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Introduction: 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., Methods: 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., Results: 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., Conclusion: 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., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the ethical standards of our institution and the Helsinki Declaration. The protocol was reviewed and approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health (reference number: 21168) and the Ethics Review Committee of the Ministry of Health and Population in Aden (reference number: GAIR/004). Both review boards approved informed verbal consent/assent to be obtained from study participants, as many participants are not able to read and write. We obtained informed verbal consent from adult participants and married girls ages 16–17 who are considered emancipated minors in this context. An informed oral assent process was used for unmarried children 10–17 and married children under age 16. This was coupled with informed oral consent from their parent/guardian. Consent for publication: NA. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To examine incidence of child marriage among displaced and host populations in humanitarian settings., Design: Cross-sectional surveys., Setting: Data were collected in Djibouti, Yemen, Lebanon and Iraq in the Middle East and in Bangladesh and Nepal in South Asia., Participants: Adolescent girls aged 10-19 in the six settings and age cohort comparators., Outcome Measures: Cumulative incidence of marriage by age 18., Results: In Bangladesh and Iraq, the hazard of child marriage did not differ between internally displaced populations (IDPs) and hosts (p value=0.25 and 0.081, respectively). In Yemen, IDPs had a higher hazard of child marriage compared with hosts (p value<0.001). In Djibouti, refugees had a lower hazard of child marriage compared with hosts (p value<0.001). In pooled data, the average hazard of child marriage was significantly higher among displaced compared with host populations (adjusted HR (aHR) 1.3; 95% CI 1.04 to 1.61).In age cohort comparisons, there was no significant difference between child marriage hazard across age cohorts in Bangladesh (p value=0.446), while in Lebanon and Nepal, younger cohorts were less likely to transition to child marriage compared with older comparators (p value<0.001). Only in Yemen were younger cohorts more likely to transition to child marriage, indicating an increase in child marriage rates after conflict (p value=0.034). Pooled data showed a downward trend, where younger age cohorts had, on average, a lower hazard of child marriage compared with older cohorts (aHR 0.36; 95% CI 0.29 to 0.4)., Conclusions: We did not find conclusive evidence that humanitarian crises are associated with universal increases in child marriage rates. Our findings indicate that decision-making about investments in child marriage prevention and response must be attuned to the local context and grounded in data on past and current trends in child marriage among communities impacted by crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Research on child marriage has increased in volume but remains scarce in humanitarian settings. This study aimed to investigate rates, correlates, and consequences of child marriage among Syrian refugees in South Lebanon., Methods: A sample of 1,593 female adolescents and 893 adults was selected using a multistage stratified cluster survey design. We quantified the cumulative incidence of child marriage among age cohorts of female refugees and identified risk factors associated with child marriage using survival methods. We also presented sexual and reproductive health measures among child brides., Results: We found evidence that child marriage was widely practiced among adolescent girls, with Kaplan-Meier curves showing that 32.56% of girls aged 10-19 transitioned to marriage by age 17. Although high, this was lower than rates among women aged 25-29 (p < .005), indicating that child marriage was already widely practiced in prewar Syria. Our Cox models indicated that several factors, which mirror drivers of child marriage in stable settings, are associated with hazard of child marriage in this context. We additionally found important sexual and reproductive health gaps among child brides, such as low levels of knowledge of the dangers of early childbearing and closely spaced births as well as high rates of early and multiple births., Conclusions: Child marriage is a pervasive practice among Syrian refugees residing in this setting. Our results suggest that a confluence of factors at different levels of the social ecology increase refugee girls' vulnerability to child marriage. They also demonstrate the pressing need for interventions that target refugee child brides., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences., Methods: A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15-49 and at least one adolescent female aged 10-19. In addition to calculating the proportion of girls married under age 18, we used survival methods - namely Kaplan Meier graphs and Cox proportional hazard models - to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls., Results: A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15-19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11-0.18), and 11% were ever married under age 18 (95% CI 8-15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls - particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94-22.40), and early childbearing was common (60%; 95% CI 45.56-72.89)., Conclusions: This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.

Background: Child marriage is a human rights violation disproportionately impacting girls in low- and middle-income countries. In the Middle East region, conflict and displacement have prompted concerns that families are increasingly resorting to child marriage to cope with economic insecurity and fears from sexual violence. This study set out to examine child marriage among Syrian refugees residing in Egypt with the aim of understanding drivers of child marriage in this context of displacement as well as how child marriage affects refugee girls' wellbeing., Methods: This analysis draws from 15 focus group discussions (FGD) conducted with married and unmarried girls, as well as parents of adolescent girls in three governorates in Egypt. FGDs included a participatory ranking exercise and photo-elicitation. Additionally, we conducted 29 in-depth interviews with girls and mothers, as well as 28 key informant interviews with health providers, community leaders, and humanitarian actors. The data was thematically analyzed using a combination of inductive and deductive coding., Results: A prevalent phenomenon in pre-war Syria, child marriage has been sustained after the influx of Syrian refugees into Egypt by pre-existing cultural traditions and gender norms that prioritize the role of girls as wives and mothers. However, displacement into Egypt engendered different responses. For some families, displacement-specific challenges such as disruptions to girls' education, protection concerns, and livelihood insecurity were found to exacerbate girls' vulnerability to child marriage. For others, however, displacement into urban areas in Egypt may have contributed to the erosion of social norms that favored child marriage, leading to marriage postponement. Among girls who were married early, we identified a range of negative health and social consequences, including lack of family planning use, disruption to schooling and curtailment of girls' mobility as well as challenges with marriage and birth registration which accentuated their vulnerability., Conclusion: Efforts to address child marriage among Syrian refugees must acknowledge the different ways in which displacement can influence child marriage attitudes and practices and should capitalize on positive changes that have the potential to catalyze social norm change. Moreover, targeted, focused and contextualized interventions should not only focus on preventing child marriage but also on mitigating its impacts.

Background: Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression. Methods: We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson's Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated. Results: Uganda's experience with the integration of refugee's dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda. Conclusion: Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels. [ABSTRACT FROM AUTHOR]