Symposium: What's known and what's next – Charting future action on the mental health consequences of child marriage

The details:

The first Child Marriage Research to Action Network (the CRANK) opportunity of 2024 was a symposium on child marriage and mental health, hosted by the University College London (UCL) Global Network on Mental Health and Child Marriage, in collaboration with the CRANK. This is a hybrid in-person and online event, hosted on Zoom and at UCL, London.

We know that mental health conditions – like anxiety and depressive disorders – are among the top causes of burden of disease among adolescents. We also know that approaches that work with girls and boys together are most effective at reducing gender-based violence.

But the evidence base on the mental health consequences of child marriage is thin and suggests that few programmes focus specifically on the mental health needs of girls and women who marry before age 18.

This half-day symposium brought together researchers, practitioners, policymakers and donors to explore the existing evidence on the mental health consequences of child marriage, and on what works to support girls who are – or have been – married.

You can find all the resources from this session – recordings, presentations, key takeaways and social media toolkit – below. We hope you are inspired to use them this World Health Day on 7 April.

Key takeaways:

• Existing evidence shows a range of poor mental health outcomes for girls and women who experience child marriage – including low self-esteem, anxiety, depression and suicidal ideation – but that support services are limited and poorly resourced. Control over married girls’ mobility and stigma around mental health block their access to services and support. The impact is greater the younger a girl is married, and is compounded by experiences of sexual violence, unwanted pregnancy (which can increase mental health disorders by five times), divorce/separation/becoming a widow, and conflict or crisis. Dedicated outreach and additional support are needed for girls who are – or have been – married (ever-married girls).
• Context matters and is complex, so efforts need to be responsive and nuanced to individual and inter-personal situations (age, marital status, type of marriage, family/partner income) and community context (geographical location, social norms, gender inequality, conflict/crisis). Community conversations (e.g. through radio dramas) can deepen understanding of how child marriage interacts with other socioeconomic challenges and norms. Governments, donors, practitioners and researchers should invest in mapping trends in needs and responses across contexts, and in collecting disaggregated data.
• Mental health support should be planned for and funded throughout research and programming; it should offer responsive action and link with referral pathways and services. Long-term, participatory, trauma-informed studies and programming can act as mental health interventions in themselves, especially if combined with girl-centred, arts-based approaches. Safe spaces, listening circles and peer learning spaces may reduce isolation for ever-married girls, and provide access to caring adults. Group psychotherapy/psychosocial support or safe spaces can be a cost-effective way to identify cases and provide some immediate support; this could be combined with individual-level support (e.g. hotlines). Interventions need to be tailored to mental health and motherhood status, and coupled with practical support to facilitate participation (childcare, transport).
• Individual support must be accompanied by work with families and communities to understand and build a more supportive ecosystem for girls. Research and programming should engage those making the decisions around marriage and married girls’ lives (older relations, community leaders, partners, in-laws). Girls may already turn to existing community support structures – including community leaders and women who experienced child marriage – so supporting these through peer mentor or learning initiatives can benefit girls. Girls, families and communities need to see real alternatives to marriage – including secure, paid employment – especially in conflict- and crisis-affected settings where marriage is seen as a protective factor.
• Child marriage and mental health interventions should connect with existing structures, services, programmes and networks across sectors – including community efforts – to bring sustainable, quality support to ever-married girls. Girls and women can identify the trusted service providers (community health care workers, teachers, police) and services (ante-natal care, child vaccinations, HIV/AIDS interventions) they are already engaging with, and these can become entry-points for work on child marriage and mental health. This could include supporting service providers to examine their own beliefs and role in addressing child marriage, and get trained in identifying, supporting and referring mental health cases. One-stop centres for health, legal, psychosocial support and referrals may be effective – as ever-married girls’ mobility is often limited – but should be tailored to their needs.
• Small-scale pilots and programmes can be scaled up by engaging policymakers from the start, and linking with national-level policy and systems. Advocates, practitioners and researchers need to engage policy- and decision-makers alongside girls, communities and service providers from the beginning to create a common understanding of the need and urgency for action. Continuously sharing evidence of what works – especially if linked to girls’ education and/or health – reinforces buy-in and drives action, from enacting and implementing laws, to scaling up effective policies and programmes. This can be strengthened through a memorandum of understanding with government, linking mental health recommendations with public health departments and universal health coverage packages.
• More evidence is needed, and we can all play a part by including some research into all investments and programmes. We need more longitudinal studies, pilot projects with married girls, and evaluations of programming and policy in diverse contexts and types of marriage. Researchers and practitioners could create evaluation tools for civil society organisations and community-based organisations to take their work to scale. Researchers could look at cases of positive deviance (where families in seemingly similar conditions make different decisions around marriage) and the impact of family or partners’ economic situation. Measures of success – from short to long term – need to be clearly defined and adapted to context.

This was a space to explore:

• What’s known: The evidence and intersections between mental health and child marriage.
• What’s working: Case studies and research reflections on existing and potential child marriage and mental health programmes targeting girls and adolescents who are married, in a union, pregnant or parenting.
• What’s next: Policy and practice priorities, including consolidated guidelines to support programme design and implementation, with a focus on trauma.

The speakers were:

• Ololade Julius Baruwa – GCRF Adolescent Accelerator Hub, University of Cape Town, South Africa, focused on Lesotho, Namibia and Zimbabwe
• Farirai Gumbonzvanda – March-Zim project, Zimbabwe
• Kimberly Howe – Tufts University, focused on Northern Iraq
• Nicola Jones – GAGE, Ethiopia and Jordan
• Olubukola Omobowale – ENCASE project, Nigeria
• Christina Mallie – Colours of Connection, Democratic Republic of the Congo
• Sam Muhumuza – Windle International, Uganda
• Abu Naser – UNFPA, Bangladesh
• Prabhleen Tuteja – The YP Foundation (TYPF), Uttar Pradesh, India
• Christina Pallito, World Health Organisation
• Loveness Mudzuru, Rozaria Memorial Trust, Zimbabwe