Preventing early and forced marriage is a global priority, however, sexual and reproductive health (SRH) among youth remains understudied in humanitarian settings. This study examined child, early and forced marriage and partnership (CEFMP) among young refugees in Bidi Bidi refugee settlement, Uganda, and associations with SRH outcomes among young women. This mixedmethods study involved a qualitative phase with young (16-24 years) sexual violence survivors (n=58), elders (n=8) and healthcare providers (n=10), followed by a quantitative phase among refugee youth (16-24 years; n=120) during which sociodemographic and SRH data were collected. We examined SRH outcome differences by CEFMP using Fisher’s exact test. Qualitative data showed that CEFMP was a significant problem facing refugee young women driven by stigma, gender norms and poverty. Among youth refugee survey participants, nearly one-third (31.7%) experienced CEFMP (57.9% women, 42.1% men). Among women in CEFMP compared to those who were not, a significantly higher proportion reported forced pregnancy (50.0% vs. 18.4%, p-value=0.018), forced abortion (45.4% vs. 7.0%, p-value=0.002), and missed school due to sexual violence (94.7% vs. 63.0%, p-value=0.016). This study illustrates the need for innovative community-engaged interventions to end CEFMP in humanitarian contexts in order to achieve sexual and reproductive health and rights for youth. (Afr J Reprod Health 2022; 26[12s]: 66-77).

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United Nations High Commissioner for Human Rights.

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Child, early and forced marriage in humanitarian

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Commissioner for Human Rights [Internet]. 2019.

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Ajayi AI. Association Between Girl-child Marriage

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and Intimate Partner Violence in Sub-Saharan

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Africa: Insights From a Multicountry Analysis of

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Demographic and Health Surveys. Journal of

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Gregowski A. New Findings on Child Marriage in

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Sub-Saharan Africa. Annals of Global Health. 2017

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Global Affairs Canada. Child, early and forced marriage.

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Psaki SR, Melnikas AJ, Haque E, Saul G, Misunas C, Patel

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SK, Ngo T and Amin S. What Are the Drivers of

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Child Marriage? A Conceptual Framework to Guide

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Policies and Programs. Journal of Adolescent Health.

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Dec 1;69(6):S13–22.

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Muthengi E, Olum R and Chandra-Mouli V. Context

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Matters—One Size Does Not Fit All When

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Designing Interventions to Prevent Child Marriage.

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Vol. 69, Journal of Adolescent Health. Elsevier Inc.;

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p. S1–3.

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Kidman R. Child marriage and intimate partner violence: A

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comparative study of 34 countries. International

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Journal of Epidemiology. 2017;46(2):662–75.

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McCleary-Sills J, Hanmer L, Parsons J and Klugman J. Child

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Marriage: A Critical Barrier to Girls’ Schooling and

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Gender Equality in Education. Review of Faith and

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International Affairs. 2015 Jul 3;13(3):69–80.

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Freccero J and Whiting A. Lessons from Research and

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Practice in Development and Humanitarian Sectors.

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Wodon Q, Male C, Nayihouba A, Onagoruwa A, Savadogo

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A, Yedan A, Edmeades J, Kes A, John N, Murithi L,

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Steinhaus M and Petroni S. Economic Impacts of

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Child Marriage: Global Synthesis Report [Internet].

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www.costsofchildmarriage.org.

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United Nations. Convention on the Elimination of All

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Forms of Discrimination against Women: General

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recommendation No. 30 on women in conflict

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prevention, conflict and post-conflict situations.

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Mlaba K. How Do Women and Girls Experience the Worst

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Ivanova O, Rai M and Kemigisha E. A systematic review

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of sexual and reproductive health knowledge,

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experiences and access to services among refugee,

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migrant and displaced girls and young women in

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Africa. International Journal of Environmental

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Research and Public Health. 2018;15(8):1583.

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Svanemyr J, Chandra-Mouli V, Raj A, Travers E and

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Sundaram L. Research priorities on ending child

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marriage and supporting married girls. Reproductive

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Health. 2015;12(1):1-4.

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Logie CH, Okumu M, Lukone SO, Loutet M, McAlpine A,

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Latif M, Berry I, Kisubi N, Mwima S, Kyambadde P,

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Neema S, Small E, Balyejjusa SM and Musinguzi J.

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Ngutulu Kagwero (agents of change): study design

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of a participatory comic pilot study on sexual

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violence prevention and post-rape clinical care with

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refugee youth in a humanitarian setting in Uganda.

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Glob Health Action. 2021;14(1):1940763.

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Logie CH, Okumu M, Loutet M, Berry I, Lukone SO,

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of change) participatory comic pilot study on postrape clinical care and sexual violence prevention

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with refugee youth in a humanitarian setting in

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fertility-control outcomes of young women in India:

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a cross-sectional, observational study. The Lancet.

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Raj A and Boehmer U. Girl Child Marriage and Its

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Association With National Rates of HIV, Maternal

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Health, and Infant Mortality Across 97 Countries.

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and childbearing in West Africa. Journal of

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Factors affecting Early Age Marriage in Dhankuta

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Municipality, Nepal. Nepal Journal of Medical

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Sciences. 2014;3(1):26-30.

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Prakash R, Beattie TS, Javalkar P, Bhattacharjee P,

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Ramanaik S, Thalinja R, Murthy S, Davey C, Gafos

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Heise L and Isac S. The Samata intervention to

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increase secondary school completion and reduce

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child marriage among adolescent girls: Results from

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a clusterrandomised control trial in India. Journal of

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Global Health. 2019;9(1):010430.

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Price AJ and Crampin AC. Early school failure

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predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi.

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Jones N, Tefera B, Stephenson J, Gupta T, Pereznieto P,

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Emire G, Gebre B and Gezhegne K. Early marriage

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and education: the complex role of social norms in

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shaping Ethiopian adolescent girls’ lives. Country

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Report: Shaping policy for development. 2014

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Wodon Q, Nguyen MC and Tsimpo C. Child Marriage,

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Education, and Agency in Uganda. Feminist

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Economics. 2016;22(1):54–79.

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Ahonsi B, Fuseini K, Nai D, Goldson E, Owusu S, Ndifuna

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I, Humes I and Tapsoba PL. Child marriage in

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Ghana: Evidence from a multi-method study. BMC

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Women’s Health. 2019;19(126):1–15.

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Kamilda MR, Nurhaeni IDA and Adriani RB.

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Biopsychosocial Determinants of Early Marriage in

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Wonogiri District, Central Java: A Logistic

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Regression. Journal of Maternal and Child Health.

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Shakya HB, Weeks J, Challa S, Fleming PJ, Cislaghi B,

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McDougal L, Boyce SC, Raj A and Silverman JG.

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Spatial analysis of individual-and village-level

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sociodemographic characteristics associated with

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age at marriage among married adolescents in rural

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Niger. BMC Public Health. 2020;20(729):1–15.

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Azeez AEP and Poonia A. Determinants, Attitudes and

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Practices on Child Marriage: Evidences from Rural

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Rajasthan. Social Work Chronicle. 2015;4(1and2).

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Misunas C, Erulkar A, Apicella L, Ngô T and Psaki S. What

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Influences Girls’ Age at Marriage in Burkina Faso

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and Tanzania? Exploring the Contribution of

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Individual, Household, and Community Level

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Factors. Journal of Adolescent Health.

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Stark L. Early marriage and cultural constructions of

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adulthood in two slums in Dar es Salaam. Culture,

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Health and Sexuality. 2018;20(8):888–901.

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Soler-Hampejsek E, Kangwana B, Austrian K, Amin S and

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Psaki SR. Education, Child Marriage, and Work

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Outcomes Among Young People in Rural Malawi.

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Journal of Adolescent Health. 2021;69(6):S57–64.

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Tomar S, Johns N, Challa S, Brooks MI, Aliou S, AbdoulMoumouni N, Raj A and Silverman J. Associations

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of Age at Marriage With Marital Decision-Making

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Agency Among Adolescent Wives in Rural Niger.

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Journal of Adolescent Health. 2021;69(6):S74–80.

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Schlecht J, Rowley E and Babirye J. Early relationships and

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marriage in conflict and post-conflict settings:

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Vulnerability of youth in Uganda. Reproductive

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Health Matters. 2013;21(41):234–42.

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Mourtada R, Schlecht J and Dejong J. A qualitative study

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exploring child marriage practices among Syrian

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conflict-affected populations in Lebanon. Conflict

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UNICEF. Child marriage in humanitarian settings:

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Spotlight on the situation in the Arab region

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Urada L and Silverman JG. A mediation analysis of

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the role of girl child marriage in the relationship

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partner violence in post-conflict Sri Lanka. Conflict

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Koski A, Clark S and Nandi A. Has Child Marriage

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Declined in sub-Saharan Africa? An Analysis of

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