Peer-reviewed article
The health consequences of child marriage: a systematic review of the evidence
Suiqiong Fan, Alissa Koski ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined research on how child marriage (marriage before age 18) affects children's health. The authors found 58 studies, mostly from sub-Saharan Africa and South Asia, looking at outcomes like fertility, maternal health, and violence. The review found consistent evidence that girls who marry young have children earlier and in less safe conditions, and experience more intimate partner violence. However, the authors note that nearly all studies had serious quality problems, so the evidence that child marriage actually causes these health problems is weak.
Key points
- Women who marry before 18 consistently begin having children at earlier ages and have more children than those who marry at 18 or older
- Child brides are consistently less likely to give birth in health care facilities or with skilled health providers
- Child marriage increases the likelihood of experiencing physical violence from an intimate partner
- Research on contraception use, unwanted pregnancy, and sexual violence shows mixed or conflicting results across studies
- All 58 included studies were at serious to critical risk of bias, limiting the strength of conclusions
Limitations
The review includes almost exclusively cross-sectional data from sub-Saharan Africa and South Asia, so findings may not generalize globally. The serious quality issues in all included studies mean causal conclusions cannot be reliably drawn from this body of evidence.
Abstract
BACKGROUND: Child marriage, defined as marriage before 18 years of age, is a violation of human rights and a marker of gender inequality. Growing attention to this issue on the global development agenda also reflects concerns that it may negatively impact health. We conducted a systematic review to synthesize existing research on the consequences of child marriage on health and to assess the risk of bias in this body of literature. METHODS AND FINDINGS: We searched databases focused on biomedicine and global health for studies that estimated the effect of marrying before the age of 18 on any physical or mental health outcome or health behaviour. We identified 58 eligible articles, nearly all of which relied on cross-sectional data sources from sub-Saharan Africa or South Asia. The most studied health outcomes were indicators of fertility and fertility control, maternal health care, and intimate partner violence. All studies were at serious to critical risk of bias. Research consistently found that women who marry before the age of 18 begin having children at earlier ages and give birth to a larger number of children when compared to those who marry at 18 or later, but whether these outcomes were desired was not considered. Across studies, women who married as children were also consistently less likely to give birth in health care facilities or with assistance from skilled providers. Studies also uniformly concluded that child marriage increases the likelihood of experiencing physical violence from an intimate partner. However, research in many other domains, including use of contraception, unwanted pregnancy, and sexual violence came to divergent conclusions and challenge some common narratives regarding child marriage. CONCLUSIONS: There are many reasons to be concerned about child marriage. However, evidence that child marriage causes the health outcomes described in this review is severely limited. There is more heterogeneity in the results of these studies than is often recognized. For these reasons, greater caution is warranted when discussing the potential impact of child marriage on health. We provide suggestions for avoiding common biases and improving the strength of the evidence on this subject. TRIAL REGISTRATION: The protocol of this systematic review was registered with PROSPERO (CRD42020182652) in May 2020.