الفهرس 
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Abstract
Child marriage is a genuinely global issue that cuts across countries, cultures, religions, and ethnicities. It is a reality for both boys and girls, yet girls are disproportionately the most affected. According to UNICEF, 650 million females alive today were married before turning 18. The practice of child marriage is quite prevalent in Egypt, as CAPMAS (2017) revealed that nearly 1 in every 20 Egyptian girls (4%) between the age 15 to 17 years and 1 in every 10 (11%) adolescent girls 15-19 years are either currently married or were married before.
This harmful phenomenon affects not only the child brides themselves, but also their families and children as well as the whole community, with its social and economic implications threatening the SDGs achievement. Thus, as a part of the SDGs, governments around the world have pledged to end child marriage by 2030. On the national level, Egypt has exerted great efforts to end child marriage. Yet, this harmful practice has remained a problem in Egyptian society, particularly in rural communities like Elbeheira Governorate that is considered one of the governorates with the highest rates of child marriage among girls.
Therefore, there was an immense need to conduct research for a deeper understanding of child marriage from the point of view of those affected by this phenomenon, particularly girls and women. This understanding would contribute to identifying the underlying motives that may help end child marriage among girls through designing and developing culturally responsive interventions and improving health programs. Thus, this study aimed to analyze the profile of child marriage among girls in Elbeheira governorate as an essential step to propose appropriate recommendations for combating this harmful practice.
The study was conducted using the concurrent triangulation mixed methods research design. The quantitative part included 210 girls aged between 10 to less than 18 using WHO standard cluster sampling technique, while the qualitative part involved 11 oldest females, 16 married girls, and 15 unmarried girls who were randomly selected. Thus, 252 participants, selected from their houses, participated in this study.
Tools for data collection:
Four tools were developed and used to collect the study’s data; where the quantitative data were collected using a girls’ profile interview questionnaire, and three semi-structured in-depth interview guides were used to collect the qualitative data from the oldest females and married as well as unmarried girls. Before data collection, the study tools were tested, for content validity through a jury consisting of three experts in the field of community health nursing.
The main findings revealed from the study:
Finding from the quantitative part:
Part I: Profile of Child Marriage among Girls in Elbeheira Governorate
Section A: Socio-demographic characteristics of girls and their families
- The girls’ age ranged from 12 to 17.91 years, with a mean of (15.824±1.285, 16.565±0.924, and 16.799±0.974 years) for single, engaged, and married girls respectively, with a statistically significant difference among the groups (FET=12.461, p=0.009).
- Around a fifth, (21%) of the studied girls was ever-married, while about a quarter (24.3%) of the girls was engaged.
- All (100%) of the ever-married girls and the majority (86.3%) of the engaged girls, as compared to three-quarters (75.7%) of the single girls were living in rural areas. A statistically significant difference was found among the groups (X22=14.003, p=0.001).
- Less than three-quarters (71.3%) of the single girls and more than four-fifths of the engaged girls as compared to all (100%) of the married girls weren’t working, while only more than a quarter (28.7%) of the single girls as compared to less than a fifth (15.7%) of the engaged girls were working, with a statistically significant difference among the groups (X22=17.310, p=0.000).
- Almost all (99.5%) of the girls were enrolled in schools. Among those girls who ever went to school, the vast majority (90.9%) of the married girls as compared to a third (33.3%) of the engaged girls and very few percentage (4.4%) of the single girls had dropped out of school, with a statistically significant difference among the groups (X22=114.342, p=0.000).
- Regarding the educational level of those girls who were still going to school, a quarter (25.7%) of the single girls and less than a fifth (17.6%) of the engaged girls as compared to half (50%) of the married girls were at preparatory school. On the other hand, more than half (55%) of the single girls and half (50%) of the married girls, as compared to about four-fifths (79.4%) of the engaged girls were at technical secondary school.
- Concerning the socio-economic level of the girls’ families, about a fifth (21.7%) of the single girls, as compared to more than two-fifths (43.1%) of the engaged girls and more than half (56.8%) of the married girls belonged to low socio-economic level families. A statistically significant difference was found among the groups (FET=19.865, p=0.000).
Section B: Girls’ experience with engagement
- The mean age of girls’ engagement in rural areas was slightly higher than that of girls in urban areas (15.899±0.984 and 15.796±1.122 years respectively).
- The age gap between the girls and their fiancés ranged between 2 to 16 years, with a mean of 7.273±3.096 years.
- Less than a third (28.6%) of urban girls as compared to a third (33.3%) of rural girls was engaged to men from their relatives.
- Out of those girls knowing their marriage date, less than two fifths (37.2%) of rural girls as compared to more than a tenth (14.3%) of urban girls would marry before the age of 18.
- In relation to the ways of ensuring rights of those girls who would marry before the age of 18, all (100%) of the families of urban girls, as compared to about two thirds (65.5%) of rural girls’ families would ask only the groom or the groom and his father to sign trust receipts.
Section C: Girls’ experience with child marriage
- The ever-married girls got married between the ages 12 to 17.41 years, with a mean of 15.55±1.12 years. More than four-fifths (84.1%) of the girls were married between the age of 15 to less than 18 years.
- The vast majority (90.9%) of the ever-married girls was included in making their marriage decision.
- The age gap between the ever-married girls and their husbands ranged between 2-15.09 years, with a mean of 7.22 ± 15.09 years. Less than two-thirds (59.1%) of the girls were younger than their husbands by 5 to less than 10 years. Moreover, about a fifth (20.5%) of them was younger than their husbands by 10 years or more.
- Less than a third (31.8%) of the ever-married girls’ husbands had finished their secondary or technical secondary education, while less than a quarter (22.7%) was illiterate.
- Concerning the consanguinity between the ever-married girls and their husbands, less than a third (29.5%) of the ever-married girls was married to men they were related to.
- More than two-thirds (68.2%) of the ever-married girls reported that ma’zoun wrote their marriage contract. On the other hand, about a third (31.8%) of contracts was written by a lawyer.
- Regarding the ways of ensuring the rights of the ever-married girls, the vast majority (93.2%) of the girls’ families had planned to guarantee their girls’ rights through trust receipts signed either by the groom as well as his father and/or his uncle (58.5%) or only by the groom (41.5%).
- Only about half (47.7%) of the ever-married girls reported that child marriage has negatively impacted their life. The main negative consequences included childhood deprivation (85.7%), school dropout (66.7%), exposure to violence (57.1%), negative physical health impacts (42.9%), negative psychological health impact (14.2%), negative pregnancy outcomes ”abortion or stillbirth” (9.5%), and divorce (9.5%). Out of those girls who reported that marriage affected their physical health negatively, the main complaints were weakness (66.6%), anemia and feeling pain all over the body (44.4%).
- The vast majority (93.2%) of the ever-married girls got pregnant. Moreover, less than two-thirds (58.8%) of them were pregnant at the time of the study.
- More than half (56.1%) of the ever-married girls reported that they experienced some health problems during pregnancy, mainly anemia (100%) and bleeding (30.4%).
- The vast majority (97.6%) of the ever-married girls had gotten antenatal care through going to the family health centers or units (95%) as well as private clinics (92.5%).
- Out of those girls who had delivered, the deliveries had been mainly at private hospitals (42.2%), governmental hospitals (31.6%), or private clinics (26.3%). Moreover, less than four fifths (78.9%) of the girls had a cesarean birth, where a girl had bleeding during delivery.
- Regarding parity, more than half (53.7%) of the ever-married girls had delivered once. Less than three quarters (72.2%) of them had a girl, while more than a quarter (27.8%) of them had a boy.
- Regarding the utilization of contraceptive methods, less than two fifths (38.6%) of the ever-married girls had used a contraceptive method after having their first child.
- The majority (86.4%) of the ever-married girls have participated in making decisions related to their families.
- It was very sorrowful to find that; more than two-fifths (43.2%) of the ever-married girls have suffered from various forms of violence.
Section D: Girls’ experience with divorce
- The study clarified that two of the studied girls, representing (4.5%) of the ever-married girls, were divorced.
- The main reasons for divorce were: exposure to domestic violence and marital dissatisfaction, the husband’s wish to marry another woman, his addiction, and or greediness.
- Concerning the divorced girls’ rights, one of the divorced girls didn’t take any of her rights, while the other took only some of her rights.
- It was very sorrowful to find that one of the divorced girls remarried again while the other was engaged.
Part II: Girls’ Opinions and Attitudes towards Marriage and Child Marriage among Girls.
- The single girls reported that 19.37±1.875 years are the mean age to be suitable for girls’ marriage, as compared to 17.84±1.433 and 16.91±1.597 years which the engaged and ever-married girls reported.
- Around two-thirds of the single and ever-married girls (67% and 61.4% respectively), as compared to more than half (56.9%) of the engaged girls reported that the girl, as well as her parents have to decide on her marriage.
- The majority (86.3%) of engaged girls, as compared to less than three-quarters (70.5%) of ever-married girls and less than two-thirds (61.7%) of single girls, reported that child marriage among girls is that marriage which occurred before the age of 18. Statistically significant differences were found among the groups (FET=38.37, p=0.000).
- There was a considerable percentage of agreement (30.5%) among the participants regarding child marriage, especially among the ever-married girls. Around two-thirds (68.2%) of the ever-married girls as compared to about two-fifths (39.2%) of the engaged girls agreed on child marriage among girls. Yet, only more than a tenth (12.2%) of the single girls agreed on it, with statistically significant differences among the groups (X22=49.543, p=0.000).
- Concerning the reasons behind child marriage among girls, the vast majority (90.5%) of all girls attributed child marriage to cultural factors, mainly girls’ protection (90.5%) and fear of spinsterhood ”fear that the girl will not marry if getting older” (65.7%), and poverty and economic hardship (71.9%). On the other hand, only 8.6% of the girls attributed child marriage to religious beliefs.
- Regarding the negative impact of child marriage on girls’ life, the vast majority of single girls and the majority of engaged girls (96.5% and 88.2%) as compared to less than half (47.7%) of ever-married girls mentioned that child marriage impacts the girls’ life negatively. Statistically significant differences were found among the groups (X22=58.000, p=0.000).
- The main negative impacts reported by the girls included negative consequences on girls’ health (97.7%), childhood deprivation (96.6%), school dropout (94.4%), hindering self-actualization (93.2%), and their ability to take care of their children (92.7%). Moreover, the majority (88.1%) reported that child marriage impacts the health of girls’ children negatively, while more than a tenth of all girls believed that child marriage increases girls’ exposure to violence and increases the probability of divorce (11.9% and 11.3% respectively).
- About two-thirds (65.9%) of ever-married girls and more than a third (35.3%) of engaged girls, as compared to less than a fifth (18.3%) of single girls agreed with the statement “I think girl child marriage protects the girl’s and her family’s honor”. Statistically significant differences were found among the groups (X22=33.259, p=0.000). Furthermore, a statistically significant association was found between girls’ agreement with this statement and their agreement on child marriage among girls (X2=94.087, p=0.000).
- Two fifths (40.9%) of the ever-married girls, as compared to around a third (31.4%) of the engaged girls and a fifth (20.9%) of the single girls, agreed with the statement “I think when the girl gets older, her chance to marry decreases”. Statistically significant differences were found among the groups (X22=6.868, p=0.032). Moreover, there was a statistically significant association between agreement with this statement and agreement on girl child marriage (X2=37.747, p=0.000).
- There were considerable percentages of agreement with the statement, “I think child marriage among girls decreases the economic burden on girls’ families”, especially among the ever-married girls. Statistically significant differences were found among the groups (X22=12.108, p=0.002). Moreover, a statistically significant association was found between girls’ agreement with this statement and their agreement on child marriage among girls (X2= 26.507, p=0.000).
- As for the statement, “I think the girl’s marriage before 18 years has no harm”, more than half (52.3%) of the ever-married girls as compared to around a tenth (11.8%) of the engaged girls agreed with it. Yet, the vast majority (96.5%) of the single girls disagreed with it, with statistically significant differences among the groups (X22=58.00, p=0.000). Also, a statistically significant association was found between girls’ agreement with the statement and their agreement on child marriage among girls (X2=89.317, p=0.000).
- Furthermore, the vast majority (94.4%) of those girls who believed that child marriage has harms disagreed with the statement, “In my opinion, the community has enough awareness about child marriage among girls and its harms”.
- More than two-thirds (67.6%) of all girls agreed with the statement, “I believe a girl’s marriage before 18 years is considered a crime against her rights”. Yet, three quarters (75%) of the ever-married girls disagreed with the statement, with statistically significant differences among the groups (X22 =57.229, p=0.000).
- The single girls were more willing to support combating child marriage, as the majority (86.1%) of them reported, as compared to less than two thirds (58.8%) of the engaged girls and only less than a third (29.5%) of the ever-married girls. Statistically significant differences were found among the groups (X22=48.845, p=0.000).
- According to those girls who supported combating child marriage, raising public awareness, and promoting girls’ education (98.6%), punishing the persons who write the marriage contract before the age of 18 years (88%), and parents’ punishment (73.9%) were the main ways to prevent this practice.
- Girls reported that multisectoral collaboration is needed to end child marriage. These sectors have to include the government (96.5%), educational institutions (93%), society (86.6%), religious institutions (82.4%), mass media (77.5%), health care providers (64.8%), women’s rights organizations (42.3%) and community leaders (31.7%).
Part III: The Association between the Girls’ and their families’ Socio-demographic characteristics and Their Agreement on Child Marriage among Girls.
- There was a significant relationship between the girls’ place of residence and their agreement on child marriage among girls (X2=5.196, p=0.023), wherea third (33.7%) of the girls who lived in rural areas agreed on girl child marriage as compared to only more than a tenth (14.3%) of those girls who lived in urban areas.
- Moreover, a statistically significant relationship was found between the girls’ marital status and their agreement on child marriage (X22=49.543, p=0.000). More than two thirds (68.2%) of the ever-married girls agreed on child marriage, as compared to about two fifths of the engaged girls and more than a tenth of the single girls (39.2% and 12.2% respectively).
- There was no significant relationship between parents’ marital status, educational level, occupation, or socioeconomic level and girls’ agreement on child marriage among girls.
- There was a statistically significant association between dropping out of school and girls’ agreement on child marriage among girls (X2 =35.028, p=0.000), where more than four-fifths (81.6%) of the girls who were still going to school disagreed on child marriage, as compared to two-fifths (40.3%) of those girls who dropped out of school.
Part IV: The Association between the Girls’ marriage experience and their Agreement on Child Marriage among Girls.
- There was a statistically significant association between girls’ satisfaction with their marriage and their agreement on child marriage among girls (FET, P=0.002). Almost all (100%) of the girls who were dissatisfied with their marriage reported that they disagreed on girl child marriage, as compared to less than a quarter (23.1%) of those girls who were satisfied with their marriage and disagreed on child marriage.
- Also, there was a statistically significant association between girls’ perception of the negative impacts of child marriage on their lives and their agreement on child marriage (X2=22.489, P=0.000). All (100%) of those girls who reported that child marriage hasn’t negatively affected their life agreed on child marriage, as compared to only a third (33.3%) of those girls who perceived these negative impacts.
Part V: The Association between the Girls’ Agreement on Child Marriage and Their Support to Combat It.
- There was a statistically significant association between girls’ agreement on child marriage among girls and their support to combat it (X2=192.232, p=0.000). All (100%) of the girls who agreed on child marriage practice didn’t support combating it.
Findings from the qualitative part:
- Girls have suffered from various and multiple problems reflecting the issue of gender inequality which is deeply rooted in our community. These problems included educational deprivation, child labor, inheritance deprivation, male preference, and various forms of violence, including sexual harassment, Female Genital cutting (FGC), and child marriage.
- Child marriage is a complex issue resulting from numerous interrelated factors, including economic factors, socio-cultural factors, factors related to the girl, factors related to the girl’s family, and factors related to men.
- Child marriage is a customary practice that still prevails in rural communities. People’s wish to protect girls (Alsutra), fear of spinsterhood (Alonousa), the culture of shame, religious beliefs, and consanguineous marriage were the main socio-cultural factors driving child marriage.
- Girls get married due to factors related to the girl herself. These factors include the girl’s body morphology, her wish to marry, and her choice to leave the school.
- Sometimes family circumstances force the family to marry off their daughter. These circumstances include family disintegration and lack of parental awareness and education.
- Men’s perceptions and reflections are among the factors driving child marriage, as some men think that little girls are pure and it’s easier to control and condition them.
- The child marriage process involves several sequential phases, including getting a marriage proposal, deciding on the proposal, engagement, marriage preparation, writing the marriage contract, and celebrating the wedding.
- Married girls rarely received premarital care.
- Concerning the way through which the child girl is married, almost all of the participants reported that the marriage contract is unofficially written by a ma’zoun and or a lawyer. They stated that such marriage is called (Urfi/ Souri/ Tahlel Sounah). After writing the contract, the families celebrate through the traditional wedding party. Later on, when the girl reaches 18, the legal age of marriage, the marriage is registered officially.
- Child marriage leads to numerous devastating consequences affecting various aspects of the girls’ and their children’s lives. It deprives the girls of their childhood, ends their education, causes physical, psychological, and social health problems, exposes them to various forms of violence, increases the likelihood of divorce, and hinders children’s registration.
- Marriage needs a mature female who can hold the responsibility, so child marriage is a problem harming the girl, and combating it would protect her.
- Ending child marriage necessitates collaboration between various sectors, including the government, educational institutions, religious men, health care providers, mass media, and community leaders. The participants suggested raising awareness, punishing those involved in child marriage, supporting girls’ education, and improving the economic conditions as essential interventions to end child marriage. In addition, they clarified that girls and their families have an important role to play in this battle.
In light of the current study findings, the following recommendations could be suggested:
• Ministry of Health and Population (MOHP):
- Train health care providers as well as community health workers ”Raedat Refiat” to provide them with human rights approach toward ending child marriage and how to teach and counsel families about the benefits of abandoning this inhuman practice. Training has to focus on changing providers’ attitudes using value clarification exercises to eliminate all forms of discrimination against married girls.
- Develop technical guidelines concerning child marriage in the light of girls’ human rights approach including legal, ethical, social, and cultural as well as the health aspects of the issue; especially teen pregnancy. Such guidelines have to be distributed to all health care settings.
- Enforce accessibility to youth-friendly sexual and reproductive health services for single as well as married girls, especially in rural areas.
- Enforce the role of family clubs in family health centers or units in supporting adolescent mothers through literacy classes and craft making.
- Strengthen community mobilization efforts including public outreach campaigns to raise awareness about child marriage and its devastative impacts on girls, their families and the whole community and help change public attitudes toward this harmful practice as well as raise the status of girls.
- Develop programs that provide support to child brides and their spouses to acquire parenting and life skills.
- Improve child brides’ access to various contraceptive methods and provide counseling as well as the needed information to utilize the suitable method to space pregnancies.
• Ministry of Higher Education:
- Revise undergraduate and post-graduate Medical and Nursing curricula and ensure their inclusion of comprehensive knowledge about girls’ and women’s rights, including prevention of all forms of discrimination and violence, including child marriage.
- Plan and implement health education campaigns, including medical and nursing students to raise public awareness about harmful practices e.g. child marriage and FGC.
- Encourage university students to include child marriage and other harmful practices in their extracurricular activities e.g. theater shows, paintings …etc.
• Ministry of Education:
- Continue revising and renewing the fundamental pre-university educational curricula by experts to include gender-based violence detrimental behaviors, such as child marriage.
- Incorporate life skills activities into school curricula to encourage critical thinking enabling girls to make informed choices.
- Improve teachers’ knowledge and skills to promote a gender transformative approach to teaching including sessions on gender, violence, bodily changes, emotions, and conflict resolution.
- Include harmful practices including child marriage and FGC in school health education activities conducted by the school health nurse.
- Support girls’ education and prevent discrimination hindering access to school due to marital status, pregnancy or motherhood.
- Provide married adolescent girls who dropped out of school with opportunities to continue their education though enhancing access to community schools.
• Ministry of State for Information:
- Launch a comprehensive mass media campaign through diverse media platforms e.g. TV, Radio, Social media, ..etc to raise public awareness about child marriage strengthening its negative inhuman consequences, explain its legal situation, and reporting mechanisms through Child Helpline 16000 and the family counseling line 16021 to provide support for the children and families.
- Involve famous public figures e.g. actors, football players, singers, and political activist to speak out against girls’ rights including protecting them from various forms of violence such as child marriage.
• Political and legislation sector:
- Enforce laws implementation to ensure girls’ and women’s rights and protect them from various forms of violence including child marriage.
- Issue a law criminalizing child marriage, as well as stiffening the penalty for everyone involved in that crime (girl’s parents/ guardian, the man marrying the girl, and the person writing marriage contract).
- Develop legislation obligating health care providers, social workers, or teachers to report any suspected or actual case of child marriage.
- Forming more protection committees covering all villages to identify and report cases of child marriage.
• Ministry of Religious Endowments and christian clerics:
- Intensify Al-Azhar and churches efforts toward combating child marriage through preparing qualified religious leaders who can convey correct messages to the public about girls’ rights and protecting girls from child marriage.
• Ministry of Social Solidarity:
- Continue the efforts for empowering girls and women through education and participation economically and socially, using more innovative advanced approaches.
- Continue providing families with financial incentives for sending their girls to school.
- Providing girls and their families with income opportunities to prevent child marriage occurring due to financial need.
Future researches to be conducted:
- Conduct in-depth studies on quality of life of the married child girls, especially in Upper Egypt, rural areas, and Bedouin communities (qualitative study).
- Explore males’ attitudes toward child marriage (qualitative study).
- Explore the role of health services providers in combating child marriage.
- Explore role of nongovernmental organizations ”NGOs” in combating child marriage: Analytical study.
- The impact of public outreach campaigns on the rural people’s attitude toward child marriage.