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In-depth examination of issues surrounding the reasons for child marriage in Kelantan, Malaysia: a qualitative study
  1. Ayako Kohno1,
  2. Maznah Dahlui2,3,
  3. Nik Daliana Nik Farid4,
  4. Siti Hawa Ali5,
  5. Takeo Nakayama1
  1. 1 Department of Health Informatics, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
  2. 2 Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  3. 3 Faculty of Public Health, Airlangga University, Surabaya, Indonesia
  4. 4 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  5. 5 Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
  1. Correspondence to Ayako Kohno; kohnoayako{at}gmail.com

Abstract

Objective To examine individual, familial, community and societal issues surrounding the reasons for child marriage in Kelantan, Malaysia.

Design Qualitative study by means of semistructured interviews with women and key informants, using social-ecological model as a conceptual framework.

Setting Interviews were conducted in Kota Bharu district, Kelantan, a northeast state in Peninsular Malaysia.

Participants Eighteen women of reproductive age (18 to 44 years old) that experienced their first marriage below the age of 18, as well as five key informants, consisting of a government officer, a community leader, an officer from religious department and two mothers. The women were recruited from a reproductive health clinic. The key informants who had specialised knowledge related to child marriage were selectively chosen.

Results Three themes emerged that aligned with the social-ecological model: immaturity in decision-making, family poverty and religious and cultural norms.

Conclusions The findings imply that sex education and awareness-building activities regarding the consequences of child marriage must be implemented to eradicate child marriage in Malaysia. Such implementation must be coordinated as a team-based approach involving experts in such fields as law, religion, psychology, social-welfare and public health. In order to increase the awareness of child marriage consequences, the target for awareness must extend not only to the adolescent girls and their families, but also to the community and society at large by clearly communicating the negative consequences of and addressing the drivers for child marriage.

  • Child marriage
  • qualitative studies
  • Malaysia
  • the social-ecological model

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Strengths and limitations of this study

  • This is one of the earliest studies that explored issues surrounding the reasons for child marriage in Malaysia using the perspectives of the women as well as different stakeholders in the setting.

  • This study used the social-ecological model, which describes the sphere of influence in multiple layers of individual, familial, community and societal factors, as a conceptual framework to analyse the data.

  • Limitations to this study include the possibility of the women altering their memories with respect to the reasons for child marriage over the years, especially among some of the older participants.

Introduction

Child marriage is a controversial topic, especially in developing countries, and in countries of emerging economies such as Malaysia. We need to examine this problem from the perspective of human rights violations versus maintaining culture and tradition. The United Nations Children’s Fund defines child marriage as a formal marriage or informal union in which one or both partners are below the age of 18.1 Child marriage is perceived in the international community as an issue that needs to be addressed in order to improve gender equality and empower women. Most of the time, the burden of child marriage is placed on the woman. Therefore, the international community is demanding the global elimination of child marriage; this is specified in Goal 5 of the United Nations Sustainable Development Goals.2 For Malaysia, a country that is going through a transition phase to gain the status of a developed nation, we must implement appropriate political, economic and social measures to eradicate child marriage.

A previous study conducted in Morocco in 2015 indicated financial dependence of the adolescents on the family, perception of child marriage as a customary social norm and lack of sufficient legal protection as the risk factors for child marriage.3 A recent report by UNICEF Malaysia in 2018 indicates low household income, dropping out of school and poor understanding of sexual and reproductive health issues as the risk factors for child marriage in Malaysia.4 Another research conducted in Lebanon in 2017 established poverty, lack of educational opportunities and anxiety about protecting the honour of the unmarried adolescent girls as the determinants of child marriage in conflict-ridden settings.5 Furthermore, various implications for the health and well-being of a woman who experiences child marriage are reported globally. These include an increased risk for sexually transmitted diseases, cervical cancer, malaria, death during childbirth, obstetric fistulas, unintended pregnancy, preterm delivery, delivery of low birthweight babies, foetal mortality and violence within marriage.6–11

In Malaysia, the law prohibits people from marrying until they are 18 years old. This is outlined in Act 164: Law Reform (Marriage and Divorce) Act 1976 which states that any marriage shall be void if either party is below the age of 18.12 However, there is an exception to this law. Child marriage is allowed in circumstances where a girl aged 16 or older wishes to be married, if such marriage is authorised by the state chief minister. Furthermore, for Muslims, another rule of law (Syariah) applies. Governed by the Family Law Enactment of Islamic States in Malaysia, the legal minimum age of marriage for Muslim girls is 16 years old, with additional conditions for marriage below the age of 16 to be allowed with the consent of the parents and approval by a Syariah (Islamic) court.13 14 There are currently no definitive statistics on the prevalence of child marriage in Malaysia. The data vary from 3.8% to 6%, depending on the sources.15 16 It has been described that the data concerning the prevalence of child marriage in Malaysia is ‘outdated, unavailable or cannot be made public’.4 The most recent record was from the National Population and Family Development Board of Malaysia, which conducted a survey in 2014 and estimated the number of women aged 15 to 19 years old who were married as 52,618 individuals.15 This amounts to 3.8% of the female population aged 15 to 19 years in relation to the reported figure in the latest (2010) census.15 16 Furthermore, the 2010 census indicates that the number of men and women who were married and were between the ages of 15 and 19 were 73,428 and 82,382, respectively.16 Using this figure, the ratio of married women among those aged 15 to 19 becomes 6.0%. Cases of child marriage may be under-reported in Malaysia, due to the lack of updated statistical data and the aforementioned legal framework.

The social-ecological model (conceptual framework)

We used the social-ecological model as a conceptual framework for this study. It describes the sphere of influence in multiple layers, typically represented as individual, relationship (familial), community and societal factors.17 This model was first developed by Bronfenbrenner in the 1970s, and many researchers have adopted this theory-based framework in explaining various public health issues, such as family health, HIV and child health.18–21 In this study, our findings were summarised in alignment with this framework so as to understand the issues surrounding the reasons for child marriage in multiple layers of influence.

Aim

The aim of this study was to examine the individual, familial, community and societal issues surrounding the reasons for child marriage among women who got married below the age of 18 in Malaysia.

Methods

Study design

This qualitative study was done by conducting individual, semistructured interviews with women who were married below the age of 18, supplemented with interviews with key informants in Malaysia. The area of interest for our research was to examine the perceived reasons for child marriage and to understand the meaning of such reasons for the participants in this study. This study followed the items in Standards for Reporting Qualitative Research (SRQR) guidelines.22

Setting and sampling

This study was conducted in Kota Bharu district, Kelantan state, Malaysia. Kelantan state has a population of 1.83 million as of 2017,23 and is located in the north-east part of Peninsular Malaysia, bordering southern Thailand. The state is known as one of the most religiously conservative states. It is known to have the largest percentage of Malay population of all the Peninsular states; thus, it is called the ‘cradle of Malay culture’.24 This particular state was chosen because it had the highest percentage of married girls between the ages of 15 and 19 in Peninsular Malaysia, according to the latest census in 2010.16 A purposive sampling technique was used for the recruitment of the women.25 26 The women were patients at a reproductive health clinic run by a non-governmental organisation (NGO) in Kota Bharu, and using a combination of criterion and convenience sampling designs,27 28 18 women were selected. In order to identify women who had gotten married as children, we collaborated with the aforementioned NGO. The nurse looked through the patients’ records which include date of marriage and the candidates who met the criteria were selected. The inclusion criteria were as follows: Malaysian women of reproductive age (18 to 49 years old) at the time of the interview, whose first marriage had occurred before they were 18 years old, with a current marital status of any type (married, separated, divorced or widowed). These candidates were invited to participate via telephone calls by the nurse, and only those who agreed to participate were then contacted by the researcher. A few candidates refused to participate because of a busy schedule or were unable to get permission from their husbands. An individual interview method was selected so that privacy could be maintained during the interview and participants could speak about their personal experiences in a comfortable environment. In addition, five key informants were chosen, based on their ability to fulfil Tremblay’s five selection criteria for the key informants: role in the community, knowledge, willingness, communicability and impartiality.29 30 Potential key informants were asked to partake in the study via an invitation letter. Follow-ups were then made by telephone calls, and interviews were arranged at a time and place convenient for the key informants. The key informants were recruited from four different groups: a government officer in charge of marital issues, a community leader, an officer from religious department and two mothers. They were selected because of their familiarity with the issue of child marriage. Government officers are involved in providing services and counselling, as well as developing relevant policies related to marriage; community leaders interact closely with the community members and take part in ceremonial events, including marriage ceremonies; officers from religious department give guidance, including on marital issues; and mothers add insights from parental perspectives. We conducted interviews with the women as well as the key informants in order to achieve data source triangulation.31 32 By interviewing people from various positions on the subject, this study adds more insights into and gains an in-depth understanding about the issue of child marriage from multiple perspectives.33

Instrument development

Three versions of the interview guides were developed: for the women and for the key informants (One for the government officers, community leaders and religious officers, and the other for the mothers. See online supplementary data files 1-3.) They were developed by reviewing the literature on child marriage research conducted in other countries. Based on that, a series of discussions were conducted among the researchers, and revisions were made accordingly to finalise the guides. The interview guide for the women contained questions about the background of the interviewee: current age, age at marriage, age of husband, number of children and education level. Other questions asked included their perceived reasons for getting married below the age of 18; their lived experiences of child marriage; their perception of their health status before and after marriage; childbearing experience; contraception use; their views on the perceptions of community members regarding their early marriage; and what can be done at the government and societal level to prevent child marriage. The interview guide for the key informants included questions about their age, a description of their work, knowledge and perceptions of child marriage, perceived impact of child marriage on the married women as well as on the society, and opinions on the role of family, community and government in preventing child marriage. After the interview guides were developed, they were pilot tested with a woman and a community leader, respectively, who met the inclusion criteria of this study. The purpose of the pilot test was to determine if there were any flaws in the prepared interview guides, and to make necessary modifications before actually implementing the guides.34 After the pilot tests, some minor modifications to the interview guides were made based on the feedback from the pilot test participants, by paraphrasing some of the questions to make it easier for the participants to respond to the questions.

Data collection

Interview with women who experienced child marriage

Data were collected from women who had married below the age of 18 (n=18) as well as key informants (n=5). All of them resided in Kota Bharu, Kelantan, Malaysia. The interviews took place from May to July 2017. The interviews were audio-recorded, and the participants gave their permission for this before the interviews started. In this study, part of the collected data regarding their perceived reasons for child marriage was investigated, and analysis of all other data was to be reported elsewhere. An average interview with an individual participant lasted for about an hour. The interviewer explained the purpose and the general procedures of the study to the participants using a participants’ information sheet. On this sheet, the contact information of a local clinic was provided in case the participant felt any adverse effects or psychological distress after participating in this study. The women were informed during the recruitment, and again before the interview began, that participation in the study was purely voluntary, and they could freely choose whether to participate. Written informed consent was obtained from all the participants. The data were collected until the point of data saturation—a state at which no new information is obtained.35 In this study, we felt that data saturation was achieved by the 16th interview. Two additional interviews were conducted with the aim of reinforcing the findings. The women were given a choice of where they wanted to be interviewed; most of them chose the office of the abovementioned NGO. The interviews were held in a room where we could ensure participants’ confidentiality and privacy. Three interviews were conducted in the participants’ houses, at these participants’ request. These participants did not have access to transportation or could not be away from home as they were taking care of young children. In those instances, privacy was maintained by ensuring that other family members were not present. The interviews were conducted in the Malay language by a research assistant who is a retired nurse and has extensive knowledge and experience on reproductive health. She has over 30 years of experience counselling adolescents, and took part in a country-wide research on adolescents’ perception of HIV. Before the start of the interviews, this research assistant received 10 hours of training in qualitative interviewing. During the training, practice interviews were conducted until she could ask questions in a natural manner, and she also learnt how and when to use probing questions. The interviewer learnt the importance of pausing in between the questions in order to allow participants time to respond, as well as how to develop rapport with the participants. The method of a semistructured interview was chosen so that the unique personal stories of each participant could be heard during the interview. In addition to the prepared set of questions according to the semistructured interview guide, additional probing questions were asked as it was deemed necessary to explore and to elicit the participants’ personal narratives. The primary researcher greeted the participants before the interview and briefly explained her background and interests in understanding why child marriage takes place in Malaysia. She stayed in the room while all the interviews were conducted and observed the discourses between the interviewer and the participants. Field notes were taken by the primary researcher to describe any characteristics or behaviour of the interviewees, and she critically reflected on the meanings that were analysed through such observations in order to address reflexivity.36

Interview with key informants

The interviews with the key informants were conducted in order to use multiple data sources ‘to add to the investigator’s depth and breadth of understanding’ in what was revealed through the interviews with the participants.37 38 The primary researcher conducted two interviews with the key informants in English as those participants were able to converse in English. The other three interviews were conducted by a research assistant in the Malay language. In all interviews, the same interview guide was used. An average interview with a key informant lasted for an hour.

Data analysis

The transcripts were initially made in Malay and translated into English for data analysis. The transcription and translation were conducted by a professional translator who is a native Malay and has sufficient knowledge of local dialects. In addition, field notes were taken by the primary researcher for each interview. It included the descriptions of the observation of the participants as well as the reflections of the primary researcher, denoting any specific issues that were worth mentioning for analysis. Transcripts and field note data were analysed using the six phases of thematic analysis introduced by Braun and Clark.39 NVivo 11 Pro was used for data management. In this study, initial coding was conducted to create the list of emergent codes for several interview transcripts. After that, the codes were grouped together to find similarities or differences in its contexts, as well as to continue to seek new insights. After initial codes were generated, the data were summarised into categories and themes and aligned with the layers of the social-ecological model: individual, relationship (familial), community and society. The initial coding was conducted by the primary researcher; the list of codes and themes were analysed independently by three researchers and differences of opinion were discussed to resolve any discrepancies. The final themes were reviewed and finalised by all researchers.

Patient and public involvement

The development of the research question of this study was informed by the voices and perspectives of the women who experienced child marriage. These perspectives were gathered through a literature review of the previous studies on child marriage. Two participants were involved in the design of this study by providing feedback during the pilot tests. The feedback obtained from them was used to improve the study guides. The participants were not involved in the recruitment for and conduct of the study. The results of this study will be disseminated to the study participants by asking them if they would like to receive a written summary document which include the results as well as the public health implications of the study.

Results

Participant characteristics

A total of 18 women and 5 key informants participated in this study. table 1 presents the socio-demographic characteristics of the women, and table 2 presents the basic information on the key informants. The average age of the women was 37 at the time of the interview, and their mean age of marriage was 16. All of them reached either a primary or secondary level of education. The majority of the women were Malay, with a few Chinese, and the remaining women had migrated from the neighbouring country, Thailand, to gain Malaysian citizenship either prior to or at the time of marriage.

Table 1

Sociodemographic information of the women (n=18)

Table 2

Basic information about the key informants (n=5)

We found three pertinent themes: immaturity in decision-making; family poverty; and religious and cultural norms.

Immaturity in decision-making

The stories told by the participants indicated that the women were still immature when they had to decide on getting married as children. How the interviewed women made their decision as adolescents before their marriage was categorised into three subthemes: an intuitive decision-making style, believing in fate and having no idea what would happen after marriage.

Intuitive decision-making style

For most of the participants, the decision to marry at a young age was made quickly and without thorough consideration. The decision seemed spontaneous and intuitive. They seemed unable to think fully about the future and foresee the possible consequences of child marriage at that time, even though the decision would affect the rest of their lives. Some of them described, without hesitation, that they settled for marriage at an early age due to lack of attractive options for their future.

‘At that time, I was a kid, I didn’t think. All I thought about was getting married [laughs]. Back then, I didn’t hang out that much. I didn’t go out to mingle. So I didn’t really enjoy [adolescent life] at that time’. (No. 2, married at 17 years old)

‘Hmm, at that time, I really didn’t think much. I didn’t think about it [marriage at a young age] long enough. At that time, I just thought about wanting to get away from home, so that I wouldn’t be controlled by my parents. That’s what I thought [laughs]’. (No. 8, married at 17 years old)

Believing in fate

Intriguingly, the women stated that they believed that getting married as a child was their fate. Many participants thought it was their unavoidable destiny to be married at an early age. They seemed to accept the situation submissively. In the mixed emotions of the interviewed women, we could sense resignation, accepting something undesirable to them and calling it fate.

‘It’s like destiny [that her marriage was early]. It was fated, I was a bit scared, but we had to be patient. Yes, we had to be patient. Go through the tough and happy times together with the husband’. (No. 2, married at 17 years old)

‘I wasn’t planning on getting married. But it was fated that I got married early’. (No. 13, married at 16 years old)

‘I didn’t know my husband before marriage, not long, about a month. My marriage was arranged by my parents. It was my fate. I accepted straight away. It’s fated’. (No. 14, married at 17 years old)

Having no idea what would happen after marriage

Almost all the participants stated that they did not imagine what would happen after marriage. They were unprepared and did not feel at ease with their new responsibilities as a wife, as a mother, doing housework, and taking care of the husband’s family members.

‘It was never in my mind at that time [about becoming a wife]. Nothing. I didn’t think about all of that. At that time, I just wanted to get married and live with him. That’s all’. (No. 11, married at 15 years old)

‘Imagining what my married life would be? Never thought of that. It was different [after marriage] because before I got married, my mother did everything. Then after I got married, all of that was my responsibility. So it was a little exhausting. It took me some time to learn how to cook. I knew how to clean the house and do the laundry, but I did not know how to cook. But I tried. Tried to cook regardless of whether it was delicious or not. That’s it’. (No. 13, married at 16 years old)

‘I didn’t think about after I get married. Because I was too young. I didn’t think to that level. Because I thought marriage wasn’t… it was just like a game. I just followed. I knew nothing. Even when I was pregnant, I didn’t know what to eat, how to do family planning. I didn’t know. That’s why I gave birth to my three children in three years. Small birth spacing [laugh]’. (No. 20, married at 17 years old)

Family poverty

Family poverty was an issue that affected the women’s decision to get married at a very young age. We found that family poverty is connected to child marriage as described by the following two subthemes: child marriage to reduce the financial burden, and leaving school due to poverty.

Child marriage to reduce the financial burden

Some of the women in this study experienced economic hardships during childhood and adolescence, which led them to want to reduce the burden on their family by getting married at a young age. For some participants, the parents had arranged a child marriage in order to give their daughter a better living environment, and the daughter had accepted the decision with conflicting feelings. Others simply felt pity given the family’s financial difficulties, and decided of their own volition to get married early.

‘My family was poor. My father worked as a rubber tapper. The plantation belonged to others. My mother helped my father. My marriage was arranged by my parents. I was introduced to my husband through my parents. Because he had a good job - he was a teacher. So when they came and proposed, I just accepted’. (No. 14, married at 17 years old)

‘I already knew about it [that if I had sex, I would get pregnant]. But I didn’t care, because at that time we were poor, they [parents] didn’t have the time and money to care for me. So I felt like if there was a guy who could look after me and marry me, then I was OK. That’s how I felt. Of course, I felt that I was forced to get married early. I couldn’t have my parents be responsible for me any longer. So I pitied them. I had to get married. If my family was not poor, I don’t think I would have married early’. (No. 5, married at 15 years old)

Leaving school due to poverty

None of the participants in this study continued their education to the university level. Some had left school in the middle of secondary education, and a few did not even complete elementary school. They were unable to continue their education because of their family’s poverty. They were either told by their parents that they could not continue their education, or they voluntarily stopped going to school in order to help with the housework. Three women who left school when they were 11, 15 and 14 years old, respectively, stated their reasons as follows:

‘I wanted to [continue school], but my mother was poor. At that time, my mother had to take care of my two other siblings, and there was no one to help her’. (No. 3, married at 17 years old)

‘Because I came from a poor family. So, my parents couldn’t afford to support me [to send her to school]. I do feel some regret, but what can I do, right?’ (No. 16, married at 15 years old)

‘I never went to see my teachers and friends because I quit school. When I left school in Form 2 [14 years old], I really wanted to stay. But my mother had no money to spend because my mother was poor, so we had no money to continue my schooling. If it was up to me, I would have stayed in school’. (No. 9, married at 17 years old)

Religious and cultural norms

We also examined why child marriage occurred by focusing on the women’s perceptions about how their child marriage was received among the community members, as well as by asking the key informants. We gained insight regarding the religious and cultural norms in the community with respect to child marriage. It seemed that religiosity—quality of being religious—was the underlying basis for people’s perceptions in accepting child marriage. In addition, there was a basic acceptance in the community that due to unavoidable circumstances such as girls having premarital sex and thus becoming pregnant, child marriage could be tolerated. Under this theme, there are three subthemes: premarital sex as a sinful act, marriage as a quick solution for an unwanted pregnancy and community tolerance of child marriage without interference.

Premarital sex as a sinful act

Among both the younger generation and their parents’ generation, premarital sex is widely regarded as a sinful act. This stemmed from the Islamic religious value of avoiding what is forbidden (haram) in Malay-Muslim society. The taboo against premarital sex, however, is sometimes violated in practice. As such, premarital sex is an unspoken but apparently dominant reason for child marriage; the couple were either afraid of having or were already in a sexual relationship outside of marriage. At the same time, there is a widely accepted understanding that, so long as the couple are married, having sex at a young age is not a problem.

‘Underage marriage, it is something that… they have pros and cons, you know? In our religion, when our people, our daughters grow up, they have a boyfriend, we cannot just let them be like that. We have something to make them, you know? What we call halal [permissible], a halal relationship. So, when the parents find out that the girl has a boyfriend, to avoid something bad happening, especially pregnancy, an unwanted child, you know? What we call an unmarried sexual relationship. So from the religious perspective, we have to. We have to suggest that our girls get married, you know? From the age of 16, after puberty. And, it sounds like we are trying to save the society so that they don’t accidentally become pregnant and all that’. (Government officer)

‘It’s just that recently there are more and more of those involved with social problems [of premarital sex]. So we should increase various programs, such as the one that the school and the Religious Department are collaborating on. It’s called “Anda Bijak Menjauhi Zina” [You are Wise to Avoid Adultery] program; it is a campaign. So we go and give lectures at schools; we tell stories and problems from the aspects of Syariah [Islamic religious] laws. You will be fined if you are caught in khalwat [close proximity with those who aren’t your spouse], if you act indecently, if you become pregnant out of wedlock, all of those situations. We inform the students so that they are scared’. (An officer from religious department)

Marriage as a quick solution for an unwanted pregnancy

Under such circumstances, to cover up the unexpected and unwanted teenage pregnancy, marriage is often permitted by the parents regardless of the daughter’s age. Further, society tends to facilitate such a marriage. When parents find out their daughter is pregnant, they will most likely urge the couple to marry quickly so that the couple can hide the fact that they had premarital sex. This pressure from the parents is justified by religious values. The society also sympathises with the family and perceives child marriage as a natural course of action. Ultimately, marriage is a solution for ensuring the baby’s family lineage. Most of the women in this study chose to keep the baby when they found out they were pregnant and hurriedly got married, as there is a strong religious and cultural aversion to abortion in Malaysia.

‘Some of them are married when they have a problem with an unwanted pregnancy. Meaning that, something happened in their relationship, you know? Unwanted child. I mean pre-marital sex’. (Government officer)

‘It’s just that, underage marriages in Kelantan are to handle the problems of an out-of-wedlock pregnancy, in which according to Islam, the baby, cannot be nasab [attributed] to the father. The baby cannot use the father’s name because of nasab [family lineage], being a legitimate heir is very important in Islam. If you were a legitimate heir, for example, a legitimate marriage will allow the children to have access to family inheritance, or ensure that they can later be the wali [guardian] for their siblings’ marriage after the death of their father. That is why, for those who get married young, if they were in their first, second or third month of pregnancy, then the baby can use the husband’s name. But, if the marriage, I mean, the wife, the woman was in her fourth, fifth or sixth month of pregnancy, then the baby cannot use their father’s name. This is where it gets complicated’. (An officer from religious department)

Community tolerance of child marriage without interference

As described in the previous subthemes, it seems that the community’s perception on child marriage was that something had happened, such as pregnancy outside of wedlock, and, therefore, marriage below the age of 18 could not be avoided. In such a case, child marriage was tolerated among the community members without interference. It was surprising to hear from the women in this study that none of them experienced any resistance to their marriage at a young age by the community members. However, it did not mean that the community embraced and fully accepted their child marriage either. Although those in the community had some objections, they usually did not express such objections directly to the marrying girls or to their families.

‘There was no objection. Nothing. Everybody was supportive of my getting married. Back in my days, there was no objection like today. Back then, I think other people didn’t object because they knew my mother had money, she was rich. So, they didn’t say anything’. (No. 12, married at 17 years old)

‘At first, when I informed my teachers [about my early marriage], they said it’s too early to get married. But afterwards, they said, “It’s OK to get married early. It’s good”’. (No. 4, married at 17 years old)

Discussion

This study examined the issues surrounding the reasons for child marriage from the perspectives of the women who got married as children, as well as the key informants. The results were in alignment with the social-ecological model and revealed that multiple factors synergistically affected the decision of child marriage. It is important to investigate further the implications behind each of the issues identified in this study and elaborate how these issues affected the decision of child marriage.

First, we revealed in this study that the women did not seem fully mature when they made the decision to marry as children. Their immaturity was observed, in this study, as an intuitive decision-making style, believing in fate and having no idea what would happen after marriage. By comparison, previous studies reported girls’ lack of voice, limited agency and lack of power to make decisions.40–43 Schvaneveldt and Adams argue that acquiring competency in decision-making style in adolescence is not a linear process but is affected by factors such as age, sex, social class, family situation, temperament, religion and family lifestyle.44 During a comparative assessment of various decision-making styles among adolescents, Schvaneveldt and Adams introduced the idea that an intuitive decision-making style takes place when the emphasis is put on emotions, feelings and fantasy rather than logic. This idea can be used to enhance the understanding of the decision-making motives of adolescents who wish to enter into child marriage. Albert and Steinberg explained that studies on the judgement and decision-making of the adolescents can be described as a dual-process model, which can be categorised as two modes of information processing: analytic (cold) and experiential (hot).45 The study also reported that as adolescents in general lack experience with negative outcomes, and thus may show an over-reliance on conscious evaluation of costs and benefits of risky behaviour, in such cases, they are prone to choose risky options. Further analysis is needed to focus on the psychological aspect of the girls’ decision-making when they choose the path of child marriage by applying the results from the field of psychology.

With respect to believing in fate, there are studies indicating that religiosity plays a role in believing in fate, which is a teleological belief described as things happening for a reason.46 Banerjee and Bloom state that believing in fate is a type of social-cognitive bias. When such a biassed view is held by an individual, it is justified and embraced as fulfilling their religiosity if a significant life event such as marriage happens unexpectedly, but it is difficult to explain why it happens, other than believing that it is given by God. Therefore, we can hypothesise that believing in fate is associated with the decision of child marriage. This hypothesis should be investigated in future studies.

Numerous studies have shown that family poverty was the root cause of child marriage globally.8 10 47 48 In this study, we revealed two aspects of family poverty—child marriage to reduce the financial burden, and leaving school due to poverty—that seemingly affected the women in their acceptance of child marriage. A previous study found that parents in poor families are inclined to marry off their daughters because they have incentives ‘to ensure their daughter’s financial security and to reduce the economic burden daughters place on the family’.47 Therefore, as long as the condition of family poverty is prolonged, the parents are inclined to endorse child marriage for their daughters. Moreover, there are studies that suggest requiring the girls to continue their schooling as an effective way to reduce child marriage.7 47 In this study, there were participants who dropped out of school in their early teens and, after a few years of either working or staying at home, decided to get married. Some of them might have delayed marriage if they had been required to finish secondary school.

Another issue revealed in this study was that premarital sex is widely considered a sinful act. The results of this study highlighted the role of religion in justifying the practice of child marriage in Malaysia. This social norm stems from Islamic religious belief. We also found that unwanted pregnancy prompted child marriage for some of the participants in this study. Under such circumstances, the decision of child marriage was to cover up the perceived sins of premarital sex and pregnancy. By comparison, a study assessing factors relating to teenage premarital pregnancy in Malaysia reported a lack of religiosity as the main reason for such consequences as teenage pregnancy outside of wedlock.49 While some of the women in this study chose to be married at an early age due to pregnancy, what distinguishes them from unmarried teenage pregnant girls is their sense of religiosity. At an individual level, religiosity was seen to function as a fundamental basis of the women’s decision to accept early marriage as a way of admitting that they had committed sins. At the societal level, religiosity is a widely accepted social norm under which child marriage is justified, combined with the pressures of society. Topics related to sex are generally considered a taboo for discussion in Malaysian society.50 Makol-Abdul explained that sex education is considered a taboo, and therefore, not taught at school in Muslim-majority countries such as Malaysia.51 Although the government has made some recent initiatives to gradually promote sex education among adolescents in the past 10 years or so, because sex education is still considered a controversial topic in Malaysia,4 52 the implementation of such a programme is not widespread. In fact, all participants in this study replied that they did not receive sex education at school prior to their early marriage. As the initiatives to try to bring changes to the sexual education in Malaysia is challenged by the belief that sex education encourages sexual activity among children, it is difficult to make a transformation about this subject.4 Due to society’s negative perceptions of sexuality, it is difficult to activate lively discussions about sex or to introduce community intervention activities that focus on the emotional aspect of sexuality, and discuss why premarital sex is occurring among young adolescents in Malaysia, in spite of the social pressure and the perception of sex outside of marriage as a sinful act. Adamczyk and Hayes stated that religion, particularly Islam, has a macro-level effect on prohibitions regarding premarital sex.53 Previous studies have described the widely accepted perception within Islam that premarital sex is a sinful act.49 54 Therefore, we come to a working hypothesis that religious and cultural norms can be used as one of the latent indicator variables among adolescent girls in future studies, in order to assess the association of religiosity and child marriage involving premarital sex. In addition, we need to be sensitive as to how the punitive aspect of religion at societal level is connected to the decision of passive and reluctant acceptance of child marriage. There are some studies that examine the association between religiosity and decisions regarding premarital sexual activity among youths in Malaysia and elsewhere.55 56 In these studies, religion is used to promote premarital sexual abstinence and religiosity is affecting the later timing of coital debut.55 56 In comparison to the results of our study, there is a gap in the perception of religion and sexuality, and previous approaches may not be sufficient to prevent child marriage. Therefore, other types of approaches with respect to religion and sexuality must be thought through. In order to enhance the understanding on the underlying issues surrounding child marriage, it is important to have an in-depth understanding about the role religion plays in justifying child marriage in Malaysia.

Conclusion

This study is one of the earliest studies to examine the issues surrounding the reasons for child marriage in Peninsular Malaysia, using a qualitative approach. We revealed that immaturity in decision-making, family poverty and religious and cultural norms are the three pertinent themes in alignment with the individual, familial, community and societal layers of the social-ecological model. Further investigation on how these variables are associated with child marriage is needed in order to develop suitable policy and intervention programme to eradicate child marriage in Malaysia. There are ongoing debates on whether to raise the legal minimum age of marriage in Malaysia, in light of the recent media coverage of cases of child marriage in the country. From an academic standpoint, we want to emphasise that the reasons for child marriage are intertwined with various issues concerning the situations of the girls, as well as the family, community and societal backgrounds. Therefore, in order to fill the gaps in the current policy for child marriage and incorporate a holistic perspective, strengthening sex education at school and awareness-building activities in the communities involving all community members must be implemented in Malaysia. In doing so, we need to adopt a team-based approach in which experts from law, religion, psychology, social-welfare and public health fields work together to create a better policy towards child marriage. It is necessary to target not only the adolescent girls and their families but also the community and society, in order to increase social awareness of child marriage. This approach has proven effective in curbing child marriage in India, Nepal, Senegal and Yemen.7 Providing adequate support and structural changes to eradicate child marriage will benefit the girls as well as the families, community and society, thus bringing hope and greater opportunities for the future.

Supplemental material

Supplemental material

Supplemental material

Acknowledgments

The authors would like to thank the study participants and the Reproductive Health Association of Kelantan for assistance during the fieldwork.

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Footnotes

  • Contributors AK designed the study, developed the data collection tools, managed participant recruitment, conducted interviewer training, conducted part of the interviews, coded and analysed the data and drafted and finalised the final manuscript. MD and NDNF provided technical and intellectual input into the study design, data collection tools, data analysis and manuscript revision. SHA and TN provided input into the data analysis and manuscript revision. All authors read and approved the final manuscript.

  • Funding This work was supported by the research grant from Kyoto University Inter-graduate School Program for Sustainable Development and Survivable Societies.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by Kyoto University Graduate School and Faculty of Medicine Ethics Committee (R1026) as well as University of Malaya Research Ethics Committee (UM.TNC2/RC/H&E/UMREC - 163).

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

  • Data availability statement No data are available.