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Jurnal Ners 
Vol. 14, No. 3, Special Issue 2019 
http://dx.doi.org/10.20473/jn.v14i3(si).17019 

This is an Open Access article distributed 
under the terms of the Creative Commons 

Attribution 4.0 International License  

Systematic Review  

Trends of Early Marriage in Developing Countries: A Systematic Review 

Suhariyati Suhariyati, Joni Haryanto and Ririn Probowati 

Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia 

ABSTRACT 

Background: Early marriage is being increasingly recognized globally as a 
fundamental violation of human rights and a major obstacle to sustainable 
development. Early marriage occurs globally to varying degrees, especially 
in developing countries. The purpose of this article was to identify the 
determinants and impact of early marriage in developing countries. 

Method: A systematic search for studies published from 2014 up to 2019 
was conducted via Scopus, Proquest, Elsevier, Science Direct, Sage Journal, 
SpringerLink and EBSCO. A total of 10 studies met the inclusion criteria. 
These were independently extracted by two reviewers. 

Result: Education and place of residence were the most commonly studied 
determinants of early marriage. Only a few of them reported results 
concerning the age difference between the spouses, access to media 
information and self-efficiency. Early marriage has a relationship with both 
the mother's and child's health. However, the significance of these 
associations was often small or inconsistent. 

Conclusion: This review summarizes the best available evidence for local 
policymakers and public health practitioners so then they can consider 
incorporating these findings into the development of intervention protocols 
for the prevention of early marriage. 

ARTICLE HISTORY 

Received: Dec 26, 2019 
Accepted: Dec 31, 2019 

KEYWORDS 

early marriage; developing countries; 
education;   

CONTACT 

Suhariyati 
 suhariyati-2017@fkp.unair.ac.id 
 Faculty of Nursing, Universitas 
Airlangga, Surabaya, Indonesia 

Cite this as:  Suhariyati, S., Haryanto, J., & Probowati, R. (2019). Trends of Early Marriage in Developing Countries: A 
Systematic Review. Jurnal Ners, 14(3si), 277-282. doi:http://dx.doi.org/10.20473/jn.v14i3(si).17019 

 

INTRODUCTION  

Globally, nearly 15 million girls under age 18 are 
married every year (Antarini, Rhadiyah, Permata, 
Marcely, & Montovani, 2016). Around 750 million 
women alive today were married in childhood, and 
unless progress is accelerated, that number will 
remain at least as high through to 2030. This shows 
that early marriage is a human rights violation on a 
vast scale and a major obstacle to sustainable 
development (Berliana et al., 2018). The violation was 
outlined in the 1989 Convention on the Rights of the 
Child (CRC). The right was included not to be 
separated from their parents against their will 
(Article 9), the right to freedom of expression (Article 
13), the right to education (Articles 28 and 29), the 
right to rest and leisure and engagement in play and 
recreational activities (Article 31) and the right to 
protection from sexual exploitation and abuse 
(Article 34) (Efevbera, Bhabha, Farmer, & Fink, 
2017). 

Early marriage have been reported and is a trend 
among adolescent women to varying degrees across 
many countries, especially in developing countries 
like Indonesia, Egypt, Pakistan, Turkey, Viet Nam, 
India, Bangladesh and countries in Sub-Saharan 
Africa (Goli, Rammohan, & Singh, 2015; Hamed & 
Yousef, 2018; Hong Le, Tran, Nguyen, & Fisher, 2014; 
Sanjaya et al., 2018; Shaud & Asad, 2018; Uddin, 2015; 
UNICEF-UNFPA, 2017; United Nations, 1989; Wells, 
2017; Yuksel-Kaptanoglu & Ergocmen, 2014). The age 
at first marriage varies from one area to another in 
the world. However, there are many women who have 
married before 18 years in developing countries. 
Marriage before this age is called ‘child’, or more 
commonly, ‘early marriage’ (Sanjaya et al., 2018). 
Although many countries have decided on a legal 
minimum age of marriage of 18, some countries are 
struggling to change their policy, like Indonesia (Goli 
et al., 2015). 

Marriage, for many people, is the most enduring 
and intimate bond of all close relationships (Hamed & 
Yousef, 2018). High quality marriages amplify 

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psychological functioning and problematic marriages 
can take a toll on one’s emotional and psychological 
health (Hamed & Yousef, 2018). One of the many 
aspects that can affect quality of marriage, and 
subsequently psychological functioning, is the timing 
of matrimony (Hamed & Yousef, 2018). Women 
married before 18 years are more exposed to 
physical, psychological and sexual violence than those 
married after 18 years (Hamed & Yousef, 2018; 
Sanjaya et al., 2018; United Nations, 1989). 

Adolescent pregnancy at a time when women are 
not biologically mature increases the risk of damaging 
the reproductive tract and pregnancy-related 
complications such as anemia, pregnancy-induced 
hypertension, preterm labor, cephalo-pelvic 
disproportion (CPD), maternal mortality, perinatal 
and neonatal mortality, low birth weight and stunting 
(Hong Le et al., 2014; Wells, 2017). Additionally, 
available evidence from developing countries has 
shown that early marriage and childbearing affects a 
women’s nutritional status both directly and 
indirectly (Hong Le et al., 2014). Adolescent pregnant 
girls do not gain weight during pregnancy and 
lactation, but rather, they lose weight (Hong Le et al., 
2014). 

A number of researchers have reported the factors 
associated with early marriage in the global context 
(Shaud & Asad, 2018). Lower socio-economic 
attainment, i.e. a lower educational degree and 
income degree (Sanjaya et al., 2018; Shaud & Asad, 
2018; Uddin, 2015; United Nations, 1989; Yuksel-
Kaptanoglu & Ergocmen, 2014). Considering the 
numerous maternal and child health risks associated 
with early marriage, this issue is worth studying. 
Therefore, this study will enrich the current situation 
on early marriage in developing countries. The 
purpose of this article was to identify the 
determinants of early marriage in developing 
countries. In addition, this review will also look into 
the impact of early marriage on maternal and child 
health. 

MATERIALS AND METHODS  

Our systematic review followed a defined protocol to 
reduce bias and ensure replicability. The Preferred 
Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) was used to search for concepts in 
the literature and to increase its integrity. Our 
simplified PRISMA flow diagram has been included in 
Figure 1. 

Data Sources 
One reviewer implemented the search strategy to 
search for relevant articles published from 2014 up to 
2019 in Scopus, Proquest, Elsevier, Science Direct, 
Sage Journal, SpringerLink and EBSCO. One reviewer 
then independently screened the identified studies 
against the inclusion criteria before extracting the 
data. The search strategy was inclusive and 
concentrated on the keywords "early marriage". 

 

Study Selection  
This systematic review included studies using any 
quantitative methodologies so long as they met the 
other criteria. The analysis of the systematic reviews 
was required. The inclusion criteria were: (i) 
reported on the determinants of early marriage 
and/or reported on the impact of early marriage; (ii) 
involved women who were early married and/or 
children born to mothers with an early marriage and 
(iii) the place of study in developing countries. The 
studies were excluded based on the following criteria: 
(i) articles that were only abstracts and (ii) where the 
outcome not the determinants and/or impact of early 
marriage. 

One reviewer identified the appropriate studies. 
All of the titles and the abstracts were retrieved 
through the database searches. Then an initial 
screening of the title and abstract were conducted by 
two reviewers against the above mentioned exclusion 
criteria. Next, an evaluation of the full text of the 
articles was conducted by the two reviewers to refine 
the results based on the inclusion criteria. 
Disagreements between the reviewers were resolved 
through a discussion. Among the 32 studies that were 
initially captured, 22 studies were excluded because 
they reported on the abstract only, the outcome did 
not include the determinants and/or impact of early 
marriage and where the place of research was not a 
developing country. 

Data Extraction 
The quality assessment was carried out using a 
structured format which drew on the 
recommendations of the modified Newcastle-Ottawa 
Scale for both cohort and cross-sectional studies. It 
was developed to assess the quality of studies in three 
domains related to the selection of the study groups, 
to boost the comparability of the groups and to assist 
in the ascertainment of exposure and outcomes. Two 
reviewers conducted pilot testing of the quality 
assessment tools independently on the included 
studies and then completed the evaluation of the 
quality of the remaining studies independently. 
Where there were disagreements, the two reviewers 
discussed the issues until consensus was achieved. 
The studies were determined as being good, fair or 
poor. Good quality studies consisted three or four 
stars in the selection domain, one or two stars in the 
comparability domain and two or three stars in the 
outcomes domain. Fair quality consisted of two stars 
in the selection domain, one or two stars in the 
comparability domain and two or three stars in the 
outcomes domain. Poor quality consisted of zero or 
one stars in the selection domain, zero stars in the 
comparability domain, and zero or one stars in the 
outcomes domain[14]. The data was extracted by the 
two reviewers in Excel with characteristics like the 
author, the year of publication, sample size, the 
participant’s demographics (e.g. age, country) and the 
outcomes. The association significantly assessed the 
p-value compilation in this study, which was <0.05. 
Only the bivariate and multivariate results were 



JURNAL NERS 

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accessed in this review. There was an initial 
agreement rate of over 95%. 

RESULT 

 

Figure 1. Flow diagram of the literature search used 
to identify the determinants and impacts of early 
marriage in developing countries 
 
The initial search of the database resulted in a total of 
761 items of literature without the help of searching 
the other sources. From this, 10 were included in the 
systematic review (Figure 1). 

Figure 1 provides a summary of each study. From 
the table, it can be seen that the sample sizes 
of the studies ranged from 164 - 339 respondents. 
Duplicate literature items were deleted, after which 
there were 310 remaining literature items. Only the 
abstracts were excluded, if the results were not 
determinants, where the impact of early marriage 
was excluded and where the place of research in 
developed countries was excluded. The results of the 
review found 10 literature items from a total of 
761literature items originally found.  

This review was conducted in 22 developing 
countries, including Indonesia (n=3), Pakistan (n=1), 
India (n=1), Egypt (n=1), Turkey (n=1), Vietnam 
(n=1), Bangladesh (n=1) and developing countries in 
Sub-Africa (n=16). Where the determinant was 
measured, this was done using questionnaires that 
included BPS’s classifications (n = 1), the Household 
questionnaire (n=1), an Individual questionnaire 
(n=1) and a Questionnaire designed by the author 
(n=1). As for impact, this was determined using the z-
score (n=2), DDST II (n=1), Demographic information 
sheet (n=1), Short marital adjustment test (n=1), 
Convergence communication scale (n=1), Kessler 

psychological distress scale (n=1), BMI (n=1), and 
early childhood development index (n=1). The rest of 
the studies (n=3) did not specify the questionnaire 
used. One of the studies used the hb level in a decilitre 
of blood. Based on the quality assessment criteria, 
only one study was rated as good (Wells, 2017) while 
the others were rated as being of fair quality (Table 
1). 

Determinants of Early Marriage 
Table 2 summarizes the associations between early 
marriage and the determinants of early marriage. The 
factors related to early marriage were investigated in 
6 studies. The outcomes were grouped into 10 
categories: age difference between the spouses, place 
of residence, region, religion, education, economy, 
access to media information, ethnicity and self-
efficiency. Education and place of residence were the 
most commonly assessed determinants of early 
marriage. 

Age Difference Between the Spouses. 
Only one study investigated the significant 
correlation of there being an age difference between 
the spouses in which the component was the husband 
being older by 5-9 years or the husband being older 
by 10+ years. Age difference between the spouses is 
an important indicator of power relations and it is 
significantly related to being married at an early age. 
The risk of being a child bride is much higher for 
women whose husbands are older than themselves 
by 5-10 years or more (Uddin, 2015). 

Place of Residence. 
Five studies investigated the association between 
early marriage and place of residence. This was 
significantly higher among rural adolescents 
compared to their urban counterparts (Sanjaya et al., 
2018; Shaud & Asad, 2018; Uddin, 2015). One study 
showed that place of residence was significantly 
higher matrilocal residential pattern (Yuksel-
Kaptanoglu & Ergocmen, 2014). There was only one 
study that showed there to be no significant 
relationship between early marriage and place of 
residence, include rural and urban (United Nations, 
1989). 

Education. 
Five studies examined the association between early 
marriage and education, in which the components 
were less than secondary, secondary or more, 
illiterate, literate, junior high school primary and 
incomplete primary were found to have a significant 
association (Sanjaya et al., 2018; Shaud & Asad, 2018; 
Uddin, 2015; United Nations, 1989; Yuksel-
Kaptanoglu & Ergocmen, 2014).  

Religion. 
Two studies investigated the association between 
early marriage and religion and found it to be a non-
significant correlate, including Islam, Christianity, 
Buddhism, no religion and other (Sanjaya et al., 2018; 
United Nations, 1989). 

 



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Economy. 
Two studies examined the association between early 
marriage and economy level. It was found to be a 
significant correlate, including low income, middle 
income, the poorest 20%, 21%-40%, 41%-60% and 
61%-80% and the highest 20% (Shaud & Asad, 2018; 
United Nations, 1989). 

Access to media information. 
Only one study examined the association between 
early marriage and access to media information, and 
found it to be a significant correlate, including radio 
and newspaper/magazines. However, there was no 
association between early marriage and access to 
media information for the television (Shaud & Asad, 
2018). 

Ethnicity. 
Two studies examined the associations between early 
marriage and ethnicity. One study showed a 
significant correlate among Santal and Muslim 
(Yuksel-Kaptanoglu & Ergocmen, 2014). One study 
showed a significant correlate with Kinh. However, 
there was no association between early marriage and 
any other ethnicities (United Nations, 1989). 

Region. 
Only one study examined the associations between 
early marriage and region. However, there was no 
significant correlate between early marriage and 
region in Turkey (1978 and 2008), including the 
South, Central, North and East (Uddin, 2015). 

Self-efficiency. 
Only one study examined the association between 
early marriage and self-efficiency, including vicarious 
experience and emotional arousal. The analytical 
results obtained that there was a very weak negative 
correlation between vicarious experiences and the 
emotional arousals factor with early marriage 
(UNICEF-UNFPA, 2017). 

Impact of Early Marriage 
Table 3 summarizes the associations between early 
marriage and the impact of early marriage. The 
impacts related to early marriage were investigated 
in 5 studies. The impacts of early marriage were 
grouped into 2 categories: the mother’s health and the 
child’s health. 

Mother’s Health. 
Three studies examined  the association between 
early marriage and the mother’s health as a 
significant correlate in which the components of 
psychological distress (early vs. late) and the 
mother’s nutritional status (thin, anemia and risk of 
experiencing IPV) came into play (Hamed & Yousef, 
2018; Shaud & Asad, 2018; United Nations, 1989). 

Child’s Health. 
Two studies examined the associations between early 
marriage and the child's health, including child 
development and the child’s nutritional status. Two 
studies showed a significant correlate between early 

marriage and child development (Goli et al., 2015; 
Wells, 2017). However, 1 study showed as being a 
non-significant correlate with the child’s nutritional 
status (Goli et al., 2015), and one study showed a 
significant correlate with the child’s nutritional status 
if there was stunting (Wells, 2017). 

DISCUSSION 

This systematic review identified 10 studies for the 
determinants of early marriage and the impacts of 
early marriage in developing countries. This review 
clearly demonstrates that for many of the variables, 
the evidence is insufficient and this is mainly due to 
the limited number of studies conducted. This review 
found that most of the early marriage determinants 
focused on education and place of residence, but place 
of residence was still a gap. Only a few of them 
reported results concerning the economy, ethnicity, 
the age difference between the spouses, access to 
media information and self-efficiency. The most 
common impact of early marriage identified by this 
review was child development. Only a few of them 
reported results concerning the mother’s health: 
psychological distress, thin, anemia and risk of 
experiencing IPV and the child’s health: child’s 
nutrition. It was not possible to establish any strong 
relationships between some of the significant 
associated factors of the mother’s health because 
these were evaluated in only 1 study. It was also not 
possible to examine the child’s nutrition because 
these were significant only in 1 study too.. 

The studies focused on (Sanjaya et al., 2018; Shaud 
& Asad, 2018; Uddin, 2015; United Nations, 1989; 
Yuksel-Kaptanoglu & Ergocmen, 2014) five 
developing counties reported that female education is 
an important determinant of early marriage. The 
study in Egypt showed that women with secondary or 
higher education had a lower prevalence than those 
with less than secondary education (Sanjaya et al., 
2018). This relationship might be reciprocal in that 
young women who have little education might view 
marriage as a pathway to adult privileges that cannot 
be reached through formal education and conversely 
that early marriage reduces the opportunities to 
complete their schooling (United Nations, 1989). This 
indicates the importance of female education in 
reducing early marriage. 

In this study, the prevalence was lower in urban 
than in rural areas (Sanjaya et al., 2018; Shaud & Asad, 
2018; Uddin, 2015; Yuksel-Kaptanoglu & Ergocmen, 
2014). This is in contrast with the data from Vietnam 
(United Nations, 1989) which showed that no relation 
was present between early marriage and the place of 
residence, including rural and urban. High early 
marriage in rural areas was reported in many studies 
from different developing countries, included 
Indonesian, Bangladesh, Egypt and Turkey (Sanjaya 
et al., 2018; Shaud & Asad, 2018; Uddin, 2015; Yuksel-
Kaptanoglu & Ergocmen, 2014). Early marriage is 
associated with the lower wealth, lower education 
levels, and higher labor force participation that are 



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more common in rural areas (Sanjaya et al., 2018). 
Living in rural areas where access to public 
information and prevention programs is much more 
limited may lead adolescents to be married early 
(Sanjaya et al., 2018; Shaud & Asad, 2018; Uddin, 
2015; Yuksel-Kaptanoglu & Ergocmen, 2014). 
Improved educational levels among urban females 
increased the age of first marriage (Shaud & Asad, 
2018). This indicates the importance of female 
education, of female employment and of prevention 
programs in both rural and urban areas.  

In Pakistan, the study results showed that age at 
marriage (early vs. late), marital adjustment and 
convergent communication patterns together 
explained the significant variance for psychological 
distress while low marital adjustment and the greater 
use of interpersonal deference communication styles 
emerged as significant predictors of psychological 
distress. Research evidence indicates that women 
with an early marriage mostly got married to much 
older men and this age difference affects the level of 
mutual understanding, the level of communication 
and their social status within a family. Women who 
marry young find their husbands to be more 
controlling and dominating. Depressive symptoms 
are more commonly found among women with early 
marriages. An undeveloped girl who is still struggling 
to comprehend her own body structure is forced to 
make marital relations. This often leads to 
psychological distress and despair due to her 
insufficient role performance and the handling of 
domestic chores (Hamed & Yousef, 2018). Early 
marriage is likely to have adverse consequences on 
the health of women.  

Our study (Hong Le et al., 2014) suggests there to 
be a large adverse effect from early marriage on the 
nutritional status of women in India. A large 
proportion of women who were married before the 
legal age and who were consequently exposed to 
early pregnancy were found to be undernourished 
(thin) relative to the women who were married at a 
later age. The analyses also show that across all of our 
models, women who married at 25 years and above 
had the highest likelihood of having a normal 
nutritional status. Similar results were also found 
with regard to the prevalence of anemia among 
women. Thin and anemic women were typically from 
rural areas, and they were also commonly illiterate 
and from poor economic status households. 

The study in Vietnam (United Nations, 1989) 
showed that all of the large proportion of the young 
women who had experienced sexual violence 
perpetrated by their intimate partner did not 
consider this to be a type of sexual abuse. This 
revealed a lack of awareness about and the limited 
nomenclature for these experiences among young 
people. Young women who were married before the 
age of 18 in Vietnam were nearly twice as likely to 
experience IPV compared with those who did not. 
Family background, in which children witnessed IPV 
between their parents, or who were affected by their 
parents’ traditional gender role stereotypes, may 

magnify the belief among adolescent brides that IPV 
is a part of marriage in Vietnam. 

The studies in Indonesian and Sub-Saharan Africa 
(Goli et al., 2015; Wells, 2017) showed that children 
born to women who marry before they are aged 18 
had significantly higher developmental disorders 
than those whose mothers married later. Importantly, 
contextual factors including the mother’s completion 
of primary education and geographic location, which 
may create enabling environments for early marriage, 
explained most of this relationship and it may also 
explain the differences observed by country. Lower 
levels of maternal education and living in a rural 
setting have been associated with a higher likelihood 
of early marriage. Living in an urban setting may 
result in the increased availability of health facilities, 
antenatal and postnatal care and early education 
opportunities, all of which can positively influence 
child development. 

Our review also found evidence in Sub-Saharan 
Africa that a small part of the relationship between 
early marriage and child stunting was explained by 
early childbearing (Wells, 2017). This is in contrast 
with the data from Indonesian that showed that there 
to be no relation between early marriage and the 
child’s nutritional status (Goli et al., 2015). This may 
be the result of a young mother’s physiological 
immaturity. 

However, some issues and limitations should be 
considered when interpreting the findings. First, the 
majority of studies relied on self-reported data and it 
was therefore difficult to judge the validity and 
reliability of the determinants and impacts of early 
marriage that were used to collect the data because 
this information was not reported in several of the 
studies. In addition, the literature reviewed 
presented very heterogeneous and inconsistent 
results with regard to the correlates of the 
determinants and impacts of early marriage. 
Furthermore, this inconsistency remained even when 
the results of the previous reviews were compared 
with those of this review. Additionally, many studies 
used samples that were non-representative or that 
were only representative of a limited geographical 
area. The majority of studies focused on specific 
countries such as Indonesia, Egypt, Pakistan, Turkey, 
Vietnam, India, Bangladesh and countries in Sub-
Saharan Africa. This indicates that the development of 
scientific research on the determinants and affects of 
early marriage in developing countries has yet to 
cover all regions of the developing countries. We 
recommend that future research make better use of a 
wider range of methods to understand the dynamics 
of the determinants and impacts of early marriage on 
maternal and child health. 

CONCLUSION 

This systematic review was conducted first to 
summarize the determinants and impacts of early 
marriage in developing countries. Education and 
place of residence were the most commonly studied 



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correlates of the determinants of early marriage. 
Additionally, child development disorder was the 
most commonly studied correlate that was an impact 
of early marriage. However, the significance of these 
associations was often small or inconsistent. This 
review highlights that there is a lack of research to 
support the causal role of the specific factors in 
improving early marriage and the impact of early 
marriage in developing countries. This review 
summarizes the best available evidence for local 
policymakers and public health practitioners so then 
they can consider incorporating these findings into 
the development of an intervention for the 
prevention of early marriage. 

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