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Patterns, prevalence and risk factors of intimate partner violence and its association with mental health status during COVID-19: a cross-sectional study on early married female adolescents in Khulna district, Bangladesh
  1. Jannatul Ferdous Nishat1,
  2. Umme Salma Khan1,
  3. Taufiq-E-Ahmed Shovo1,
  4. Benojir Ahammed2,
  5. Mohammad Mizanur Rahman3,
  6. Md Tanvir Hossain1
  1. 1Sociology Discipline, School of Social Science, Khulna University, Khulna, Bangladesh
  2. 2Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
  3. 3Department of Urban and Regional Planning, Faculty of Social Sciences, Jahangirnagar University, Savar, Bangladesh
  1. Correspondence to Dr Md Tanvir Hossain; tanvirku05{at}soc.ku.ac.bd

Abstract

Objectives This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with mental health problems.

Design Cross-sectional survey.

Settings Dumuria Upazila (subdistrict) under the Khulna district of Bangladesh.

Participants A total of 304 participants were selected purposively based on some specifications: they must be female adolescents, residents of Dumuria Upazila and married during the COVID-19 pandemic when under 18 years of age.

Outcome measures By administering a semi-structured interview schedule, data were collected regarding IPV using 12 five-point Likert scale items; a higher score from the summation reflects frequent violence.

Results The findings suggest that the prevalence of physical, sexual and emotional IPV among the 304 participants, who had an average age of 17.1 years (SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. Stepwise regression models identified age at marriage (p=0.001), number of miscarriages (p=0.005), education of spouse (p=0.001), income of spouse (p=0.016), age gap between spouses (p=0.008), marital adjustment (p<0.001) and subjective happiness (p<0.001) as significant risk factors. Hierarchical regression, however, indicated that age at marriage (p<0.001), age gap between spouses (p<0.001), marital adjustment (p<0.001) and subjective happiness (p<0.001) had negative associations with IPV, while the number of miscarriages (p<0.001) had a positive relationship. Pearson’s correlation showed that IPV was significantly associated with depression, anxiety and stress.

Conclusion During the COVID-19 pandemic, an increase in IPV and mental health problems among early married adolescents was documented. To reduce physical and mental harm and to assure their well-being, preventive and rehabilitative measures should be devised.

  • COVID-19
  • mental health
  • child & adolescent psychiatry
  • public health

Data availability statement

Data are available upon reasonable request.

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • The data were collected by administering a semi-structured interview schedule in Bangla in order to ensure a comprehensive understanding of the questions and spontaneous responses from the participants.

  • This study assessed intimate partner violence (IPV), marital adjustment, subjective happiness and mental health symptoms using globally recognised and validated measurement tools.

  • The cross-sectional design might have limited the understanding of the causal relationship between IPV and its associated risk factors.

  • The self-rated scale for measuring IPV, marital adjustment, subjective happiness and symptoms of mental health conditions may not be accurate due to the tendency to provide socially desirable information.

  • Due to the use of non-probability sampling, sampling bias may also limit the generalisability of the findings of this study.

Introduction

Intimate partner violence (IPV) refers to harmful behaviours, that is, physical aggression, psychological abuse and sexual coercion, inflicted by intimate partners in home settings.1 2 It is one of the major forms of violence against women and female adolescents and is a major concern within public health globally. A recent study suggests that the global prevalence of IPV among women aged 15–49 years in marriage, cohabitation or any other form of union is 27%; this rises to 35% in South Asia and 26% for South Asian female adolescents specifically.3 Despite various initiatives to ensure good health and gender equality, with an emphasis on reducing domestic violence (DV) and IPV in order to achieve sustainable development goals (SDGs),4 the overall prevalence of IPV is 72.6% in Bangladesh, while the prevalence of physical, sexual and emotional IPV is 49.6%, 27.2% and 28.7%, respectively, and 37.5%, 21.9% and 22.4%, respectively, for female adolescents.5 A more recent longitudinal study in Bangladesh suggests that the prevalence of all forms of IPV is 82.7% and that psychological IPV (77.2%) is more common than sexual (58.8%) and physical (44.4%) IPV.6 The same study concluded that all types of IPV are strongly associated with major depressive episodes (MDEs) among married women in Bangladesh.

The outbreak of COVID-19 in late December in China wreaked havoc on the regular lives of people across the globe, as various non-therapeutic measures, such as ‘face masks’, ‘lockdowns’ and ‘isolation’ were strictly implemented by governments across the world, with Bangladesh no exception. The prolonged ‘lockdown’ led to heightened mental health outcomes among various cohorts7–12 and caused financial difficulties13 and food insecurity among the people,14 particularly marginalised and poor people in the rural areas15 16 of Bangladesh. Due to their financial inability to meet basic requirements, such as food, medical aid and educational expenses, marginalised and poor parents were compelled to marry off their underage daughters in order to reduce their overall household burden during the pandemic.15 16

A recent study, conducted during the COVID-19 pandemic in Bangladesh, has outlined the mental health outcomes among early married female adolescents; the overall prevalence of depression, anxiety and stress symptoms was 60.9%, 74.7% and 23.7%, respectively.17 In that study, the authors identified IPV, among other issues, as an important risk factor for growing mental health problems among early married female adolescents. They did not report the patterns and prevalence of IPV. However, there have been studies addressing IPV issues among early married female adolescents in other parts of the world. For example, Banati et al,18 addressing the psychosocial and emotional well-being of adolescents, reported IPV among female adolescents in Lebanon, Syria and Ethiopia; they attributed prolonged home confinement and financial hardship as major factors in increased IPV. A Kenyan study has reported that the overall prevalence of IPV among adolescent girls and young women (AGYW) pre-pandemic and during two follow-ups was just over 17%.19 However, the partnered AGYW experienced more IPV (27.6%) during the pandemic; low social support, a higher age gap between partners and pre-COVID economic activity were the critical risk factors for IPV among Kenyan AGYW.

It is evident that IPV has risen, particularly among early married female adolescents,18 19 during the COVID-19 pandemic. However, to the best of the authors’ knowledge, to date, there has been no research investigating the patterns, prevalence and risk factors of IPV among early married female adolescents and its association with mental health problems during the COVID-19 pandemic in Bangladesh, where IPV is relatively higher than in other countries.5 6 This makes it particularly important to help policymakers and development workers devise strategies for preventing IPV and providing support services to victims. This study was, therefore, designed to identify the patterns and prevalence of IPV among early married female adolescents, outline the possible risk factors and assess the association of IPV with mental health problems during the COVID-19 pandemic in rural Bangladesh.

Methods

Study settings, procedures and participants

Khulna is a southwestern district in Bangladesh with a population of over two million, of which three out of five people reside in rural areas.20 21 Within the Khulna district, there are 14 upazila (subdistricts); among them, Dumuria Upazila is the top-ranked in terms of population concentration (0.31 million) and geographical coverage (454.2 km2).21 22 It is reported that over 3000 school-aged girls were married off during the COVID-19 pandemic in the Khulna district, with the majority being from Dumuria Upazila (751).23 Against this backdrop, Dumuria Upazila was selected purposively as the study area (see figure 1), and the sample size for the selected study area was determined with the assumption of a 95% CI (1.96) and 5% margin of error,24 25 for a population of 751 early married female adolescents,23 resulting in a required sample size of 254. In order to identify potential participants for this cross-sectional study, some criteria were set out: each participant must be a female adolescent, a resident of Dumuria Upazila and married before the age of 18 years during the COVID-19 pandemic. Based on the specifications, 371 early married female adolescents were approached purposively. A total of 330 early married female adolescents (with a response rate of 88.9%), with written informed consent from participants and verbal assent from local guardians, were purposively interviewed between 22 July 2022 and 31 August 2022 by 12 trained data enumerators in a face-to-face situation at their home or a neighbour’s home. A semistructured interview schedule was administered using a ‘pen and paper personal interview’ approach. The data enumerators were trained extensively for 3 days in a ‘lecture theatre’ and ‘role playing’ environment by faculty members in the sociology discipline at Khulna University. They were taught the content of the interview schedule as well as the procedures for conducting a ‘face-to-face’ interview with an unconditional acceptance principle of bias-free authentic information and the avoidance of questions that might create unease among participants. Moreover, the data enumerators were strictly instructed to seek written consent from the participants and verbal assent from their local guardians, assuring anonymity as well as confidentiality of information. From the total number of interviews, 304 responses were retained for this study following a thorough check of the collected interview schedules. It is important to note that the interview schedule contained nine mutually inclusive modules, with sociodemographic questions on personal, parental, spousal and in-laws’ households. In addition, there were several Likert scale questions on IPV, marital adjustment, subjective happiness and symptoms of mental health issues. Each interview took less than half an hour without interruption.

Figure 1

Map of the study area.

Ethical issues

The Khulna University Ethical Clearance Committee (KUECC) approved this cross-sectional survey (Reference No. KUECC-2022/08/24). Before the interviews, the participants anonymously filled out a written consent form, with prior verbal assent from their local guardians, that is, spouses, in-laws or parents. The participants did not receive any compensation or incentive but rather responded voluntarily after being briefed about the purpose of this investigation and assured of anonymity and confidentiality of information. Moreover, the participants were given the right to withdraw from the survey without any explanation within a specified timeframe, that is, up to 1 month after the interview.

Measures

Sociodemographic information

Some sociodemographic variables of both early married female adolescents and their spouses were considered in this study. For example, for early married female adolescents, their age, religion, education, age at first marriage, duration of marriage, dropout status and number of miscarriages were collected. In addition, information regarding the spouses’ age, education, occupation, income and age gap with their spouses was collected.

Marital adjustment

In this study, the Short Marital Adjustment Scale (SMAS), which assesses the marital adjustment of couples, was used to measure the marital adjustment of early married female adolescents. The SMAS was developed by Locke and Wallace26 and later adapted for Bangladeshi couples by Khatun et al.27 In the SMAS, there are 15 self-reported items that assess the marital adjustment of couples, reported by either one or both partners.26 Item 1 measures marital happiness using a seven-point scale, while items 2–8 are measured on a six-point scale, and items 9–15 are measured using a tailored scale for each item.26 In this study, the internal consistency of SMAS was Cronbach’s α=0.723.

Subjective happiness

In this study, the subjective happiness scale (SHS), developed by Lyubomirsky and Lepper,28 was used to measure the subjective happiness of early married female adolescents. Four seven-point Likert scale items are used in the SHS, with a higher score representing greater happiness. In the original SHS, the internal consistency ranged from 0.79 to 0.94, depending on participants’ occupation, language and culture.28 In this study, however, the internal consistency of SHS was Cronbach’s α=0.897.

Depression, anxiety and stress scale-21 (DASS-21)

In this study, the DASS-21, modified by Henry and Crawford29 from the original 42 four-point items developed by Lovibond and Lovibond,30 was used to assess the mental health symptoms of early married female adolescents, as this scale has proven to be an effective tool for assessing the mental health of different cohorts in Bangladesh.7 17 31 In DASS-21, there are seven four-point Likert scale items for each subscale, that is, depression, anxiety and stress. For each subscale, the sum of scores is estimated to measure the presence of negative emotional states, with the presence of depression, anxiety and stress assessed by a score of ≥10, ≥8 and ≥15, respectively. The internal consistency of DASS-21 in this study was excellent (Cronbach’s α=0.931),32 while the internal consistency (Cronbach’s α) of the depression, anxiety and stress subscales was 0.820, 0.817 and 0.795, respectively.

Intimate partner violence

In this study, an IPV scale was also used; this was developed from the WHO’s women’s health and DV-related study.33 In the IPV scale, there are 12 five-point Likert scale items (‘1’ = never, ‘2’ = rarely, ‘3 = sometimes, ‘4’ = very often and ‘5’ = always), with physical IPV, sexual IPV and emotional IPV consisting of five items, three items and four items, respectively, where the participants were asked whether it happened to them in the past 12 months33 and a higher score from the summation reflecting frequent violence by an intimate partner. To measure the prevalence of IPV, the summation of the score is categorised for each sublevel as: ‘None≤5’, ‘Mild=6–12’, ‘Moderate=13–18’ and ‘Severe≥19’ for physical IPV; ‘None≤3’, ‘Mild=4–7’, ‘Moderate=8–11’ and ‘Severe≥12’ for sexual IPV and ‘None≤4’ ‘Mild=5–9’, ‘Moderate=10–14’ and ‘Severe≥15’ for emotional IPV. This approach to classifying IPV is similar to that of Esie et al6 and Hossain et al34 as they initially created a summation score for each of the three categories of IPV, which were further recategorised into ‘none,’ ‘low/mild’, ‘medium/moderate’ and ‘high/severe’. On the contrary, for the stepwise and hierarchical regressions, the summed scores of the three categories were added to create a final composite score.6 In this study, the internal consistency of the IPV scale was Cronbach’s α=0.929.

Analysis

The data were analysed using IBM SPSS Statistics (Version 25) for Windows over four consecutive stages. In the first phase, the frequency and percentage analyses were calculated in order to describe the sociodemographic information. In the second phase, stepwise multiple regression was executed, as the sum of the IPV was a continuous variable. A total of three models were built, as all independent variables are considered at the beginning, then deleted one at a time if they do not contribute significantly to the regression equation.35 This identifies the most relevant variables with a substantial predicting capacity36 37 that can be used in the next phase, the hierarchical regression.38 39 In the third phase, the hierarchical regression—weighing the values added by independent variables, entered in blocks, after controlling other risk factors at its own point of entry—was executed.35 40 In stepwise and hierarchical regression, the multicollinearity of risk factors using the variance inflation factor (VIF) with a fixed cut-off point (VIF≥10) was checked, and the value of VIF was found within the cut-off point. Finally, a Pearson’s product–moment correlation was performed in order to ascertain the strength and direction of the correlation of IPV with depression, anxiety and stress among early married female adolescents.41

Patient and public involvement

None.

Results

Basic information

The basic information regarding the participants and their spouses is shown in table 1. Among the 304 participating early married female adolescents, it is evident that the average age (SD) of the participants was 17.1 (±1.42) years, and their average age at marriage was 15.3 (1.24) years, whereas the average age (SD) of their spouses was 25.8 (±3.64) years and their average age at marriage (SD) was 23.3 (±3.46) years. The participants had an average (SD) duration of marriage of 2.0 (0.74) years and schooling of 5.1 (±3.41) years. More than 70% of the participants were Muslims, and 95.1% had dropped out of school following their marriage. The average years of schooling (SD) of the spouses were 8.9 (±3.15) years, and more than half (55.6%) were manual workers or farmers with an average income (SD) of 16 592.1 (±6175.49) Bangladeshi Taka.

Table 1

Basic information

Patterns and prevalence of IPV among early married female adolescents

The patterns and prevalence of IPV among early married female adolescents are shown in figure 2. It is apparent that the prevalence of physical, sexual and emotional IPV among the participants was 89.5%, 87.8% and 93.7%, respectively. It is also evident that 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV.

Figure 2

Patterns and prevalence of intimate partner violence among early married female adolescents.

Risk factors of IPV among early married adolescents

Three models to identify the significant risk factors of IPV among early married female adolescents in relation to their personal attributes, the personal attributes of their spouses, marital adjustment and subjective happiness are shown in table 2. Model 1 shows the effects of personal profiles on IPV. Among the seven personal variables of the participants, the findings suggest that age at marriage (β=−0.190, p<0.001) negatively influenced IPV and number of miscarriages (β=0.159, p=0.005) positively and significantly influenced IPV among early married female adolescents.

Table 2

Stepwise multiple regression predicting intimate partner violence

Model 2 presents the risk factors relevant to the background information of the spouses, including the age gap with the spouse, age, education, occupation, income and age at marriage. Of these six variables, this study found that three variables significantly influenced IPV among early married female adolescents. These significant variables were the education of the spouse (β=−0.194, p<0.001), age gap with the spouse (β=−0.148, p=0.008) and income of the spouse (β=−0.143, p=0.016), which all had a significant negative effect on IPV.

Model 3 also shows risk factors such as marital adjustment and subjective happiness; the model accounts for both variables. It is evident that higher marital adjustment (β=−0.304) and subjective happiness (β=−0.267) were significantly (p<0.001) negatively associated with IPV.

The results of hierarchical regression predicting IPV among early married female adolescents are presented in table 3. Model 1, where the personal attributes of the participants were added, was significant, with F (2, 301) = 9.009, p<0.01, R2=0.056; this suggests that this model collectively explains 5.6% of the variance in IPV. Adding the personal attributes of the spouses in Model 2 increased R2 by 14%, with the overall model remaining significant, with F (5, 298) = 10.890, p<0.01, R2=0.154 (an increase from 5.6% in Step 1 to 15.4%); this suggests education, income and the age gap of the spouse play a decisive role in explaining IPV among early married female adolescents. Finally, adding the marital adjustment and subjective happiness in Model 3 increased R2 by 32.2%, with the overall model remaining significant, with F (7, 296)=21.592, p<0.01, R2=0.338 (an increase from 15.4% in Step 2 to 33.8%); this indicates that marital adjustment and subjective happiness play a key role in explaining IPV among early married female adolescents and significantly influence a reduction in IPV.

Table 3

Hierarchical multiple regression predicting intimate partner violence

IPV and mental health problems

To investigate the relationship between IPV and common mental health problems, that is, depression, anxiety and stress symptoms, among early married female adolescents, Pearson’s correlation coefficient was executed (table 4). It is apparent that IPV is significantly and positively correlated with depression (r=0.415), anxiety (r=0.431) and stress (r=0.403) at a 1% level of significance among early married female adolescents.

Table 4

Correlation of IPV with depression, anxiety and stress

Discussion

The current study focuses on the patterns, prevalence and risk factors of IPV against early married female adolescents during COVID-19 in rural Bangladesh. The findings indicate that the prevalence of physical, sexual and emotional IPV among the participants was 89.5%, 87.8% and 93.7%, respectively, which is higher than in other studies conducted during the pre-pandemic42 43 and pandemic periods.18 19 For example, a pre-pandemic multicountry study on health and DV by the WHO in developing countries suggested that the lifetime prevalence of IPV among women aged 15–24 ranged from 19% to 66% among AGYW,43 while another multicountry study on economically distressed urban settings in both developed and developing countries indicated that the prevalence of IPV among ever-partnered female adolescents aged between 15 and 19 years varied from 10.2% to 36.6%.42 During the COVID-19 pandemic, on the other hand, the prevalence of IPV among partnered AGYW aged between 15 and 24 years was 27.6%.19 It is also evident from the current study that 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. The heightened prevalence of IPV can be attributed to the prolonged home confinement of the early married female adolescents together at home with abusive partners during the lockdown, as well as the ever-increasing uncertainty and stress over economic security and hardship.18 44 Moreover, the traditional mentality of rural female adolescents in terms of tolerating physical assault by bad-tempered spouses, lack of involvement in sexual intercourse, difficulty in childbirth34 and reluctance to seek legal support against IPV45 due to low or no decision-making power within and outside households46 may also have contributed to the heightened prevalence of IPV during the pandemic.

The regression analyses regarding the personal attributes of the early married female adolescents indicate that girls who were married at a younger age were more likely to suffer from IPV. Previous studies have identified a similar trend, where girls married at younger ages experienced more violence.47 48 The number of miscarriages was also found to be associated significantly with IPV in this study; Wood et al48 mentioned in their quantitative analysis that girls are typically blamed for the stillbirth of children. Furthermore, this study assessed the relationship between IPV and the personal attributes of the spouses, including education, income and the age gap between spouses. The findings reveal that the higher the educational status of the spouse, the lower the possibility of the spouse committing IPV. Similar results have been observed in other studies, identifying that girls with educated husbands were less likely to suffer from violence by their partners.45 49 In terms of the age gap between spouses, the findings suggest that a higher age gap reduces the probability of IPV. In contrast, Decker et al19 identified that a higher age gap between spouses increased IPV during the COVID-19 pandemic. The likelihood of committing acts of violence becomes higher among husbands as they get older and stay married for a longer time.47 One possible explanation for this finding might be that young girls tend to obey and respect their spouse more when their spouse is considerably older than them, as the spouse, in some cases, exercises authority50 or rewards them for their behaviour.51 In addition, husbands’ care and affection for their young partners might be more prevalent when the wives are of adolescent age and unable to comprehend some things as they have less experience in life; therefore, the wives might not be intimidated, as their husbands are already much older than them. Moreover, the maturity of the older spouse might contribute to greater tolerance for the perceived inadequacies of their younger partners.52 This study, additionally, found that spouses with relatively greater income during the COVID-19 pandemic were less likely to be violent towards their younger female partners. A previous study assessing sexual and gender-based violence (SGBV) among female Rohingya refugees during COVID-19 identified a higher rate of SGBV towards women as their spouses were unemployed amid lockdown restrictions and remained idle within the home.53 Income loss due to COVID-19 has also been linked with violent behaviour against women in Kenya and Burkina Faso.54

Furthermore, the findings of this study show that marital adjustment and subjective happiness were significantly but negatively associated with IPV, indicating that early married female adolescents with higher marital adjustment and greater subjective happiness experienced lower IPV. Previous findings during COVID-19 are also in line with the current study; women who had better relationships with their spouses were less likely to experience violence of any type55 than those who had bonded poorly with their partners. This lack of bonding is especially common among female adolescents, as they move directly from their imaginary fairytale idea of marriage to the harsh reality of married life, that is, the responsibilities of in-laws, decision-making, becoming pregnant early and the use of contraception.51 The situation becomes worse when spouses consider their wives to be immature due to their young age and tend to consult their mothers on family issues instead of their wives, resulting in poor marital understanding between the couple.51 Likewise, it is apparent that female adolescents who are less happy in married life experience more IPV; this finding is in line with a study in Pakistan, which indicated that women who were less happy experienced greater psychological violence.55 The situation often deteriorated further with prolonged lockdowns in patriarchal settings where women had little or no authority.51 55

In addition to the assessment of the patterns, prevalence and risk factors of IPV among early married female adolescents in rural Bangladesh, this study also investigated the association of IPV with mental health outcomes. The findings indicate that early married female adolescents who experienced IPV also showed symptoms of depression, anxiety and stress; previous studies show similar findings, indicating that early married female adolescents who experience brutality from their partners also suffer from mental health disorders.6 56 A recent study in Bangladesh found that IPV is positively associated with depression, anxiety and stress symptoms among early married girls; it concluded that financial hardship, growing household debt, unmet sexual demands of the spouse and prolonged home confinement with an abusive partner can contribute to heightened IPV as well as depleted mental health.17 During COVID-19, men, particularly in marginalised and poor households, often lost or were at risk of losing their work,13 15 16 which provoked anxiety; this subsequently triggered rage, resulting in DV.57 The findings of the current study are consistent with a study in China that found living with partners during the quarantine period deteriorated mental health and increased psychological distress.58 The lockdown made it difficult for people to leave their homes, causing significant psychological distress for both offenders and victims; this led to violent situations.59

Strengths and limitations

The current study provides a unique contribution to the literature as it is the first of its type in Bangladesh to investigate the patterns, prevalence and risk factors of IPV among early married female adolescents and its association with mental health conditions during the third wave of the COVID-19 pandemic. In this study, globally recognised and validated measurement tools were used to assess IPV, marital adjustment, subjective happiness and symptoms of mental health conditions. However, there are several limitations that should be considered when interpreting the results. For example, the cross-sectional design of the study may have limited the direct and indirect causal relationship between IPV and sociodemographic and marital issues, as well as mental health outcomes. IPV, marital adjustment, subjective happiness and the mental health status of the participants may be subject to recall and social desirability bias. The use of non-probability sampling may also have limited generalisability due to sampling biases. Moreover, there are several important sociocultural factors, such as the influence or interference of in-laws, dowry, etc., that were not explored in this study. Future research should address the aforementioned limitations using longitudinal and mixed-method design at a national level in order to unearth the dynamics between IPV and sociodemographic and marital issues, as well as mental health outcomes.

Conclusion

The COVID-19 pandemic had a multifaceted impact on people, irrespective of caste and creed, across the globe, including financial, social, cultural, psychological and behavioural effects. In societies like Bangladesh, where DV and IPV are socially accepted and early marriage is a culturally approved social norm, the pandemic has had far-reaching impacts on society at individual, community and societal levels; if not addressed properly, it could cause long-term uninterrupted cycles of social evils and harms, such as early marriage, DV, SGBV and IPV. This could further lead to maternal mortality, infant mortality, under-five child mortality and the deterioration of mental health. In order to achieve SDGs, for example, good health, well-being and gender equality, the government and its development partners need to implement well-designed and periodically monitored preventive and responsive programmes and strategies that will protect underage girls in poor and marginalised families in both rural and urban settings from getting married off due to poverty, increase collective awareness about the outcomes of early marriage and also prioritise the needs of the victims of IPV and other SGBV, whether socially, culturally or legally, through survivor centres.

Data availability statement

Data are available upon reasonable request.

Ethics statements

Patient consent for publication

Ethics approval

This study involves human participants and was approved by the Khulna University Ethical Clearance Committee, Reference No. KUECC-2022/08/24. Participants gave informed consent to participate in the study before taking part.

Acknowledgments

The authors are indebted to the participants for their valuable information and voluntary participation in this study. The authors also acknowledge the support from the faculties and MSS students of Sociology Discipline, Khulna University.

References

Footnotes

  • JFN, USK and T-ES contributed equally.

  • Contributors JFN, MTH and TEAS designed the study. MTH and BA performed the analysis. TEAS, JFN, USK and MTH interpreted the results. JFN, MTH and TEAS participated in the design and conducted the original cross-sectional study. JFN, TEAS, USK and MTH wrote the manuscript. MTH, TEAS, USK, BA and MMR critically reviewed the manuscript. All authors contributed to and approved the final version of the manuscript. The author responsible for the overall content as the guarantor is MTH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.