Elnakib Shatha, Zimmerman Linnea A, Attal Bothaina, Alkebsi Tareq, Aldaram Aisha, Al Kaff Abdullah, Mieth Kate, Robinson Court
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21231, USA.
Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
BMC Public Health. 2024 Dec 3;24(1):3365. doi: 10.1186/s12889-024-20889-9.
Yemen has one of the highest rates of child marriage in the Middle East and North Africa region and is home to one of the world's worst humanitarian crises. How the conflict and resulting displacement have impacted family formation patterns is not entirely clear. In this study, we investigate the impact of displacement on child marriage and early childbearing by comparing time-to-first-marriage and time-to-first-birth among displaced and non-displaced girls.
We used data collected through cross-sectional multistage stratified cluster household surveys in three governorates in Yemen with high concentrations of internally displaced persons (IDPs). Employing an analytic sample 1,861 girls aged 15-24, we compared entry into first marriage and time to first birth between IDPs and non-displaced persons using Kaplan Meier curves and Cox regressions.
We found high rates of child marriage in this population, with 37.8% and 34.5% of ever-displaced and never-displaced girls aged 20-24 married before age 18. Overall, those who were displaced had 30% higher hazard of overall marriage compared to their host counterparts (95% CI 1.16-1.47), and 23% increased hazard of child marriage (95%CI 1.01-1.51). Stratification by governorate revealed heterogeneity across governorates, with displaced populations at higher hazard of marriage in Aden and Maarib but not in Hadramout. We found that child brides and displaced participants were more likely to initiate earlier childbearing compared to non-child brides (HR = 3.44; 95% CI 2.94 4.0) and host counterparts (HR 1.35; 95% CI 1.15-1.58). Despite generally having lower age at first birth, child brides experienced a 19% lower hazard of first birth after marriage compared to those married over 18, indicating that child brides tended to wait longer before first birth (95% CI 0.72-0.92). We did not find a significant association between displacement status and marriage to birth interval after adjusting for child marriage status.
Our results highlight the impact of forced displacement on time-to-first-marriage and suggest that those who are displaced are more vulnerable to child marriage. We did not find compelling evidence for child marriage driving an increase in early childbearing. Nonetheless, our findings highlight the need for interventions that focus on prevention and mitigation of child marriage in this setting, particularly among IDPs who are at increased vulnerability.
也门是中东和北非地区童婚率最高的国家之一,也是世界上最严重的人道主义危机发生地之一。冲突及由此导致的流离失所如何影响家庭形成模式尚不完全清楚。在本研究中,我们通过比较流离失所和未流离失所女孩的初婚时间和初育时间,调查流离失所对童婚和早育的影响。
我们使用了通过在也门三个境内流离失所者(IDP)高度集中的省份进行的横断面多阶段分层整群家庭调查收集的数据。采用1861名年龄在15 - 24岁之间的女孩作为分析样本,我们使用Kaplan Meier曲线和Cox回归比较了境内流离失所者和非流离失所者的初婚情况和初育时间。
我们发现该人群童婚率很高,20 - 24岁曾经流离失所和从未流离失所的女孩中,分别有37.8%和34.5%在18岁之前结婚。总体而言,与她们的收容地同龄人相比,流离失所者的总体结婚风险高30%(95%置信区间1.16 - 1.47),童婚风险增加23%(95%置信区间1.01 - 1.51)。按省份分层显示各省份存在异质性,在亚丁和马里卜,流离失所人群的结婚风险较高,而在哈德拉毛则不然。我们发现,与非童养媳相比,童养媳和流离失所参与者更早开始生育的可能性更大(风险比 = 3.44;95%置信区间2.94 - 4.0),与收容地同龄人相比也是如此(风险比1.35;95%置信区间1.15 - 1.58)。尽管童养媳的初育年龄通常较低,但与18岁以后结婚的人相比,童养媳婚后初育的风险低19%,这表明童养媳在初育前往往等待更长时间(95%置信区间0.72 - 0.92)。在调整童婚状况后,我们没有发现流离失所状况与结婚到生育间隔之间存在显著关联。
我们的结果突出了被迫流离失所对初婚时间的影响,并表明流离失所者更容易童婚。我们没有找到令人信服的证据表明童婚会导致早育增加。尽管如此,我们的研究结果强调了在这种情况下需要采取干预措施,重点是预防和减轻童婚现象,特别是在更易受影响的境内流离失所者中。