Introduction

Child marriage, defined as formal or informal marriage before the age of 18, remains a significant global issue. In 2023, the United Nations Children’s Fund reported that 640 million girls and women worldwide were married before 18, with nearly half of all child brides from South Asia [1]. Each year, approximately 15 million girls marry as children, which translates to one girl every two seconds [2]. While recent efforts have reduced child marriage rates, progress remains insufficient to meet the Sustainable Development Goal target of eliminating child marriage by 2030 [1]. Child marriage disrupts girls’ lives, prematurely imposing adult responsibilities that can adversely impact their physical, emotional, and economic well-being. It interrupts education, limits earning potential, can lead to early motherhood, and restricts girls’ agency, reinforcing cycles of poverty and gender inequality [3].

The Nepalese government is committed to ending child marriage, as evidenced by its signing of international treaties, such as the Convention on the Elimination of All Forms of Discrimination against Women, the Universal Declaration of Human Rights, and the Convention on the Rights of the Child. In Nepal, the legal age of marriage is set at 20 years for both men and women. Child marriage has been prohibited since 1963, with the 2015 Constitution reinforcing this prohibition [4]. However, enforcement remains limited, and child marriage persists as a long-standing social norm. It is estimated that Nepal has around 5 million women who were married as children, including 1.3 million who married before the age of 15 [5]. Nearly 35% of Nepalese women aged 20-24 were married by 18, compared to only 7% of men [6]. Despite the higher prevalence among women, the rate of child marriage among Nepalese men still ranks among the world’s highest [7].

Several challenges hinder effective law enforcement in preventing child marriage at the local level in Nepal. These include persistent cultural beliefs, low awareness of legal consequences, social customs, and the practice of unregistered “love marriages” [8–10]. Additionally, the low rate of marriage registration complicates the identification and prevention of child marriages [11]. Law enforcement officials are often reluctant to prosecute impoverished families who may face further economic hardship from penalties, complicating legal deterrence efforts [12].

In Nepal, child marriage disproportionately affects women from marginalized ethnic groups, as well as those with lower levels of education, limited skills, and limited employment opportunities [12,13]. Parental education levels also play a key role, as child marriage is more common in families with lower educational attainment [14]. A recent evaluation of a program in Nepal highlighted addressing key structural obstacles, such as poverty and low education, as essential steps in reducing child marriage [15]. Financially, parents may view investment in a daughter’s education as less valuable than in a son’s due to patrilocal customs, where daughters move to their husband’s family while sons remain to support aging parents [16].

Karnali, the largest and most remote province in Nepal, has some of the country’s highest rates of child marriage. The provincial government has introduced initiatives to address this issue, such as the “Bank Account for Daughters: Lifelong Security” scheme, which incentivizes families to keep daughters in school and unmarried until age 20 by providing monthly savings that mature at adulthood [17]. Additionally, efforts are underway to educate religious figures, who often officiate weddings, on the importance of refusing to marry couples under the age of 20 [18]. However, data indicate that over half of women in Karnali marry before 18, and 18.8% of adolescent girls aged 15-19 have already given birth [19].

HealthBridge Foundation of Canada and International Nepal Fellowship are implementing a project titled Improving Reproductive Health and Preventing Child Marriage in Nepal and Vietnam. In Nepal, the project operates in Khadachakra municipality in Kalikot district. As part of the project’s baseline assessment, this qualitative study explores key community stakeholders’ perceptions of child marriage causes and consequences to inform context-specific intervention strategies.

Methods

Results

Perceived causes of child marriage

Child marriage was found to be influenced by a complex interplay of factors operating at multiple levels. The factors identified in this study were organized and analyzed using the Social Ecological Model of Health Promotion (Fig 1), and the quotes are presented in Table 1. These levels encompass individual, interpersonal, community, and policy [22].

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Fig 1. Levels of perceived causes of child marriage by FGD and KII participants.

https://doi.org/10.1371/journal.pgph.0004323.g001

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Table 1. Perceived influence on child marriage-quotes from FGD and KII participants.

https://doi.org/10.1371/journal.pgph.0004323.t001

Discussion

To our knowledge, this is the first qualitative study in Kalikot district of Karnali province in Nepal to explore the perceptions of different stakeholders about child marriage and its perceived causes and consequences. The FGD and KII participants are residents of Kalikot, and their view is valuable in understanding the issue of child marriage in this particular context, and for providing information that can be helpful in laying a foundation to develop effective and culturally appropriate interventions to reduce child marriage. The diversity of FGDs and KIIs provided a wide spectrum of viewpoints in understanding how the policies, initiatives and projects designed to reduce child marriage are perceived by different stakeholders.

Findings suggest that the participants were in agreement that child marriage is a gradually declining but still pressing challenge, and results in a number of negative consequences for young girls in particular. Because child marriage often leads to early child bearing, there are associated negative consequences for the young parents, especially the mothers, and their offspring, as well as for the community. Furthermore, participants expressed multiple views of the possible causes of child marriage that include individual, inter-personal, community, and policy level determinants.

Culture and gender norms, as well as the poor and isolated living conditions, were identified as interconnected and primary causes of child marriage. Inequity in accessing information and services was also discussed, especially for women and adolescent girls whose cultural needs may not be considered in the design and delivery of programs and interventions. The intersection of gender, socioeconomic status, and residential location can result in a significant proportion of adolescent girls and women not being reached by the services they need.

There are similarities between the identified causes of child marriage in this study and other studies from Nepal [8,9,23] and elsewhere [24–27]. Economic factors, social norms, insufficient parental awareness, and constrained access to education are examples of similar emerging themes. However, the distinct theme that highlights the unique context of mountainous regions in Nepal is the geographic isolation of the communities, which limits access to economic and educational opportunities and leads to poor prospects, especially for those sub-groups of the community who live furthest from the community centre.

A common factor identified by adult participants was that widespread use of mobile phones, which facilitates easy connections among adolescents, along with easy access to online information. This exposes adolescents to content that can lead to poor decision-making, particularly in relation to their future, including marriage. Regarding social media, unlike adult participants, adolescents viewed open access to social media as a means of expanding their network and building strong relationships in their community. Despite the negative impact of digital technology and social media on adolescents’ well-being [28,29], there is evidence of the positive impact of moderate and social use of social media for social connectivity and as a peer-to-peer support platform [30–32]. This needs further investigation to explore how the power of digital connection can be harnessed to increase awareness and knowledge of all community members, not only adolescents.

In Karnali, the rate of child marriage among adolescent girls surpasses that of adolescent boys (48% and 25%, respectively) [33]. Nevertheless, the high incidence of child marriage among adolescent boys indicates that a significant number of these marriages involve child couples rather than unions solely between an adult man and a child girl. The participants’ perspective suggests diverse motivations that encourage marriages between adolescent boys and girls. Families of adolescent boys, driven by the prospect of additional assistance in the household, particularly in agrarian-dependent households, advocate for their son’s early marriage. While the adverse effects of child marriage disproportionately impact girls, a few of the participants in this study highlighted the need to extend policies and protective measures to adolescent boys and to engage them in the interventions if reduction in child marriage is to be achieved.

The Nepal national government’s strategy on ending child marriage [34] lays a strong foundation for eradicating child marriage, which is reflected in the declining pattern of child marriage in Nepal in recent years [6]. Our findings may suggest that in more traditional and isolated communities like Kalikot, the proximal influences such as family and community play a more influential role in comparison to macro-level influences (national policy and local government strategies). In these communities, a large portion of community members regard traditional healers as the primary health care providers, and religious leaders actively participate in overseeing arranged marriages by granting approval and determining suitable ceremony dates. Thus, it is imperative for any intervention addressing child marriage to incorporate their full involvement. Their engagement is critical in any interventions designed to reduce child marriage, and their role and responsibilities should be aligned with any attempts to achieve this.

Legal measures might yield minimal effectiveness in remote and isolated communities where tangible consequences to child marriage are lacking. The findings suggest that adolescents continue to marry through traditional ways, with families waiting until the young couple reaches the legal age before registering their marriage. Further, self-initiated marriages were identified as a growing trend in the community. In an environment where government-issued marriage certificates hold no relevance to daily life, the implementation of such policies has significant hurdles, indicating a requirement for the adoption of customized legal measures for these communities. The irrelevance of marriage certificates in these communities can explain the low number of registered marriages; a recent study by the Ministry of Health and Population in Nepal revealed that only 6.5% of married adolescents have registered their marriage with civil authorities and obtained a marriage certificate. The same study suggests that marriage registration is lowest in rural Karnali province, which is our study site [6].

While ambitious programs such as the “Bank Account for Daughters: Lifelong Security” scheme, implemented by the Karnali provincial government [35], are crucial for addressing child marriage, it’s essential to carefully evaluate their applicability in the local context. The scheme’s eligibility criteria include registering within 45 days of a girl’s birth, completing a high school education, and avoiding marriage until the age of 20. Considering the current rate of high child marriage, low levels of education, and limited low birth registration in the province [6] as well as social determinants such as peer pressure and poverty, it is improbable that the scheme’s criteria will be met, making it unlikely to result in a reduction in child marriage rates; this aligns with observations from a similar conditional cash-transfer program to reduce child marriage in India [36].

Sustainability was identified as a key success factor for programs to work. The Nepal government facilitated the creation of a network of FCHVs; this network has contributed to providing reproductive age women with information and services on family planning, maternal, newborn and child health, and nutrition, among other topics [37,38]. Tackling child marriage requires an ongoing commitment through interventions that capitalize on government-supported initiatives. For instance, interventions that leverage available local resources, such as the FCHV-facilitated Mother’s Group, are more likely to be sustainable [39].

One noteworthy finding of this study, which emerged through careful examination of the views of FGD participants, pertains to the perceived responsibilities and necessary actions defined by each group to prevent child marriage. While different groups recognized the important role of other stakeholders and discussed the actions that could be undertaken by these other groups, none of the groups acknowledged their own distinct roles. This phenomenon of “diffusion of responsibility” has the potential to result in a lack of initiative from any single group [40].

Although FGD participants acknowledged the local government’s effort in dealing with child marriage, a significant proportion of adult FGD participants view the government as the principal stakeholder with the capacity to resolve the child marriage issue. The interplay of cultural norms, demography, and the type of governance could all contribute to shaping this view. As a result, the average community members may feel that their individual efforts would have little impact, as they perceive themselves as lacking resources and skills. These perceptions might also be attributed to the community’s historical role in decision-making and initiating actions. One of the FGD groups highlighted a previous youth-led campaign that encountered considerable resistance from the community. Such past unsuccessful attempts to bring about change, known as “learned helplessness” in psychology [41], might also lead the community to not recognize their power to change the status quo.

Foremost, a gender transformative and long-term strategy should be pursued, one that considers cultural nuances and their implications in implementing successful legal measures. The Nepal government’s strategy to end child marriage by 2030 [34] can serve as a basis for developing programs that are multifaceted, including infrastructure advancement, creating job opportunities, strengthening the healthcare system, and improving educational access for all sub-groups of the community. Failure to adopt such a holistic approach might lead to failure to overcome the challenge of child marriage, and could leave out two major escape routes for adolescents and young adults, particularly the more disadvantaged demographics: early marriage, which can worsen the situation, especially for girls with far-reaching inter-generational adverse impacts; or rural-out immigration, which could affect their future well-being and their home communities [42].

The study does have some limitations. Data collection was completed during the COVID-19 pandemic, and the principal investigators had to train the local data collection team, who lacked prior experience in qualitative data collection, through online platforms. As mentioned earlier, comprehensive training was delivered by the Nepali PI, NR, based in Ottawa. The data quality is considered satisfactory, and the feedback from facilitators suggests that because the research team was local and had cultural understanding, participants felt free to express their views. However, the absence of the experienced Nepali PI from the data collection process might have influenced the group dynamic, preventing probing questions and more in-depth discussions. Real-time access to data was not feasible, resulting in the PIs having to determine data saturation by consulting PH, the local Project Officer who facilitated five FGDs, interviewed 5 KIs, and attended two further KIIs as a note-taker. As the data analysis progressed, it became evident that data saturation had been achieved.

The FGDs and KIIs were conducted in Nepali. The non-Nepali PI, BA, leading the analysis and drafting the findings and discussions, could not access the verbatim transcriptions. Instead, a translated version of the organized data, prepared by NR, was used. Both PIs worked closely together, discussing the findings word by word to ensure the essence of the participants’ perspectives was understood and analyzed accurately, thus overcoming the language barrier.

The extensive range of stakeholders in this study improved the data credibility; however, all FGD groups were homogeneous. Introducing a mix of stakeholders in an FGD could have sparked fresh and thought-provoking views. Further, the key role of traditional healers and religious leaders was frequently emphasized, but these figures were not among the FGD participants or KIs. However, the research findings were shared and discussed with local stakeholders, including some participants, to validate the findings and refine project activities. Specifically, tailored presentations were prepared by our local partners and delivered to traditional healers and religious leaders. These presentations emphasized the community’s perception of them as influential figures in combating child marriage and encouraged them to take an active role as agents of change. The project team has been since collaborating with this group to explore various opportunities to leverage their influence.

Most KIs were male, reflecting the prevailing dominance of men in higher-level governmental positions. While this is not a study limitation, it could influence the perspective diversity.

This study provides an in-depth insight into child marriage in the context of remote mountainous areas in Nepal and lays a foundation for development of effective interventions in the future. A prominent emerging theme is the intersection of cultural norms and socioeconomic determinants, which contribute to the intricate nature of the child marriage issue. Another key theme is the significance of recognizing the agency of individuals, and community groups, in their ability to effect change. Understanding the roles and responsibilities of the community as a whole is crucial in order for the different players to take ownership of preventing child marriage and holding the local government accountable in their efforts.

Before concluding the discussion, it is crucial to outline tangible action items for donors, local government, and program managers. These recommendations capture the collective efforts needed to combat the complex issue of child marriage in Nepal and pave the way for sustainable change. Donors are urged to maintain financial support, emphasizing the declining trend in child marriage, with local stakeholders recognizing the role of interventions, among other factors, in this positive shift. While policymakers’ efforts are acknowledged, the findings underscore the need for more robust legal measures to enforce child protection laws for all.

Program managers are urged to collaborate with funders, ensuring adequate time and resources, to observe a substantial decrease in child marriages through thoughtful planning in collaboration with the communities. Further, recognizing specific challenges faced by women, girls, and those in hard-to-reach areas to benefit from the available programs and services, the article highlights the necessity of engaging these groups to develop inclusive programs.

Supporting information

Acknowledgments

We sincerely thank Rebecca Brodmann for leading the conceptualization and funding acquisition of the project entitled “Improving Reproductive Health and Preventing Child Marriage in Nepal and Vietnam” which provided the context for the research. Special appreciation is also extended to Kamilla Pinter, the Project Officer, for her exceptional support throughout the implementation of this research. Our thanks also go to Moyandi Tamara Udugama for her contribution to data visualization. We express our appreciation to Dal Budha, the Project Coordinator at INF, for his unwavering support during the data collection phase and for his thorough review of the manuscript, and to Esther Gurung, for her ongoing support throughout the research. A profound acknowledgment is due to our dedicated local data collection team, Mahesh Sanjyal, Nabin Budha, and Sushmita Neupane, who demonstrated outstanding commitment and skill in navigating the mountainous and hard-to-reach areas and in using their knowledge of the culture and language to completing the assignment. Finally, we extend our gratitude to every individual who participated in this study. Their willingness to engage in discussions on this important and sensitive topic without any expectation reflects their commitment to improving their community. We deeply appreciate their contributions, recognizing that it is through collective efforts that meaningful progress is achieved. Artificial intelligence (AI), in the form of a language model, was used to improve the clarity of the language.