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KNOWLEDGE , ATTITUDE AND PRACTICE OF EARLY
MARRIAGE IN ElTTONDOUB AREA , ALJAZEERA STATE
2016
Conducted by:
Group 16 A
Fifth year Medical students
University of Khartoum, Faculty of Medicine,2016
Supervised by:
Dr. Ahmed Babiker
Department Of Community Medicine
Faculty of medicine , University Of Khartoum
November 2016
Dedication
We dedicate this research report affectionately to the following :
Elttondoub area residents
High school students in Elttondoub Area
With love and respect .
Acknowledgements
We would like to take this opportunity to express our profound
gratitude and deep regard to our supervisor Dr. Ahmed abdulraheem, for
his exemplary guidance, valuable feedback and constant encouragement
throughout the duration of the survey. His valuable suggestions were of
immense help throughout our survey work.
We would like to thank Dr.Elhami Alturabi and our colleagues Group
6 who helped us in the survey.
Also , we extend our profound sense of gratitude to the study participants.
Executive summary :
The main objective of this baseline survey on child marriage was to gather information on the knowledge,
attitude and practice of child marriages in Elttondoub , as a basis for raising awareness on how children,
particularly girls, are affected by the practice.
The survey was conducted in Elttondoub area, Aljazeera State, in November 2016 .
These region is highly affected by child marriage.
As shown in this report, girls are more affected by child marriage than boys, since girls are marginalized,
their voices are never heard .
The survey sought to find out firstly whether people in these regions knew anything
about child marriage in their areas. Respondents were asked if they had any views on child
marriage in their area and the source of their information . Secondly, respondents were asked about the
reasons of child marriage in their area. Causes of child marriage formed a further category of questioning.
The respondents were then asked if they knew the impact of child marriage on the individual children.
Also respondents were asked if they got married early and if the marriage affect their academic
performance or their health .
Respondents were asked if they had any ideas about the age at which girls or boys are considered ready for
marriage, their opinion on child marriage , and if the girls take all their rights by the early marriage.
Finally, respondents were asked whether they agree and support child marriage or not , and their
suggestions to stop this phenomenon.
Majority (77.4%) have excellent knowledge about negative consequences of child marriage,
aware of appropriate age for marriage (75%). Majority(86.9) believes that the main causes are
the traditions. Majority (67.4%)of cases got married in an early age. Some of had experienced
major health complications of the early marriage.
Table of contents:
Chapter
Page number
Chapter 1: Introduction
1.1-Background information
1.2- Problem statement
1.3- Justification
Chapter 2: Objectives
2.1- General objective
2.2- Specific objectives
Chapter 3: Literature review
Chapter 4: Methodology:
4.1- Study design
4.2- Study area
4.3- Study population
4.4- Sampling
4.5- Data collection method
4.6- Data analysis
4.7- Ethical consideration
Limitations and constrains. -4.8
Chapter 5 : Research findings
Chapter 6 : Discussion
Chapter 7: Conclusion and recommendation
7.1- Conclusion
7.2- Recommendation
. Chapter 1:
Introduction
1.1. Background Information :
1.1- Background :
Child marriage is a marriage of a child under 18 years of age. Worldwide over 60 million girls married
before the age of 18 [1].
Marriage before the age of 18 is a reality for many young women. In many parts of the world
parents encourage the marriage of their daughters while they are still children in hopes that the
marriage will benefit them both financially and socially, while also relieving financial burdens on
the family. In actuality, child marriage is a violation of human rights, compromising the
development of girls and often resulting in early pregnancy and social isolation, with little
education and poor vocational training reinforcing the gendered nature of poverty. [2]
Young married girls are a unique, though often invisible, group. Required to perform heavy
amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising
children while still children themselves, married girls and child mothers face constrained
decision-making and reduced life choices [2].
Although child marriage includes both boys and girls, most children
married under the age of 18 are girls. In Sub-Saharan Africa and
Bangladesh over 60% of girls are married under the age of 18 year [3,4].
Child marriage is a human violation and the United Nations declared
that child marriage violates human rights and children’s rights [3].
Today, many girls as young as 14 or 15 years are forced into marriages by their parents, guardians
or relatives. This is sanctioned by the 1971 Law of Marriages Act (LMA) which gives parents and
judges the power to permit the marriage of children as young as 14 years. Girls are often forced
to drop out of school to get married, and forego the chance to grow to maturity before marriage
or make their own decisions about their lives. Child marriage disproportionately affects girls
because social and biological factors make them more vulnerable to sexually transmitted
infections (STIs) and child bearing complications. [5]
1.2- Problem statement :
There is little credible data about marriages of children under the age of 14, and even less on
those below the age of 10 [6]. However, it is estimated that, in 2002, about 52 million girls
below 18 years of age were married worldwide[7] ,25,000 are being married each day; and
100 million will be married by 2012 [8]
In Sudan there is no law determining the legal age of marriage. Child marriages in Sudan are
arranged by parents, and girls rarely meet their future husband before the wedding. After
the marriage the girls move to their husband’s household and become a responsible person
in their own home. Child marriage affect the development of children, they miss their
opportunity for education [9]. Moreover child marriage put the girl at higher risk of
depression and sexual transmitted infections, preterm birth and low birth weight [10].
Children have small pelvis and if they get pregnant soon after child marriage they will be at
higher risk of obstructed labour and its consequences. Their risk for obstetric fistula is 88%
[11]. Sudan had high incidence rate of teenage pregnancy and maternal mortality [12,13]. In
Sudan while teenage pregnancy accounts for 14.7%, 67.1% had no antenatal care and 12.6%
were grandmultiparous. Also in our country various obstetric complications that strongly
linked to teenage pregnancy were reported these include:
preterm birth (2.6%), preeclampsia-eclampsia (4.2%) and obstructed labour (1.9%) [14].
In Sudan where the personal status of Muslims Act of 1991 allows children -girls and boys- as
young as 10 to marry, 38% of young women were married before the age of 18 , according
to 2010 government survey.
Blue Nile state had the highest rate of child marriage with 62% of girl marrying before they
turned 18 and 19% marrying before 15.
although the minimum age of sexual consent of the child is 18 , an exemption in Sudan's
penal code protect the spouse from being charged for 6 within marriage to a child under 18 .
1.3- Justification :
During our residency in El ttondob area we’ve notice the spread of this phenomenon among
the people of Elttondob; young females\males get married in extremely small age and how it
is affecting them whether by the various health problems that the female or the child that is
conceived from such marriage could face, such as Eclampsia, neonatal death, complicated
labor or even depression.
The difficulties doesn’t end here also this marriage deprives the partners from affair chance
to get educated ; many of them drop school after marriage due to the tough burdens and
responsibilities they come across during their marital life.
Because of all of these issues that we’ve noticed in Elttondob area, we thought that it is our
duty to put this subject under the spot light, due to its major effect and influence on the
people of Elttondob specifically and the other areas of Sudan generally, hopefully at the end
we as medical student can make a difference in our society, and that its why we are
interested in doing this mini survey subject.
Chapter 2
OBJECTIVES:
2.1- General objective:
To assess the knowledge, attitude and practice about early marriage of girls below the age of
18 in Elttondoub area .
2.2- Specific objectives :
1- To assess the knowledge about the effects of early marriage of girls below the age of 18 in
Elttondoub area .
2 - To identify causes of early marriage of girls below the age 18 in Elttondoub area .
3- To identify the attitude towards the early marriage of girls below the age 18 in Elttondoub
area .
4-To assess the practice in Elttondoub regarding the early marriage of girls below the age of
18 in Elttondoub area .
Chapter 3:
3.1-LITREATURE REVIEW
1- Knowledge Attitude and Practices (KAP) towards child marriage
Among married women residing in Nandyal - A Qualitative study
Abstract:
Background: Globally, child marriage (CM) is defined as marriage before the age of 18 years
which applies to both boys and girls (1).However in India, as per ‘Prohibition of Child
Marriage Act 2006’, a marriage is legally considered as CM when girl is less than 18 years old
or boy is less than21 years old.(2) In 2007, United Nations Children’s Fund (UNICEF) reported
that a girl under the age of15 is five times more likely to die during pregnancy and childbirth
than a woman in her 20s(3) Most importantly, early marriage bereaves young girls of their
childhood by overburdening them with domestic responsibility, motherhood, and sexual
relations rather than allowing them to play with friends, go to school, and dream about a
career (4) Aims and objectives: Our aim is to assess women’s knowledge and attitude
towards child marriage practice who married before 18 years. To know the association
between the child marriages and their consequences Methods community based cross
sectional study was conducted among women residing in urban slums of Nandyal. Anin-
depth interview was conducted with 30 pre identified married women of reproductive age
(15–49 years). The criteria for selection of participants was those woman who married
before the age of 18 years (child marriage) and married for at least 5 years and had at least
one child birth. Reasons for setting the said selection criteria were to make sure that the
interviewee had a prenatal and postnatal experience that they have spent a considerable
time in marital union.
Results: Among 30 participants the mean age of child marriage is 14 years. Mean age at first
child birth is 15years. Majority (86.7%) were stopped education after marriage. According to
Modified Kuppuswamy class 63.3% were belong to upper lower class &13.3%lower class.
Almost (56.7%) unaware of appropriate age for marriage. Majority (73.3%) are unaware of
negative consequences of child marriage. Most of the marriages are consanguineous (40%).
Majority (60%) are home deliveries and pre term deliveries (46%). Majorities (73.3%) are
opposing child marriage and 26.7% are supporting child marriage and having future
intention. Satisfied with their married life 60% and 40% participants are having conflicts
Conclusions: Raising the level of awareness about negative outcomes of child marriage by
intensifying the Health education (IEC) activities. In this modern society the child marriages
are following because of the customs and traditions followed in the community. Home
deliveries are more which utmost leads to danger to the mother and child. [15]
2- Child Marriage: A Cultural Health Phenomenon Jennifer Birch
Abstract
Child marriage continues to be a challenge worldwide and especially in southern Asia and
Africa. While it affects both sexes, girls are more affected as they are the majority of the
victims. Child marriage causes untold suffering to the victims; it curtails the child’s
education, affects the general health, and puts the affected in a disadvantaged position.
From this paper, culture continues to perpetuate and entrench the practice of child marriage
in most communities. This paper discusses the cultural factors behind the practice of child
marriage such as bride wealth, value of virginity among others. It also examines the health
implications on the life of the children as well as the strategies put in place by various
stakeholders in order to end the practice. The paper recommends that the communities
should be actively involved in coming up with the ways of ending the practice. Awareness
should be created on the negative implications of child marriage on the health of the
children and their general wellbeing. [16]
3-Minimum Marriage Age Laws and the Prevalence of Child Marriage and Adolescent
Birth:
Evidence from Sub-Saharan Africa
Background: The relationship of national laws that prohibit child marriage with the
prevalence of child marriage and adolescent birth is not well understood.
METHODS: Data from Demographic and Health Surveys and from the Child Marriage
Database created by the MACHE quity program at McGill University were used to examine
the relationship between laws that consistently set the age for marriage for girls at 18 or
older and the prevalence of child marriage and teenage childbearing in 12 Sub-Saharan
African countries. Countries were considered to have consistent laws against child marriage
if they required females to be 18 or older to marry, to marry with parental consent and to
consent to sex. Associations between consistent laws and the two outcomes were identified
using multivariate regression models.
RESULTS: Four of the 12 countries had laws that consistently set the minimum age for
marriage at 18 or older. After adjustment for covariates, the prevalence of child marriage
was 40% lower in countries with consistent laws against child marriage than in countries
without consistent laws against the practice (prevalence ratio, 0.6). The prevalence of
teenage childbearing was 25% lower in countries with consistent minimum marriage age
laws than in countries without consistent laws (0.8).
CONCLUSION: Our results support the hypothesis that consistent minimum marriage age
laws protect against the exploitation of girls. [17]
4- EMERGING CONCERNS AND CASE STUDIES ON CHILD MARRIAGE IN SRI LANKA
This study looks at the interface and connection between statutory rape and early marriage
in selected districts in Sri Lanka. While both the concepts of early marriage and statutory
rape have legal definitions (with the latter being an exclusively legally defined concept) this
study also looked at the social and cultural dimensions of early marriage as well as its
causes, trends and impact. The field work was conducted in 7 districts in Sri Lanka and
consisted of in-depth interviews with service providers as well as individuals and families. A
minimum of 10 case studies on early marriage and statutory rape were developed from each
district. The study completed 71 case studies and 81 in-depth interviews. Additionally,
newspaper reports from selected national newspapers in Sinhala and English were also
analyased. The field work was preceded by a comprehensive literature review. The study
found that early marriage cannot be considered a traditional practice in Sri Lanka and that
there was a high level of public awareness regarding the minimum age of marriage. Among
the 71 case studies there were only 6 cases of early marriage. However, there were 32 cases
of cohabitation which were recognized as ‘marriages’ by families and the community, with
the understanding that these relationships need to be formalized through registration when
the parties reached the legal age of marriage. There were 21 cases of teenage pregnancy
and 49 cases of statutory rape. The majority of the victims of statutory rape were between
the ages of 14-15 years. The age of the perpetrators ranged from under 18 years to the
oldest being 65 years. [18]
Knowledge, Attitude and Practices of Adolescents in Rural Rajasthan, India
Abstract-
Studies suggest that child marriage is the leading cause of young women between the ages
of 15-24 dying during pregnancy. Also offspring born too early in their mothers’ lives are at
increased risk of illness and death. A study was undertaken in Rajasthan, India to develop
benchmark on Knowledge, Attitude and Practices of adolescents on Sexual & reproductive
health, life skills, child rights, protection and gender issues, to map the existing situation of
child marriages and their consequences and to understand the role of parents, community
groups and service providers existing in the community through adolescents perspective.
Results suggest that every fifth adolescent (18%) in the intervention area is married, three
fourth (75%) of the boys have no idea about menstruation, only 22 percent girls have access
to sanitary napkins and 89 percent of the adolescent defecate in open. Only 54 percent boys
believe that men-women have equal rights.
Chapter 4 :
4. -METHODOLOGY
:Study design 4.1
This study is descriptive cross sectional community based study.
:Study area 4.2
Elttondoub area which consist of three main regions: Abukilewa (the largest), aAlnubi and
Alhosh, its 15 km away from Tamboul city.
:populationStudy 4.3
All adults in Elttondob area.
AdultsInclusion: 4.3.1
.: people below 13 yearsExclusion 4.3.2
:sampling 4.4
:Sample size 4.4.1
Will be calculated using the equation (Cochran):
2
n = (z2* p * q)/d
Where:
N ≡ the sample size
Z ≡the value of the normal curve responding to the level of confidence 95% i.e. 1.96
P ≡ the prevalence =0.5
Q= 1-P
:Sample type 4.4.2
Systemic random sample
:Data collection methods 4.5
Data was collected through self-administered well designed and tested questionnaires, using
stratified random sampling.
:Data management and analysis 4.6
Data was tabulated and analyzed using the Statistical Package for the Social Science (SPSS),
version 20. Then the results were presented in form of frequency tables, percentage and
charts.
:Ethical concern 4.7
Approval was obtained from community department committee. The researcher respected
the respondent autonomy and confidentiality. Written consent was obtained from the
respondent after informing them about the objective and benefit of this research.
:Limitations and constrains. 4.8
Limitation faced was the shortage time. Another limitation was transportation problems, as
the study was not funded.
: Chapter 5
Research Findings
Figure(1):show the gender
72.4% female while 27.6% male
Figure (2): show educational level
12.2% uneducated, 11.8% university, 38% primary school, 38% high school
Figure (3): show occupation
67.4% not working, 28.1% business, 4.5% employee
Figure (4): show month income
34.8% less than 1000, 39.4% 1000, 25.8% more than 1000
Figure (5): show marital status
16.3% had unmarried, while 83.7% married
Figure (6): show the sources of early marriage
68.8% get it from relatives, 14.9% get it from social media, 14% from friends and 2.3% from
internet
Figure (7): show causes of early marriage
61.1% tradition and believes, 24.9% saving, 9% financial and reminder 5% not knowing
Figure (8): show the knowledge score and estimation 77.3% excellent, 16.5% had good, 6.3% poor knowledge
Figure (9) show attitude scoring
79.2% had positive attitude while 20.8% had negative attitude
Figure (10): show practical scoring
67.1%had poor practice, 23.8% had good practice and reminder9.1%had excellent practice
: Chapter 6
6.1- Discussion
From the charts it is evident that in the area of ELttondoub, early marriage is quite
prevalent, even though the percentage is decreasing with the increased level of education
but it still a significant percentage as we see above the majority are educated at least till
high school and then drop because of various reasons and the commonest reason is early
marriage by 49.2%.
We had 100% of people know about the early marriage .The people of ELttondoub have an
excellent knowledge about it by 77.4%, also there were for some extent good knowledge by
16.5% and the poorest knowledge by 6.1%.
Most of the participant in this mini survey knew about the major causes that leads the
community to go with getting their children to marry in a very young age that ranges from
13 to 18 years old .the majority believes that the main causes are the tradition that
encourage the families by 86.9% , the other cause is to protect the honor of the family by
73.8% ; they think by getting their child marry in an early age they protect him\her from the
forbidden sexual affaires, and finally the last cause is the socioeconomic status of the
families by 38.5%, as the literature reviews shows poverty is one of the major causes to this
phenomena ; an old , rich man marries a poor , female teenager , what a sad story!
Unfortunately through our data collection we came across many of cases of females\males
who got married in an early age approximately by 67.4%. Some of them had experience one
or more of the major health related complications of the early marriage such as Eclampsia
by 37.5%, complicated labor by56.3%, postpartum fetal death by 43.8%, sexually
transmitted diseases by 6.5% and depression by12.5%. Thankfully there some cases of
married people we got married in a suitable age (older than 18) by 23.9%. The other 8.7% of
the participant in this survey they didn’t get married yet but this will not deny the fact that
they knew people from their families or friends who got married in an early age.
One of the best encouraging things that we came across is the attitude of the people of
ELttondoub, almost 79.1% of them are against the early marriage because they believes that
this kind of marriage doesn’t promise a healthy , happy life because of its burden upon the
young couple from the various responsibilities that they will have , the health of the mother
and the child that is conceived from such marriage and finally the increased divorce rates
upon the early married couples who are so young to deal with the conflicts and difficulties
that they may face.
If we flip to other side of the coin there is 20.9% of the people of ELttondoub who are
rooting for early marriage, in their believe that the pros of the early marriage concord the
cones. And here we come hopefully we can make changes and alter their believes so there
will not be any new cases of early marriage in the area of ELttondoub.
Chapter 7:
7.1- Conclusion and Recommendations
Conclusion -7.1
Mean age of child marriage is 14 years. Majority (49.2%) are stopped education after
marriage. Majority (77.4%) have excellent knowledge about negative consequences of child
marriage, aware of appropriate age for marriage (75%). Majority(86.9) believes that the
main causes are the traditions. Majority (67.4%)of cases got married in an early age. Some of
had experienced major health complications of the early marriage Eclampsia (37.5%),
complicated labor (56.3%), postpartum fetal death(43.8%), sexually transmitted diseases
(6.5%) and depression(12.5%).Majority (79.1%) are against the early marriage.
7.2- Recommendations
Implementing and enforcing stringent laws against child marriage practice.
Promoting civil, sexual and reproductive health rights for women.
Provision of economic opportunities for women can help to eliminate the child marriage
practice.
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Social Science Vol. 3 No. 17; September 2013
17 - Minimum Marriage Age Laws and the Prevalence of Child Marriage and Adolescent
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18 - EMERGING CONCERNS AND CASE STUDIES ON CHILD MARRIAGE IN SRI LANKA, Reza
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