Early Marriages in Uganda: A Comparative Assessment Of Determinants Across Regions

Background: Early marriage is any marriage associated with persons under the age of 18. Worldwide, early marriage disproportionately affects females, and is associated with high teenage pregnancies, alongside its negative effects. While early marriage is common in Uganda (49%), it is highest in Eastern (30%) and lowest in Central (19%); as such, not all girls face the same risk of early marriage even within a country. The factors that influence early marriages are important to know for policy implication purposes in Uganda. This study aims to investigate the socio-economic and enabling factors that influence early marriages across the regions of Uganda. Methods: Using a weighted sample of 13,768 ever married women from the 2016 Uganda Demographic and Health Survey. Frequency distributions were used to describe the background characteristics of the women. Pearson’s chi-square (χ 2 ) test was used to investigate the associations between early marriage and socio-economic and enabling factors and multivariable logistic regression analyses were used to examine the net-effect of socio-economic and enabling factors on early marriage. Results: Early marriage was highest among women in Eastern region (30%), followed by Northern (27%) and Western (25%) while Central had the lowest proportion at 19%. Across the regions, the key determinants of early marriage were education level, age at first birth and age at first sex (p<0.05). However, residence, wealth status and religion were only predictors of early marriage in Western region (p<0.05). Conclusions: The study underscores the need to strengthen strategies that promote girl child education, delayed initiation of sexual intercourse and child birth as measures for addressing early marriage across regions. In light of the variations in factors across regions, there is also a need to employ interventions that target women in particular regions.


Introduction
Early marriages are among the main barriers to attainment of gender equality, equity and development in many developing countries [1][2][3]. Early marriages increase the risk of acquiring sexually transmitted diseases, HIV, cervical cancer, obstetric fistulas, neonatal and maternal mortality [4][5][6][7][8]. Globally, over 41,000 girls are affected by early marriage d a i l y [9] and about 700 million women were married before their 18th birthday in 2014 [10]. If it is not prevented, the total number of women involved in early marriages is expected to increase from about 700 million to about 1.2 billion by 2050 [11][12][13][14].
In Uganda, early marriage is estimated at 49% [15], one of the highest in the region and elsewhere [16]. While early marriage is common in Uganda, prevalence was noted highest in Eastern (30%), followed by Northern (27%), Western (25%) and lastly, Central (1 9 %) [15]. Studies done on early marriage in Uganda focused on the determinants of early marriage in Uganda as a whole, in Western Uganda, statistics of early marriage, early marriage as purely a cultural phenomenon, and the effect of the enactment of the death penalty on child marriage in Uganda [15,[17][18][19][20]. Studies done, do not appreciate that, not all girls face the same risk of becoming child brides even within a country [21], and as such therefore, it becomes inevitable to witness the ever growing levels of early marriage across the country. Several factors are associated with early marriage, such as; wealth status, education level, residence, age at first sex, age at first birth, age of the household head, religious affiliation, and ethnicity [15,[17][18][19][20]. However, due to variations in factors responsible for the causation of early marriage within countries, it is vital to separately identify them and develop workable solutions towards its complete eradication.

Methods
Early marriages are among the main barriers to attainment of gender equality, equity and development in many developing countries [1][2][3]. Early marriages increase the risk of acquiring sexually transmitted diseases, HIV, cervical cancer, obstetric fistulas, neonatal and maternal mortality [4-8]. Globally, over 41,000 girls are affected by early marriage d a i l y [9] and about 700 million women were married before their 18th birthday in 2014 [10]. If it is not prevented, the total number of women involved in early marriages is expected to increase from about 700 million to about 1.2 billion by 2050 [11][12][13][14].
In Uganda, early marriage is estimated at 49% [15], one of the highest in the region and elsewhere [16]. While early marriage is common in Uganda, prevalence was noted highest in Eastern (30%), followed by Northern (27%), Western (25%) and lastly, Central (1 9 %) [15]. Studies done on early marriage in Uganda focused on the determinants of early marriage in Uganda as a whole, in Western Uganda, statistics of early marriage, early marriage as purely a cultural phenomenon, and the effect of the enactment of the death penalty on child marriage in Uganda [15,[17][18][19][20]. Studies done, do not appreciate that, not all girls face the same risk of becoming child brides even within a country [21], and as such therefore, it becomes inevitable to witness the ever growing levels of early marriage across the country. Several factors are associated with early marriage, such as; wealth status, education level, residence, age at first sex, age at first birth, age of the household head, religious affiliation, and ethnicity [15,[17][18][19][20]. However, due to variations in factors responsible for the causation of early marriage within countries, it is vital to separately identify them and develop workable solutions towards its complete eradication.

Results
Descriptive characteristics Table 1, presents the descriptive results. Table 1 shows that across regions, Northern had the highest proportion with no education (21%) compared to the rest. Central had the highest with education (52%), Eastern, Northern, and Western region reported high numbers in primary level of education with 65%, 65%, and 62% respectively. Most women in Eastern (87%), Northern (86%) and Western region (80%) were rural residents, with about a half in central region (49%). The highest numbers of women were Christians i.e.
Catholics and Protestants, followed by Muslims and Pentecostals. More than half of the women had first sex when they were below 18 years; with the highest proportion in Eastern (66%) and Northern region (58%) whereas Central and Western regions had the lowest, with 55% and 55% respectively. Table 2 shows the results of the cross tabulation (chi-square tests) between early marriage and socio-economic and enabling factors by regions. In Table 2, religion was the only socio-economic variable that was not significantly associated at bivariate level with early marriage across regions (p>0.05). The rest of the socio-economic variables were significant across the regions; education level, wealth index, and residence (p<0.05).
Furthermore, Table 2 show that the enabling factors (age at first birth and age at first sex) were significantly associated at bivariate level with early marriage across regions (p<0.05).
In Table 3, using the multivariable logistic regression model, the net impact of the explanatory variables was assessed on early marriage with all the variables analysed at bivariate level.

Discussion
The analysis reveals that the factors associated with early marriage across the regions of the country are; education level, age at first sex, and age at first birth. Religion, residence and wealth status were only predictors in some regions. In regards to education level, the study divulged that higher education levels (secondary and higher) were associated with reduced odds of early marriage; which may be attributed to the delay in age at marriage caused by advancement in education. This study finding resonates with the research results that note that education is focal in delaying marriage [24][25][26][27]. In line with this, a number of strategies to promote education in Uganda, more so girl child education have been established [22]. However, more efforts are still required in some regions, due to the fact that the odds ratios decrease as education level increases but at a much slower rate especially for the girls in Northern and Western region [15]. There is therefore need to understand the factors that account for such variations in the education sector. Besides, the significance in age at first sex and first birth reverberates with the argument that early age of exposure to sexual activity increases on the likelihood of pregnancy and child birth, and thereby early marriage; this could be because in many Ugandan communities, teenage pregnancies and births are associated with disrespect, bad omen and bad influence in the community, which therefore propels early marriage across the country [22,28]. This coincides with studies which note that early involvement in sex results into increased chances of early marriage due to the possible outcome of pregnancy and child birth together with its resultant effects [22,28]. Therefore, later engagement in sexual activity and child birth should be promoted across all the regions through the involvement of schools, parents, guardians, religious and cultural leaders in girl child sex education, financial and social support of the girl child.
The study indicated that wealth status significantly predicted early marriage among women in Western region; where women from richer wealth index had increased odds of marrying early as compared to women from the poorest wealth index. This study finding however, contradicts with studies that observe poverty as an influence on early marriage, because it lowers a woman's future expectations and opts for early marriage as the only available opportunity for survival, and as an avenue for the parents to off-set themselves from financial burdens [29,30]. We therefore suggest that future studies be directed towards understanding the association between women from richer wealth index and early marriage in Western Uganda.
Our findings identified that religion significantly predicted early marriage in only Western region; whereby, protestant women had increased odds of marrying early compared to the Catholic women. Importantly, there have been no studies done to justify this variation by region of religion within any country. This therefore, informs prospect studies to focus on understanding the relationship between protestant religion and early marriage in Western Uganda.
In addition, the study results also reveal that rural residence is significantly associated with early marriage in Western region. Studies that have been done provide a general comparison of rural and urban residence in association with early marriages in a country; whereby, early marriage in rural areas is considered highest, since it is one form of legacy from the older generations to be preserved [24, 31, 32]. However, no study has been conducted to understand the variations of early marriage across regions of a country based on rural and urban residence, which therefore, proposes future studies in regards to this area for total elimination of early marriages within a country.
The potency of this manuscript is that the analysis was based on the Uganda Demographic Survey data that is nationally representative.

Conclusions
The predictors of early marriage among women across regions were education level, age at first sex and age at first birth. Therefore, as Uganda continues to focus on maternal and child health by ending early marriages, it is prudent that the government understands and appreciates the regional variations in cause of early marriage. The findings of the study direct to the need for government to develop and improve on the strategies to end the vise. This finding further suggests that messages that promote early marriage in the rural areas be de-popularized by completely eliminating culturally harmful practices through de-politicizing efforts that end the practice; for example elimination of female genital mutilation, bride price and pride embedded in early marriage of the girl child in the rural areas. Additionally, the findings of the study informs government on early marriage to embrace the following strategies; mandatory free girl child education at all levels, mandatory parent education on girl child support, mandatory sex education for girls at school, and promotion of women/girl equity in society in regard to service provisions across regions. Hold sensitizations and dialogues with civil organizations, protestant religious leaders, cultural leaders and the people in Western Uganda about the disadvantages early marriage to their girl child, particularly the protestant's and those in the richer wealth index.  Figure 1 Derivation of the sample adopted in the investigation

Supplementary Files
This is a list of supplementary files associated with the primary manuscript. Click to download. tables.docx