Exploring the Consequences of Early Marriage: A Conventional Content Analysis

Abstract

Early marriage is one of the most important social issues for young women and can have many consequences. The present study aimed to explore the consequences of early marriage among Kurdish women in western Iran who were married under the age of 18. This qualitative study was conducted with the approach of conventional content analysis. The data were collected through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed using Graneheim and Lundman’s method. A total of 389 codes, 12 subcategories, 4 sub-categories, and 2 main categories were extracted from the data analysis. Negative consequences of early marriage include: 1—physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, depression, and emotional distress); 2—family problems (dissatisfaction with married life, experience of having lots of responsibility, lack of independence in family life); 3—social problems (risky social behaviors, lack of access to social and health services, social isolation, lack of access to a job, and educational opportunities); and 4—positive consequences, including receiving intra-family support, improving living conditions, and opportunities for progress and empowerment. It is possible to reduce problems and challenges after early marriage by increasing the awareness and knowledge of young women about contraceptives and providing appropriate social and health facilities, and services during pregnancy. Providing the necessary training and psychological counseling for them and their husbands on how to deal with personal problems and marital life will be effective to a great extent.

• What do we already know about this topic?

• Early marriage is associated with the following: non-use of contraceptives before the first delivery; high fertility (3 or more births); repeated pregnancy in less than three months; unwanted pregnancies; more domestic violence, including various forms of physical, emotional, and sexual violence; depression; the risk of getting sexually transmitted diseases; and preterm birth.

• How does your research contribute to the field?

• Few qualitative studies have been conducted on the consequences of early marriage in Iran and around the world. Therefore, the current research can reveal the hidden layers of this issue, and its results can be provided to site developers and planners to take action to improve the health of children who experience early marriage.

• What are your research’s implications for theory, practice, or policy?

• Early marriage brings many negative consequences for women, such as physical and mental problems and family and social challenges. Of course, in some cases, it can bring positive consequences, such as receiving support within the family, improving living conditions, and the opportunity for advancement and empowerment.

Introduction

In the last 3 decades, many national and international organizations have paid extensive attention to children’s rights. ¹ One of the violations of children’s rights is early marriage, ² which refers to marriage under the age of 18, ³ and it can have devastating consequences for both genders. However, it is regarded as an example of gender discrimination because it is more harmful to girls. ⁴ It is estimated that almost 5 times as many girls as boys are married under the age of 18, and about 250 million of them marry before the age of 13. ³ The rate of early marriage varies from country to country; Africa and Western Europe have the highest and lowest rates, respectively. ⁵ In Iran, the minimum legal age for the marriage of girls is 13, but men can marry girls under 13 with a judge’s order. ⁶ The prevalence of early marriage in rural areas of Iran is reported at 19.6 and in urban areas at 13.7. ⁷ In the first 9 months of 2016 in Iran, 13 820 cases of marriage under the age of 18 were registered. But the actual figures for early marriage appear to be higher than the official figures because many cases of early marriage occur within families and are not officially registered. ⁸

Early marriage in other countries occurs for reasons such as cultural beliefs, ⁹ social norms, ¹⁰ poverty, ¹¹ control over girls, ¹² and religion. ¹³ Low literacy and lack of awareness among girls and their parents, lack of decision-making power and authority of girls, gaining social prestige and support, and poverty have been identified as the most important causes of early marriage of girls in Iran.^6,14

There are many devastating consequences of early marriage. In a study, early marriage was significantly associated with non-use of contraceptives before the first delivery, high fertility (3 or more births), and repeated pregnancies—women becoming pregnant again within 3 months of giving birth. ¹⁵ A study on behavioral control and spousal violence toward women in Pakistan found that women who were married as children experienced more behavioral control than adult women. They also experienced more domestic violence, including various forms of physical and emotional violence. ¹⁶ Irani and Roudsari, in 2019, also showed in a review study that early marriage in girls was associated with death during childbirth, physical and sexual violence, depression, the risk of getting sexually transmitted diseases, and preterm birth. ¹⁷ A qualitative study conducted by Mardi et al in 2018 in Ardabil, Iran, showed that adolescent girls confronted experiences such as misunderstanding of sexual relations, death of dreams, and decreased independence. Also, the results of their study showed that adolescent girls could not understand life opportunities, and health care providers and policymakers needed to make adolescents aware of the negative consequences of early marriage and prevent them from doing it. ¹⁸

In Iran, few qualitative studies have been conducted on the consequences of early marriage, and none of the studies have been conducted in Kurdish regions. Since the study population is different in terms of ethnicity, language, and culture from other parts of Iran, and according to the experiences of the first author of the article, who has been conducting research on women in this area for many years, it seemed that a separate study should qualitatively examine the consequences of early marriage in this region. Therefore, the present study aimed to explore the consequences of early marriage among Kurdish women in western Iran.

Methods

Design and Participants

This qualitative study employed the conventional content analysis method. ¹⁹ Qualitative content analysis is an appropriate and coherent method for textual data analysis that is used with the aim of a better understanding of the phenomenon. In conventional content analysis, categories and subcategories are obtained directly from interviews or group discussions.^20-22

The study population consisted of married women who had married under the age of 18. The following criteria were used to select participants: having been married under the age of 18, being under 25 at the time of the study, residing in one of the 2 Kurdish provinces of Kermanshah or Kurdistan at the time of marriage, and willingness to participate in research.

Kermanshah and Kurdistan provinces are located in the west of Iran. These 2 provinces have many cultural and social commonalities. The people of both provinces are Kurds and speak Kurdish. Also, economically, both provinces are almost on the same level.

The purposeful sampling method was used in this study. The researchers proceeded to the study area after obtaining the ethics approval (IR.IUMS.REC.1397.1225) from the Iran University of Medical Sciences. Study participants were included based on inclusion criteria after collecting addresses from the selected health centers. Before beginning the interview sessions, the researchers explained the goals and objectives to the participants and written consent was obtained from all participants.

Data Collection

The information needed for the study was obtained through semi-structured face-to-face interviews. All interviews were conducted by a woman with a master’s degree in women’s studies who was familiar with qualitative research and semi-structured interviews. No men were present during the interviews so that the participants could quickly share their experiences with the researcher. All the interviews were recorded using a recorder, and note-taking was done during the interviews. The researcher initially chose a quiet place for the interview in coordination with the participant so that the interviews were conducted without the presence of another person, and the researcher tried to elicit the required information from the participants by creating a sincere atmosphere. First, she asked general questions. Then, after creating an empathetic atmosphere, she asked the more sensitive questions. At the beginning of each interview, in addition to stating the goals and necessity of the study, provided a brief description of their scientific resume. Then the interview started with a few questions about demographic characteristics, such as age and education, and continued with the main questions (Table 1). The authors designed the interview questions and sent them to 3 participants as a test to ensure they could achieve the research objectives with the designed questions, which were approved. It then ended with short complementary questions to get the depth and breadth of the answers. The place and time of the interview were determined by the participants, mostly in places such as their homes, libraries, cultural places, parks, and other public places. The duration of the interviews varied for each participant, but the average time was 68 minutes. The interview was conducted in Kurdish and translated into Persian by the article’s first author. After data analysis, an expert translated all parts of the article into English. The first author assisted the translator, who explained any unclear parts to the translator so they could be translated better.

Table 1.

Interview Guide.

Number	Questions
1	How did you feel when you got married?
2	Are you satisfied that you got married as a child? If yes, Why?
3	As someone who got married early, what are your experiences with this phenomenon?
4	What changes did early marriage make in your life, individually, familially, and socially?
5	Did you face any problems after marriage, and how was your life?
6	How did your spouse treat you after marriage? Please explain.
7	How did the families treat you as someone who got married early?
8	Did you get pregnant under the age of 18? If yes, please explain why you became pregnant and the conditions you had after pregnancy.
9	Has early marriage had a positive effect on you? Please explain.

The researchers stopped the interviews when saturation occurred, and data saturation occurs when no new data are obtained from the interviews. ²³ Conceptual saturation occurred in interview 23 when the codes were repetitive, but the researchers conducted 7 more interviews to gain greater confidence and prevent false saturation, reaching 30 people. Finally, data saturation was achieved after 30 interviews. Data collection and analysis began in July 2019 and ended on April 13, 2020.

Data Analysis

The data analysis process was performed using the 5 steps suggested by Graneheim and Lundman. ¹⁹ In the first step, the corresponding author and first author of the article listened to all the interviews that were recorded, once individually and then together. Later, they typed all the interviews in Microsoft Word. In the second step, the texts of the interviews were read several times to gain an understanding of the whole text. In the third step, the texts were read word for word, and thus, the codes were retrieved. The open codes were then categorized under more general headings. In the fourth step, the codes were categorized into categories based on their similarities and differences, and how they were related was determined. In the last step, the data were placed in the main categories, which were more abstract and more conceptual (Table 2). The analysis of the data was done manually, and all the authors of the article monitored the process and expressed their views in separate meetings.

Table 2.

An Example of Data Analysis.

Main categories	Categories	Subcategories	Codes	Quotations
Negative consequences	Family problems	Dissatisfaction with married life	economic, physical, psychological, and sexual violence, emotional divorce, divorce, and sexual dissatisfaction	“I’m not financially independent. Every time I ask my husband for money, he annoys me a lot to give me money. Sometimes he forces me to stop another request for the money he gives me.”
				“It’s been less than 2 months since our marriage, my husband gave me a beating. He is very violent. He often beats me for trivial things.”
				“I’ve heard a lot of insults from my husband. He says a lot of ugly things to me. Sometimes he yells at me in the family gathering and says ugly things to me.”
				“I was very annoyed the first night and that’s why I never enjoy sex anymore. Every time we do this, I get more annoyed. My sister, who got married early, says like me, she doesn’t enjoy it at all.”
				“My husband and I don’t understand each other at all. Sometimes we don’t talk for 10 minutes in a week. If it weren’t for my baby, I would separate.”
				“I had a disagreement and argument with my husband from the very beginning of my life. He said “you don’t know anything”. Our life wasn’t good at all. We fought with each other all the time and I had to divorce him.”
		Experience of having a lot of responsibility	responsibility of child-wife, mother-child, and bride-child, being the head of the household, staying in the role of child and being thrown into the adult world	“When I got married, I was very young. I used to watch cartoons at my father-in-law’s house. My husband argued with me many times about this. He said, ‘Why are you behaving like this? You grew up. You mustn’t watch the cartoon.’ ”
				“We lived with my husband’s family. They expected me to behave like a perfect woman, but I didn’t know many things. Whenever they had guests, they would argue with me a lot, saying my behavior was wrong.”
				“When my husband died, I was 17 years old and had a 2-month-old baby. I had to be both a father and a mother to my child while I was still a child.”
				“It wasn’t until a month after we got married that I realized I was pregnant. I got confused; I didn’t know what to do. I was just crying. I was a child myself. When my baby was born, I couldn’t protect her at all.”
				“I was a child myself, but I was expected to be both a good wife and a good mother. No one understood me.”

Ethical Considerations

The researchers went to the health centers of the surveyed cities and villages after receiving the ethics approval (IR.IUMS.REC.1397.1225) from the Iran University of Medical Sciences. The health centers were asked to identify women who met the study’s eligibility criteria and collect their contact information. When contacting the women, they were asked to determine the time and place of the interview. Then the researchers visited the people’s homes and invited them to participate by stating the research’s goals and necessity.

Trustworthiness

To confirm the validity and consistency of the study, the researchers used the Lincoln and Guba criteria. ²⁴ To gain credibility in this study, the participants were selected based on who had the most diversity in terms of socioeconomic characteristics. Then the findings were given to 8 participants, and they expressed their views on the matching of the findings to their experiences of early marriage. In addition, because the researchers were natives of the study areas and had experience conducting qualitative research on Kurdish women, they could easily communicate with participants and obtain good information from them. To gain confirmability, the researchers sent the data analysis process to 4 people who were familiar with the principles of qualitative research and had experience conducting research on early marriage, and later, their supplementary feedback was used. To gain dependability, all the authors of the article participated in the process of analysis and coding, and the opinions of all members of the research team were used. Also, in order to obtain transferability, in addition to presenting many direct quotes from the participants, a detailed description of the whole research process was provided to the readers in this article (Supplemental File 1). The results of the study were also given to 4 women who had similar characteristics to the participants in the project but did not participate in the study. They were asked to state whether they agreed with the research outcome and whether they had similar experiences with the participants in this study. Then they accepted the results of the study.

Results

The study ended with the participation of 30 women, whose demographic characteristics are shown in Table 3. After analyzing the data, 389 open codes, 14 subcategories, 4 categories, and 2 main categories were extracted, which are described below (Table 4).

Table 3.

Demographic Characteristics of Participants.

Variable	Dimension	Frequency (%)
Age	<16	6 (30)
	16-20	16 (53.33)
	20-25	8 (26.66)
Education	Illiterate	4 (13.33)
	Under diploma	14 (46.66)
	Diploma	8 (26.66)
	Higher than diploma	4 (13.33)
Residence	Urban	11 (36.66)
	Rural	19 (63.33)
The age of first marriage	<15	7 (23.33)
	15-16	10 (33.33)
	16-18	13 (43.33)
Type of marriage	Forced	10 (33.33)
	Traditional	12 (40)
	Self-choice	8 (26.66)
Age difference with spouse	<5	7 (23.33)
	5-10	13 (43.33)
	>10	10 (33.33)
Abortion background	Yes	11 (36.66)
	No	19 (63.33)

Table 4.

Main Categories, Categories, Subcategories, and Codes Extracted From the Analysis of Interviews.

Main categories	Categories	Subcategories	Codes
Negative consequences	Physical and psychological problems	High-risk pregnancies and childbirths	Unwanted pregnancy, Lack of awareness how to control fertility, infant mortality, an increase of abortion, recurrent abortion, abnormal delivery, postpartum hemorrhage, and short interval between births
		Physical illnesses	High blood pressure, underweight, severe headaches, malnutrition, delayed physical growth, iron deficiency, and backache
		Depression and emotional distress	Yearning for childhood, yearning for adolescence, yearning for love, yearning for studying, remorse for early marriage and remorse for early pregnancy, depression, suicide ideation, and attempt, feelings of inferiority, and low self-confidence
	Family problems	Dissatisfaction with married life	Economic, physical, psychological, and sexual violence, emotional divorce, divorce, and sexual dissatisfaction
		Experience of having a lot of responsibility	Responsibility of child-wife, mother-child, and bride-child, being the head of the household, staying in the role of child and being thrown into the adult world
		Lack of independence in family life	Powerlessness in decisions for home, powerlessness in decisions for children, and powerlessness in determining family relationships
	Social problems	Risky social behaviors	Having an emotional/sexual relationship outside the family, a desire to run away from home, and a desire to drink alcohol and smoking
		Lack of access to social and health services	Lack of access to necessary health services, lack of access to social services such as counseling centers, lack of social support in society, deprivation of the media, and low knowledge of technology
		Social Isolation	Leaving relationships with peers, being locked up at home, interacting with people who are incompatible in terms of age, etc.
		Lack of access to job and educational opportunities	Drop out of school, unemployment, low literacy and lack of skills
Positive Consequences	Gaining support and empowerment	Receive intra-family support	Receiving information support, receiving financial support, receiving support for childbirth and childcare
		Improving living conditions	Change in her economic status, change in her family’s economic status and escaping bad family circumstances
		Opportunity for progress and empowerment	Returning to school, taking a job, engaging in favorite skills, self-confidence, and self-efficacy

Negative Consequences of Early Marriage

Early marriage posed many challenges for women at various individual, family, and social levels, leading most participants to regret the marriage.

1—Physical and psychological problems

Marriage during childhood endangered women’s health and forced them to deal with additional medical and psychological issues, such as high-risk pregnancies and births, physical problems, yearning and remorse, and psychological difficulties.

High-risk pregnancies and childbirths

Most adolescent women had little awareness and knowledge about contraceptives due to the taboo of talking about sexual issues in Iran. These issues were never fully explained to adolescent women, so their knowledge was limited. Therefore, most adolescent women became pregnant accidentally, and since they had no preparation for this and had not received pregnancy knowledge in adolescence, they experienced several challenges that risked their and their child’s health.

“Honestly, I didn’t want to get pregnant, but I didn’t know how to prevent it. There was no one to guide me. I became pregnant very soon.” (Participant, 5)

“I have had two abortions. Most of those who get married at a young age have such an experience.” (Participant, 14)

“I really wanted to give birth naturally, but I couldn’t give birth to my baby, so I had a cesarean section.” (Participant, 28)

“For the first four years of my life, I was pregnant all the time and my baby was not born alive. My body had nothing left.” (Participant, 17)

“I became very weak after my child’s birth, and I had a lot of problems.” (Participant, 30)

Since adolescent women did not have the proper knowledge and skills of contraception, they usually became pregnant unwantedly soon after marriage, and because they were not physically and mentally ready for childbirth, they tackled many problems, which endangered the health of mothers and newborn children, and it may have even led to the death of both.

Having physical illnesses

Some girls who got married in childhood confronted many physical problems and got pregnant, which could affect their health and reduce their quality of life. Most of these girls who got married early were from humble families, and on the one hand, they had financial problems in preparing proper food, and on the other hand, they did not eat nutritious food due to their lack of nutrition knowledge. Therefore, they confronted many physical problems. The pressures of early pregnancy could also exacerbate the disease and physical problems.

“I had my first abortion, then I had a nosebleed two months later. I went to the doctor. They told me that my blood pressure had gone up. Every once in a while, my blood pressure rises, and it bothers me.” (Participant, 4)

“I don’t know, maybe I’m wrong, but I feel like the marriage made me have a severe headache. I went to a doctor, and he said I had a migraine.” (Participant, 10)

“I’m young, but every part of my body is in pain. Sometimes my backache drives me crazy.” (Participant, 18)

Girls who got married during childhood had many physical problems after the marriage that could endanger their health and lower their quality of life.

Depression and emotional distress

The experience of love and having children is one of the sweetest moments in most women’s lives, but most women who got married in childhood did not get this sweet experience since most of their marriages were traditional and without love and affection. Therefore, most adolescent women became pregnant accidentally, and since they had no preparation for this and had not received pregnancy knowledge in adolescence, they experienced several challenges that risked their and their child’s health. Also, the fact that many girls were forced to drop out of school after marriage, which made them regret that they did not continue their education in order to have a job. This lack of a job and sufficient literacy caused them to have less self-confidence. These events increased the problems and challenges of adolescent women, while they had neither the training nor the skills to cope with any of these challenges, so in some cases, these women saw no other way but to end their lives and commit the severest and most violent type of suicide attempts, i.e., self-immolation.

“I never had the childhood that I always yearned for. I always wanted to ride a bike, but they forced me to marry. “After marriage, if you ride a bike, everyone will blame you.” (Participant, 20)

“When I see some of my friends getting married with love and affection, my heart breaks, and I feel very sorry that I wish I had fallen in love.” “It’s annoying that I can’t experience love anymore.” (Participant, 30)

“I cry when I hear from some people that the best experiences of their lives are being married and having children because it has been the worst experience of my life.” (Participant, 3)

“I regret when I thought I could enjoy my marriage and having children, but because of my early marriage, everything was ruined.” (Participant, 1)

“I haven’t laughed from the bottom of my heart for a long time. I’m always sad for getting married early. I’m not in the mood for anyone. My sister tells me I’m depressed.” (Participant, 12)

“I have decided several times to kill myself and get rid of this life. Once I poured oil on myself, but as soon as I lit the fire, my brother-in-law understood and did not let me kill myself.” (Participant, 12)

“My self-confidence is very low. I feel worthless. I don’t like to be with others at all. When I want to talk, I mispronounce some words.” (Participant, 20)

Early marriage prevents a child from experiencing childhood and adolescence like their peers. Marriage can be marvelous experience for many people, but early marriage turns it into one of the worst events of girls’ lives. These issues could lead girls who had been married as children to face a lot of yearnings and regrets. Also, when these young women saw their successful peers who had been educated and had a job, they inevitably compared it with their lives and circumstances and have more regret. Early marriage puts a lot of pressure on women, causing them a lot of psychological harm, and because they have no skills or abilities to solve these problems, it lowers their self-confidence and increases their feelings of inferiority. As a result, it led to depression, and in the end, it could even lead to suicide.

2—Family problems

Families, in which early marriage is common are more fragile than other families due to their circumstances and face many problems and in some cases these problems can destroy the functioning of that family.

Dissatisfaction with married life

As previously mentioned, most girls who married in childhood lost the opportunity to continue their education, learn skills, and get a job, and thus, they became financially dependent on their husbands. In some cases, their husbands have abused this financial dependency, giving women less money and necessities of life, and somehow using economic or financial violence against them. Adolescent women also entered into married life without any skills or education, and in some cases, their husbands may be young and have no skills and training for married life. Consequently, women may undergo sexual violence from the beginning. And after marriage, there were some problems in their genitals, as some participants said that on the wedding night, they were bothered and hurt because they or their partner did not know how to have sex. They may also be subjected to physical and psychological violence due to their lack of marital management skills and their poor position in married life.

In some marriages, the age gap between couples was so huge that they had no understanding of each other, so in many cases, either divorce occurred, or they tolerated each other only to avoid the restrictions and problems after getting a divorce. Most women said they did not have a desired married life, which in some cases led to divorce, and if they were still in a relationship, there was an emotional separation and sexual dissatisfaction.

“I’m not financially independent. Every time I ask my husband for money, he annoys me a lot to give me money. Sometimes he forces me to stop another request for the money he gives me.” (Participant, 14)

“It’s been less than two months since our marriage, my husband gave me a beating. He is very violent. He often beats me for trivial things.”(Participant, 15)

“I’ve heard a lot of insults from my husband. He says a lot of ugly things to me. Sometimes he yells at me in the family gathering and says ugly things to me.” (Participant, 1)

“I didn’t know much about sex in the beginning, so I didn’t know how to please my husband. My husband sometimes got angry and told me I didn’t know anything, and he would do whatever he wanted, even if I wasn’t happy.” (Participant, 8)

“I was very annoyed the first night and that’s why I never enjoy sex anymore. Every time we do this, I get more annoyed. My sister, who got married early, says like me, she doesn’t enjoy it at all.” (Participant, 25)

“My husband and I don’t understand each other at all. Sometimes we don’t talk for ten minutes in a week. If it weren’t for my baby, I would separate.” (Participant, 23)

“I had a disagreement and argument with my husband from the very beginning of my life. He said “you don’t know anything”. Our life wasn’t good at all. We fought with each other all the time and I had to divorce him.” (Participant, 12)

“My husband and I have a big age difference, so we can’t satisfy each other sexually.” (Participant, 6)

Girls who married as adolescents had lower levels of awareness, abilities, and power in adulthood, as well as an understanding of social rights, sexual dilemmas, and marriage and their spouses mistreated them. Furthermore, since they grew up in a traditional environment where discussing sex was usually frowned upon and they had not been adequately acquainted with sex in the educational system, they lacked a solid knowledge of sex and were unable to meet the needs of their husbands. They were sexually assaulted and may have suffered serious injuries. Some of the participants were forced to marry or married owing to poor social and economic situations, without love or desire, and had a significant age gap with their spouses. As a result, they had numerous troubles in life and were dissatisfied with their marriage.

Experience of having a lot of responsibility

Many wives, even though they were still children, were forced to take on various responsibilities that put a lot of pressure on them. In fact, teenage girls were forced to take on responsibilities as a wife for which they were not yet prepared. But this was not the end of the story, because they added another responsibility with their early pregnancy. If they were unlucky that in the event of the death of their husband, they had to take on the responsibility of the head of the household, and taking on all these responsibilities without receiving any training and support can endanger their health and even their future.

“When I got married, I was very young. I used to watch cartoons at my father-in-law’s house. My husband argued with me many times about this. He said, ‘Why are you behaving like this? You grew up. You mustn’t watch the cartoon.’ ”(Participant, 26)

“We lived with my husband’s family. They expected me to behave like a perfect woman, but I didn’t know many things. Whenever they had guests, they would argue with me a lot, saying my behavior was wrong.” (Participant, 2)

“When my husband died, I was 17 years old and had a two-month-old baby. I had to be both a father and a mother to my child while I was still a child.” (Participant, 4)

“It wasn’t until a month after we got married that I realized I was pregnant. I got confused; I didn’t know what to do. I was just crying. I was a child myself. When my baby was born, I couldn’t protect her at all.” (Participant, 23)

“I was a child myself, but I was expected to be both a good wife and a good mother. No one understood me.” (Participant, 29)

“I feel like I didn’t have a typical adolescent experience like others. I knew I had been thrust from my childhood into the adult world. It is really difficult to adjust to married life.” (Participant No. 1)

With early marriage, children were forced to take on several different responsibilities at the same time. Each of these responsibilities had its own importance, and because they had no training for any of these roles, they were under a lot of pressure.

Lack of independence in family life

When women got married in childhood, they had very little power in their married lives because they did not know many issues related to life. Also, because they lived with the husband’s family, in many cases, they interfered in the young couple’s life under the pretext of instructing them on the issues of married life so that they made the final decision in their personal issues and decided for them what to do and what not to do. This may happen in all stages of life and is not only related to the early years of married life. Several participants stated that even after having children, the husband’s family had made the main decisions in their lives.

“My husband makes his decisions without telling me anything.” He hasn’t asked my opinion at all. (Participant, 8)

“My mother-in-law makes a lot of decisions for me.” She says, “You are very young.” “You don’t have much experience.” (Participant, 4)

“I can’t even wear my favourite clothes; I didn’t want to have children at all, but my husband’s family kept on me about it, so I had to do it.” (Participant, 2)

“When you get married as a child, everyone likes to interfere in your life because they think you don’t understand anything about life.” (Participant, 30)

“I wanted to name my daughter whatever I liked, but my husband and his family chose something else.” “They didn’t ask me if I liked this name or not.” (Participant, 18)

Girls become more vulnerable in their married lives as a result of early marriage, and they have less bargaining and negotiating power to achieve their goals. There should also be space for others to interfere, as adults think that the young bride does not have enough experience and should be trained to live, so they allow themselves to interfere in their most personal matters.

3—Social problems

In addition to individual and family problems, young women also faced problems and limitations in society that could make their living conditions more difficult.

Risky social behaviors

Since most women married in childhood out of compulsion or unawareness and it was rare for them to marry out of love and affection, they faced difficulties in married life because they were not emotionally supported in the family. Moreover, they wanted to fill this emotional void by building up emotional or even sexual relationships outside the family. Early marriage could lead to other high-risk behaviors, such as smoking and alcohol consumption. In rare cases, women resorted to alcohol and smoking to endure post-marital conditions and to reduce or alleviate their pain. Of course, sometimes, due to their young age and big age difference with their husbands, they had less power in the family, so if their husbands were addicted to drugs, they may have forced young women to use drugs.

“My husband and I have a big age difference. We cannot understand each other at all. We also have sexual problems. “My husband cannot satisfy me much, so I sometimes have sex with other people to satisfy my sexual needs.” (Participant. 7)

“I’m 22 years younger than my husband. We don’t understand each other at all. “I often go on social networks and talk with other people.” (Participant, 17)

“For the first few years of my life, I just cried.” My husband is a smoker. “I started smoking; at first he disagreed, but then he didn’t say anything to me.” (Participant, 2)

“In order to think less about my life and grieve less, I sometimes drink.” “We always have it in the fridge; my husband drinks a lot.” (Participant, 14)

Marriage in childhood causes many problems for girls. In some cases, these girls were drawn to risky social behaviors to get rid of these conditions or to endure them.

Lack of access to social and health services

Adolescent women needed a lot of social and health services after marriage due to the physical condition of pregnancy and the psychological pressures of married life in order to cope with the new situation. However, in the study area, there was no special service for these women, and they were left alone and helpless. This could make the process of adapting to the new life more difficult for them. Also, most married teenage women had low literacy due to early marriage and dropping out of school. In many cases, they were not able to use modern technologies, so they were not familiar with the internet. Therefore, they could not use its contents to raise their awareness and knowledge of the issues of married life.

“They do not provide us with any health services.” “Even when we become pregnant, there is no organisation to support us.” (Participant, 3)

“We face many problems during and after pregnancy, but the government and other organisations do not help us at all, and sometimes we are even reprimanded in hospitals.” (Participant, 17)

“When I got married, I didn’t know many things. “There was no special place for me to ask for their help and advice.” (Participant, 11)

“I studied until the third grade of elementary school. I don’t know much about education. I can’t even work with new phones. “I don’t know anything about the Internet, either.” (Participant, 15)

“I and all those who got married at a really young age have our own special needs, but there is no special place for us.” (Participant, 29)

Despite the many social and health needs of girls who had experienced early marriage, there was no institution or organization in society to support these girls, and no special training or privileges were provided for them. Lack of sufficient literacy and media skills and abilities was another problem for these women, which made them not even know how to find the answers to their questions.

Social isolation

According to the culture and customs of the society under study, when a woman gets married, she needs to devote all her time and attention to her family and spend less time with her friends, especially her single friends. This issue causes girls who get married early to stay away from their peers. Likewise, when they dropped out of school due to marriage and became pregnant, they had to stay home full time and raise their children. Therefore, most of these women were socially isolated, and their circle of social relationships became limited. This issue can cause many psychological and social problems for them.

“When I got married, I cut off most of my school friends.” Nobody was left. “I felt very bad.” (Participant, 6)

“My husband doesn’t like me to be in a relationship with my single friends.” “I had nobody left to confide in.” (Participant, 20)

“In my husband’s family, those who are married are all too old, and I cannot be intimate with single people.” That’s why I have more relationships with people who are older than me. We cannot understand each other. “I hate having to deal with people who are older than me, and we don’t understand each other.” (Participant, 17)

“After marriage, I had to stay at home all the time.” My husband is the driver of a big truck. He’s been at home for at least 4-5 days. When he leaves, I have to stay home. Because he dislikes it, I go somewhere alone. (Participant, 26)

Girls who married young were cut off from their peers’ worlds and were forced to have relationships with people their older age. This made them less inclined to have relationships with others, which in turn led to more social isolation. Also, it was not culturally acceptable for married women to associate with single girls. So, girls who have early marriages will soon be separated from their peers.

Lack of access to job and educational opportunities

Most participants stated that after marriage, they were forced to drop out of school or had studied for a short time. So, they did not have the opportunity to learn a skill due to marrying early and getting busy with life and child care.

“I was 16 when I got married, and then I had to drop out of school. My husband used to say, “Why does a woman want to study!?” (Participant, 2)

“I got married as a child. I didn’t know anything. Now that I want to have a job, I don’t have any skills. “I wish I hadn’t gotten married.” (Participant, 3)

“I was good at tailoring.” I was learning fashion design with my aunt. She always told me that I had the best talent. But when I got married, I could continue my work only for a month. Then I knew that I was pregnant. “I got busy with child care and quit my work.” (Participant, 19)

Many children are forced to drop out of school after marriage and are forced to stay at home as housewives, having no financial independence because they are neither educated nor skilled.

Positive Consequences

Marriage in childhood is not only associated with negative consequences; in some cases, these marriages can be useful and improve the lives and health of young girls, or at least save them from the bad conditions of the paternal family.

1—Gaining support and empowerment

This category consists of the subcategories of receiving intra-family support, improving living conditions, and the opportunity for progress and empowerment.

Receiving intra-family support. Young brides enjoyed a lot of prestige in their husband’s family, receiving more attention and support due to the existing social and cultural norms of the study area. In some cases, where the bride and groom were both very young, their families, and especially the groom’s family, had a duty to fully support them. The young couples received more financial support, and in some cases, they were paid living expenses for years. Paying living expenses for a young couple can relieve them of the worries of having a job, and thus, they can continue their education. Besides, young couples may have very little sexual knowledge at the beginning, so their family members, especially the women, can provide the young bride with information about the ways of having sex, etc. Of course, providing this kind of information has decreased in recent years because, with the expansion of internet access, young couples can find the information they need. In most cases, young brides who had lived with the husband’s family for a few years received more support from his family during pregnancy and childbirth. Because most of the child-related work was done by the mother-in-law or sister-in-law. However, if the bride is not young, none of this support may be provided. Thus, such situations can be considered one of the positive consequences of early marriage for girls.

“I didn’t know anything about married life, but my sister-in-law, who had an early marriage, explained everything to me before the wedding.”(Participant, 13)

“My husband and I were both very young, so my father helped us, and my husband’s family didn’t let us be under much pressure.” They said, “You’re too young; we have to take care of you.” (Participant, 16)

“When I told my mother-in-law that I was pregnant, she got very happy.” She told me not to worry at all, and she would take care of my baby herself. Indeed, it was as she said. She did everything related to my baby until my baby reached 3 years old. (Participant, 9)

Young couples were supported more by their families after marriage, as early marriage was accepted by the parents in the study area.

Improving living conditions

There were a lot of demands for marriage with adolescent girls. Some of these girls, who lived in families with poor economic and social conditions, could save their lives and their families’ lives by marrying people who had better economic and social status. In some cases, this change in their economic and social status may lead to their inner satisfaction with early marriage.

“I lived in a poor family. When I got married, my situation changed a lot. I had things I couldn’t even dream of. “It’s true that my husband is 10 years older than me, but I’m very happy with my life.” (Participant, 7)

“My father was an addict, and he sold drugs.” Our house was always full of addicts. My uncle was always very worried that my father’s friends would hurt me. That’s why he adopted me as his son. He supported us a lot. We have the best life now. Maybe if I hadn’t gotten married sooner, my life would have been ruined, and I would have killed myself. (Participant, 27)

In some cases, girls living in economically and socially disadvantaged families made significant changes to their lives through early marriage. The early marriage made it easier for them to achieve better conditions, so this made them happy and satisfied.

Opportunities for progress and empowerment

Some women who dropped out of school in their singlehood due to financial and social limitations were able to resume their studies after marriage with the support of their husbands and even be accepted to university. This led to their inner satisfaction. Some of the other participants were able to pursue their favorite hobbies and activities, gain skills in various fields, and have a job that was not possible for them in their single life due to their financial and social restrictions.

“Before I got married, I dropped out of school. After marriage, my husband helped me to continue my study. He was the teacher of the village. My mother-in-law helped with the housework. That’s why I spent most of my time studying. I was accepted in the entrance exam of the University of Medical Sciences. Maybe if I hadn’t gotten married, I wouldn’t have thought about studying.” (Participant, 21)

“Before I got married, I really wanted to be a hairdresser, but my family didn’t allow me. After marriage, my husband took me to hairdressing courses. “Now I have a hair salon, and I am really happy with my life.” (Participant, 7)

“When my first child was born, I felt very good.” I felt like I matured. I enjoyed seeing that I could take care of my kid. I did my best to take care of her in the best possible way. “When all my husband’s family members praised me, my self-confidence increased.” (Participant, 22)

“My husband is a good person and helps me a lot to be someone for myself.” When I finished my sewing class and got a job, I felt good about myself. “I feel like I can do anything well.” (Participant, 21)

“I enjoy seeing everyone count on me and get help and advice from me in their work, especially when my husband’s family or my family is complimenting me in front of others.” (Participant, 13)

Some of the participants grew up in families that put a lot of restrictions on them and prevented them from doing what they loved to do, but by getting married, these restrictions were removed and they pursued their favorite interests and skills, and this issue has led to the development of their talents. Some other women who were able to cope with life’s problems after marriage also felt good, which made them more satisfied.

Discussion

The aim of this study was to explore the consequences of early marriage among Kurdish women in western Iran. The results showed that early marriage was associated with severe negative consequences that could jeopardize the future of women and their families. But in a substantial number of cases—nearly a quarter of participants—early marriage had positive consequences for them. It made positive differences in their lives.

Physical weakness and illness were some of the consequences of early pregnancy, which could be due to the fact that these women were married at a time when their bodies had not yet completed the growth process and they were not ready to face the stress of pregnancy and childbirth. The occurrence of physical problems among women who are early married has also been shown in previous studies. ²⁵ In this regard, another physical consequence of early marriage was high-risk pregnancy and childbirth, which was repeatedly mentioned by women. It may also be due to incomplete pelvic growth and possibly the synchronization of pregnancy and puberty development. These consequences had also been shown in previous studies.^26,27 Adhikari et al also found that women who married under the age of 18 had more unwanted pregnancies than other women. ²⁸ Adolescent women did not have any understanding of marital relations and early pregnancy after marriage. So, they got pregnant very quickly without wanting to, and neither their bodies were ready for such a pregnancy nor were they mentally ready to accept it. Thus, the process of pregnancy and childbirth was difficult and painful for them. This could endanger the health of the child and the mother, leading to multiple abortions. One of the main reasons for early pregnancy in these women was the low awareness and weak communication skills of these women and their husbands; therefore, the need for continuous instruction before and after marriage to help these couples was becoming more apparent. Marriage education and telephone counseling can be one of the strategies to help women plan for pregnancy and childbirth in order to prevent negative consequences.

Emotional and psychological problems were another consequence of early marriage, which were frequently mentioned by the participants in this study. Women who married young had different and unfavorable experiences in their lives. Since they spent most of their life periods (childhood, adolescence, etc.) experiencing being forced and without being satisfied, they had different conditions from their peers, and this led to a kind of yearning and remorse in them. Marriage in childhood also deprives many girls of the opportunity to continue their education and employment. This had led to longing and regret for them, which bothered them. In this line, challenges such as depression, suicide ideation and attempt, feelings of inferiority, and low self-confidence were other psychological problems at the individual level that were mentioned. A study conducted by Uecker found that early marriage had a negative effect on women’s mental health. ²⁹ Research by John et al and Daraz et al also showed that women who experienced early marriage had psychological problems, such as stress, depression, and anxiety.^30,31 Many married women were unprepared to experience any of the realities of their lives and never received training on how to deal with them, which puts them under a lot of stress. Failure to provide a proper response can lead to suicide. In 2019, the study of Lebni et al conducted in the Kurdish regions of Iran (the study area of this study), found that forced marriage was one of the important determinants of women’s self-immolation. ³² Gage, in his study, found a significant association between early marriage and suicide attempts. ³³ This is one of the issues that requires mental health intervention for couples who have early marriages.

The findings of this study indicated that women who married as children frequently experienced emotional and sexual dissatisfaction and conflict. In some cases, they stated that they were forced to continue their marital relationship, and if they had suitable conditions or received more support from their father’s family, they would no longer be willing to continue the married life. The study of Hajihasani and Sim, conducted in Iran, explored that women who had the experience of early marriage had low satisfaction with marital life. ⁸ Emotional divorce was another noticeable consequence of early marriage in this study, which has been less discussed in previous studies. Some women stated that they did not have a stable relationship with their husbands in their married lives and that they were only physically together and did not have any emotional interactions with each other. Tilson and Larsen also reported that early marriage could lead to divorce. ³⁴ This can also be due to the fact that early marriages are not based on real knowledge and interest and occur mostly by force or due to irrelevant reasons such as coercion, war, economic problems, etc.

Experiencing all kinds of violence was one of the family consequences of early marriage in this study. Most previous research had shown that early marriage sets the stage for violence.^16,35-37

The experience of having lots of responsibility while they had not yet completed childhood was another family problem of early marriage. Most participants stated that they had some sort of identity conflict due to having lots of responsibilities at the same time. These women were forced to take on the responsibilities of wives while they were still children, and after having children, the responsibilities of mothers were added. Since most of these women lived with their husbands’ families, they were forced to take on more responsibility, which put a lot of pressure on them.

Lack of autonomy due to a lack of awareness and a lack of life knowledge and skills was another important consequence of early marriage in this study. The results showed that women who got married early had a weak position in family life, and many life decisions were made by their husbands or even the husband’s family. Research conducted by Mardi et al also found that women who experienced early marriage were less independent in family life. ¹⁸

In response to these problems, some of the women had high-risk behaviors, such as having relationships outside of the family, having the desire to run away from home, and having the desire for alcohol and smoking. In this study, in contrast to previous research that studied the association of early marriage with prostitution and AIDS,^38-40 there was no prostitution among any of the samples that could refer to the social and cultural conditions of the study area because most women in this study lived in villages or small towns where everyone knew each other and could not engage in prostitution. Of course, it should be noted that there were tendencies to run away from home and have an emotional relationship outside the family.

Lack of access to social and health services was one of the interesting findings in this study. For instance, women who experienced early marriage had the greatest need for social and health services. This may be because young women are not literate enough to use these services and may also be restricted by their husbands and unable to use them. Paul and Chouhan also reported in a study of Indian women that women who married under the age of 18 had less access to maternal health care than other women. ⁴¹

Lack of access to opportunities for education and employment was another finding of this study that led women to social isolation with early marriage, and it is consistent with previous research.^42,43 Most women who married as children were forced to drop out of school and had no chance of learning job skills, which in turn made them weak and fragile and led to other problems. Beattie et al considered staying in school to be a way to prevent children from marrying and falling into the trap of prostitution. ³⁹ Therefore, strategies and interventions should be provided to complete the education and training of women who marry early.

Although the negative consequences of an early marriage outweighed the positive consequences, one of the important findings was that a quarter of the women reported positive results of early marriages, and in contrast to previous studies that showed only negative consequences, this study revealed the fact that women’s marriages in certain family contexts, such as parental addiction and poor family circumstances, had exceptionally improved women’s condition. This, however, cannot be generalized and requires further investigation when these outcomes are positive. One of the positive results was receiving more family support. Some young women said that after marriage, they were supported by their and their husband’s families in issues such as sex and marriage, finance, and childcare. These supports are rooted in a cultural belief that gives the young bride more value and dignity, and in the community under study, having a young bride is considered an advantage, so families are more supportive of their young brides. The improvement of life conditions was another desirable consequence of early marriage. This finding adds to previous research showing that early marriage under certain conditions may have positive outcomes, but in total, negative outcomes outweigh the positive ones. Providing opportunities for progress and empowerment was another new and thought-provoking finding in this study that occurred in a limited number of cases. The results showed that early marriage changed the living conditions of some women by developing their talents. In fact, with their marriages and the support of their husbands, the women who dropped out of school before marriage were able to return to school to learn and develop their favorite skills. This caused them to have high self-confidence and self-efficacy. This finding could be the basis for future research on the conditions under which a woman’s early marriage had positive consequences.

Strengths and Limitations

This research is one of the few studies that has qualitatively examined the consequences of early marriage in Iran, especially in Kurdish areas that have their own social and cultural context. So, it can provide first-hand information for policymakers, social workers, and activists in the field of children and women in order to have a proper plan to reduce the negative consequences of this phenomenon. Another strength of the present study was that the researchers were natives of the study area and had the experience of conducting several studies on women’s problems. Hence, they were well acquainted with the characteristics and social customs of that region. They obtained the women’s consent to participate in the research in a better way, and they created such an atmosphere for the interviews that the women shared their information more easily with them.

However, there were some limitations to this study. The first limitation was the lack of familiarity of the women studied with the process of qualitative research and their fear of participating in the research. The researchers could attract their attention by explaining the process of interviews and publishing results, as well as by using a woman researcher familiar with the qualitative study. The study was conducted only among women who were married under the age of 18 and were less than 25 years old at the time of the interview. So, it can be said that the results of our study mostly showed the short-term consequences of early marriage. Therefore, it is suggested that further studies be conducted among older women to reveal the long-term effects and consequences of early marriage. Besides, this study was conducted only among one of the Iranian ethnic groups (Kurds), who have a different social and cultural structure than other Iranian ethnic groups, so these results cannot be considered a complete representation of Iranian society. According to the findings, it is suggested to carry out qualitative research with the title “Exploring the long-term consequences of early marriage” and “Exploring the consequences of early marriage from the perspective of men.”

Conclusion

The results showed that early marriage caused many individual, family, and social problems for women that could endanger their health, but in a limited number of cases, early marriage had some positive consequences, such as receiving intra-family support, improving living conditions, and eventually creating an opportunity for progress and empowerment. Therefore, in the first stage, early marriage should be prevented, but if it happens, in order to reduce the negative effects and consequences, young men and women can be educated and provided with conditions for having a less dangerous pregnancy and childbirth. Hence, providing necessary training and psychological counseling on how to deal with personal and married life problems with appropriate health and social services is necessary.