that the family is not very poor. The family has approximately one-half acre of land that provides food year-round. In addition to the parents, the household consists of five other siblings. One of the boys born to this family died early, possibly of blood cancer. The family members said that they had visited the BUDS mobile health van three times.

Sahuni and her 23-year-old sister participated in the interview; their mother provided intermittent comments. Like some of her peers, Sahuni received Quran-based religious education in a madrasa (a local center for Islamic religious studies); however, none of the other children in the family has ever set foot inside a school. From a medical perspective, Sahuni, her mother, and her sister looked tired and weak and showed signs of anemia and malnourishment. Sahuni’s estimated weight is <35 kg. The mother’s grueling daily routine and lack of proper nutrition likely contribute to her pallor and weakness. A homemaker, her day begins at 5:00 am. Following ablutions, she reads the Quran and begins her daily chores. After her husband leaves for work, she sews to augment the family income. She is worried about Sahuni’s sister’s marriage because the family is too poor to afford a dowry (which usually consists of a motorcycle).

Sahuni’s medical condition—complaints of headache, body ache, depression, and fatigue—likely results from her poor physical and mental health status. Gradually, as rapport was built, including a visit to the health van parked nearby, Sahuni told her story. She was married at age 15 or 16 years to a man who worked as a driver. Sahuni had 8 successive miscarriages with heavy bleeding in her attempts to provide her husband with children. All attempts failed. After she was hospitalized for a blood transfusion, Sahuni’s husband abandoned her at her maternal home. She described the cycle of poverty, ignorance, and illiteracy that is the lot of young women in her community and the threat of gender violence that drives jawanladkis (sexually mature adolescent girls) to be married at an early age.

Sahuni has no views of her own about being married early. During a revisit to question further, the authors were given an answer that they had heard repeatedly in the community: “ Izzat ka sawal hai ” (it is a question of honor). Sahuni conformed to what her parents had asked her to do. Now she has nowhere to go and nothing to do. “Society makes it more of an issue than our parents,” she said.

Sahuni has no aspirations. Unschooled and confined to the house, she hopes that her husband will give her a new set of clothes for Eid (a major Muslim festival that was just a few days away when the interview was conducted) as he has given his sisters. Despite having cultivable land and a pukka (cemented) house, the woman of the house and her adolescent children are neglected, resulting in a chronic cycle of disease that could be corrected by medication/supplementation and a good diet.

Child marriage is associated with major health complications in teenage mothers and their children. Most underage mothers are at risk of reproductive health challenges, impaired mental health, malnutrition, anemia, vaccine-preventable infectious diseases, and exposure to sexually transmitted diseases. The children of underage mothers are at increased risk of prematurity, intrauterine growth retardation, being small for gestational age, birth asphyxia, perinatal complications, and even death. 9 Teenage mothers risk hypertensive disorder, eclampsia, preeclampsia, and postpartum hemorrhage.

The onset of menarche indicates to the elders and community that a girl is of marriageable age, irrespective of her chronological age. Ladki jawan ho gayi hai means that the girl has become sexually mature. According to the two interviewees, the threat to family honour and adherence to social customs are determinants of early/child marriage. These factors may influence decision-making at the family level; however, at the community and societal level, social norms may be used to camouflage the actual causes such as structural inequalities and patriarchy. 16 Some sexual reproductive factors—such as the onset of menarche—contribute to the gating of women; Salma said that adolescent girls never leave the house unaccompanied. Therefore, gender norms play out in the overemphasis of the connection between girls’ virginity and chastity and family honor. 16 Child marriage is used as a strategy to preserve such customs and traditions that are an extension of the normative conditioning that adolescents are subject to from infancy. 2 , 17 As a number of studies in India have shown, these societal threats coerce adolescents to conform to norms. 16 , 17 Consequently, the control of the patriarchy, endorsed by community support, is perpetuated from one generation to the next.

These social, cultural, and patriarchal mindsets and gender norms discourage girls aged 10-12 years (or more) from going to school. Most young children are educated in the Urdu language at madrasas and are not sent to formal schools at all. Children who receive minimal education become home-bound, and the lack of livelihood opportunities perpetuates poverty in the family. Lack of knowledge about government programs also adds to disempowerment and isolation of families within communities ( Table ). 18 These are the drivers behind low knowledge among adolescents about the negative health outcomes of early marriage (eg, multiple miscarriages, infections, anemia). The BUDS team found that social norms and neglect influence structural norms that contribute to the collective community experiences and uninformed decision-making. Illiteracy, lack of mobility, and early marriage influence the macroenvironment (disempowerment of women, apathy, inability to earn) that in turn strengthens social norms and neglect of adolescents ( Figure ).

BUDS, Bal Umang Drishya Sanstha; HIV, human immunodeficiency virus.

Resources are available; the villages in Mewat District have mainstream schools in the vicinity, a primary health center, and a district hospital. The low access to these facilities may be explained by adolescent girls conforming to prevalent social norms, vested interest groups, and gender prescriptions and by inefficient implementation of the Prohibition of Child Marriage Act. 5

The persistence of child marriage is a social and medical emergency, and its symptoms may already be overburdening India’s already-overburdened health systems. 5 Incorporating child rights and protection training into the medical school curriculum and continuing medical education of physicians is an urgent need. Physicians need to be aware of and involved with cases of child marriage because of its effects on two generations of children: the underage parent and her infant.

In rural and marginalized social environments, the roles of physicians should not be confined to clinical activities alone, but they should also provide comprehensive health services, prevention, and anticipatory guidance. Primary care physicians and healthcare providers are often the first point of contact outside of the family with abused and neglected children. They may come across various forms of exploitation, including child marriage, in their practices. Trained primary care physicians—pediatricians in particular—should be taught to engage with issues of violence and child marriage. Medical providers should ask questions about potential areas of child neglect, such as lack of education and poor nutrition. They should probe for the underlying etiology in all children with functional symptoms such as chronic fatigue. Practitioners who work in hospitals can order behavioral, counseling, or mental health/psychiatric consultations. This approach involves shifting from the diagnostic-prescriptive mode and into the realm of participative inquiry.

Globally, progress in understanding and preventing violence against children from birth 0-18 years is advancing rapidly. In 2016, the World Health Organization released INSPIRE, a package of seven evidence-based strategies to prevent violence against children. 19 INSPIRE is an essential tool to help achieve Sustainable Development Goal (SDG) Target 16.2 (End abuse, exploitation, trafficking, and all forms of violence and torture against children) and also for achieving SDGs 1, 3, 4, 5, 10, 11, and 16 that target poverty, health, education, gender equality, reduced inequalities, safe environment, and justice. 20 Some of the well-known strategies to prevent child marriage include (1) empowering girls with information, skills, and support; (2) educating and mobilizing parents and community members to restrict harmful gender and social norms; (3) enhancing the accessibility and quality of formal schooling; (4) providing economic support and incentives for girls; and (5) fostering an enabling legal and policy framework. Implementation of preventive programs faces challenges such as lack of convergence of various sectors, engagement of medical and multidisciplinary professionals, government policies, and gaps in implementation of the law. 2

Nongovernmental organizations (NGOs) and medical professional societies such as Indian Child Abuse, Neglect and Child Labour, the Indian Academy of Pediatrics, and the Federation of Obstetric and Gynaecological Societies of India have huge numbers of pediatrician and gynecologist members who can be trained in identifying child abuse, neglect, and exploitation.

Physicians can be trained in the principles of trauma-informed care and in how to take a proper history, as well as how to properly document and record all cases. They should be able to work effectively with multidisciplinary child protection professionals such as forensic and law enforcement agencies, the National Commission for Protection of Child Rights, child welfare committees, the CHILDLINE India Foundation (1098 tele helpline), child rights activists, and NGOs. Primary care physicians can give adolescents access to therapeutic treatment and justice. Clinical evidence, data, and strategic interventions by large numbers of practitioners can lead to social and policy change.

The social determinants of child marriage identified in these case studies are indicative of a patriarchal system that prevents women from obtaining an education, earning a livelihood, and becoming productive citizens. Child marriage is a violation of the basic rights of the child and a major public health problem. The need is urgent to provide an enabling environment for all adolescents, including those who have never been to school or who have dropped out of school. Preventive measures and anticipatory guidance to prevent child neglect, abuse, and child marriage should become a part of routine medical management. Social pediatrics, community medicine twinned with social/mixed methods research outcomes, and documentation of good practices are powerful enablers. Proactive and sustained evidence-based advocacy with government, civil societies, and professional societies can bring about changes in the macroenvironment, help ensure that laws are enforced, and eventually help adolescents find their rightful place in society. Physicians have an important role as influencers of public health policy and as advocates in the community for prevention of child marriage.

ACKNOWLEDGMENTS

The authors have no financial or proprietary interest in the subject matter of this article.

This article meets the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties Maintenance of Certification competencies for Patient Care, Medical Knowledge, Interpersonal and Communication Skills, and Systems-Based Practice.

Enter the URL below into your favorite RSS reader.

Evaluating interventions to reduce child marriage in India

• Citation (BibTeX)

Sorry, something went wrong. Please try again.

If this problem reoccurs, please contact Scholastica Support

Error message:

View more stats

This paper estimates the costs and benefits of investing in education interventions and specific child marriage programs to reduce child marriage in India. Child marriage in India remains highly prevalent despite considerable progress in the last decade or more, associated, in particular, with a decline in poverty. The economic consequences of the COVID 19 pandemic are likely to reverse these gains, meaning that the interventions to reduce child marriage evaluated in this paper assume even greater importance.

A literature search to identify interventions with costs and estimates of impact on reduction in child marriage for India, and other low and middle income countries was conducted. The costs and effectiveness of the interventions were modelled for India, and economic benefits of reducing school dropout rates and increasing secondary school completions were estimated. The ratio of the economic benefits to the intervention costs estimated gave the benefit-cost ratio.

The interventions resulted in an average benefit-cost ratio of 16.8. The interventions are projected to decrease the estimated marriage rate for girls aged 15–17 years for India from an estimated rate of 16.4% in 2020 by 7.5 percentage points by 2050, with education interventions targeting increased attendance being the larger factor. By 2030, the proportion of girls completing school is estimated to increase by 13 percentage points and productivity to have increased by 16.4%.

Conclusions

The results indicate substantial economic and social gains to reducing child marriage by interventions that decrease school dropout rates, increase secondary school completions for girls, and address some of the broader social and cultural disadvantages they face in India. This has significant implications not only for their health, but also for the quality of the available economic opportunities and the possibility of attaining Sustainable Development Goal 5.

Child marriage (CM) is defined as a legal or customary union that occurs before the age of 18. In India, the minimum legal age of marriage is 18 for girls and 21 for boys. The Prohibition of Child Marriage Act, 2006 has closed loopholes which allowed CM and has made it a punishable offence. 1 India is party to a range of international conventions outlawing child marriages, including several UN human rights conventions including the Convention on Consent to Marriage, Minimum Age for Marriage, and Registration of Marriages (1962). The accepted measure of the prevalence of CM is the proportion of women aged 20–24 who were married prior to 18. 2 This is generally higher than the proportion of girls aged 18 or under, married at a particular point in time, due to underreporting for girls below the legal age of marriage. 3

In part, because of its size and high prevalence in a number of poorer states, India, in spite of the laws, has the highest number of child marriages in the world, about 1.5 million each year. 4 However, CM in India has fallen significantly from 47% in 2005–06 to 27% in 2015–16. 5–7 The decline in CM is closely associated with improvements in girls’ education, transition of households to an improved standard of living and a decrease in average household size. 8 , 9 Some of the decline may also be due to the number of interventions and government programs, even though few have been appropriately evaluated. The serious economic impact of the COVID 19 pandemic on India is likely to reverse these favourable trends in child marriage.

While a complex range of factors contribute to the continuing practice of CM, the most important are:

poverty, 2 , 10 the average CM rate is 63% in the lowest quintile, whereas it is 10% in the highest. In Jumui in Bihar, the CM rate is 81% in the lowest quintile; 11

social and cultural norms, 2 , 9 , 12–14 such as the practice of dowry; 9 and

truncated educational opportunities, 9 , 11 , 15 girls discontinue education after marriage, mainly due to pressure from community, lack of permission from in-laws, and increasing household responsibilities and financial burden. 15

There are significant differences in CM rates between the Indian states. As indicated, the reasons are complex, but a number, such as poverty and educational outcomes, are reflected in gross state product (GSP). Figure 1 shows the strong association between CM prevalence and GSP per capita in Indian states.

The theory of change 16 , 17 on which our modelling framework is based, is that girls at risk of marriage benefit from improved educational and economic opportunities as alternatives to CM. The economic benefits of reduced CM arise from more productive employment opportunities because of improved education outcomes. The interventions to improve education outcomes are those designed to keep girls at school, reduce the dropout rate and extend the time at school to at least secondary school completion. These have the effect of delaying CM. Other interventions are aimed directly at reducing CM. By delaying marriage, these interventions help keep girls at school. These relationships are illustrated in Figure 2 .

The aims of this paper are to identify the most effective interventions to reduce child marriage, to estimate their cost and impact for the case of India, and, using existing models 18–20 , to estimate the benefit-cost ratio for their application to India and their potential impact on CM.

Interventions

Of the interventions considered, three have direct impacts on CM rates, while four have indirect impacts through the effect of educational interventions on school attendance, and hence on CM rates ( Figure 2 ). We estimate the impact of reduced CM on educational outcomes, notably early dropout, years of schooling and completion of secondary schooling. We also estimate the economic benefit of better educational outcomes (such as higher productivity and access to better employment), leading to higher levels of gross domestic product (GDP) per capita. The results are brought together in a cost-benefit analysis.

Evidence of the costs and effectiveness of specific CM interventions was sought through a literature search of peer reviewed articles and grey literature (see Figure 3 ). The peer-reviewed literature search for articles is an extension of the search conducted in Rasmussen et al. 21 Web of Science and PubMed were searched from 2006 to 2020 (English articles only). The terms were varied, with the initial search (child marriage OR girl marriage OR early marriage) and (reduc* OR prevent*) resulting in 1456 articles in Web of Science, and 2012 articles in PubMed. These results were refined to (impact* OR intervention* OR trial* OR evaluation*) resulting in 562 articles in Web of Science and 777 in PubMed, totaling 1339 articles. The two sets were combined in Endnote (Clarivate Analytics, version x9.3), and 370 duplicates were removed, leaving 949 articles. The titles and abstracts of these were reviewed and 21 full-text articles were chosen for the assessment.

A grey literature search for non peer-reviewed literature and relevant reports was conducted in Google Scholar, university library catalogs, and websites of relevant agencies, in particular international agencies (e.g. World Bank, UNICEF, UNFPA, Population Council) and research centers. We specifically sought evidence from the Indian sub-continent. Fifty-five reports were downloaded and investigated for intervention results or impact.

Citations in relevant peer-reviewed journal articles and grey literature were hand searched for further relevant literature. A final set of 3 journal articles and 16 reports were selected for consideration in the modeling because of their relevance to interventions and impact on child marriage (see Table 1 ).

Malhotra et al. 13 identified five main effective strategies that included: life skills, community mobilisation, education incentives, conditional economic incentives and legal framework. Kalamar et al. 22 ranked interventions according to their detail, rigor, design and included impact measurement, randomization, and pre and post comparisons. From Table 1 , we selected intervention studies, with a preference for those from India, that included cost and effectiveness estimates and which met Kalamar et al.'s 22 criteria and conformed to Malhotra et al.'s 13 framework. Where there were no available data for India, and where possible, we drew on evidence from studies conducted in other countries. A more recent review of interventions by Malhotra and Elnakib, 23 broadly confirmed the selection of interventions used in this study. This included life skills training, conditional asset transfers to delay marriage, supply-side education interventions and the creation of female-focused employment opportunities.

Discussed below are the specific CM and the education interventions used in the modelling. The CM interventions used in the modelling included only life skills and conditional economic incentives. We considered modelling the interventions for community mobilisation 24 as suggested by Malhotra et al., 13 however, that indicated a low level of effectiveness, and accordingly was not included in the modelling.

Specific child marriage interventions

The 'Life Skills ’ programs were represented by the Maharashtra program 25 , 26 and the Youth Information Centres program 27 in Bihar and Uttar Pradesh. Based on these two programs, we adopted an effectiveness rate of 40%. A 70% reduction in the marriage rate was achieved by the Maharashtra Life Skills program with an odds ratio of 4.0, 26 although the likelihood of selection bias in these comparisons and other unobserved variables is acknowledged. Exposure to the Youth Information Centres program 27 reduced CM compared with the control group by 56% (Adj. OR 2.25, CI 1.28–3.94).

For the cost of the life skills program, we used the average of the highly effective but relatively expensive Egyptian Ishraq program of $31.50 per girl, and the much cheaper but less effective life skills component of the Indian Deepshika program, 4 about $4–6.50 per girl, which resulted in an average of $21.50 per girl.

For the conditional economic incentive interventions, we used the costs and effectiveness of the Kanyashree Prakalpa program, 28 the only one evaluated in India, at a cost of $11.55 per girl and a effectiveness of 32.9%.

Education interventions

Education interventions, which also reduced CM rates, were derived from a meta-analysis. 20 It measured the impact of education interventions to reduce secondary school dropout rates in terms of standard deviations. Only those showing an effect size in excess of 0.1 standard deviations for either learning improvement or dropout reduction were selected. The evidence suggested those which had a significant impact on CM 20 , 43 were (with their standard deviations in brackets):

Increase provision of school in rural areas to give girls greater access to schools (S.D. 0.38 (ρ = 0.27)).

Improve educational infrastructure, e.g. provision of girls’ latrines (SD = 0.12 (ρ = 0.0)).

Pedagogical changes (SD = 0.13 (ρ = 0.004)).

Private public partnerships (SD = 0.15 (ρ = 0.136)).

The costs of the education interventions derived from Wils et al. 20 are expressed as percentages of the base cost of Indian education programs. The costs are respectively 10%, 5% and 10% for points 1, 2, and 3 above, and a negligible cost for point 4 above.

Modelling framework

In line with the theory of change, 16 , 17 we developed a simulation/modelling study, which aimed to synthesize the available evidence on CM in India. The basic methodological approach followed our previous paper. 21

Two Microsoft Excel models were used to undertake the cost-benefit analysis: a cost and outcomes model which generated education costs and other education outcomes; and a benefits model which forecast economic benefits from employment, GDP levels and productivity gains. The modelling compared two scenarios, a continuation of existing conditions described as ‘base scenario’, and an ‘intervention scenario’ which included the interventions discussed above. For the ‘base scenario’, the cost and outcomes model projected base education costs, as well as CM prevalence and education enrolments. The intervention scenario estimated the impact of the interventions on this base scenario from 2020. The benefit-cost ratios are calculated on the basis that the annual cost of the interventions increases progressively to 2030, thereafter remaining constant to 2050. The benefits are modelled to include productivity and employment gains until retirement for each age cohort.

To estimate the CM prevalence for 2020, we projected the rate from the 2016 National Family and Health Survey. To estimate the marriage rate for those aged 15–17 in 2020, we used the declining trend in the estimated single-year marriage rates from the Survey to project the rate for 2020. We estimated that the rate would have declined to 16.4% by 2020. We used this as the starting CM rate for the benefit-cost analysis.

For the intervention scenario, the models were run with the addition of the interventions discussed above. With the cost model, new estimates of education costs, student enrolments and child marriage prevalence were calculated, and the benefits model generated new estimates of productivity gains, employment levels and GDP, based on the improved education outcomes. The additional economic gains from the employment and productivity effects, arising from the interventions, were compared with the costs of the interventions, to enable the benefit-cost ratios to be calculated. 18 , 20 , 21 , 44 The sensitivity of the benefit-cost ratios to different intervention cost and effectiveness assumptions was tested by varying each by +/– 10%.

These models made extensive use of international data sources: UNICEF, 45 UNESCO Institute for Statistics (UIS), ILO, and the World Bank Development Indicators and EdStats database. Indian data came from the National Sample Survey (NSS), the Annual Status of Education Report and the District Information System for Education.

Reduction in child marriage rates

The application of all interventions reduced the marriage rate for those aged 15–17 from the base of 16.4% in 2020 by 7.5 percentage points in 2050 (excluding any further trend decline), to 8.9% ( Table 2 ). Much of the impact was estimated to be achieved by 2030 with a reduction of 6.1 percentage points. The effect of the child marriage interventions, however, was modest with reductions of only 0.8 and 1.2 percentage points by 2030 and 2050 ( Table 2 ).

Note: *Base excludes trend decline.

This shows that the education inventions have a greater effect on the CM rate than the specific marriage interventions. However, we estimate that the net present value of costs to 2050 of the education interventions was six times larger, $243 billion, compared with $40 billion for the specific marriage interventions.

Regrettably, the severe effect of COVID appears likely to interrupt the downward trend in poverty and CM in India. 46 , 47 We estimate that the effect of COVID 19 in 2020–21 will be to lift the estimated number of CMs by 179,000, an increase of almost 3%. This is based on the decline of 9% in per capita income for India in 2020–21 compared with a year earlier. 48 Paul 49 has shown that CM increases by 0.3% for 1% increase in poverty, meaning that the marriage rate would increase by 2.7 percentage points, representing an additional 155,000 CMs. In addition, the number of 15–17 year old girls who will now be poor (less than $2 per day), and a have a higher propensity to marry, is estimated to have increased from 6 million to 13.4 million. Based on our modelling, this is estimated to add a further 22,000 to the number married.

At this early stage, it is difficult to project the impact of COVID on the longer-term decline in CM in India and we have not attempted to do so. However, it would appear that a greater investment than modelled here will be required to achieve the level projected in this study.

Better schooling outcomes and increased productivity

Table 3 presents schooling and productivity effects for the education and specific CM interventions. The interventions increase the share of girls completing secondary education by 13.1 percentage points to 2030. The education interventions had the larger effect, shifting completions by 11.6 percentage points compared with 2.0 for the marriage interventions.

Improved schooling outcomes were assumed to increase productivity. It is assumed that each additional year of schooling provides an economic return by way of increased income, and secondary school completions increase the number of girls employed and the proportion engaged in formal employment. 18 The immediate economic effect of increased schooling is negative because it withdraws girls from the workforce. This is later offset, as a higher proportion of the cohort enters the workforce in more productive roles. Table 3 shows the productivity changes, for the two productivity effects and the two sets of interventions to 2030. Overall, the productivity improvement for both sets of interventions is 16.4%, of which 14.8% is a result of the education interventions and 1.8% for the CM interventions.

The change in employment type (increased formal employment) had a larger effect on productivity, than did the additional years of schooling. The change in employment level and type had a productivity effect of 10.5%, compared with 5.4% of the additional years of schooling effect.

Benefit-cost ratios

Our study calculated the benefit-cost ratios based on total employment benefits as a ratio of the total costs of the relevant education interventions and the specific CM ones discussed above. The modelling assumed that coverage of the interventions is progressively increased to reach an 11.3% target level by 2030. 20 Both costs and benefits are discounted at 3%.

Table 4 shows relevant benefit-cost ratios for four education interventions and two specific CM interventions. The ratios for all interventions is 16.8, meaning that there are almost $17 in economic benefits for every dollar invested. This is very high. It would be lower if the benefits were to be evaluated over a more limited period. Including the benefits to retirement age reflects the fact that the benefits of additional education are transformational and last for their working lifetime. The benefit-cost ratio is 13.1 for the education interventions and 21.0 for the CM interventions. While productivity and schooling gains of the education interventions are larger, so is their cost.

Note: * discount rate 3%.

The benefit-cost ratio remains high, 14.9, even when the intervention costs are increased by 10% and their effectiveness reduced by 10%. It increases to 18.9 if more favourable assumptions are adopted, a 10% reduction in intervention costs and an increase of 10% in effectiveness.

To explore the effect of regional differences, modelling was conducted for two states with contrasting economic circumstances, the relatively well-off Tamil Nadu and relatively poor Madhya Pradesh, illustrated in Figure 1 . While Tamil Nadu had a secondary completion rate for girls of 79.4% in 2018, it was only 46.3% in Madhya Pradesh. However, by 2050, it was projected to increase by 32.3 percentage points for Madhya Pradesh to 79.1%, but only 11.1 percentage points to 90.6% for Tamil Nadu. While the benefit-cost ratios are the outcome of the interaction of many factors, there is a marked difference in the two ratios, 14.8 for Madhya Pradesh and 9.0 for Tamil Nadu, indicating the benefit of this relative outperformance by the poorer state catching up with an already well-performing better-endowed state.

As discussed, CM is the outcome of the complex interactions of many factors which include poverty, level of education, and social and cultural attitudes. While CM in India has on average declined sharply over the intercensal decade to 2016, progress has been very uneven between regions, rural and urban areas, income groups and education levels. This study indicates that ongoing interventions in education, and social and cultural attitudes are still a highly valuable investment in continuing this reduction in CM with an overall benefit-cost ratio of 16.8, meaning that there are almost $17 in economic benefits for every dollar invested.

In modelling the two sets of interventions separately, we show that the direct CM interventions deliver a higher benefit-cost ratio (21.0) than the education interventions (13.1). This is partly due to the relatively high costs of the education interventions compared with the CM ones. The cost of the education interventions range from $3,200 to $5,900 per girl, compared with the CM interventions which are in the range $12–$22 per girl. The education interventions which we modelled are all supply-side interventions to make education more attractive (closer, more girl-friendly schools with better-trained teachers). In contrast, the CM interventions increase demand by providing conditional non-cash incentives to delay marriage and life skills programs to empower girls to remain unmarried and therefore to stay longer at school.

While these results certainly support the expansion of CM intervention programs, they should not be undertaken at a cost to the education system, since the two are inter-dependent. The benefits of the CM interventions arise because they allow girls to stay at school. Ultimately, a quality and accessible education system is fundamental to providing the skills and training necessary to generate very large economic benefits. As Malhotra and Elnakib argue, ‘the enhancement of girls’ own human capital and opportunities is the most compelling pathway to delaying marriage’. 23(p1) Together, the two sets of interventions act to discourage girls from dropping out of school and continuing in their studies to complete secondary school. They deliver large benefits not only in improved productivity for every year of additional schooling, but also in the opportunity to find higher paid jobs in the formal sector. 50–54

In communities where girls are systematically excluded from participation in social, economic and political life, CM represents a serious human rights issue for individual girls. Delaying marriage and extending years at school have benefits that go beyond enhanced employment opportunities and higher incomes. There are other benefits, such as reduced fertility and improved health outcomes, not included in this study. 55 Together with the employment benefits, these benefits are transformational for communities with high levels of poverty. Better-educated women with smaller families are better placed to break the intergenerational cycle of early marriage, limited education and low incomes. 56 , 57

The context in which these interventions are being evaluated is undoubtedly important. Our analysis for the UNFPA showed that since 1990, trends in countries with high CM prevalence could be placed in three categories of almost equal size, as trending down, stuck after a downward shift or no change/increase. 58(p91-113) The Indian context has been supportive to reducing CM and therefore is favourable to the effectiveness of our modelled interventions. However, the impact of COVID is to cause a significant retracement of poverty rates, making reductions in CM more difficult and stimulating the requirement for greater investment to continue the downward trend. Other countries which have demonstrated the effectiveness of these interventions, but which now face rising COVID-related poverty, may also find greater resistance to reductions in CM using these interventions and require increased investment in expanded programs to reduce CM. 59

LIMITATIONS

As with all modelling exercises, the results produced here depend on the assumptions made in specifying the relevant variables. Some causes of CM were not modelled. Moreover, the relationships between CM, education and employment outcomes are complex, and the direction of causation is often highly interdependent. It is not possible, given the limited evidence, to capture all these relationships.

In deriving the effectiveness and cost parameters from the CM intervention literature, we acknowledge that we are adopting an experimental approach in which the outcomes with and without the interventions are compared. 60 While there are weaknesses in such an approach, one strength is that we are able to test the cost effectiveness of interventions based on the results of actual field experiments. 60 , 61 A limitation of the approach is that some relevant interventions may not have been formally evaluated and we are unable to include their impact in our modelling. Offsetting that limitation is that those deemed most important tend to be those that have been evaluated.

Accordingly, the modelling attempts to incorporate the most important relationships based on the best understanding from the available evidence. Nonetheless, this analysis relies on a small number of studies, not all of them Indian. Furthermore, the results of these studies are broadly applied to contexts which may be very different from those where the results were produced. Even so, the benefit-cost ratios are very high permitting substantially higher costs or lower effectiveness in the implementation of the modelled interventions, without undermining the very advantageous economic outcomes from investing in reducing CM.

CONCLUSIONS

Modelling the impacts of education interventions and child marriage interventions on early marriage makes it possible to compare the value of the economic and social gains from reducing child marriage, with the costs of the interventions to do so. This study suggests that interventions that reduce child marriage through increased attendance at school and changing social attitudes to child marriage, are both socially important and economically valuable. While the knowledge of impact and costs remain imperfect, the benefit-cost ratios are robust for different intervention levels. The interventions generate economic and social benefits that are many times their costs, leaving a significant margin for error. While the COVID 19 pandemic has introduced new uncertainties into outcomes modelled in this paper, with the extent of the economic downturn yet to be realised, the pandemic can only have exacerbated the factors driving poor families to marry off their daughters. There is even more reason for the interventions identified in this paper to be implemented.

Acknowledgements

The authors are grateful for the advice and support of Howard Friedman, Venkatesh Srinivasan, Devender Singh and Shobhana Boyle of UNFPA.

The authors gratefully acknowledge funding support from the UN Populations Fund (UNFPA/IND/2018/003).

Authorship contributions

BR, NM and PJS conceptualized this paper and drafted it with contributions from SS, AK and RK. JS provided the data and modeling, and participated in the analysis. MK conducted the formal literature review strategy and did the overall edit. All authors reviewed the findings. All authors agreed with the final version of the paper.

Competing interests

The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.

Correspondence to:

Bruce Rasmussen, Victoria Institute of Strategic Economic Studies, Victoria University, PO Box 14428, Melbourne, Victoria, 8001, Australia.

[email protected]

Submitted : November 12, 2020 BST

Accepted : March 06, 2021 BST

Economic and Health Costs of Child Marriages in India

161 Pages Posted: 9 Jan 2020

Risha Singh

Jawaharlal Nehru University, Centre for the Study of Regional Development

Date Written: July 20, 2017

Although, child marriages, marrying girls and boys before completion of their 18 years of age, has been recognized as a human right violation, they are still practiced widely affecting 15 million girls per year globally. Economic considerations are fundamental to the prevalence of child marriages as poverty is both a cause and consequence of child marriages. Child marriages can hamper girls’ educational attainment and her chances to participate in labor force. Child brides can have negative general and pregnancy-related health outcomes because of early marriage and early childbearing. The isolation and violence inflicted upon the girls can further have physical and psychological health impacts. Apart, from the individual level outcomes child marriages can have household level and in turn national level impacts too. So, our study has following objectives: (i) To examine the levels and trends of child marriages in India and its states. (ii) To assess the demographic and health costs of child marriages in India. (iii) To study the effects of child marriages on women wages and household economic status. (iv) To measure the impact of child marriages on the economic status of the State. The main data source of the study is IHDS 2 (2011-12). The study used univariate, bivariate and multivariate analysis. Our findings show that current levels of child marriages are significantly high in India with variations across different regions of the country. Our cost estimations revealed that nearly 100 million additional pregnancies occurred for the total ever-married women as on 1st March, 2011, because of child marriages. Also, there were 27 thousand additional neonatal deaths, 55 thousand additional infant deaths and 1.6 lakh child deaths in 2011, due to child marriages. Further, it was found that there are 6.3 million additional underweight women alive as on 1st March, 2011 because of child marriages. Women married below the age of 18 years have less likelihood of completing secondary and higher secondary schooling. Also, the annual wage rates of the child brides were found to be almost half than the women married at 18 years and above and the household economic status of child brides was poorer. child marriages have negative consequences on the macro-level economic status of the country. According to our cost estimates, India incurred loss of nearly 1899 billion INR, which is almost 1.68 percent of total GDP of India.

Keywords: Child Marriage, Economic status, Health costs, Marriage, Health

Suggested Citation: Suggested Citation

Risha Singh (Contact Author)

Jawaharlal nehru university, centre for the study of regional development ( email ).

New Delhi India +918130574729 (Phone)

Do you have a job opening that you would like to promote on SSRN?

Paper statistics, related ejournals, development economics: women, gender, & human development ejournal.

Subscribe to this fee journal for more curated articles on this topic

Health Economics eJournal

Economic anthropology ejournal, health & the economy ejournal, cultural anthropology: history, theory, methods & applications ejournal, medical anthropology ejournal, social & personality psychology ejournal, women & health ejournal, public health ejournal, developmental psychology ejournal, child & adolescent health ejournal, anthropology of kinship, gender, the body & sexuality ejournal, human rights ejournal.

Subscribe to this free journal for more curated articles on this topic